Clinical Trials /

Nivolumab, Carboplatin, and Paclitaxel in Treating Patients With Stage III-IV Head and Neck Squamous Cell Carcinoma That Can Be Removed by Surgery

NCT03342911

Description:

This phase II trial studies how well nivolumab, carboplatin, and paclitaxel work in treating patients with stage III-IV head and neck squamous cell carcinoma that can be removed by surgery. Monoclonal antibodies, such as nivolumab, may interfere with the ability of tumor cells to grow and spread. Drugs used in chemotherapy, such as carboplatin and paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving nivolumab, carboplatin, and paclitaxel may work better in treating patients with head and neck squamous cell carcinoma.

Related Conditions:
  • Head and Neck Squamous Cell Carcinoma
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Nivolumab, Carboplatin, and Paclitaxel in Treating Patients With Stage III-IV Head and Neck Squamous Cell Carcinoma That Can Be Removed by Surgery
  • Official Title: Nivolumab Plus Weekly Carboplatin and Paclitaxel as Induction in Resectable Locally Advanced Head and Neck Cancer

Clinical Trial IDs

  • ORG STUDY ID: 17P.513
  • NCT ID: NCT03342911

Conditions

  • Name Human Papillomavirus Positive Oropharyngeal Squamous Cell Carcinoma
  • Stage II Oropharyngeal Squamous Cell Carcinoma
  • Stage III Hypopharyngeal Squamous Cell Carcinoma
  • Stage III Laryngeal Squamous Cell Carcinoma
  • Stage III Oral Cavity Squamous Cell Carcinoma
  • Stage III Oropharyngeal Squamous Cell Carcinoma
  • Stage IV Hypopharyngeal Squamous Cell Carcinoma
  • Stage IV Laryngeal Squamous Cell Carcinoma
  • Stage IV Oral Cavity Squamous Cell Carcinoma
  • Stage IV Oropharyngeal Squamous Cell Carcinoma
  • Stage IVA Hypopharyngeal Squamous Cell Carcinoma
  • Stage IVA Laryngeal Squamous Cell Carcinoma
  • Stage IVA Oral Cavity Squamous Cell Carcinoma
  • Stage IVA Oropharyngeal Squamous Cell Carcinoma
  • Stage IVB Hypopharyngeal Squamous Cell Carcinoma
  • Stage IVB Laryngeal Squamous Cell Carcinoma
  • Stage IVB Oral Cavity Squamous Cell Carcinoma
  • Stage IVB Oropharyngeal Squamous Cell Carcinoma
  • Stage IVC Hypopharyngeal Squamous Cell Carcinoma
  • Stage IVC Laryngeal Squamous Cell Carcinoma
  • Stage IVC Oral Cavity Squamous Cell Carcinoma
  • Stage IVC Oropharyngeal Squamous Cell Carcinoma

Interventions

DrugSynonymsArms
Paclitaxel125973, 33069-62-4, 673089, Anzatax, Asotax, Bristaxol, Taxol, PraxelTreatment (nivolumab, paclitaxel, carboplatin)
CarboplatinCarboplat, Carboplatin Hexal, Ribocarbo, CarbosolTreatment (nivolumab, paclitaxel, carboplatin)
Nivolumab946414-94-4, BMS-936558, MDX-1106, ONO-4538Treatment (nivolumab, paclitaxel, carboplatin)

Purpose

This phase II trial studies how well nivolumab, carboplatin, and paclitaxel work in treating patients with stage III-IV head and neck squamous cell carcinoma that can be removed by surgery. Monoclonal antibodies, such as nivolumab, may interfere with the ability of tumor cells to grow and spread. Drugs used in chemotherapy, such as carboplatin and paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving nivolumab, carboplatin, and paclitaxel may work better in treating patients with head and neck squamous cell carcinoma.

Detailed Description

      PRIMARY OBJECTIVES:

      I. To estimate pathologic complete response (pCR) at the primary site in patients with newly
      diagnosed and untreated stage III-IVA squamous cell carcinoma of the head and neck (SCCHN) of
      the oral cavity, oropharynx, larynx, and hypopharynx with nivolumab, paclitaxel and
      carboplatin in addition to standard chemotherapy.

      SECONDARY OBJECTIVES:

      I. Safety. II. Complete pathologic response at all sites of disease. III. Major pathologic
      response rate at primary site. IV. Overall clinical response rate. V. Clinical complete
      response rate. VI. 1 year progression-free survival (PFS). VII. Overall survival.

      TERTIARY OBJECTIVES:

      I. To explore whether PDL1 expression is associated with treatment response. II. To explore
      whether there is a net change in the Th1/Th2 ratio (IFN-gamma, IL-4, IL10, etc.) or cell
      subset frequencies (M2 monocytes, myeloid-derived suppressor cells, etc.) within a patient's
      peripheral blood either at baseline or in response to treatment is associated with treatment
      response.

      III. To explore whether exosomes or other immune related serum biomarkers change after
      combination therapy.

      IV. To explore the predictive value of serial cell free deoxyribonucleic acid (DNA) levels
      and response.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (nivolumab, paclitaxel, carboplatin)ExperimentalPatients receive nivolumab IV over 60 minutes on day 1, paclitaxel IV on days 1 and 8, and carboplatin IV on days 1 and 8. Treatment repeats every 14 days for up to 3 courses in the absence of disease progression or unacceptable toxicity.
  • Paclitaxel
  • Carboplatin
  • Nivolumab

Eligibility Criteria

        Inclusion Criteria:

          -  Patients must be 18 years of age and older.

