Clinical Trials /

Neoadjuvant Immunoradiotherapy in Head & Neck Cancer (NIRT 2-HNC)

NCT04938609

Description:

The purpose of this study is to evaluate the efficacy of neoadjuvant immunoradiotherapy (NIRT) prior to surgery for the treatment of stage III and IVA HPV- HNSCC.

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

Not yet recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Neoadjuvant Immunoradiotherapy in Head & Neck Cancer (NIRT 2-HNC)
  • Official Title: Neoadjuvant Immunoradiotherapy in Head & Neck Cancer (NIRT 2-HNC)

Clinical Trial IDs

  • ORG STUDY ID: 2020000720 NIRT 2
  • NCT ID: NCT04938609

Conditions

  • Head and Neck Cancer
  • Head and Neck Squamous Cell Carcinoma

Interventions

DrugSynonymsArms
PembrolizumabKeytrudaPembrolizumab + SBRT + Surgery

Purpose

The purpose of this study is to evaluate the efficacy of neoadjuvant immunoradiotherapy (NIRT) prior to surgery for the treatment of stage III and IVA HPV- HNSCC.

Detailed Description

      This clinical trial uses pembrolizumab and radiotherapy prior to definitive surgical
      resection of tumors in patients with Head and Neck Squamous Cell Carcinoma (OHNSCC) with the
      primary objective of determining the safety and efficacy of preoperative immunoradiotherapy.
      In addition, tumor tissue, microbiome samples, and peripheral blood will be obtained for
      exploratory immunologic end points including measurements of tumor infiltrating immune cell
      populations based on flow cytometry and immunohistochemistry as well as circulating
      immunological parameters.

      Estimated duration of 52 weeks: neoadjuvant immunoradiotherapy +/- surgery at week 7,
      followed by risk adapted adjuvant therapy, per standard of care. Patients will then be
      treated with adjuvant pembrolizumab every 3 weeks for 14 additional doses (17 doses total).

      Phase II efficacy study (n = 28, total) to assess rate of down-staging after neoadjuvant
      immunoradiotherapy using Simon's two-stage design (futility assessment at n = 12).

      Phase I studied nivolumab in 10 patients with HPV+ HNSCC, the results of which suggest that
      the combination is safe and efficacious. The phase II portion of study will evaluate the
      efficacy of neoadjuvant pembrolizumab in combination with SBRT as a safe means to down-stage
      HNSCC prior to surgical resection, improve quality of life, and enhance local control and
      overall survival. Patients will be followed for disease free and overall survival at 5 years.

      Eligible patients may be enrolled unless a rate of unplanned surgical delay attributed to
      immunoradiotherapy is found to exceed 33% after enrollment of the first 10 patients. We
      estimate at least 2 patients per month will be enrolled. Time to full accrual is estimated as
      2.5 years.
    

Trial Arms

NameTypeDescriptionInterventions
Pembrolizumab + SBRT + SurgeryExperimentalPembrolizumab administration (3 dose) every 3 weeks and 1 dose before radiation (5 days) therapy followed by an additional administration of Pembrolizumab (2 doses) prior to restaging and surgical resection followed by risk-adapted adjuvant therapy, per standard of care. Patient will then be treated with adjuvant pembrolizumab every 3 weeks for 14 additional doses (17 doses total)
  • Pembrolizumab

Eligibility Criteria

        Inclusion Criteria:

          1. Male/female participants who are at least 18 years of age on the day of signing
             informed consent.

          2. Histologically confirmed diagnosis of stage III-IVA HPV-negative HNSCC who are planned
             for surgical resection and in the opinion of the investigator are able to safely
             undergo neoadjuvant anti-PD-1 and radiation will be enrolled in this study. Oral
             cavity, hypopharynx, and larynx cancer are not required to undergo HPV testing by p16
             IHC as by convention these tumor locations are assumed to be HPV-negative

             Male participants:

          3. A male participant must agree to use a contraception as detailed in Appendix 3 of this
             protocol during the treatment period and for at least 75 days, corresponding to time
             needed to eliminate any study treatment) plus an additional 120 days (a
             spermatogenesis cycle) after the last dose of study treatment and refrain from
             donating sperm during this period.

