Description:
The purpose of this study is to look at the effectiveness of nivolumab in patients with oral
cavity cancer (OCC) who are about to undergo surgery.
Title
- Brief Title: Trial of Nivolumab as a Novel Neoadjuvant Pre-Surgical Therapy for Locally Advanced Oral Cavity Cancer
- Official Title: Phase II Trial of Nivolumab, an Anti-PD-1 Monoclonal Antibody, as a Novel Neoadjuvant Pre-Surgical Therapy for Locally Advanced Oral Cavity Cancer
Clinical Trial IDs
- ORG STUDY ID:
102510
- NCT ID:
NCT03021993
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Nivolumab | OPDIVO | Nivolumab |
Purpose
The purpose of this study is to look at the effectiveness of nivolumab in patients with oral
cavity cancer (OCC) who are about to undergo surgery.
Detailed Description
OCC patients who are scheduled for surgery will be given Nivolumab prior to surgery to see if
there are any changes in surgical outcomes.
Trial Arms
Name | Type | Description | Interventions |
---|
Nivolumab | Experimental | Nivolumab (OPDIVO) will be administered every two weeks for up to four doses prior to surgery at 3mg/kg | |
Eligibility Criteria
Inclusion Criteria:
1. Newly diagnosed histologically proven locoregional OCSCC without evidence of distant
metastases and a clinically determined T-stage of 2-4,
OR
Recurrent or persistent histologically proven locoregional OCSCC that was initially
treated with surgery alone, and a clinically determined recurrent T-stage of 2-4.
Note - OCSCC includes the subsites of oral tongue, floor of mouth, gingiva, retromolar
trigone, and buccal mucosa.
Note - To allow sufficient tumor tissue for the immunological analyses, patients with
T-stage 1 OCSCC will be excluded
2. Greater than or equal to 18 years of age
3. ECOG performance status of 0 or 1
4. Screening labs must meet the following criteria and must be obtained within 14 days
prior to registration:
- WBC > 2,000/µL
- Absolute Neutrophil Count >1,500/µL
- Platelets > 100 X 103/µL
- Hemoglobin > 9.0 g/dL
- Serum creatinine < 1.5 X ULN or CrCl > 40mL/min (if using the Cockcroft-Gault
formula below):
Female CrCl = (140 - age in years) x weight in kg x 0.85 72 x serum creatinine in
mg/dL Male CrCl = (140 - age in years) x weight in kg x 1.00 72 x serum creatinine in
mg/dL
- AST/ALT ≤ 3 x ULN
- Total Bilirubin ≤ 1.5 x ULN (except subjects with Gilbert Syndrome, who can have
total bilirubin < 3.0 mg/dL)
5. Reproductive Status:
WOCBP must use appropriate method(s) of contraception. WOCBP should use an adequate method
to avoid pregnancy for 23 weeks (30 days plus the time required for nivolumab to undergo
five half-lives) after the last dose of investigational drug.
Men receiving nivolumab and who are sexually active with WOCBP will be instructed to adhere
to contraception with a failure rate of less than 1% per year for a period of 31 weeks
after the last dose of investigational product.
WOCBP is defined as any female 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 consecutive months of amenorrhea in a
woman over 45.
Women of childbearing potential must have a negative serum pregnancy test (minimum
sensitivity 25 IU/L or equivalent units of HCG) within 24 hours prior to registration Women
who are not of childbearing potential (i.e., who are postmenopausal or surgically sterile)
and azoospermic men, are not required to use contraception.