          -  Pathologically confirmed SCCHN, not previously treated, with a plan to undergo surgery

          -  Patients who have stage III-IV disease without distant metastases (M0) of 1) oral
             cavity, 2) larynx, 3) hypopharynx 4) oropharynx (human papillomavirus [HPV] neg) using
             American Joint Committee on Cancer (AJCC) 8th edition

          -  Patients who have oropharyngeal cancer that HPV positive, stage II-III disease without
             distant metastases (M0) using AJCC 8th edition

          -  All patients with oropharyngeal SCCHN must be tested for HPV (by p16 and/or HPV in
             situ hybridization [ISH] or polymerase chain reaction [PCR])

          -  Patients must be evaluated by a head and neck surgeon and be deemed surgically
             resectable at baseline

          -  Tumor sample must be available for HPV p16 and PD-L1 testing and if oropharyngeal,
             must be tested for HPV p16

          -  Eastern Cooperative Oncology Group (ECOG) performance status 0-1

          -  While blood cells 2000/ul or more

          -  Absolute neutrophil count 1500/ul or more

          -  Platelets 100,000/ul or more

          -  Hemoglobin 9 g/dl or more; (transfusion permitted)

          -  Bilirubin less than or equal to 1.5 x the upper limit of normal (except subjects with
             Gilbert syndrome, who can have total bilirubin < 3 mg/dl)

          -  Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) less than or equal
             to 3 x the upper limit of normal

          -  Glomerular filtration rate (GFR) greater than or equal to 40 ml/min using the
             Cockcroft-Gault formula or serum creatinine less than or equal to 1.5 x upper limit of
             normal (ULN)

          -  Women of reproductive potential should have a negative serum or urine pregnancy test
             (minimum sensitivity 25 IU/L or equivalent units of human chorionic gonadotropin
             [HCG]) within 21 days of study enrollment

          -  Women of reproductive potential must use highly effective contraception methods to
             avoid pregnancy for 23 weeks after the last dose of study drugs; "women of
             reproductive potential" 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 months of amenorrhea
             in a woman over 45 in the absence of other biological or physiological causes; in
             addition, women under the age of 55 must have a documented serum follicle stimulating
             hormone (FSH) level less than 40 mIU/mL

          -  Men of reproductive potential who are sexually active with women of reproductive
             potential must use any contraceptive method with a failure rate of less than 1% per
             year; men who are receiving the study medications will be instructed to adhere to
             contraception for 31 weeks after the last dose of study drugs; men who are azoospermic
             do not require contraception

          -  All subjects must be able to comprehend and sign a written informed consent document

        Exclusion Criteria:

          -  Primary nasopharyngeal carcinoma

          -  Patients who have participated in a study with an investigational agent or device
             within 2 weeks of initiation of treatment

          -  Any prior radiotherapy to the neck

          -  Any prior treatment for SCCHN

          -  Any prior therapy with anti-PD-1, anti-PD-L2, anti-CTLA-4 antibody, or any other
             antibody or drug specifically targeting T-cell co-stimulation or immune checkpoint
             pathways

          -  Any history of a sever hypersensitivity reaction to any monoclonal antibody

          -  Any history of allergy to the study drug components

          -  Any concurrent malignancies- exceptions include- basal cell carcinoma of the skin,
             squamous cell carcinoma of the skin, superficial bladder cancer or in situ cervical
             cancer that has undergone potentially curative therapy; patients with a history of
             other prior malignancy must have been treated with curative intent and must have
             remained disease-free for 3 years post-diagnosis

          -  Any diagnosis of immunodeficiency or receiving systemic steroid therapy or any other
             form of immunosuppressive therapy within 14 days of initiation of therapy

          -  Patients that have an active autoimmune disease requiring systemic treatment within
             the past 3 months or a documented history of clinically severe autoimmune disease, or
             a syndrome that requires systemic steroids (> 10 mg daily prednisone equivalents) or
             immunosuppressive agents; subjects with vitiligo, type I diabetes mellitus, or
             resolved childhood asthma/atopy would be an exception to this rule; subjects that
             require intermittent use of bronchodilators or local steroid injections would not be
             excluded from the study; subjects with hypothyroidism stable on hormone replacement or
             Sjorgen's syndrome will not be excluded from the study

          -  Patients with a known human immunodeficiency virus infection (HIV 1/2 antibodies) or
             acquired immunodeficiency syndrome (HIV/AIDS), active hepatitis B (e.g., hepatitis B
             surface antigen [HBsAg] reactive) or hepatitis C (e.g., hepatitis C virus [HCV]
             ribonucleic acid [RNA] [qualitative] is detected)

          -  Patients with evidence of non-infectious pneumonitis or history of interstitial lung
             disease

          -  Patients who have received a live vaccine within 30 days prior initiation of the
             systemic regimen

          -  Patients must not be receiving any other investigational agents

          -  Patients with uncontrolled intercurrent illnesses including, but not limited to an
             active infection requiring systemic therapy or a known psychiatric or substance abuse
             disorder(s) that would interfere with cooperation with the requirements of the trial

          -  Women must not be pregnant (as above) or breastfeeding
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Pathologic complete response rate
Time Frame:Up to 26 months
Safety Issue:
Description:Pathologic complete response rate and its associated score 95% confidence interval will be estimated.

Secondary Outcome Measures

Measure:Major pathologic response defined as 10% or less residual viable tumor
Time Frame:Up to 26 months
Safety Issue:
Description:

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Sidney Kimmel Cancer Center at Thomas Jefferson University

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