             Female participants:

          4. A female participant is eligible to participate if she is not pregnant (see Appendix
             3),or breastfeeding and at least one of the following conditions applies:

               1. Not a woman of childbearing potential (WOCBP) as defined in Appendix 3 OR

               2. A WOCBP who agrees to follow the contraceptive guidance in Appendix 3 during the
                  treatment period and for at least 75 days (corresponding to time needed to
                  eliminate any study treatment) plus 30 days (a menstruation cycle) after the last
                  dose of study treatment.

          5. The participant must provide (or legally acceptable representative if applicable)
             written informed consent for the trial.

          6. Have provided archival tumor tissue sample collected within the last 6 months or newly
             obtained core or excisional biopsy of a tumor lesion not previously irradiated.
             Formalin-fixed, paraffin embedded (FFPE) tissue blocks are preferred to slides. Newly
             obtained biopsies are preferred to archived tissue.

             Note: If submitting unstained slides, slides should be submitted to the testing
             laboratory within 14 days from the date slides are cut. For archival tissue samples
             collected >6 months from screening, PI approval is required.

          7. Have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1.
             Evaluation of ECOG is to be performed within 10 days prior to the date of enrollment

          8. Have adequate organ function as defined in the following table (Table 1). Specimens
             must be collected within 10 days prior to the start of study treatment.

        Exclusion Criteria:

          1. A WOCBP who has a positive serum or urine pregnancy test within 72 hours prior to
             first dose of pembrolizumab (see Appendix 3). If the urine test is positive or cannot
             be confirmed as negative, a serum pregnancy test will be required.

          2. Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti PD L2 agent or with
             an agent directed to another stimulatory or co-inhibitory T-cell receptor (eg, CTLA-4,
             OX 40, CD137).

          3. Has received prior systemic anti-cancer therapy including investigational agents
             within 4 weeks [could consider shorter interval for kinase inhibitors or other short
             half-life drugs] prior to enrollment

             Note: Participants must have recovered from all AEs due to previous therapies to
             ≤Grade 1 or baseline. Participants with ≤Grade 2 neuropathy may be eligible.

             Note: If participant received major surgery, they must have recovered adequately from
             the toxicity and/or complications from the intervention prior to starting study
             treatment.

          4. Has received prior radiotherapy to the head and neck region.

          5. Has received a live or live-attenuated vaccine within 30 days prior to the first dose
             of study drug. Administration of killed vaccines is allowed.

          6. Is currently participating in or has participated in a study of an investigational
             agent or has used an investigational device within 4 weeks prior to the first dose of
             study treatment.

             Note: Participants who have entered the follow-up phase of an investigational study
             may participate as long as it has been 4 weeks after the last dose of the previous
             investigational agent.

          7. Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy
             (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of
             immunosuppressive therapy within 7 days prior to the first dose of study drug.

          8. Has a known additional malignancy that is progressing or has required active treatment
             within the past 2 years. Note: Participants with basal cell carcinoma of the skin,
             squamous cell carcinoma of the skin, carcinoma in situ (e.g. breast carcinoma,
             cervical cancer in situ) or other solid tumor or hematologic malignancy that have
             undergone potentially curative therapy outside of the head and neck are not excluded.

          9. Has known active CNS metastases and/or carcinomatous meningitis. Participants with
             previously treated brain metastases may participate provided they are radiologically
             stable, i.e. without evidence of progression for at least 4 weeks by repeat imaging
             (note that the repeat imaging should be performed during study screening), clinically
             stable and without requirement of steroid treatment for at least 14 days prior to
             first dose of study treatment.

         10. Has severe hypersensitivity (≥Grade 3) to pembrolizumab and/or any of its excipients.

         11. Has active autoimmune disease that has required systemic treatment in the past 2 years
             (i.e. with use of disease modifying agents, corticosteroids or immunosuppressive
             drugs). Replacement therapy (eg., thyroxine, insulin, or physiologic corticosteroid
             replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a
             form of systemic treatment.

         12. Has a history of (non-infectious) pneumonitis/interstitial lung disease that required
             steroids or has current pneumonitis/interstitial lung disease.

         13. Has an active infection requiring systemic therapy.

         14. Has a known history of Human Immunodeficiency Virus (HIV) testing is not required
             unless mandated by local health authority

         15. Has a known history of Hepatitis B (defined as Hepatitis B surface antigen [HBsAg]
             reactive) or known active Hepatitis C virus (defined as HCV RNA) infection. Note: no
             testing for Hepatitis B and Hepatitis C is required unless mandated by local health
             authority.

         16. Has a known history of active TB (Bacillus Tuberculosis). testing is not required
             unless mandated by local health authority

         17. Has a history or current evidence of any condition, therapy, or laboratory abnormality
             that might confound the results of the study, interfere with the subject's
             participation for the full duration of the study, or is not in the best interest of
             the subject to participate, in the opinion of the treating investigator.

         18. Has known psychiatric or substance abuse disorders that would interfere with
             cooperation with the requirements of the trial.

         19. Is pregnant or breastfeeding, or expecting to conceive or father children within the
             projected duration of the study, starting with the screening visit through 120 days
             after the last dose of trial treatment.

         20. Patients with T1,T2 and T3 larynx cancer are excluded.

         21. Patients with prior history of solid organ and/or allo-transplantation.

         22. Patients with pre-existing neuropathy of grade 2 or higher peripheral neuropathy.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:To determine the pathologic response rate (MPR + pCR) at time of surgery
Time Frame:52 weeks
Safety Issue:
Description:Prior to surgery neoadjuvant immunoradiotherapy (NIRT) with stereotactic body radiation therapy (SBRT) + pembrolizumab in stage III-IVA HPV-negative HNSCC patients.

Secondary Outcome Measures

Measure:Overall Response Rate
Time Frame:5 years
Safety Issue:
Description:Number of patients who have a partial or complete response to treatment per RECIST 1.1.
Measure:Clinical swallowing evaluation assessed by VFSS
Time Frame:5 years
Safety Issue:
Description:Clinical swallowing evaluation using the Video Fluoroscopic Swallowing Study (VFSS)
Measure:Quality of Life assessed by PSS-HN
Time Frame:5 years
Safety Issue:
Description:Quality of life using the Performance Status Scale for Head and Neck Cancer (PSS-HN)
Measure:Quality of Life assessed by FACT-H&N
Time Frame:5 years
Safety Issue:
Description:Quality of life using Functional Assessment of Cancer Therapy - Head and Neck Cancer (FACT-H&N)
Measure:Quality of Life assessed by MDASI-HN
Time Frame:5 years
Safety Issue:
Description:Quality of life using the MD Anderson Symptom Inventory for head and neck cancer (MDASI-HN) module.
Measure:Quality of Life assessed by Eat-10
Time Frame:5 year
Safety Issue:
Description:Quality of life using the Eating Assessment Tool (Eat-10)
Measure:Quality of Life assessed by FOIS
Time Frame:5 years
Safety Issue:
Description:Quality of life using the Functional Oral Intake Scale FOIS
Measure:Quality of Life assessed by UW-QOL
Time Frame:5 years
Safety Issue:
Description:Quality of life using the University of Washington Quality of Life Questionnaire (UW-QOL)
Measure:Adverse events
Time Frame:From time of informed consent through 90 days after the last study treatment
Safety Issue:
Description:Frequency, duration, and severity of adverse events
Measure:Surgical Complications
Time Frame:30 days post-op
Safety Issue:
Description:Post surgery: Clavien-Dindo classification for grading surgical complications

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:Providence Health & Services

Trial Keywords

  • HNSCC
  • radiation
  • surgery
  • pembrolizumab
  • Phase 2
  • immunotherapy
  • antibodies

Last Updated

June 24, 2021