Patient case: 72-year-old male with melanoma; genetic feature: TP53 loss of function

Clinical trial: Radiation Therapy With or Without Cisplatin in Treating Patients With Stage III-IV Squamous Cell Carcinoma of the Head and Neck Who Have Undergone Surgery

Summary: This phase II trial studies how well radiation therapy with or without cisplatin works in treating patients with stage III-IV squamous cell carcinoma of the head and neck who have undergone surgery. Radiation therapy uses high energy x-rays to kill tumor cells and shrink tumors. Drugs used in chemotherapy, such as cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known if radiation therapy is more effective with or without cisplatin in treating patients with squamous cell carcinoma of the head and neck.

Detailed description: PRIMARY OBJECTIVES:
  I. To evaluate the disease-free survival (DFS) of patients with stage III-IV squamous cell carcinoma of the head and neck (SCCHN) and disruptive p53 mutations after primary surgical resection followed by postoperative radiotherapy (PORT) alone or PORT with concurrent cisplatin.
  SECONDARY OBJECTIVES:
  I. To evaluate the DFS of patients with stage III-IV SCCHN and non-disruptive p53 mutations after primary surgical resection followed by PORT alone or PORT with concurrent cisplatin.
  II. To evaluate the DFS of patients with stage III-IV SCCHN and p53 wild type after primary surgical resection followed by PORT alone or PORT with concurrent cisplatin.
  III. To evaluate toxicities of PORT alone or PORT with concurrent cisplatin. IV. To evaluate p53 mutation as a predictive biomarker of survival benefit given post-operative concurrent radiation and cisplatin.
  V. To identify potential genomic alterations in addition to TP53 mutations that may be developed to a novel treatment approach.
  OUTLINE: Patients are randomized to 1 of 2 treatment arms.
  ARM A: Patients undergo intensity-modulated radiation therapy (IMRT) once daily (QD) 5 days a week for 6 weeks in the absence of disease progression or unacceptable toxicity.
  ARM B: Patients undergo IMRT QD 5 days a week and receive cisplatin intravenously (IV) over 1-2 hours weekly for 6 weeks in the absence of disease progression or unacceptable toxicity.
  After completion of study treatment, patients are followed up every 6 months for 3 years and then every 12 months for 7 years.

Eligibility: Inclusion Criteria:
  -  PRE-REGISTRATION (STEP 0)
  -  Pathologically proven diagnosis of squamous cell carcinoma (including variants such as verrucous carcinoma, spindle cell carcinoma, carcinoma not otherwise specified [NOS]) of the head/neck (oral cavity, oropharynx, hypopharynx or larynx); clinical stage T2-T4a, N0-2, M0 or T1, N1-2, M0
  -  Patient has undergone total resection of the primary tumor with curative intent
  -  Patient must have negative human papillomavirus (HPV) status of the tumor as determined by p16 protein expression using immunohistochemistry (IHC)
  -  The patient must have the following assessments done within 80 days prior to randomization:
  -  Examination by an Ear, Nose, and Throat (ENT)/Head & Neck Surgeon
  -  Neck computed tomography (CT) scan (from skull base to clavicle) and
  -  Chest x-ray (or chest CT scan or CT/positron emission tomography [PET] of the chest) to rule out distant metastatic disease
  -  Patients with, per the operative and/or pathology report, positive margin(s) (tumor present at the cut or inked edge of the tumor), nodal extracapsular extension, and/or gross residual disease after surgery are not eligible
  -  A paraffin-embedded surgical tumor tissue specimen has been located is available for shipment to Foundation Medicine, Inc. following pre-registration
  -  Patients with a history of a curatively treated malignancy must be disease-free for at least two years except for carcinoma in situ of cervix and/or non-melanomatous skin cancer
  -  Patient must not have had previous irradiation to the head and neck that would result in overlap in radiation fields for the current disease
  -  RANDOMIZATION (STEP 1)
  -  Per the operative report, the gross total resection of the primary tumor with curative intent was completed within 7 weeks prior to randomization
  -  Patient has Eastern Cooperative Oncology Group (ECOG) performance status 0-1 within 2 weeks prior to randomization
  -  Women must not be pregnant or breast-feeding; females of childbearing potential must have a blood or urine study within 2 weeks prior to randomization to rule out pregnancy; a female of childbearing potential is any woman, regardless of sexual orientation or whether they have undergone tubal ligation, who meets the following criteria: 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months)
  -  Women of childbearing potential and sexually active males must be strongly advised to use an accepted and effective method of contraception or to abstain from sexual intercourse for the duration of their participation in the study
  -  Absolute neutrophil count >= 1,500/mm^3
  -  Platelets >= 100,000/mm^3
  -  Total bilirubin =< the upper limit of normal (ULN)
  -  Calculated creatinine clearance must be > 60 ml/min using the Cockcroft-Gault formula
  -  Patient must not have an intercurrent illness likely to interfere with protocol therapy

Relevance to patient case: not relevant