Radiation Therapy and Cisplatin With or Without Epoetin Alfa in Treating Patients With Cervical Cancer and Anemia
| Status: | Completed |
|---|---|
| Conditions: | Cervical Cancer, Cervical Cancer, Cervical Cancer, Cervical Cancer, Cervical Cancer, Cervical Cancer, Cervical Cancer, Cervical Cancer, Cancer, Cancer, Cancer, Other Indications, Women's Studies, Anemia |
| Therapuetic Areas: | Hematology, Oncology, Other, Reproductive |
| Healthy: | No |
| Age Range: | Any |
| Updated: | 8/10/2017 |
| Start Date: | August 2001 |
Phase III Trial to Evaluate the Efficacy of Maintaining Hemoglobin Levels Above 120 g/l With Erythropoietin Versus Above 100 g/l Without Erythropoietin in Anemic Patients Receiving Concurrent Radiation and Cisplatin for Cervical Cancer
Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop
growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Epoetin alfa
may stimulate red blood cell production to treat anemia in patients who have received
chemotherapy and/or radiation therapy for cervical cancer. Randomized phase III trial to
study the effectiveness of epoetin alfa in treating anemia in patients who have cervical
cancer.
growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Epoetin alfa
may stimulate red blood cell production to treat anemia in patients who have received
chemotherapy and/or radiation therapy for cervical cancer. Randomized phase III trial to
study the effectiveness of epoetin alfa in treating anemia in patients who have cervical
cancer.
OBJECTIVES:
Assess the efficacy of raising and maintaining hemoglobin (Hgb) levels above 12.0 g/dL with
epoetin alfa vs maintaining Hgb levels above 10.0 g/dL without epoetin alfa on
progression-free survival, overall survival, and local control in anemic patients with
cervical cancer receiving concurrent radiotherapy and cisplatin. Compare the quality of life
of patients treated with these regimens.
OUTLINE:
This is a randomized study. Patients are stratified according to stage (IIB vs IIIB vs IVA),
method of brachytherapy (low-dose vs high-dose), and surgical staging of para-aortic nodes
(yes vs no). Patients are randomized to 1 of 2 treatment arms.
Arm I: Patients undergo radiotherapy comprising pelvic external beam radiotherapy daily five
days a week for 5 weeks, followed by either 1 or 2 implants of low-dose rate intracavitary
brachytherapy or 5 fractions of high-dose rate intracavitary brachytherapy, followed by 3-5
days of parametrial boost radiotherapy. Patients receive cisplatin IV concurrently with
pelvic external beam radiotherapy on days 1, 8, 15, 22, 29, and once during the week of
parametrial boost radiotherapy.
Arm II: Patients undergo radiotherapy and chemotherapy as in arm I. Additionally, patients
receive epoetin alfa subcutaneously once weekly concurrently with radiotherapy and
chemotherapy. Quality of life is assessed at baseline, during weeks 3 and 6, within 1 week of
last brachytherapy, and every 3 months for 2 years. Patients are followed every 3 months for
2 years, every 6 months for 3 years, and then annually thereafter.
PROJECTED ACCRUAL: A total of 460 patients will be accrued for this study within 3.5 years.
Assess the efficacy of raising and maintaining hemoglobin (Hgb) levels above 12.0 g/dL with
epoetin alfa vs maintaining Hgb levels above 10.0 g/dL without epoetin alfa on
progression-free survival, overall survival, and local control in anemic patients with
cervical cancer receiving concurrent radiotherapy and cisplatin. Compare the quality of life
of patients treated with these regimens.
OUTLINE:
This is a randomized study. Patients are stratified according to stage (IIB vs IIIB vs IVA),
method of brachytherapy (low-dose vs high-dose), and surgical staging of para-aortic nodes
(yes vs no). Patients are randomized to 1 of 2 treatment arms.
Arm I: Patients undergo radiotherapy comprising pelvic external beam radiotherapy daily five
days a week for 5 weeks, followed by either 1 or 2 implants of low-dose rate intracavitary
brachytherapy or 5 fractions of high-dose rate intracavitary brachytherapy, followed by 3-5
days of parametrial boost radiotherapy. Patients receive cisplatin IV concurrently with
pelvic external beam radiotherapy on days 1, 8, 15, 22, 29, and once during the week of
parametrial boost radiotherapy.
Arm II: Patients undergo radiotherapy and chemotherapy as in arm I. Additionally, patients
receive epoetin alfa subcutaneously once weekly concurrently with radiotherapy and
chemotherapy. Quality of life is assessed at baseline, during weeks 3 and 6, within 1 week of
last brachytherapy, and every 3 months for 2 years. Patients are followed every 3 months for
2 years, every 6 months for 3 years, and then annually thereafter.
PROJECTED ACCRUAL: A total of 460 patients will be accrued for this study within 3.5 years.
Inclusion Criteria:
- Histologically confirmed invasive squamous cell carcinoma, adenocarcinoma, or
adenosquamous carcinoma of the cervix
- Stage IIB, IIIB, or IVA
- Primary, previously untreated disease
- Hemoglobin less than 14 g/dL at presentation
- Negative, non-suspicious para-aortic nodes determined by lymphangiogram, CT scan, MRI,
or lymphadenectomy
- Eligible for treatment with radical intent involving concurrent cisplatin and pelvic
radiotherapy
- No involvement of the lower third of vagina
- No carcinoma of the cervical stump
- Performance status - GOG 0-3
- See Disease Characteristics
- Absolute neutrophil count at least 1,500/mm^3
- Platelet count at least 100,000/mm^3
- Bilirubin no greater than 1.5 times normal
- SGOT no greater than 3 times normal
- Alkaline phosphatase no greater than 3 times normal
- Creatinine no greater than 2.0 mg/dL
- No uncontrolled hypertension
- No history of thrombotic vascular events (e.g., deep vein thrombosis or myocardial
infarction)
- No active hemolysis
- No history of pulmonary embolism
- No septicemia or severe infection
- No circumstances that would preclude study participation
- No other invasive malignancy within the past 5 years except nonmelanoma skin cancer
- No history of hypersensitivity to epoetin alfa or human albumin
- No diagnosis of vitamin B_12 or folic acid deficiency
- No recent (within the past 3 months) or uncontrolled seizure disorder
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- See Disease Characteristics
- See Disease Characteristics
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