Study on the Efficacy of Treatment by Radiotherapy and Pembrolizumab in Newly Diagnosed Metastatic Head & Neck Cancers (PembroMetaRT)

Randomized Trial of Loco-regional Radiotherapy Added to Pembrolizumab Alone or With Chemotherapy Versus Systemic Treatment Alone for Patients With Newly Diagnosed Head and Neck Squamous Cell Carcinoma With Synchronous Metastases

Study to evaluate the efficacy of treatment by radiotherapy and pembrolizumab in newly diagnosed metastatic head & neck cancers

Study Overview

• Status: Recruiting
• Conditions: Squamous Cell Carcinoma of Head and Neck
• Intervention / Treatment: Drug: Pembrolizumab; Radiation: Loco-regional radiotherapy; Drug: Chemotherapy

Detailed Description

Comparative interventional prospective phase 3, randomised, open-label, multicentric trial comparing the combination of radiotherapy and pembrolizumab alone or with chemotherapy to systemic treatment as first line treatment of patients with newly diagnosed head and neck squamous cell carcinoma with synchronous metastases.

• Study Type: Interventional
• Enrollment (Estimated): 102
• Phase: Phase 3

Contacts and Locations

• Study Contact: Name: NICOLAS DE SOUSA CARVALHO; Phone Number: 0171936709; Email: n-de-sousa@unicancer.fr
• Study Contact Backup: Name: Laure MONARD; Phone Number: 01 73 79 73 09; Email: l-monard@unicancer.fr

Study Locations

• France
  • Avignon, France, 84000
    • Recruiting
    • Institut Sainte Catherine
    • Principal Investigator: Benoit CALDERON, Dr
  • Besançon, France, 25030
    • Recruiting
    • Chu Jean Minjoz
    • Principal Investigator: Salim BENHMIDA
  • Bordeaux, France
    • Recruiting
    • Institut Bergonie
    • Principal Investigator: Pauline GUILLON, Dr
  • Bordeaux, France, 33075
    • Recruiting
    • CHU Bordeaux
    • Principal Investigator: Amaury DASTE, Dr
  • Caen, France, 14076
    • Recruiting
    • Centre Francois Baclesse
    • Principal Investigator: Juliette THARIAT, Dr
  • Carcassonne, France, 1A810
    • Recruiting
    • CH Carcassonne
    • Principal Investigator: Samir HACENE, Dr
  • Clermont-Ferrand, France, 63011
    • Recruiting
    • Centre Jean Perrin
    • Principal Investigator: Hervé DEVAUD, Dr
  • Dijon, France
    • Recruiting
    • Centre Georges François Leclerc
    • Principal Investigator: Noémie VULQUIN, Dr
  • Le Havre, France
    • Suspended
    • Centre Guillaume Le Conquerant
  • Le Mans, France
    • Recruiting
    • Centre Jean Bernard - Clinique Victor Hugo
    • Principal Investigator: Yoann POINTREAU, Dr
  • Lille, France, 59020
    • Recruiting
    • Centre Oscar Lambret
    • Principal Investigator: Xavier LIEM, Pr
  • Lorient, France
    • Recruiting
    • Groupe Hospitalier Bretagne Sud
    • Principal Investigator: Christian SIRE, Dr
  • Lyon, France
    • Withdrawn
    • Centre Leon Berard
  • Marseille, France
    • Recruiting
    • Hopital de la Timone
    • Principal Investigator: Sebastien SALAS, Pr
  • Montbéliard, France, 25209
    • Recruiting
    • Hopital Nord Franche Comté - Site de Mittan
    • Principal Investigator: Xushan SUN, Dr
  • Nice, France
    • Recruiting
    • Centre Antoine Lacassagne
    • Principal Investigator: Cyrielle SCOUARNEC, Dr
  • Reims, France, 51726
    • Recruiting
    • Institut Jean Godinot
    • Principal Investigator: Alain PREVOST, Dr
  • Rouen, France, 76038
    • Recruiting
    • Centre Henri Becquerel
    • Principal Investigator: Florian CLATOT, Dr
  • Saint-Priest-en-Jarez, France, 42270
    • Not yet recruiting
    • CHU de Saint Etienne
    • Principal Investigator: Eric JADAUD, Dr
  • Strasbourg, France
    • Recruiting
    • Institut de cancerologie Strasbourg-Europe
    • Principal Investigator: Mickael BURGY, Dr
  • Tarbes, France, 65000
    • Not yet recruiting
    • Polyclinique de l'Ormeau
    • Principal Investigator: Pierre-Marie PIALAT, Dr
  • Toulouse, France, 31059
    • Recruiting
    • Institut Claudius Regaud
    • Principal Investigator: Anouchka MODESTO, Dr
  • Valence, France, 26000
    • Not yet recruiting
    • Hopital Prive Drome Ardeche
    • Principal Investigator: Matthieu BOSSET, Dr
  • Valence, France, 26953
    • Not yet recruiting
    • CH Valence
    • Principal Investigator: Rim BATTI, Dr
  • Vandoeuvre les nancy, France, 54519
    • Recruiting
    • Institut de Cancerologie de Lorraine
    • Principal Investigator: Yolanda FERNADEZ DIEZ, Dr
  • Villejuif, France
    • Recruiting
    • Gustave Roussy
    • Principal Investigator: YUNGAN TAO, Dr
    • Sub-Investigator: Caroline EVEN, Dr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Patient must have signed a written informed consent form prior to any study specific procedures. When the patient is physically unable to give their written consent, a trusted person of their choice, independent from the investigator or the sponsor, can confirm in writing the patient's consent.
2. Histologically confirmed squamous cell carcinoma of head and neck (oral cavity, oropharynx, hypopharynx, and larynx) including unknown primary head and neck lymph nodes with distant metastases at presentation (T1-4 N0-3 M1). Histological confirmation is required in case of a single metastatic lesion.
3. Eligible for treatment by pembrolizumab according to the European Marketing Authorization
4. Patient ≥18 years old
5. Performance status: 0-1 (WHO)
6. Combined Positive Score (CPS) ≥1 for primary tumor (as determined per local practice)
7. Subjects must have at least one measurable lesion as per RECIST v1.1 to assess efficacy

