This phase II trial compares the effectiveness of adding BMX-001 to usual symptom management versus usual symptom management alone for reducing oral mucositis in patients who are receiving chemoradiation for head and neck cancer. Oral mucositis (inflammation and mouth sores) is a common side effect of chemoradiation that can cause pain and difficulty swallowing. Usual management of these side effects typically consists of using mouth rinses and pain medications during treatment and for several weeks after completion of treatment. BMX-001 neutralizes harmful substances in the body, preventing damage to macromolecules such as DNA and minimizes free radical-related toxicity in normal tissues. Adding BMX-001 to usual symptom management may be more effective than usual symptom management alone at reducing oral mucositis in patients receiving chemoradiation for head and neck cancer.
PRIMARY OBJECTIVE: I. To compare the incidence of severe oral mucositis (SOM) between manganese superoxide dismutase (MnSOD) mimetic BMX-001 (BMX-001) and placebo, defined as \>= grade 3 per World Health Organization (WHO) criteria from the start of radiation through 4 weeks after completion of study treatment, with additional assessments at 6, 8 and 12 weeks after completion of study treatment. SECONDARY OBJECTIVES: I. To compare the duration of SOM in the BMX-001 arm versus (vs.) placebo arm. II. To assess the difference between arms in the Oral Mucositis Weekly Questionnaire-Head and Neck (OMWQ-HN) change score from baseline to 4 weeks after the end of chemoradiation. III. To describe the incidence and severity of xerostomia and radiation dermatitis, as measured by Common Terminology Criteria for Adverse Events (CTCAE) version (v)5.0, in both arms. IV. To compare the duration of radiation dermatitis in the BMX-001 arm vs. placebo arm. V. To describe toxicity, as measured by CTCAE v5.0 and Patient Reported Outcome (PRO)-CTCAE, in both arms. EXPLORATORY OBJECTIVES: I. To assess the between arm difference in progression-free survival (PFS). II. To assess the between arm difference in overall survival (OS). III. Data demonstrating improvement in pain, as measured by reduction in narcotic use between BMX-001 versus usual care. IV. Collect serum and plasma for future translational research analyses. OUTLINE: Patients are randomized to 1 of 2 arms. ARM 1: Patients receive cisplatin once weekly (QW) or once every 3 weeks (Q3W) and undergo image-guided intensity-modulated radiation therapy once daily (QD) 5 days per week for 7 weeks per standard of care (SOC). In addition to usual symptom management, patients receive placebo subcutaneously (SC) as early as 96 hours and no later than one hour prior to their first dose of radiation therapy, and as early as 96 hours and no later than 48 hours prior to first dose of cisplatin. Patients then receive placebo SC twice a week (BIW) for 8 weeks (16 doses). Patients also undergo computed tomography (CT) and/or magnetic resonance imaging (MRI) on study and may optionally undergo collection of blood, serum, and/or plasma throughout the study. ARM 2: Patients receive cisplatin QW or Q3W and undergo image-guided intensity-modulated radiation therapy QD 5 days per week for 7 weeks per SOC. In addition to usual symptom management, patients receive BMX-001 SC as early as 96 hours and no later than one hour prior to their first dose of radiation therapy, and as early as 96 hours and no later than 48 hours prior to first dose of cisplatin. Patients then receive BMX-001 SC BIW for 8 weeks (16 doses). Patients also undergo CT and/or MRI on study and may optionally undergo collection of blood, serum, and/or plasma throughout the study. After completion of study treatment, patients are followed up at 1, 2, 3, 6, 12, and 24 months.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
QUADRUPLE
Enrollment
98
Receive usual symptom management
Undergo collection of blood, serum, and/or plasma samples
Given cisplatin
Undergo CT
Undergo image-guided radiation therapy
Undergo intensity-modulated radiation therapy
Undergo MRI
Given SC
Given SC
Ancillary studies
Arizona Center for Cancer Care - Gilbert
Gilbert, Arizona, United States
RECRUITINGArizona Center for Cancer Care-Peoria
Peoria, Arizona, United States
RECRUITINGArizona Center for Cancer Care - Phoenix
Phoenix, Arizona, United States
RECRUITINGArizona Center for Cancer Care - Scottsdale
Scottsdale, Arizona, United States
Incidence of severe oral mucositis (SOM)
Proportion of patients with reported SOM \>= grade 3 per World Health Organization criteria.
Time frame: From start of radiation through 4 weeks after completion of study treatment
Duration of SOM
Defined from first determination of \>= grade 3 oral mucositis (OM) to the first instance of non-SOM (=\< grade 2), without subsequent instance of \>= grade 3 within the following 4 weeks.
Time frame: Up to 12 weeks after completion of chemoradiation
Time to SOM
Defined from date of randomization to date of first determination of \>= grade 3 OM.
Time frame: Up to 12 weeks after completion of chemoradiation
Incidence and duration of xerostomia and radiation dermatitis
The proportion of patients with any grade and grade ≥ 3 xerostomia and radiation dermatitis, separately. Duration is measured from the first determination of radiation dermatitis or xerostomia, separately, (grade ≥ 1 as measured by Common Terminology Criteria for Adverse Events \[CTCAE\] version \[v\] 5.0) to the first report of none (grade 0).
Time frame: Up to 12 weeks after completion of chemoradiation
Incidence of toxicity
Adverse events (AEs) will be graded by the physician-reported CTCAE v5.0 and also measured using the Patient Reported Outcome-CTCAE. Counts of all AEs by grade will be provided by treatment arm.
Time frame: Up to 24 months after completion of chemoradiation
Patient reported oral mucositis
Will be measured by the Oral Mucositis Weekly Questionnaire (OMWQ). Decline within patients is defined using a minimally important difference of 7.
Time frame: Up to 24 months after completion of chemoradiation
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Arizona Center for Cancer Care-Surprise
Surprise, Arizona, United States
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