Minocycline for Reduction of Radiation Therapy Treatment-Related Symptom Burden in Oropharynx Cancer: A Randomized Study.

The Study Drug:

Minocycline is an antibiotic and has been shown to interrupt cytokine production, which may
help to reduce multiple symptoms.

Study Groups:

If you agree to take part in this study, you will be randomly assigned (as in the flip of a
coin) to 1 of 2 groups. Group 1 will take minocycline. Group 2 will take a placebo. A placebo
is a substance that looks like the study drug but has no active ingredients.

Neither you nor the study staff will know if you are receiving the study drug or the placebo.
However, if needed for your safety, the study staff will be able to find out what you are
receiving.

Study Drug Administration:

You will take the study drug/placebo, by mouth, every day for 7 weeks starting at the first
week of radiation therapy. You may take the study drug/placebo with a full glass (8 ounces)
of water. You may take it with or without food. If it causes an upset stomach, you should
take it with food. If you have trouble swallowing the dose of study drug/placebo, you can
open the capsule right before you take them. You should not lie down for at least 30 minutes
after taking the study drug/placebo to prevent possible irritation of the inside of the
esophagus, a known side effect. You will be given pamphlets with more information about how
to take the study drug/placebo.

You will be given a daily diary to write down what time you take the study drug/placebo. You
must bring the diary with you to every study visit for the study doctor and research staff to
review.

You must bring the study drug/placebo container to every study visit.

Study Visits:

Before you start your radiation treatment:

- You will have blood (about 2 teaspoons) drawn to check your liver function, if this test
has not been done in the last 3 months.

- If you are able to become pregnant, you will have a urine pregnancy test. The study
staff will give you the pregnancy test kit, and will review and record the results of
the test before you can pick up the study drug from the pharmacy. If you are pregnant,
you will not be given the study drug.

- You will also complete 5 questionnaires about pain and other symptoms, your alcohol and
tobacco history, your health status, and your quality of life. It should take about 15
minutes to complete all of the questionnaires.

During radiation treatment (approximately Weeks 1- 7 of radiation):

You will complete the symptom questionnaire in the clinic or by telephone 2 times a week. You
will be asked about symptoms you may be experiencing and how they may be interfering with
your normal daily activities. You will complete the symptom questionnaire during one of your
regular clinic visits. If you do not have a clinic visit scheduled around the time that the
questionnaire needs to be completed, a member of the study staff will call you at your home
at a time that is convenient for you. The symptom questionnaire should take about 5 minutes
to complete each time.

At about Week 4 of radiation, you will complete 4 additional questionnaires about pain and
other symptoms, your tobacco use, and a quality of life questionnaire. It should take about 5
minutes to complete all of the questionnaires.

During the last week of radiation (about Week 6-7), you will complete 4 additional
questionnaires about pain and other symptoms, your health status, and your quality of life.
It should take about 10 minutes to complete all of the questionnaires.

Starting after the last week of radiation (about Weeks 7-10), the study staff will call you 2
times each week to check on you. This phone call should last about 5 minutes. If you have had
several side effects from the radiation therapy, this phone call may take longer.

Follow-Up Phone Calls:

During Weeks 11-15, you will complete the pain and other symptoms questionnaire 1 time a week
by phone. A member of the study staff will call you at your home at a time that is convenient
for you. The symptom questionnaire should take about 5 minutes to complete by phone each
time.

End of Study Visit:

Your last study visit will be the same day that you have your last clinic visit with the
radiation doctor (around Weeks 13-15). At this visit, you will complete the pain and other
symptoms questionnaire, your health status and the 2 smoking questionnaires. It should take
about 5 minutes to complete both questionnaires.

Length of Study:

You will be on study for up to 15 weeks. You will take the study drug/placebo for up to 7
weeks and continue to complete the symptom survey until 15 weeks. You will be taken off study
early if you experience intolerable side effects or the study doctor thinks it is in your
best interest.

This is an investigational study. Minocycline is FDA approved and commercially available for
the treatment of bacterial infection. Using minocycline for the treatment of the symptoms of
radiation treatment for oropharynx cancer, nasopharynx cancer, or unknown primary cancer of
head and neck, is investigational.

Up to 60 patients will take part in this research study. All will be enrolled at MD Anderson
main campus as well as the regional care centers.

Inclusion Criteria:

1. Patients with a pathologically proven diagnosis of oropharyngeal cancer,
nasopharyngeal cancer, or unknown primary cancer of head and neck in MDACC receiving
radiation therapy with or without induction chemotherapy.

2. Patients > = 18 years old.

3. Patients with the above cancers, T0, TX, T1 to T3, N any, M0 receiving IMRT (to
unilateral or bilateral neck) at least 64-72 Gy in 6-7 weeks as definitive treatment.

4. Patients must have normal renal function test and no prior renal disease: The
screening cut off for serum creatinine < upper limit of normal.

5. Patients must have normal hepatic function test and no prior liver disease: The
screening results for total bilirubin must be < 1.5 times the upper limit of normal.
The screening results for the following must be < 2 times the upper limit of normal
for patients to be eligible: Alkaline phosphatase (ALP) and Alanine aminotransferase
(ALT). The screening results for Aspartate aminotransferase (AST) must be < 2 times
the upper limit of normal if available.

6. Patients who speak English (due to the novel research and its complexity, we are only
accruing English speaking patients to the protocol).

7. Patients must be willing to discontinue taking dong quai and/or St John's wort.

8. Patients must be willing and able to review, understand, and provide written consent.

Exclusion Criteria:

1. Patients receiving concurrent chemotherapy or concurrent biologic agent.

2. Patients who are taking medications or have conditions that potentially preclude use
of any study medications or interventions as determined by the treating physician.

3. Patients who are enrolled in another symptom management trial or receiving active
treatment under another clinical trial.

4. Bile duct obstruction or cholelithiasis.

5. History of clinically significant cutaneous drug reaction, or a history of clinically
significant hypersensitivity reaction, including multiple allergies or drug reaction.

6. Pre-existing psychosis or bipolar disorder.

7. Hypersensitivity to any tetracyclines.

8. Patients on anticoagulants (ie warfarin/heparin).

9. Patients with INR > 1.5.

10. Patients taking any tetracycline within the last 15 days.

11. Patients that are pregnant.

12. Patients treated with upfront radical surgery at the primary site (other than
diagnostic tonsillectomy or excision).