8. Adequate hematologic and end-organ function, defined by the following laboratory test results, obtained within 14 days prior to randomization:

   a. If randomization is done before treatment start: i. Absolute neutrophil count ≥1.5 × 10⁹/L ii. Platelet ≥100 × 10⁹/L iii. Hemoglobin ≥90 g/L iv. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT), ≤3 × upper limit of normal (ULN), (unless documented liver metastases where ≤5 x ULN is permitted) v. Bilirubin ≤1.5 × ULN. vi. Serum albumin ≥25 g/L vii. Creatinine clearance ≥30 mL/min (calculated per institutional guidelines or by Cockcroft-Gault or Modification of Diet in Renal Disease (MDRD) formula) viii. Corrected serum calcium of ≤11.5 mg/dL or ≤2.6 mmol/L. b. If randomization if done after treatment start i. Absolute neutrophil count ≥1.0 × 10⁹/L ii. Platelet ≥75 × 10⁹/L iii. Hemoglobin ≥85 g/L

9. Patient must agree to use adequate contraception methods for the duration of the study treatment and up to 4 months after the last dose of pembrolizumab administration
10. Patients must be affiliated to a Social Security System (or equivalent)
11. No disease progression during systemic treatment if the randomization is done after the start of pembrolizumab for the current disease

Exclusion Criteria:

