Correlative Study of Nicotine Levels With Response Rates to Therapy Using Radiation Alone or in Combination With Chemotherapy in Head and Neck Cancer
The exposure to tobacco related carcinogens is highly dependent upon dose as well as
interindividual characteristics of metabolism. Risk assessment of carcinogenic profiles for
nicotine and its individual metabolites is complicated by interindividual variations in
nicotine metabolism associated with quantitative nicotine exposure, gender, genetic
polymorphisms, and behavioral and environmentally induced differences in nicotine
metabolizing enzyme activities. Consequently, differences in smoking behavior or tobacco
use have been correlated to differences in nicotine metabolism resulting in cessation
strategies based upon tobacco use, nicotine dependence, and behavioral modification.
Cotinine has been shown to be a reliable marker of nicotine exposure and more reflective of
recent rather than acute nicotine use with better assessment of baseline nicotine levels.
Therefore, subjects will have blood samples drawn weekly during radiation for cotinine
analysis.
Radiation therapy efficacy is known to be dependent on tissue oxygen status. Since
therapeutic treatment is less efficacious in patients with poorly vascularized/ hypoxic
tumors, it is desirable to identify and target such patients for special treatment. Recent
magnetic resonance imaging and computed tomography investigations have shown that there are
significant blood flow changes during radiation or chemo-radiation therapy, suggesting that
early blood flow may have prognostic value. Among those methods for oxygen and blood flow
measurements, the near-infrared spectroscopy (NIRS) is more benefit with merit of
non-invasive, portable, fast test, and inexpensive. Our instrument system combined
near-infrared diffuse reflectance spectroscopy (DRS) and diffuse correlation spectroscopy
(DCS) is capable of monitoring tissue oxygen and blood flow simultaneously. This hybrid
diffuse optical instrument has already been used for monitoring of therapeutic effects
(e.g., radiation therapy, chemotherapy) in tumors in human head & neck and breast. In this
study, we will use this hybrid instrument to investigate the hemodynamic responses to
different therapies (radiation alone, radiation + chemotherapy) in patients with different
nicotine levels. Baseline measurement of tissue oxygen saturation, total hemoglobin
concentration and blood flow using a hybrid optical instrument (DRS for oxygen measurement
and DCS for blood flow measurement). A hand-hold optical probe connected to the hybrid
instrument will be placed on the head/neck tumor for about 3-5 minutes, then move it on the
normal arm muscle for control purposeTumor oxygenation and flow measurements will be
performed at the beginning of every week during the treatment period. During this monitoring
process non-invasive blood pressure monitoring will also occur. Weekly optical measurements
will be obtained during treatment.In this study we will investigate the hemodynamic
responses to different nicotine levels and different therapies (radiation alone, radiation +
chemotherapy).
Observational
Observational Model: Case-Only, Time Perspective: Prospective
Correlation of serum cotinine with volumetric response
RECIST criteria will be used as a correlate for standardization of tumor response. Volumetric analysis may provide better assessment of bulky tumor size that may have a large necrotic or hypoxic component that may be resistant to treatment. Furthermore, volumetric analysis has been associated with a higher rate of concordance to response based upon RECIST criteria.
2 years from start of treatment
No
Mahesh Kudrimoti, MD
Principal Investigator
University of Kentucky
United States: Institutional Review Board
NICOTINE-HN
NCT01084733
August 2007
December 2015
Name | Location |
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Markey Cancer Center | Lexington, Kentucky 40536 |