University of Kansas Medical Center

Eligibility

Eligible Ages

Over 18 Years

Eligible Sex

All

Accepts Healthy Volunteers

No

Criteria

Inclusion Criteria:

- Patients must be planned to receive radiation and concurrent cisplatin chemotherapy
as definitive therapy. Patients planned to receive concurrent cisplatin and
radiation therapy in the adjuvant setting are not eligible.

- At least two subsites (buccal mucosa, lips, retromolar trigone, floor of mouth, oral
tongue, tonsil, soft palate, or hard palate) must have at least 1cc or 1% of the
subsite volume receiving >= 50 Gy. In cases of uncertainty, the enrolling clinician
can ensure coverage by inspecting the 50 Gy isodose line and using the table
describing the anatomic boundaries of the individual subsites contained within the
extended cavity contour. The two or more subsites receiving >= 50 Gy must be
documented by the enrolling physician and will be reviewed centrally to confirm
eligibility.

- Pathologically confirmed (histologically or cytologically) squamous cell carcinoma
of the oropharynx, larynx, hypopharynx, nasopharynx, or oral cavity.

- P16 and/or human papillomavirus (HPV) status (via polymerase chain reaction [PCR] or
in situ hybridization [ISH]) must be documented for patients with oropharynx cancer.

- No definitive clinical or radiologic evidence of metastatic (M1) disease related to
current diagnosis.

- Able to receive intensity-modulated radiation therapy (IMRT) delivered as daily
fractions of 2.0 Gy once per weekday with a cumulative radiation dose of 70 Gy.

- Age >= 18.

- Zubrod performance status of 0-2.

- Potassium ≥ institutional lower limit of normal (LLN) and magnesium ≥ institutional
LLN. Oral or intravenous (IV) replacement therapy of potassium or magnesium is
permitted if parameters can be met after repletion.

- Absolute neutrophil count (ANC) >= 1,500 cells/mm^3.

- Platelets >= 100,000 cells/mm^3.

- Hemoglobin >= 9.0 g/dl (Note: The use of transfusion or other intervention to
achieve hemoglobin [Hgb] >= 10.0 g/dl is acceptable).

- Adequate renal function defined as creatinine clearance (CrCL) > 50 mL/min by the
Cockcroft-Gault formula.

- Total bilirubin =< 2 x institutional upper limit of normal (ULN) (not applicable to
patients with known Gilbert's syndrome).

- Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT])
and alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =<
3 x institutional ULN.

- No prior radiotherapy that would result in overlap of radiation treatment fields
with planned treatment for study cancer, e.g., breast cancer with irradiation of the
supraclavicular fossa/level 4 neck.

- No concurrent treatment with nitrates or other drugs that may, in the judgment of
the treating investigator, create a risk for a precipitous decrease in blood
pressure.

- No prior history of gross total excision of both primary and nodal disease; this
includes tonsillectomy, local excision of primary site, and nodal excision that
removes all clinically and radiographically evident disease. In other words, to
participate in this protocol, the patient must have clinically or radiographically
evident gross disease for which disease response can be assessed.

- No current treatment of adjuvant post-operative (op) chemoradiation.

- No systemic treatment with inducers or strong inhibitors of cytochrome P450 =< 4
days before registration. Note: Patients undergoing steroid treatment as a component
of the anti-emetic regimen for cisplatin are eligible for the study.

- No prior unrelated malignancy requiring current active treatment with the exception
of cervical carcinoma in situ, basal cell skin carcinoma, resected T1-2N0M0
differentiated thyroid cancers, Ta bladder cancers, or low risk prostate cancer.

- No clinically significant hearing impairment that precludes cisplatin, as per
physician assessment.

- No serious cardiovascular disease or cerebrovascular disease in the last 6 months
prior to study enrollment; defined as a cerebrovascular accident, myocardial
infarction, unstable angina, serious cardiac arrhythmia uncontrolled by medication
or with the potential to interfere with protocol treatment, or current New York
Heart Association (NYHA) grade II or greater congestive heart failure (CHF), or
admission within last 6 months for CHF exacerbation; (Note: Patients with known
history or current symptoms of cardiac disease, or history of treatment with
cardiotoxic agents, should have a clinical risk assessment of cardiac function using
the New York Heart Association Functional Classification).

- No significant vascular disease (e.g., aortic aneurysm requiring surgical repair or
recent arterial thrombosis) within 6 months prior to enrollment.

- No history or evidence upon physical/neurological examination of central nervous
system disease (e.g., seizures) unrelated to cancer unless adequately controlled by
medication.

- Acute bacterial, viral, or fungal infection requiring intravenous antimicrobials
within 7 days of enrollment.

- No history of chronic obstructive pulmonary disease exacerbation or other
respiratory illness requiring hospitalization or precluding study therapy within 30
days of registration.

- No known personal or family history of long QT Syndrome; no marked baseline
prolongation of QT/corrected QT (QTc) interval (i.e., ≥ 2 electrocardiograms [EKGs]
in prior 3 months of a QTc interval > 450 milliseconds (ms) for males and > 470 ms
for females using the specific/usual choice by clinical center for correction
factor.

- Persistent grade 3-4 (CTCAE version 5.0) electrolyte abnormalities must be
reversible to ≤ grade 1 with supplementation.

- Poorly controlled hypertension (systolic blood pressure [SBP] > 160 and/or diastolic
blood pressure [DBP] > 95) over 2 repeated measures within 30 days prior to
registration.

- No grade >= 2 oral mucositis per CTCAE version 5.0.

- No grade >= 2 hypotension per CTCAE v. 5.0.

- No medical necessity for medications listed as prohibited.

- For standard management of oral mucositis, clinicians may consult the
Multinational Association of Supportive Care in Cancer/International Society of
Oral Oncology (MASCC/ISOO) Clinical Practice Guidelines for the Management of
Mucositis Secondary to Cancer Therapy
https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/cncr.33100. The
only intervention against mucositis that is supported by level I evidence is
low-level laser therapy (LLLT). Honey is rated at level II and benzydamine,
which isn't available in the United States (US), is rated at level III. There
are no other positively rated interventions.

- LLLT is prohibited in this study as its availability remains limited, it is not
Food and Drug Administration (FDA) approved in the US, and it is considered
investigational in many circumstances requiring enrollment in a dedicated
protocol who requirements could conflict with this one. Therefore, institutions
that use LLLT should only enroll patients who would not be eligible for (or do
not want) that intervention. Honey is not on the list of prohibited medications
for this study. Given the MASCC recommendation, benzydamine is allowed,
although there is lack of availability in the United States of America (USA).
The other listed prohibited medications are not recommended by MASCC and some
are potentially harmful, such as glutamine, which is associated with mortality
in patients receiving stem cell transplant.

- No history of allergic reaction to the study agent(s), compounds of similar chemical
or biologic composition to the study agent (s) (or any of its excipients).

- Childbearing potential is defined as any person who has experienced menarche and who
has not undergone surgical sterilization (hysterectomy or bilateral oophorectomy) or
who is not postmenopausal.