Exclusion Criteria:
1. Prior immunotherapy or treatment with another anti PD 1 agent
2. Prior chemotherapy including Cetuximab or radiation therapy
3. Previous severe hypersensitivity reaction to another monoclonal antibody
4. Women who are pregnant, lactating or expecting to conceive
5. Men who are expecting to father children within the research period
6. Known history of HIV or AIDS
7. Positive test for HBV sAg or HCV antibody indicating acute or chronic infection
8. Concomitant malignancies except cutaneous squamous cell carcinoma or basal cell
carcinoma
9. Unresectable primary tumor or regional disease; presence of distant metastases.
10. History of pneumonitis or interstitial lung disease
11. Active, known or suspected autoimmune disease. Note: Subjects are permitted to enroll
if they have vitiligo, type I diabetes mellitus, residual hypothyroidism due to
autoimmune condition only requiring hormone replacement, psoriasis not requiring
systemic treatment, or conditions not expected to recur in the absence of an external
trigger
12. Presence of condition requiring systemic treatment with either corticosteroids (> 10
mg daily prednisone or equivalents) or other immunosuppressive medications within 14
days of study drug administration. Inhaled or topical steroids and adrenal replacement
doses > 10 mg daily prednisone equivalents are permitted in the absence of active
autoimmune disease
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Objective response rate using pathological response |
Time Frame: | Time of surgery (day 36 or day 50) |
Safety Issue: | |
Description: | Objective response rate: the sum of patients with either a pCR defined as no invasive and no in situ residuals present in the surgical specimen or partial pathologic response defined at least a 30% reduction in the size of the lesion in the surgical specimen. The reduction in size will be determined by comparing the pretreatment clinical measurements (the sum of the greatest axial measurement obtained with calipers at the time of initial evaluation) with the final pathologic measurements. |
Secondary Outcome Measures
Measure: | Level of Treg cells in peripheral blood using immunostaining |
Time Frame: | Day 1 and time of surgery (day 36 or day 50) |
Safety Issue: | |
Description: | 1. Levels of Treg cells in pre and post treatment peripheral blood will be evaluated using immunostaining for CD4 and flow cytometric analysis of Foxp3. Differences will be calculated (absolute change and percentage change) between pre and post treatment measures. |
Measure: | Level of activated T-cells in peripheral blood |
Time Frame: | Day 1 and time of surgery (day 36 or day 50) |
Safety Issue: | |
Description: | 2. Levels of activated T-cells in peripheral blood will be assessed using flow cytometry for expression of CD69, IFN γ, T-bet and ICOS in CD4+ cells. Differences will be calculated (absolute change and percentage change) between pre and post treatment measures. |
Measure: | Level of immune stimulatory cytokines in peripheral blood |
Time Frame: | Day 1 and time of surgery (day 36 or day 50) |
Safety Issue: | |
Description: | 3. Intratumoral immune activity assessed by levels of immune stimulatory cytokines including IL-2, IFN γ, and IL-12 or inhibitory cytokine, IL10 and TGF-beta, in OCSCC tumor lysates will be measured flow cytometrically by cytokine bead array. Differences will be calculated (absolute change and percentage change) between pre and post treatment measures. |
Measure: | Expression of Th1 responses in CD4+ cells from peripheral blood |
Time Frame: | Day 1 and time of surgery (day 36 or day 50) |
Safety Issue: | |
Description: | Expression of IL-2 (Th1 responses) in CD4+ cells from peripheral blood of patients following PD-1 inhibition therapy will be compared between pre-treatment peripheral blood samples and post-treatment samples from the same patient. |
Measure: | Expression of Th2 responses in CD4+ cells from peripheral blood |
Time Frame: | Day 1 and time of surgery (day 36 or day 50) |
Safety Issue: | |
Description: | Expression of IIL 10 (Th2 responses) in CD4+ cells from peripheral blood of patients following PD-1 inhibition therapy will be compared between pre-treatment peripheral blood samples and post-treatment samples from the same patient. |
Measure: | Expression of CD8+ cells expressing granzyme B (ctolytic response) from peripheral blood |
Time Frame: | Day 1 and time of surgery (day 36 or day 50) |
Safety Issue: | |
Description: | 2. Expression of CD8+ cells expressing granzyme B (cytolytic response) from peripheral blood of patients following PD-1 inhibition therapy will be compared between pre-treatment peripheral blood samples and post-treatment samples from the same patient. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Active, not recruiting |
Lead Sponsor: | Medical University of South Carolina |
Last Updated
August 16, 2021