RATIONALE: Drugs used in chemotherapy, such as carboplatin and capecitabine, work in
different ways to stop the growth of tumor cells, either by killing the cells or by stopping
them from dividing. Radiation therapy uses high-energy x-rays to kill tumor cells. Giving
chemotherapy together with radiation therapy may kill more tumor cells.
PURPOSE: This phase I trial is studying the side effects and best dose of capecitabine when
given together with carboplatin followed by radiation therapy in treating patients with
stage III or stage IV head and neck cancer.
- Determine the maximum tolerated dose (MTD) of capecitabine when administered with
carboplatin as induction chemotherapy in patients with stage III-IVB squamous cell
carcinoma of the head and neck.
- Determine the MTD of capecitabine when administered with concurrent carboplatin and
intensity-modulated radiotherapy in these patients.
- Determine the toxicity of this regimen in these patients.
- Determine, preliminarily, tumor response in patients treated with this regimen.
- Determine the quality of life of patients treated with this regimen.
OUTLINE: This is a dose-escalation study of capecitabine.
- Induction chemotherapy: Patients receive carboplatin IV on days 1, 8, 15, 22, 29, and
36 and oral capecitabine twice daily on days 1-14 and 22-35.
- Concurrent chemoradiotherapy: Beginning 2 weeks after completion of induction
chemotherapy, patients receive carboplatin and capecitabine as in induction
chemotherapy. Patients also undergo intensity-modulated radiotherapy (IMRT) once daily
on days 1-5, 8-12, 15-19, 22-26, and 29-33 and non-IMRT boost once daily on days 36-40
Treatment continues in the absence of disease progression or unacceptable toxicity.
Within 4-8 weeks after completion of concurrent chemoradiotherapy, patients who achieve a
clinical complete response or who are medically operable with resectable persistent or
recurrent disease undergo neck dissection (salvage surgery).
Cohorts of 3-6 patients receive escalating doses of capecitabine (during both induction
chemotherapy and concurrent chemoradiotherapy) until the maximum tolerated dose (MTD) is
determined. The MTD is defined as the dose preceding that which 2 of 3 or 2 of 6 patients
experience dose-limiting toxicity.
Quality of life is assessed at baseline, after completion of induction chemotherapy, and
then at 1 week and 3, 6, and 12 months after completion of concurrent chemoradiotherapy.
After completion of study therapy, patients are followed monthly for 3 months and then every
3 months for 1 year.
PROJECTED ACCRUAL: Approximately 6-48 patients will be accrued for this study.
- Histologically confirmed squamous cell carcinoma of the head and neck, including 1 of
the following types:
- Oral cavity
- Clinical stage III-IVB (T2-T4, N0-N3, M0) disease
- Measurable disease by physical exam, endoscopy, and/or CT scan or MRI
- Residual measurable disease after fine needle aspiration, core needle biopsy, or
incisional or excisional biopsy of the primary tumor
- No evidence of distant metastases (M1)
- 18 and over
- Zubrod 0-1
- Not specified
- Absolute neutrophil count > 1,500/mm^3
- Platelet count > 100,000/mm^3
- Hemoglobin > 9 g/dL
- No uncontrolled coagulopathy
- AST < 2 times normal
- Alkaline phosphatase < 2 times normal
- Bilirubin normal
- Creatinine < 2.0 mg/dL OR
- Creatinine clearance > 50 mL/min
- No congestive heart failure
- No symptomatic coronary artery disease
- No uncontrolled cardiac arrhythmias
- No myocardial infarction within the past year
- No other clinically significant cardiac disease
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception during and for at least 30 days
after completion of study treatment
- Nutritional and general physical condition must be compatible with proposed study
- Mentally reliable
- No pre-existing peripheral neuropathy > grade 1
- No history of hypersensitivity to fluorouracil, capecitabine, or carboplatin
- No active infection
- No other malignancy within the past 5 years except nonmelanoma skin cancer
- No major medical, psychiatric, or neurologic illness that would preclude study
participation or giving informed consent
PRIOR CONCURRENT THERAPY:
- Not specified
- More than 5 years since prior chemotherapy
- Not specified
- No prior radiotherapy for head and neck tumor
- No prior radiotherapy to the region of planned study radiotherapy fields
- Recovered from prior surgery
- No unhealed surgical wounds
- More than 4 weeks since prior investigational drugs
- No concurrent warfarin, diphenylhydantoin, or fluconazole unless willing to undergo
careful monitoring and appropriate dose adjustments