Clinical Trials /

Neoadjuvant Targeting of Myeloid Cell Populations in Combination With Nivolumab in Head & Neck Ca

NCT04848116

Description:

The primary objective of this study is to assess safety and feasibility of pre-operative nivolumab in combination with either cabiralizumab, anti colony stimulating factor 1 receptor (CSF1R) or BMS-986253 (anti-interleukin-8) in patients with squamous cell carcinoma of head and neck (SCCHN) who will undergo surgery.

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

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Neoadjuvant Targeting of Myeloid Cell Populations in Combination With Nivolumab in Head & Neck Ca
  • Official Title: Neoadjuvant Targeting of Myeloid Cell Populations in Combination With Nivolumab in Head & Neck Cancer Patients Undergoing Surgery

Clinical Trial IDs

  • ORG STUDY ID: J2085
  • SECONDARY ID: IRB00254591
  • NCT ID: NCT04848116

Conditions

  • Head and Neck Squamous Cell Carcinoma

Interventions

DrugSynonymsArms
NivolumabBMS-936558Cohort 1
HuMax-IL8BMS-986253Cohort 1
CabiralizumabBMS-986227Cohort 2

Purpose

The primary objective of this study is to assess safety and feasibility of pre-operative nivolumab in combination with either cabiralizumab, anti colony stimulating factor 1 receptor (CSF1R) or BMS-986253 (anti-interleukin-8) in patients with squamous cell carcinoma of head and neck (SCCHN) who will undergo surgery.

Trial Arms

NameTypeDescriptionInterventions
Cohort 1ExperimentalNivolumab + HuMax (BMS-986253) will be administered as an IV infusion.
  • Nivolumab
  • HuMax-IL8
Cohort 2ExperimentalNivolumab + Cabiralizumab will be administered as an IV infusion.
  • Nivolumab
  • Cabiralizumab
Cohort 3ExperimentalNivolumab + another agent (which will be determined depending on results from Cohort 1 and Cohort 2) will be administered as an IV infusion.
  • Nivolumab

Eligibility Criteria

        Inclusion Criteria:

          -  The primary site should be a head and neck squamous cell carcinoma (including, but not
             limited to oral cavity, oropharynx, hypopharynx, or larynx, paranasal sinuses, nasal
             cavity). Squamous cell carcinoma of unknown primary, diagnosed in lymph nodes in neck,
             can be included but should be tested for p16 and confirmed with an HPV specific assay
             (testing NOT required for enrollment; can be done at an interval).

          -  Subjects must be human papillomavirus (HPV) negative (confirmed testing for
             oropharyngeal primary tumors - if otherwise suspected HPV positivity e.g. some oral
             cavity or sinonasal tumors if e.g. absence of smoking) OR (if HPV+) be high risk based
             on a ≥20 pack year smoking history.

          -  HPV testing is required per clinical standards

          -  Subjects must have been determined to be candidates for surgical resection by a
             multidisciplinary team including a surgeon, a medical oncologist and a radiation
             oncologist. Resection should typically be definitive but may also be done for
             symptomatic control e.g. in the setting of (suspected) metastatic disease with
             dominant local symptoms.

          -  Subjects must have at least one lesion that can be (or has been) biopsied at baseline.

          -  Patients with metastatic disease (both HPV(-) and high-risk HPV(+) (i.e. ≥20 pack
             years of smoking) are allowed, as long as patients have an indication for surgery for
             locoregional disease, and a life expectancy of ≥6 months. Metastatic disease can be
             addressed with additional treatments after trial treatment, e.g. focal radiation, or
             additional systemic therapy (e.g. chemotherapy or as indicated a targeted therapy or
             standard of care immunotherapy).

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

          -  Age greater than or equal to 18 years

          -  Life expectancy of greater than 6 months

          -  Patients must have normal organ and marrow function

          -  The effects of nivolumab, as well as the other agents in this study on the developing
             human fetus are unknown.

               -  Women of childbearing potential (WOCBP) must have a negative urine or serum
                  pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG) within 24
                  hours prior to the start of study treatment.

               -  Women must not be breastfeeding

               -  Women of childbearing potential (WOCBP) must agree to follow instructions for
                  method(s) of contraception as outlined in protocol

               -  Males who are sexually active with WOCBP must agree to follow instructions for
                  method(s) of contraception as outlined in protocol

          -  Patient understands the study regimen, its requirements, risks and discomforts and is
             able and willing to sign the informed consent form. Voluntary signed and dated
             Institutional Review Board (IRB) approved written informed consent form in accordance
             with regulatory and institutional guidelines must be obtained before the performance
             of any protocol related procedures that are not part of normal patient care. Subjects
             must be competent to report AEs, understand the drug dosing schedule and use of
             medications to control AEs

          -  Measurable disease - either radiologically (per RECIST) or clinically measurable on
             exam in order to assess treatment response.

        Exclusion Criteria:

          -  Any active history of a known autoimmune disease. Subjects with vitiligo, type 1
             diabetes mellitus, residual hypothyroidism requiring hormone replacement, or
             conditions not expected to recur in the absence of an external trigger are permitted
             to enroll.

          -  For patients planned to receive cabiralizumab only the following conditions are
             excluded:

               -  Participants who have current or a history of clinically significant muscle
                  disorders (eg,myositis), recent unresolved muscle injury with elevation of serum
                  creatine kinase levels.

