Phase II Treatment Stratification Trial Using Neck Dissection-Driven Selection to Improve Quality of Life for Low Risk Patients With HPV+ Oropharyngeal Squamous Cell Cancer
Condition: Oropharyngeal Squamous Cell Cancer
MeSH terms: Neoplasms, Squamous Cell; Carcinoma, Squamous Cell
Intervention: Neck Dissection; Standard-of-Care (SOC) Transoral Surgery of Primary Site; SOC Radiation; SOC Carboplatin; SOC Paclitaxel; Videofluoroscopy
Intervention description: All patients will undergo neck dissection of the cervical lymph nodes; Patients with a single lymph node that measures less than six centimeters, have no extracapsular extension in the lymph node, and have no perineural or perivascular invasion of the primary biopsy will undergo transoral surgery of the primary site.; Patients who have 2 positive nodes with no extracapsular extension, or have perineural or perivascular invasion of the primary biopsy will undergo radiation.; Patients who have extracapsular extension in any number of lymph nodes or in those patients in whom negative margins are unable to be obtained after the completion of transoral surgery will undergo chemoradiation (Radiation, Carboplatin and Paclitaxel).; Patients who have extracapsular extension in any number of lymph nodes or in those patients in whom negative margins are unable to be obtained after the completion of transoral surgery will undergo chemoradiation (Radiation, Carboplatin and Paclitaxel).; All patients undergo a videofluoroscopy procedure one year after completion of therapy to assess swallowing function.
Intervention MeSH terms: Paclitaxel; Carboplatin
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 40.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: head and neck neoplasms; HPV; human papilloma virus; de-escalation; low-risk; oropharyngeal cancer

Summary:

      Investigators will determine whether a treatment paradigm of up-front neck dissection, to
      more accurately pathologically stage patients, minimizing the number of treatment modalities
      in patients with low risk oropharyngeal squamous cell carcinoma, can improve quality of life.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients must have pathologically-confirmed, previously untreated, p16-positive
             oropharyngeal squamous cell carcinoma

          -  Patients must have pretreatment neck and chest imaging

          -  Tumors must be potentially surgically resectable via a transoral approach, at the
             discretion of the treating surgeon

          -  Patients with T stage T1-3

          -  Patients with N stage N0-N2c

          -  ECOG (Eastern Cooperative Oncology Group Performance Status: an attempt to quantify
             cancer patients' general well-being and activities of daily life. The score ranges
             from 0 to 5 where 0 is asymptomatic and 5 is death.) Performance status 0-2

          -  Patients are adults (Age >18)

          -  Patients must agree to biospecimen submission for tissue and serum processing and
             storage for secondary biomarker studies

          -  Patients must give documented informed consent to participate in this study.

          -  Patients must agree to use adequate contraception (hormonal or barrier method of birth
             control) prior to study entry, for the duration of chemoradiation (treatment) and for
             3 months after discontinuing treatment. Women of childbearing potential must have a
             negative serum or urine pregnancy test within 3 days prior to starting treatment.

          -  Women of child-bearing potential, unless they are using highly effective methods of
             contraception during dosing and for 30 days after study treatment. Women not of
             childbearing potential will be defined as all women older than age 50 and anovulatory
             for 12 months.

          -  Sexually active males must use a condom during intercourse while receiving
             chemoradiation and for 90 days after stopping treatment and should not father a child
             in this period. A condom is required to be used also by vasectomized men in order to
             prevent delivery of the drug via seminal fluid. Likewise, male subjects should not
             donate sperm during the time they are receiving chemoradiation and for 90 days after
             stopping treatment.

        Exclusion Criteria:

          -  Prior head and neck radiation or prior chemotherapy for HNSCC (Head and Neck Squamous
             Cell Carcinoma)

          -  Patients with T4 disease

          -  Patients with N3 disease

          -  FNA evidence of squamous cell carcinoma involving 3 or more lymph nodes

          -  Patients with matted lymph nodes, defined as three nodes abutting one another with
             loss of intervening fat plane that is a replaced with radiologic evidence of
             extracapsular spread

          -  Patients with an outside primary site biopsy showing perineural or perivascular
             invasion

          -  Documented evidence of distant metastases.

          -  Active infection

          -  Patients residing in prison.

          -  Age < 18 years

          -  Class 3 or 4 cardiac disease as defined by the New York Heart Association Functional
             Classification

          -  Unstable angina or a history of myocardial ischemia within prior 6 months

          -  Patients with any of the following laboratory values at baseline:

               -  Absolute neutrophil count (ANC) < 1,000/mm3

               -  Platelets < 75,000/mm3

               -  Hemoglobin < 9.0 gm/dL

               -  Calculated or measured creatinine clearance (method determined by the prescribing
                  physicians) < 50 ml/min

               -  Bilirubin > 1.5 x ULN (Upper Limit of Normal), except for patients with known
                  Gilbert syndrome who are excluded if total bilirubin > 3.0 x ULN or direct
                  bilirubin > 1.5 x ULN

               -  Aspartate transaminase (AST) > 3.0 x ULN

               -  Alanine transaminase (ALT) > 3.0 x ULN

          -  Pregnancy or breastfeeding female.

          -  Other severe, acute, or chronic medical or psychiatric condition or laboratory
             abnormality that may increase the risk associated with study participation