Clinical trial NCT06737822: Upfront Surgery Vs Induction Chemotherapy Followed By Surgery In Oral Cancers:
Official title: Upfront Surgery Vs Induction Chemotherapy Followed By Surgery In Oral Cavity Squamous Cell Cancers With Advanced Nodal Disease (SurVIC Trial): A Phase 3 Multicentric Randomized Controlled Trial
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE3
Conditions: Oral Cancer
Head and Neck Neoplasms
Lead sponsor: All India Institute of Medical Sciences, Jodhpur
Sponsor class: OTHER_GOV
Collaborators: name: All India Institute of Medical Sciences, Rishikesh
name: All India Institute of Medical Sciences, Bhubaneswar
name: All India Institute of Medical Sciences, Bathinda
name: King George's Medical University
name: Shri Mahant Indiresh Hospital, Dehradun
name: Geetanjali Medical College, Udaipur
First posted: 2024-12-17
Enrollment: 346
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: A majority of oral cancer patients in India present in the advanced stage hence tend to have poor oncological outcomes. Chemotherapy has been associated with improved oncological outcomes in various cancers but its role in oral cancer is not well defined in curative setting apart from radio sensitization. Attempted trials of neoadjuvant chemotherapy failed to show oncological advantage despite an excellent response rate, in part due to poor patient selection. Patients with a biologically aggressive disease are more likely to benefit, hence we intend to find out the oncological advantage of adding induction chemotherapy to oral squamous cell cancer with advanced nodal disease (N2-N3).

Earlier studies suffered from their heterogeneous patient population- all head and neck subsites together and included a spectrum ranging from early- stage operable cases to inoperable cancer. Due to such patient selection, the intended results were never met. The current study is intended to study the role of chemotherapy in curable patients who are most likely to benefit (biologically aggressive and advanced stage of presentation).

Objective

Primary:

To study the 2 year disease free survival by adding induction chemotherapy before surgery in patients of oral cancer with advanced nodal disease as compared to upfront surgery.

Secondary:

To assess treatment related outcomes between the treatment arms- Response rate; Treatment compliance; treatment related toxicity, postoperative complications and Quality of life.

To study the overall survival at 2 years. Oral cancer tissue biobanking for future translational research.

Study population Operable Oral cavity Squamous cell carcinoma with advanced nodal disease (N2-N3) Study Design Open label, Multi centric, randomized controlled trial with allocation ratio of 1:1

Sample Size The primary end point is disease-free survival. In order to have 80% power to detect a hazard ratio of 0.67, using a two-sided significance level, a total of 184 events are needed. Assuming an accrual rate of 15 patients a month, 300 patients need to be recruited. The analysis of DFS will take place 32 months after the start of the trial. The follow-up of patients will continue for 5 years. The analysis of OS will be conducted when 184 deaths are observed. taking 10% of withdrawal of consent, a total of 346 patients need to be included.

Inclusion Criteria Biopsy proven, operable oral Squamous cell carcinoma cT1-T4; cN2-N3, with adequate organ function, Age- 18-75 years, ECOG-PS:0-2 Treatment Arms

Standard Arm (SURG arm):

Surgery (Wide local Excision/composite resection with neck dissection) followed by adjuvant Radiotherapy ± Concurrent Chemotherapy

Experimental Arm (ICT):

2# TPF or TPX based induction chemotherapy followed by Surgery (Wide local Excision/composite resection with neck dissection) followed by adjuvant Radiotherapy ± Concurrent Chemotherapy

Study endpoints Primary- Disease free survival Secondary- Overall survival/ Quality of life/ Toxicity of treatment/ Treatment tolerance


Eligibility criteria: Inclusion Criteria:

* Newly diagnosed, treatment naïve, biopsy or cytology proven OSCC
* Clinical Stage cT1-4a, cN2-N3\*\*, M0- as per UICC 2018
* No evidence of distant metastases on chest x-ray and/or CT Thorax
* ECOG PS 0-2
* No contraindication to Cisplatin or radiotherapy\*\*\*
* Patients eligible for definitive curative intent treatment after discussion in multidisciplinary tumour board
* Adequate organ function at time of participation, defined as Haematological: Haemoglobin \> 9gm/dl, ANC ≥ 1500/cmm3, Platelet ≥100000/cmm3 Liver Function test: Bilirubin ≤2 x upper limit normal (ULN), AST/ALT/ ALP ≤ 2.5 x ULN Renal Function test: Creatinine ≤ 1.5 ULN, Creatinine Clearance ≥60 ml/min.

Exclusion Criteria:

* Pregnant
* History of moderate to severe hearing loss.
* History of previous malignancy excluding non-melanoma skin cancers or cervical carcinoma in situ.
* Documented Weight loss of more than 15% in the last 6 months.
* Patients with known HIV, hepatitis B or C infection.

Primary outcomes:
measure: Disease Free Survival
timeFrame: 2 Years
Secondary outcomes:
measure: Overall Survival
timeFrame: 2 Years
measure: Treatment Completion Rate
timeFrame: 2 Years
measure: Treatment Related Toxicity
timeFrame: 2 Years
measure: Quality of Life using PROs
timeFrame: 3 Months; 6 Months; 12 Months; 18 Months; 24 Months; 36 Months; 48 Months; 60 Months
measure: Postoperative Surgical Morbidity
timeFrame: 30 Days and 90 Days
measure: Biobanking of Tumor, Non Tumor tissue and Blood
timeFrame: 2 Years
measure: Financial Toxicity using Questionnaire
timeFrame: 3 Months; 6 Months; 12 Months; 18 Months; 24 Months; 36 Months; 48 Months; 60 Months
measure: Early Radiotherapy Related Toxicity
timeFrame: 30 Days
measure: Late Radiotherapy Relate Toxicity
timeFrame: 2 Years
Other outcomes:
Locations:
city: Bhubaneshwar
country: India
facility: All India Institute of Medical Sciences, Bhubaneshwar
state: Orisa
city: Jodhpur
country: India
facility: All India Institute of Medical Sciences, Jodhpur
state: Rajasthan
city: Bathinda
country: India
facility: All India Institute of Medical Sciences, Bathinda
city: Dehradun
country: India
facility: Shri Mahant Indresh Hospital, Dehradun
city: Lucknow
country: India
facility: King George's Medical University
city: Rishīkesh
country: India
facility: All India Institute of Medical Sciences, Rishikesh
city: Udaipur
country: India
facility: Geetanjali Medical College, Udaipur
Study officials:
affiliation: AIIMS Jodhpur
name: Dharma R Poonia, MS DNB
role: PRINCIPAL_INVESTIGATOR
References: