De-ESCALaTE HPV: Determination of Epidermal growth factor receptor-inhibitor (cetuximab) versus Standard Chemotherapy (cisplatin) early And Late Toxicity Events in Human Papillomavirus-positive oropharyngeal squamous cell carcinoma

ISRCTN ISRCTN33522080
DOI https://doi.org/10.1186/ISRCTN33522080
EudraCT/CTIS number 2011-005165-21
ClinicalTrials.gov number NCT01874171
Secondary identifying numbers 11723
Submission date
20/02/2012
Registration date
20/02/2012
Last edited
29/10/2021
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Cancer
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

http://www.cancerresearchuk.org/cancer-help/trials/a-trial-looking-side-effects-treatment-throat-cancer-de-escalate-hpv

Study website

Contact information

Mrs Tessa Fulton-Lieuw
Scientific

Warwick Clinical Trials Unit
Division of Health Sciences
Warwick Medical School
The University of Warwick
Coventry
CV4 7AL
United Kingdom

Phone +44 2476 574 880
Email M.T.Fulton-Lieuw@warwick.ac.uk

Study information

Study designBoth; Interventional; Design type: Treatment
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Hospital
Study typeTreatment
Participant information sheet Not available in web format, please use the contact details below to request a patient information sheet
Scientific titleDe-ESCALaTE HPV: Determination of Epidermal growth factor receptor-inhibitor (cetuximab) versus Standard Chemotherapy (cisplatin) early And Late Toxicity Events in Human Papillomavirus-positive oropharyngeal squamous cell carcinoma: a randomised controlled trial
Study acronymDe-ESCALaTE HPV
Study objectivesOropharyngeal squamous cell carcinoma (OPSCC) incidence is increasing rapidly in the developed world. This has been attributed to a rise in Human Papillomavirus (HPV) infection. HPV+ OPSCC is considered a distinct disease entity, affecting younger patients and has a good prognosis following treatment. Subsequently, patients can live with the considerable side effects for several decades.

Radiotherapy and cetuximab have demonstrated similar efficacy to ‘platin’ chemoradiotherapy in head and neck cancer, but is potentially less toxic.

Results of this trial will be used to determine the optimum treatment of this debilitating cancer, with the primary aim of decreasing toxicity and improving quality of life for HPV+OPSCC patients.
Ethics approval(s)NRES Committee West Midlands –Coventry & Warwickshire, 29/11/2011, ref: 11/WM/0381
Health condition(s) or problem(s) studiedTopic: National Cancer Research Network; Subtopic: Head and Neck Cancer; Disease: Head and Neck
InterventionHPV positive patients will be randomised to receive either cisplatin + radiotherapy (Arm A) or cetuximab + radiotherapy (Arm B) and will be followed up for two years. Patients that are HPV negative will enter into the Registration Cohort Study.

Cetuximab, Initial dose of 400mg/m2, administered intravenously, 1 week before start of radiotherapy followed by 7 weekly doses of 250mg/m2, administered intravenously. during radiotherapy.

Cisplatin, Three doses of cisplatin 100mg/m2, administered intravenously, on days 1, 22 and 43 of radiotherapy.
Intervention typeDrug
Pharmaceutical study type(s)
PhasePhase III
Drug / device / biological / vaccine name(s)Cetuximab, cisplatin
Primary outcome measureCurrent primary outcome as of 13/03/2012:
Severe toxicity (acute and late) (Grade 3-5); Timepoint(s): Two years from end of treatment

Previous primary outcome:
Severe toxicity (Grade 3-5); Timepoint(s): Two years from end of treatment
Secondary outcome measures1. Acute severe toxicity; Timepoint(s): 3 months from end of treatment
2. Late severe toxicity; Timepoint(s): Two years from end of treatment
3. Quality of Life; Timepoint(s): Two years from end of treatment
4. Dysphagia; Timepoint(s): Two years from end of treatment
5. Cost effectiveness; Timepoint(s): Two years from end of treatment
6. Overall survival, recurrence and metastasis; Timepoint(s): Two years from end of treatment
Overall study start date01/09/2011
Completion date31/07/2019

Eligibility

Participant type(s)Patient
Age groupAdult
Lower age limit18 Years
SexBoth
Target number of participantsPlanned Sample Size: 304; UK Sample Size: 304; Description: Depending on the number of participants recruited by international sites, the UK sample size may be smaller.
Total final enrolment334
Key inclusion criteriaCurrent inclusion criteria as of 13/03/2012:
1. Stage III-IVa oropharyngeal squamous cell tumours
2. Clinical multidisciplinary team decision to treat with primary curative chemoradiotherapy
3. No previous treatment for the primary tumour, including surgery, neck dissection or tracheostomy [except node biopsies or diagnostic tonsillectomy]
4. Medically fit Eastern Cooperative Oncology Group (ECOG) 0, 1 or 2
5. Adequate cardiovascular, haematological, renal and hepatic function
6. Age 18 years or over
7. Written informed consent given
8. Using adequate contraception [male and female participants]. Must take contraceptive measures during, and for at least three months after treatment.

Previous inclusion criteria:
1. Stage III-IVa oropharyngeal squamous cell tumours
2. Clinical multidisciplinary team decision to treat with primary curative chemoradiotherapy
3. No previous treatment for the primary tumour, including surgery, neck dissection or tracheostomy [except node biopsies or diagnostic tonsillectomy]
4. Medically fit Eastern Cooperative Oncology Group (ECOG) 0, 1 or 2
5. Adequate cardiovascular, haematological, renal and hepatic function
6. Age 18 years or over
7. Written informed consent given
8. Using adequate contraception [male and female participants]
Key exclusion criteriaCurrent exclusion criteria as of 13/03/2012:
1. Distant metastasis (i.e. stage IVc disease)
2. Tumor, Node, Metastasis (TNM) Stage T1-2N0 disease
3. Treated with primary radical surgery to the primary site e.g. resection
4. Concurrent use of CYP3A4 inducers or inhibitors
5. Serious cardiac illness or other medical conditions precluding the use of cisplatin or cetuximab
6. HPV+ patients who have p16+ tumours who also have N2b, N2c or N3 nodal disease and who also smoke more than 10 pack years (i.e. have both risk factors)
7. Pregnant or lactating
8. Previous treatment for any other cancer with cytotoxics, radiotherapy or antiEGFR therapies
9. Inadequate renal, haematological or liver functions
10. Patients with clinically significant hearing impairment.
11. Life expectancy less than three months
12. Other malignancy within the past three years except basal cell skin cancer or preinvasive carcinoma of the cervix

Previous exclusion criteria:
1. Distant metastasis (i.e. stage IVc disease)
2. Tumor, Node, Metastasis (TNM) Stage T1-2N0 disease
3. Treated with primary radical surgery to the primary site e.g. resection
4. Concurrent use of CYP3A4 inducers or inhibitors
5. Serious cardiac illness or other medical conditions precluding the use of cisplatin or cetuximab
6. HPV+ patients who have p16+ tumours who also have N2b, N2c or N3 nodal disease and who also smoke more than 10 pack years (i.e. have both risk factors)
7. Pregnant or lactating
8. Previous treatment for any other cancer with cytotoxics, radiotherapy or antiEGFR therapies
9. Inadequate renal, haematological or liver functions
10. Life expectancy less than three months
11. Other malignancy within the past three years except basal cell skin cancer or preinvasive carcinoma of the cervix
Date of first enrolment09/10/2012
Date of final enrolment28/10/2016

Locations

Countries of recruitment

  • Belgium
  • England
  • Ireland
  • Italy
  • Netherlands
  • Scotland
  • United Kingdom
  • Wales

