Patient case: 64-year-old male with head and neck squamous cell carcinoma; genetic feature: CDKN2A

Clinical trial: Paclitaxel, Cisplatin, and Filgrastim Combined With Radiation Therapy in Treating Patients With Locally Recurrent Head and Neck Cancer

Summary: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Colony-stimulating factors such as filgrastim may increase the number of immune cells found in bone marrow or peripheral blood and may help a person's immune system recover from the side effects of chemotherapy. Radiation therapy uses high-energy x-rays to damage tumor cells.
  PURPOSE: Phase II trial to study the effectiveness of paclitaxel, cisplatin, and filgrastim combined with radiation therapy in treating patients who have locally recurrent head and neck cancer and have received previous treatment with radiation therapy.

Detailed description: OBJECTIVES:
  -  Determine the median, one-year, and long-term (defined as two-year) disease-free survival and overall survival in patients with previously irradiated locally recurrent squamous cell cancer of the head and neck treated with paclitaxel, cisplatin, and filgrastim (G-CSF) combined with radiotherapy.
  -  Determine the rates of acute and late toxic effects of this regimen in these patients.
  -  Determine the pattern of disease progression in patients treated with this regimen.
  OUTLINE: Patients undergo radiotherapy twice daily (4-6 hours apart) on days 1-5. Patients receive paclitaxel IV over 1 hour beginning immediately after completion of the first fraction of radiotherapy and completing less than 3 hours before starting the second fraction of radiotherapy on days 1-5. Patients receive cisplatin IV over 30 minutes beginning immediately after completion of paclitaxel infusion on days 1-5 and filgrastim (G-CSF) subcutaneously on days 6-13. Treatment repeats every 2 weeks for 4 courses in the absence of disease progression or unacceptable toxicity. Patients who initially respond to therapy but develop a recurrence with a resectable lesion (inside or outside the retreatment field) may undergo surgical resection.
  Patients are followed at 4 weeks after completion of radiotherapy, every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter.
  PROJECTED ACCRUAL: A total of 100 patients will be accrued for this study within 34 months.

Eligibility: DISEASE CHARACTERISTICS:
  -  Histologically proven locally recurrent primary squamous cell cancer (SCC) of the head and neck or second primary SCC of the head and neck
  -  More than 1 prior recurrence allowed if the first recurrence occurred at least 6 months after completion of prior radiotherapy
  -  Disease must be confined to the head and neck (above the clavicles)
  -  No primary SCC of the nasopharynx or salivary gland
  -  Prior irradiation of 45-75 Gy to the majority (75% or greater) of tumor volume
  -  Entire tumor volume must be included in a treatment field that limits the total spinal cord dose (prior and anticipated) to 50 Gy
  -  Prior radiotherapy records, including simulation and portal films, available in order to assure that cord tolerance is not exceeded
  -  Measurable disease
  -  Ineligible for complete surgical resection
  -  No distant metastases
  PATIENT CHARACTERISTICS:
  Age:
  -  18 and over
  Performance status:
  -  Zubrod 0 or 1
  Life expectancy:
  -  No other concurrent illness that would limit survival
  Hematopoietic:
  -  Granulocyte count at least 1,500/mm^3
  -  Platelet count at least 100,000/mm^3
  Hepatic:
  -  Bilirubin no greater than 1.5 mg/dL
  -  Serum glutamate oxaloacetate transaminase (SGOT) and serum glutamate pyruvate transaminase (SGPT) no greater than 2 times normal*
  -  Alkaline phosphatase no greater than 2 times normal*
  -  * Greater than 2 times normal allowed if no metastases by liver ultrasound or CT scan
  Renal:
  -  Creatinine no greater than 1.5 mg/dL
  Other:
  -  No other invasive malignancy within the past 2 years except in situ malignancies (e.g., carcinoma in situ of the cervix, carcinoma in situ of the breast, or nonmelanoma skin cancer)
  -  No other concurrent illness that would impair tolerance to therapy
  -  No grade 2 or worse pre-existing peripheral sensory neuropathy
  -  No hypersensitivity to E. coli derived products
  -  Not pregnant or nursing
  -  Fertile patients must use effective contraception
  PRIOR CONCURRENT THERAPY:
  Biologic therapy:
  -  Not specified
  Chemotherapy:
  -  Prior chemotherapy allowed as a component of the primary treatment
  -  No prior chemotherapy for recurrent disease
  -  At least 6 months since prior chemotherapy
  Endocrine therapy:
  -  Not specified
  Radiotherapy:
  -  See Disease Characteristics
  -  At least 6 months since prior radiotherapy
  Surgery:
  -  See Disease Characteristics

Relevance to patient case: not relevant