The BURAN study is a randomized, open-label phase III study to assess the treatment effect of
once-daily buparlisib in combination with weekly paclitaxel compared to weekly paclitaxel
alone in patients with refractory, recurrent, or metastatic head and neck squamous cell
carcinoma (HNSCC) that have progressed after prior platinum-based therapy with or without
prior anti PD 1/anti PD L1 therapy.
Inclusion Criteria:
1. Aged ≥18 years old.
2. Able to provide informed consent obtained before any trial related activities and
according to local guidelines.
3. Patient has histologically and/or cytologically-confirmed HNSCC.
4. Patient has archival or new tumor tissue for the analysis of biomarkers. One tumor
block (preferred) or a minimum of 12 (15 recommended) unstained slides to be provided.
Enrollment in the study is contingent on confirmation of an adequate amount of tumor
tissue. Patients progressing following treatment with an anti PD 1/anti PD L1 therapy
are encouraged to have a new tumor biopsy for biomarker analysis (optional).
5. Patient has either:
1. refractory disease defined as progression or recurrence within six months after
the last dose of platinum based chemotherapy in combination with radiation
therapy for locally advanced disease given with a curative intent or
2. disease progression after platinum based chemotherapy for recurrent or metastatic
disease or
3. recurrent or metastatic disease after platinum based chemotherapy and anti PD
1/anti PD L1 treatment (defined as progression after one month from the last dose
of anti PD 1/anti PD L1 therapy). Pretreatment with cetuximab as part of
chemoradiation, first-line therapy or maintenance is allowed.
6. Patient has received no more than two prior lines of treatment for HNSCC.
7. Patient has measurable disease as determined per RECIST version 1.1. If the only site
of measurable disease is a previously irradiated lesion, documented progression of
disease and a four-week period since radiotherapy completion is required.
8. Patient has adequate bone marrow function and organ function as shown by the
following:
1. Absolute neutrophil count (ANC) ≥1.5 x 109/L.
2. Hemoglobin ≥9 g/dL (which may be reached by transfusion).
3. Platelets ≥100 x 109/L (which may be reached by transfusion).
4. International normalized ratio (INR) ≤1.5.
5. Calcium (corrected for serum albumin) within normal limits (WNL) or ≤ grade 1
severity according to NCI-CTCAE version 5.0 if judged clinically not significant
by the Investigator. Patients concomitantly taking bisphosphonates or denosumab
for calcium correction are eligible.
6. Alanine aminotransferase (AST) and aspartate aminotransferase (ALT) ≤1.5 x upper
limit of normal (ULN) or <3.0 x ULN if liver metastases are present.
7. Total serum bilirubin ≤ ULN or ≤1.5 x ULN if liver metastases are present; or
total bilirubin ≤3.0 x ULN with direct bilirubin below or within normal range in
patients with well documented Gilbert's Syndrome. Gilbert's syndrome is defined
as presence of episodes of unconjugated hyperbilirubinemia with normal results
from cells blood count (including normal reticulocyte count and blood smear),
normal liver function test results, and absence of other contributing disease
processes at the time of diagnosis.
8. Serum creatinine ≤1.5 x ULN or calculated or directly measured creatinine
clearance (CrCL) >30 mL/min.
9. Haemoglobin A1c (glycosylated hemoglobin; HbA1c) ≤8%.
9. Patient has Eastern Cooperative Oncology Group (ECOG) performance status ≤1.
10. Patient is able to swallow and retain oral medication. Patients able to swallow oral
medication but mostly self-nourished through gastric or jejunal feeding tube are
eligible.
11. Patients must apply highly effective contraception during and throughout the study, as
well after the final dose of study treatment
Exclusion Criteria:
Patients meeting any of the following criteria will not be eligible for participation in
the study:
1. Patient has received previous treatment with any protein kinase B (PKB/AKT), mammalian
target of rapamycin (mTOR) inhibitors, or phosphatidylinositol 3 kinase (PI3K) pathway
inhibitors.
2. Patient received treatment with a taxane as part of prior treatment for metastatic
disease.
3. Patient has only received anti-PD 1/anti PD L1 monotherapy for HNSCC.
4. Patient has symptomatic central nervous system (CNS) metastases. Patients with
asymptomatic CNS metastases may participate in this study. Patient must have completed
any prior local treatment for CNS metastases ≥28 days prior to the start of study
treatment (including radiotherapy) and must be on a stable low dose of corticosteroid
therapy. Radiosurgery must have been completed at least 14 days prior to start of
study treatment.