Study participating centres

Warwick Clinical Trials Unit
University of Warwick
Coventry
CV4 7AL
United Kingdom
Aberdeen Royal Infirmary
Foresterhill Road
Aberdeen
AB25 2ZN
United Kingdom
St Luke’s Centre for Radiation at Beaumont Hospital
Beaumont Road
Dublin
-
Ireland
Bradford Royal Infirmary
BIHR – Temple Bank House
Bradford Royal Infirmary
Bradford
BD9 6RJ
United Kingdom
Bristol Haematology & Oncology Centre
Horfield Road
Bristol
BS2 8ED
United Kingdom
Castle Hill Hospital
Castle Road
Cottingham
HU16 5JQ
United Kingdom
Cheltenham General Hospital
Sandford Road
Cheltenham
GL53 7AN
United Kingdom
Clatterbridge Cancer Centre
Clatterbridge Road
Bebington
Wirral
CH63 4JY
United Kingdom
Colchester General Hospital
Turner Road
Colchester
Essex
CO4 5JL
Colchester
CO4 5JL
United Kingdom
Glan Clwyd Hospital
North Wales Cancer Treatment Centre
Glan Clwyd Hospital
Bodelwyddan
Denbighshire
Bodelwyddan
LL18 5UJ
United Kingdom
James Cook University Hospital
Marton Road
Middlesbrough
TS4 3BW
United Kingdom
Leicester Royal Infirmary
Infirmary Square
Leicester
LE1 5WW
United Kingdom
Musgrove Park Hospital
The Beacon Centre
Taunton
TA1 5DA
United Kingdom
New Cross Hospital
Deansley Centre
WV10 9PQ
United Kingdom
Nottingham City Hospital
Hucknall Road
Nottingham
NG5 1PB
United Kingdom
Queen Elizabeth Hospital Birmingham
Cancer Centre, Edgbaston
Birmingham
B15 2TH
United Kingdom
Royal Derby Hospital
Uttoxeter Road
Derby
DE22 3NE
United Kingdom
Royal Marsden Hospital (London)
Fulham Road
London
SW3 6JJ
United Kingdom
Royal Marsden Hospital (Sutton)
Downs Road
Sutton
Surrey
Sutton
SM2 5PT
United Kingdom
Royal Surrey County Hospital
Egerton Road
Guildford
GU2 7XX
United Kingdom
Royal United Hospital
Combe Park
Bath
BA1 3NG
United Kingdom
Singleton Hospital
Sketty Lane
Swansea
SA2 8QA
United Kingdom
St James's Institute of Oncology
Beckett Street
Leeds
LS9 7TF
United Kingdom
St Luke’s Hospital
Highfield Road
Rathgar
Dublin 6
Dublin
-
Ireland
University Hospitals Coventry & Warwickshire
Clifford Bridge Road
Coventry
CV2 2DX
United Kingdom
Velindre Hospital
Whitchurch
Cardiff
CF14 2TL
United Kingdom
VU University Medical Center
De Boelelaan 1117
1081 HV
Netherlands
Manor Hospital
Moat Road
Walsall
WS2 9PS
United Kingdom
Western General Hospital
Crewe Road
Edinburgh
EH4 2XU
United Kingdom
Weston Park Hospital
Whitham Road
Sheffield
S10 2SJ
United Kingdom
Northampton General Hospital
Cliftonville
Northampton
NN1 5BD
United Kingdom
Norfolk & Norwich University Hospital
Colney Lane
Norwich
NR4 7UY
United Kingdom

Sponsor information

University of Warwick (UK)
University/education

Warwick Medical School
Medical School Building
Coventry
CV4 7AL
England
United Kingdom

ROR logo "ROR" https://ror.org/01a77tt86

Funders

Funder type

Charity

Cancer Research UK (CRUK) (UK)
Private sector organisation / Other non-profit organizations
Alternative name(s)
CR_UK, Cancer Research UK - London, CRUK
Location
United Kingdom

Results and Publications

Intention to publish date31/12/2019
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryData sharing statement to be made available at a later date
Publication and dissemination planPlanned publication in a high-impact peer reviewed journal.
IPD sharing planThe current data sharing plans for the current study are unknown and will be made available at a later date.

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Results article results 05/01/2019 Yes No
Plain English results 06/02/2019 29/10/2021 No Yes
HRA research summary 28/06/2023 No No

Editorial Notes

29/10/2021: The following changes have been made:
1. The Cancer Research UK lay results summary has been added.
2. The total final enrolment number has been added.
20/11/2018: Publication reference added.
20/01/2017: Overall trial dates were updated from 01/03/2012 - 28/02/2015 to 01/09/2011 - 31/07/2019. Recruitment dates were updated from 01/03/2012 - 28/02/2015 to 09/10/2012 - 28/10/2016. Added trial participation centres.
17/01/2017: No publications found in PubMed, verifying study status with principal investigator.