               -  Participants with a known history of sensitivity to infusions containing TWEEN-20
                  (polysorbate 20).

               -  Concomitant use of statins while on study with the following exception:

               -  A participant using statins for over 3 months prior to study treatment
                  administration and in stable status without creatine kinase (CK) rise may be
                  permitted to enroll.

               -  Participants with evidence of a bleeding diathesis. (Concomitant treatment with
                  anti-coagulant or anti-platelet agents is allowed.)

               -  Any uncontrolled inflammatory GI disease including Crohn's disease and ulcerative
                  colitis.

          -  Patients who received prior therapy with anti programmed death-1 (PD-1), anti-PD-L1,
             anti-PD-L2, anti CD137, anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4),
             anti-CSF1R, anti-interleukin-8 (IL8) therapies, any other antibody or drug
             specifically targeting T-cell co-stimulation or checkpoint pathways.

          -  Any live / attenuated vaccine (e.g. varicella, zoster, yellow fever, rotavirus, oral
             polio and measles, mumps, rubella (MMR) etc.) within 30 days of first dose of study
             treatment.

          -  Patients with uncontrolled brain metastases

        Patients with brain metastases must have stable neurologic status following local therapy
        (surgery and/or radiation) for at least 2 weeks without the use of steroids or on stable or
        decreasing dose of ≤ 10mg daily prednisone (or equivalent), and must be without neurologic
        dysfunction that would confound the evaluation of neurologic and other adverse events.
        Patients with a history of carcinomatous meningitis are not eligible.

        However, patients with metastatic disease (both HPV(-) and high-risk HPV(+) (i.e. ≥20 pack
        years of smoking) are allowed, as long as patients have an indication for surgery for
        locoregional disease, and a life expectancy for ≥6 months. Metastatic disease can be
        addressed with additional treatments after trial treatment, e.g. focal radiation, or
        additional systemic therapy (e.g. chemotherapy or as indicated a targeted therapy or
        standard of care immunotherapy).

          -  Patients who have an active concurrent malignancy that is not controlled/cured and
             could impact life expectancy within the next 3 years. E.g. patients with localized
             cutaneous squamous cell carcinoma or basal cell carcinoma or treated prostate cancer
             with no evidence of disease progression may be allowed to enroll after review by the
             study team and principal investigator.

          -  Uncontrolled inter-current illness including, but not limited to, no clinically
             significant active infection requiring (antimicrobial) treatment in the last week,
             symptomatic congestive heart failure, unstable angina pectoris, uncontrolled cardiac
             arrhythmia, myocardial infarction or new onset angina within six months of enrollment,
             or psychiatric illness/social situations that would limit compliance with study
             requirements.

          -  Women who are pregnant or nursing

          -  Men with female partners who are not willing to use contraception (Contraception
             method defined in protocol)

          -  Active infection with hepatitis B or hepatitis C (active infection is defined by
             either a) abnormal liver function tests (=elevated aspartate aminotransferase/alanine
             aminotransferase) or b) ongoing use of an antiviral hepatitis treatment).

               -  Patients with normal liver function tests (=normal aspartate
                  aminotransferase/alanine aminotransferase) and no antiviral medication per
                  definition do not have an active infection and are eligible to enroll without
                  additional testing).

               -  Patients with normal liver function test do NOT need additional Hepatitis (no
                  need for Hepatitis serology and/or PCR)

          -  Patients with a condition requiring chronic systemic treatment with either
             corticosteroids (>10 mg daily prednisone equivalent) or other immunosuppressive
             medications within 14 days of study start. However, inhaled or topical steroids and
             adrenal replacement steroid doses < 10 mg daily prednisone equivalent, are permitted
             in the absence of active autoimmune disease. Also, a burst of steroids (≤10 days use,
             e.g. a contrast premedication, or a methylprednisolone dose pack or similar) are
             acceptable and not excluded.

          -  Epstein-Barr Virus (EBV) positive head and neck cancer (e.g. EBV(+) nasopharyngeal
             carcinoma)

          -  Patients with HIV are excluded given the unknown risk of interaction with HAART and
             the unknown benefit of immunotherapy in this population.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Safety of neoadjuvant Nivolumab in combination with HuMax or Cabiralizumab
Time Frame:Up to 100 days after the last dose of study drug
Safety Issue:
Description:Adverse events will be reviewed to determine the safety of the combination of investigational products in the neoadjuvant setting. AEs and other toxicities will be graded using NCI Common Terminology Criteria for Adverse Events 5.0 (CTCAE).

Secondary Outcome Measures

Measure:Immune Related Pathologic Response
Time Frame:From neoadjuvant therapy to surgical resection, approximately 4 weeks
Safety Issue:
Description:Will be used to assess resection specimen and examine tumor regression.
Measure:Pathologic Response
Time Frame:From neoadjuvant therapy to surgical resection, approximately 4 weeks
Safety Issue:
Description:Examines total viable cells remaining after neoadjuvant therapy.
Measure:Relapse Free Survival
Time Frame:Up to 5 years after surgery
Safety Issue:
Description:The time measured between surgery and the development of signs/symptoms of cancer, if applicable.
Measure:Overall Survival
Time Frame:Up to 5 years after surgery
Safety Issue:
Description:Longevity of life after neoadjuvant therapy.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

Last Updated

May 26, 2021