| E.1 Medical condition or disease under investigation | 
| E.1.1 | Medical condition(s) being investigated  | 
| Patients with histological or cytological confirmed squamous cell carcinomas of the oral cavity, oropharynx, hypopharynx, larynx, T2-T3-T4, any N, M0 | 
 
 
 | 
| E.1.1.1 | Medical condition in easily understood language  | 
 | 
| E.1.1.2 | Therapeutic area  | Diseases [C] - Cancer [C04] | 
| MedDRA Classification | 
| E.1.2 Medical condition or disease under investigation | 
| E.1.2 | Version  | 14.0 | 
 
| E.1.2 | Level  | PT | 
 
| E.1.2 | Classification code  | 10067821 | 
 
| E.1.2 | Term  | Head and neck cancer | 
 
| E.1.2 | System Organ Class  | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) | 
 
 
 | 
| E.1.3 | Condition being studied is a rare disease  |  Yes  | 
| E.2 Objective of the trial | 
| E.2.1 | Main objective of the trial  | 
| Determine if tumor hypoxia can be accurately visualised with [18F]HX4 PET imaging in head and neck cancer tumors | 
 
 
 | 
| E.2.2 | Secondary objectives of the trial  | 
- Observe spatial and temporal stability of [18F] HX4 PET images 
 - Correlation of [18F] HX4 with local tumor recurrence and survival
 - Image quality of [18F] HX4-PET at different time points 
 - Kinetic analysis of HX4
 - Correlation of hypoxia imaging with blood hypoxia markers (osteopontin, circulating CA-IX)
 - Correlation of hypoxia imaging with tumor tissue biomarkers (HPV, CA-IX, VEGF, EGFR, CD44, HIF-1a, mir-210) and autophagy related genes
 - Spatial correlation of [18F] HX4-PET with [18F] FDG PET pre-treatment
 - Spatial correlation of [18F] HX4-PET with [18F] FDG PET three months after treatment
 
 | 
 
 
 | 
| E.2.3 | Trial contains a sub-study  |  No  | 
| E.3 | Principal inclusion criteria  | 
- Histological or cytological confirmed HNSSC of the oral cavity, oropharynx, hypopharynx, larynx, T2-T3-T4, any N, M0
 - Tumor (or lymph node) diameter ≥ 2,5 cm
 - WHO performance status 0 to 2
 - Scheduled for primary curative (concurrent chemo-) radiotherapy
 - No previous surgery to the head and neck
 - No previous radiation to the head and neck
 - Adequate renal function (calculated creatinine clearance at least 60 ml/min) 
 - The patient is willing and capable to comply with study procedures
 - 18 years or older
 - Have given written informed consent before patien registration
 	
 | 
 
 
 | 
| E.4 | Principal exclusion criteria | 
No recent (< 3 months) myocardial infarction
 - No Uncontrolled infectious disease
 - Not pregnant or breast feeding and willing to take adequate contraceptive measures during the study
  
 
 | 
 
 
 | 
| E.5 End points | 
| E.5.1 | Primary end point(s) | 
| Tumor to background ratio of [18F]HX4 PET images | 
 
 
 | 
| E.5.1.1 | Timepoint(s) of evaluation of this end point | 
 | 
| E.5.2 | Secondary end point(s) | 
- Overlap fraction of (for example) >50% max regions (i) before and during treatment (ii) in the time series.
 - Define the optimal time point for HX4 imaging in head and neck cancer, based on the highest tumor to background ratio.
 - Determine if there is a relationship between the SUVmax, SUVmean or tumor to muscle ratio in comparison to the amount of osteopontin in the blood, circulating CA-IX in the blood or the degree and presence of tumor tissue markers. 
 - Overlap fraction of (for example) >50% max regions between HX4-PET and FDG-PET pre-treatment or three months after treatment.
 - Correlation of the SUVmax, SUVmean and tumor to muscle ratio in the [18F] HX4 PET images in comparison to local tumor recurrence and survival.
 
 | 
 
 
 | 
| E.5.2.1 | Timepoint(s) of evaluation of this end point | 
 | 
| E.6 and E.7 Scope of the trial | 
| E.6 | Scope of the trial | 
| E.6.1 | Diagnosis |  No  | 
| E.6.2 | Prophylaxis |  No  | 
| E.6.3 | Therapy |  No  | 
| E.6.4 | Safety |  No  | 
| E.6.5 | Efficacy |  No  | 
| E.6.6 | Pharmacokinetic |  Yes  | 
| E.6.7 | Pharmacodynamic |  No  | 
| E.6.8 | Bioequivalence |  No  | 
| E.6.9 | Dose response |  No  | 
| E.6.10 | Pharmacogenetic |  No  | 
| E.6.11 | Pharmacogenomic |  No  | 
| E.6.12 | Pharmacoeconomic |  No  | 
| E.6.13 | Others |  No  | 
| E.7 | Trial type and phase | 
| E.7.1 | Human pharmacology (Phase I) |  No  | 
| E.7.1.1 | First administration to humans |  No  | 
| E.7.1.2 | Bioequivalence study |  No  | 
| E.7.1.3 | Other |  No  | 
| E.7.1.3.1 | Other trial type description |  | 
| E.7.2 | Therapeutic exploratory (Phase II) |  Yes  | 
| E.7.3 | Therapeutic confirmatory (Phase III) |  No  | 
| E.7.4 | Therapeutic use (Phase IV) |  No  | 
| E.8 Design of the trial | 
| E.8.1 | Controlled |  No  | 
| E.8.1.1 | Randomised |  No  | 
| E.8.1.2 | Open |  No  | 
| E.8.1.3 | Single blind |  No  | 
| E.8.1.4 | Double blind  |  No  | 
| E.8.1.5 | Parallel group |  No  | 
| E.8.1.6 | Cross over  |  No  | 
| E.8.1.7 | Other |  No  | 
| E.8.2 |  Comparator of controlled trial | 
| E.8.2.1 | Other medicinal product(s) |  No  | 
| E.8.2.2 | Placebo  |  No  | 
| E.8.2.3 | Other |  No  | 
| E.8.3 | 
                                The trial involves single site in the Member State concerned
                             |  Yes  | 
| E.8.4 |  The trial involves multiple sites in the Member State concerned  |  No  | 
| E.8.5 | The trial involves multiple Member States |  No  | 
| E.8.6 Trial involving sites outside the EEA | 
| E.8.6.1 | Trial being conducted both within and outside the EEA |  No  | 
| E.8.6.2 | Trial being conducted completely outside of the EEA |  No  | 
| E.8.7 | Trial has a data monitoring committee |  No  | 
| E.8.8 | 
                        Definition of the end of the trial and justification where it is not the last
                        visit of the last subject undergoing the trial
                     | 
 | 
| E.8.9 Initial estimate of the duration of the trial | 
| E.8.9.1 | In the Member State concerned years | 2 | 
| E.8.9.1 | In the Member State concerned months | 3 | 
| E.8.9.1 | In the Member State concerned days | 0 |