Comparing High-Dose Cisplatin Every Three Weeks to Low-Dose Cisplatin Weekly When Combined With Radiation for Patients With Advanced Head and Neck Cancer

Inclusion Criteria:

   - Pathologically (histologically or cytologically) proven diagnosis of SCCHN of the
   oropharynx, larynx, hypopharynx, or p16-positive unknown primary prior to
   registration; specimen from cervical lymph nodes with a well-defined primary site
   documented clinically or radiologically is acceptable; in patients with carcinoma of
   unknown primary this will be sufficient for pathologic confirmation without a
   clinically or radiographically defined primary site

      - For patients with oropharyngeal cancer (OPC)/cancer of unknown primary (CUP):

P16 status based on local site immunohistochemical tissue staining is required. A cell
block obtained from a fine needle aspiration (FNA) biopsy specimen may be used as the sole
diagnostic tissue. Centers are encouraged to contact the pathology chair for clarification

   - Note: Institutions must screen patients for p16 status by immunohistochemistry (IHC)
   in order to be eligible for the trial using a Clinical Laboratory Improvement
   Amendments (CLIA)-certified laboratory. A rigorous laboratory accreditation process
   similar to the United States (U.S.) CLIA certification, such as the provincial
   accreditation status offered by the Ontario Laboratory Accreditation (OLA) Program in
   Canada, the College of American Pathologists (CAP), or an equivalent accreditation in
   other countries, is acceptable.

      - The p16 results must be reported on the pathology report being submitted. The p16
      positivity is defined as > 70% of tumor cells showing strong nuclear and/or
      cytoplasmic immunostaining with p16 antibody.

      - For patients with laryngeal and hypopharyngeal primaries: Analysis of p16 status
      is NOT required

         - Patients must have clinically or radiographically evident measurable disease
         at the primary site or at nodal stations. Simple tonsillectomy or local
         excision of the primary without removal of nodal disease is permitted, as is
         excision removing gross nodal disease but with intact primary site. Limited
         neck dissections retrieving =< 4 nodes are permitted and considered as
         non-therapeutic nodal excisions

         - Clinical stage (American Joint Committee on Cancer [AJCC], 8th ed.),
         including no distant metastases based on the following diagnostic workup:

      - History/physical examination within 60 days prior to registration

      - One of the following imaging studies is required within 60 days prior to
      registration:

   - Computed tomography (CT) scan of neck (diagnostic quality with contrast, unless
   contraindicated) OR

   - Magnetic resonance imaging (MRI) of the neck (diagnostic quality with contrast, unless
   contraindicated) OR

   - Fludeoxyglucose F-18 (FDG)-positron emission tomography (PET)/CT of the neck; the CT
   component must be of diagnostic quality with contrast, unless contraindicated.

      - Note: A diagnostic quality CT or MRI with contrast or FDG-PET/CT scan of neck
      performed for the purposes of radiation planning may serve as both staging and
      planning tools

         - One of the following imaging studies is required within 60 days prior to
         registration:

   - FDG-PET/CT of the chest; FDG-PET/CT scan is strongly preferred and highly recommended
   to be used for eligibility OR

   - Chest CT

      - Exam with laryngopharyngoscopy (mirror or in office direct procedure acceptable)
      within 70 days prior to registration;

   - Eligibility by patient cohort;

      - Non-OPC/p16-negative OPC Cohort; Tumor Site: Larynx/Hypopharynx; Clinical Staging
      (AJCC, 8th ed.): T3-4 N0 or T1-4 N1-3 T2 N0 (hypopharynx only)

      - Tumor Site: p16-negative OPC; Clinical Staging (AJCC, 8th ed.): T2N1, T1-4 N2-3,
      or T3-4 N0-1

   - p16-positive OPC/CUP Cohort;

      - Tumor Site: OPC; Smoking Status: =< 10 pack-years; Clinical Staging (AJCC, 8th
      ed.): T1-3 N2-3 or T4 N0-3