5. Patient has received wide field radiotherapy ≤4 weeks or limited field radiation for
palliation ≤2 weeks prior to starting study treatment or who have not recovered to
grade 1 or better from related side effects of such therapy (except alopecia).
6. Patient has grade ≥2 neuropathy, colitis, pneumonitis, elevated HbA1C, and
uncontrolled endocrinopathies (e.g., hypothyroidism) from previous treatment.
7. Patient has had major surgery within 14 days prior to starting study treatment or has
not recovered from major side effects.
8. Patient is currently receiving increasing or chronic treatment (>5 days) with
corticosteroids or another immunosuppressive agent. The following uses of
corticosteroids are permitted: single doses; standard premedication for paclitaxel,
topical applications (e.g., rash), inhaled sprays (e.g., obstructive airways
diseases), eye drops, or local injections (e.g., intra-articular), or <10 mg
prednisolone or equivalent.
9. Patient is being treated at start of study treatment with any of the following drugs:
1. Drugs known to be strong inhibitors or inducers of isoenzyme cytochrome P450 3A4
(CYP3A4) including herbal medications.
2. Drugs with a known risk of inducing Torsades de Pointes. Note: The patient must
have discontinued strong inducers for at least one week and must have
discontinued strong inhibitors before the treatment is initiated. Switching to a
different medication prior to starting study treatment is allowed.
10. Patient is currently receiving warfarin or other coumarin-derived anti-coagulant, for
treatment, prophylaxis, or otherwise. Therapy with heparin, low molecular weight
heparin (LMWH), fondaparinux or new oral anticoagulants (NOACs) is allowed.
11. Patient has a known hypersensitivity and/or contraindication to paclitaxel, standard
premedication for paclitaxel, or other products containing Cremophor®.
12. Patient has other concurrent severe and/or uncontrolled medical conditions that would,
in the Investigator's judgment, contraindicate patient participation in the clinical
study (e.g., active or uncontrolled severe infection, chronic active hepatitis,
immunocompromised, acute or chronic pancreatitis, uncontrolled high blood pressure,
interstitial lung disease, etc).
13. Patient has a known history of human immunodeficiency virus (HIV) infection (testing
not mandatory).
14. Patient has any of the following cardiac abnormalities:
1. Symptomatic congestive heart failure.
2. History of documented congestive heart failure (New York Heart Association
functional classification III-IV) or documented cardiomyopathy.
3. Left ventricular ejection fraction (LVEF) <50% as determined by multiple gated
acquisition (MUGA) scan or echocardiogram (ECHO).
4. Myocardial infarction ≤six months prior to enrollment.
5. Unstable angina pectoris.
6. Serious uncontrolled cardiac arrhythmia.
7. Symptomatic pericarditis.
8. QT interval corrected according to the formula of Fridericia (QTcF) >450 msec for
males and >470 msec for females, on the screening electrocardiogram (ECG).
9. Currently receiving treatment with medication that has a known risk to prolong
the QT interval or inducing Torsades de Pointes, and the treatment cannot be
discontinued or switched to a different medication prior to starting study
treatment.
15. Patient has impairment of gastrointestinal (GI) function or GI disease that may
significantly alter the absorption of study treatment (e.g., ulcerative diseases,
uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, or small bowel
resection).
16. Patient has a medically documented history of or active major depressive episode,
bipolar disorder (I or II), obsessive-compulsive disorder, schizophrenia, a history of
suicidal attempt or ideation, or homicidal ideation (e.g., risk of doing harm to self
or others), or active severe personality disorders (defined according to the
Diagnostic and Statistical Manual of Mental Disorders Fifth Edition [DSM-V]) are not
eligible. Note: For patients with psychotropic treatments ongoing at baseline, the
dose and the schedule should not be modified within the previous six weeks prior to
start of study treatment.
17. Patient has other prior or concurrent malignancy except for the following: adequately
treated basal cell or squamous cell skin cancer, or other adequately treated in situ
cancer, early gastric or GI cancer resected completely by endoscopy procedures or any
other cancer from which the patient has been disease free for ≥3years.
18. Patient has a history of non-compliance to any medical regimen or inability to grant
consent.
19. Patient is concurrently using other approved or investigational cancer agent.
20. Patient is pregnant or nursing (lactating). Patients with elevated human chorionic
gonadotrophin (hCG) at baseline that is judged to be related to the tumor are eligible
if hCG levels do not show the expected doubling when repeated five to seven days
later, or pregnancy has been ruled out by vaginal ultrasound.