      - Tumor Site: OPC; Smoking Status: > 10 pack-years; Clinical Staging (AJCC, 8th
      ed.): T1N2-3, T2N1-3 or T3-4 N0-3

      - Tumor Site: CUP; Smoking Status: Any; Clinical Staging (AJCC, 8th ed.): T0 N2-3

Note: Cigar and pipe tobacco consumption is not included in calculating the lifetime
pack-years. Marijuana consumption is likewise not considered in this calculation. There is
also no clear scientific evidence regarding the role of chewing tobacco-containing products
in oropharyngeal cancer, although this is possibly more concerning given the proximity of
the oral cavity and oropharynx. In any case, investigators should not count use of
non-cigarette tobacco products in the pack-years calculation.

   - Age >= 18

   - Zubrod (Eastern Cooperative Oncology Group [ECOG]) performance status of 0-1 within 14
   days prior to registration

   - Absolute neutrophil count (ANC) >= 1,500 cells/mm^3 (within 30 days prior to
   registration)

   - Platelets >= 75,000 cells/mm^3 (within 30 days prior to registration)

   - Hemoglobin >= 8.0 g/dL (within 30 days prior to registration)

      - Note: The use of transfusion or other intervention to achieve hemoglobin [Hgb] >=
      8.0 g/dL is acceptable)

   - Calculated creatinine clearance (CrCl) >= 50 mL/min by the Cockcroft-Gault formula
   (within 30 days prior to registration)

   - Total bilirubin =< 1.5 x institutional upper limit of normal (ULN) (within 30 days
   prior to registration) (not applicable to patients with known Gilbert's syndrome)

   - Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 1.5 x
   institutional ULN (within 30 days prior to registration)

   - Known human immunodeficiency virus (HIV) infected patients on effective
   anti-retroviral therapy with undetectable viral load within 6 months and CD4 T Cell
   count > 200 cells/mm^3 are eligible for this trial. Testing is not required for entry
   into protocol

   - Patients with a prior or concurrent malignancy whose natural history or treatment does
   not have the potential to interfere with the safety or efficacy assessment of the
   investigational regimen are eligible for this trial

   - Negative urine or serum pregnancy test (in persons of childbearing potential) within
   14 days prior to registration. 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. Menopause is defined clinically
   as 12 months of amenorrhea in a woman over 45 in the absence of other biological or
   physiological causes

   - Willing to use highly effective contraceptives for participants of childbearing
   potential (participants who may become pregnant or who may impregnate a partner)
   during therapy and for 14 months (females); for 11 months (males) following last dose
   of cisplatin; this inclusion is necessary because the treatment in this study may be
   significantly teratogenic

   - The patient or a legally authorized representative must provide study-specific
   informed consent prior to study entry and, for patients treated in the United States
   (U.S.), authorization permitting release of personal health information

Exclusion Criteria:

   - Patients with oral cavity cancer, nasopharynx cancer, or p16-negative cancer of
   unknown primary (CUP)

   - Recurrence of the study cancer

   - Definitive clinical or radiologic evidence of distant metastatic disease

   - Prior systemic chemotherapy for the study cancer; note that prior chemotherapy for a
   different cancer is allowable, however, any prior exposure to cisplatin is excluded

   - Prior radiotherapy to the region of the study cancer that would result in overlap of
   radiation therapy fields

   - Severe, active co-morbidity defined as follows:

      - Unstable angina requiring hospitalization in the last 6 months

      - Myocardial infarction within the last 6 months

      - New York Heart Association Functional Classification III/IV (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.)

      - Persistent grade 3-4 (CTCAE version 5.0) electrolyte abnormalities that cannot be
      reversed despite replacement as indicated by repeat testing

      - Patient must not have an active infection requiring IV antibiotics prior to
      registration;

      - Other chronic renal disease like nephrotic syndrome, that could be worsened by
      cisplatin therapy

      - History of allogenic organ transplantation

      - Any symptomatic peripheral sensory neuropathy grade >= 2 (CTCAE version 5.0);

   - Pregnancy and individuals unwilling to discontinue nursing

   - History of hypersensitivity to cisplatin or platinum-containing compounds