1. Symptomatic central nervous system (CNS) metastases and / or carcinomatous meningitis
2. History of another malignancy within 2 years prior to study inclusion, with the exception of completely resected basal or squamous cell skin cancer, or successfully treated in-situ carcinoma
3. Prior radiotherapy in the head and neck region
4. Any prior or current non-surgical treatment for invasive head and neck cancer. (except for pembrolizumab +/- chemotherapy for the current cancer for a maximum of 6 cycles). This will include but is not limited to: prior tyrosine kinase inhibitors, any monoclonal antibody, chemotherapy, anti-PD-1/PD-L1 and CTLA-4, prior radiotherapy (RT), or use of any investigational agent. Loco-regional recurrent or second primary head and neck cancer after prior surgical treatment alone in the head and neck region could be eligible.
5. Known Acquired Immune Deficiency Syndrome (AIDS)
6. Known currently active infection including hepatitis B or hepatitis C
7. Patient having received live attenuated vaccine within 28 days prior to enrolment
8. Pregnant or breast feeding woman
9. Active autoimmune disease except vitiligo, type-1 diabetes, hypothyroid stabilized with hormonal substitution, or psoriasis which do not require systemic treatment
10. Active immunodeficiency or ongoing immunosuppressive therapy
11. Active symptomatic interstitial lung disease
12. Significant disease which, in the judgment of the investigator, as a result of the medical interview, physical examinations, or screening investigations would make the patient inappropriate for entry into the trial
13. Any social, personal, medical, geographic and/or psychologic factor(s) that could interfere with the observance of the patient to the protocol and/or the follow-up and/or the signature of the informed consent
14. Prior organ transplantation including allogenic stem-cell transplantation
15. Other severe acute or chronic medical conditions including colitis, pneumonitis, pulmonary fibrosis or psychiatric conditions including active suicidal ideation; or laboratory abnormalities that may increase the risk associated with study participation and, in the judgment of the investigator, would make the patient inappropriate for entry into this study
16. Person deprived of their liberty or under protective custody or guardianship
17. Patient who have taken any investigational medicinal product or have used an investigational device within 30 days prior to study inclusion

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Radiotherapy added to systemic treatment; Pembrolizumab 200mg every 3 weeks until disease progression or unacceptable toxicity. Loco-regional radiotherapy(RT) depending on the RT timing : Before 3 cycles of pembrolizumab: RT could start at any time between one week after the first administration of pembrolizumab and the first day of the 3rd cycle.; After 3 cycles of pembrolizumab: RT could start at any time after 3rd cycle and up to a maximum of 4 weeks after the 6th cycle of pembrolizumab. If the investigator decides before randomization to add chemotherapy and depending on the RT timing: Start of RT planned before 3rd cycle: Chemotherapy could be delayed after the end of RT and start from cycle 3 or 4 of pembrolizumab.; RT planned after 3rd cycle: Chemotherapy should start at the same time of pembrolizumab. Chemotherapy will be composed of carboplatin AUC 5 mg/mL/min or cisplatin 100 mg/m² every 3 weeks with 5-fluorouracil (5-FU) 1000mg/m²/day during 4 days every 3 weeks for a maximum of 6 cycles	Drug: Pembrolizumab; Pembrolizumab 200 mg every 3 weeks until disease progression (as confirmed according to response evaluation criteria in solid tumors version 1.1 (RECIST v1.1)) or unacceptable toxicity. The treatment of pembrolizumab should not be delayed because of radiotherapy planning.; Other Names: KEYTRUDA; Radiation: Loco-regional radiotherapy; Depending on the choice of radiotherapy timing: Before 3 cycles of pembrolizumab with or without chemotherapy : radiotherapy could start at any time between one week after the first administration of pembrolizumab and the first day of the 3rd cycle.; After 3 cycles of pembrolizumab with or without chemotherapy : radiotherapy could start at any time after 3rd cycle (C3D1) and up to a maximum of 4 weeks after the 6th cycle of pembrolizumab. Dose/fraction of radiotherapy: 54 Gy/18 fractions (recommended schedule) or 70Gy/33-35 fractions or other curative dose/fraction schedules with shorter duration and biologically equivalent dose of at least 60Gy at the discretion of local investigators, in the head and neck region. The volume of RT will include only involved loco-regional tumor region and no prophylactic neck volume will be necessary. Other cycles of pembrolizumab will be administered during and after radiotherapy.; Drug: Chemotherapy; If the investigator decide to add chemotherapy with pembrolizumab, and depending on the radiotherapy timing: Start of radiotherapy planned before 3rd cycle: Chemotherapy could be delayed after the end of radiotherapy and start from cycle 3 or 4 of pembrolizumab. Administration of chemotherapy can be delayed in case of non resolved grade 3 or higher toxicity from radiotherapy.; Radiotherapy planned after 3rd cycle: Chemotherapy should start at the same time of pembrolizumab. Chemotherapy will combine carboplatin AUC 5mg/mL/min or cisplatin 100mg/m² every 3 weeks with 5-FU 1000mg/m²/j during 4 days every 3 weeks for a maximum of 6 cycles
Active Comparator: Systemic treatment; Pembrolizumab 200 mg every 3 weeks until disease progression or unacceptable toxicity. If the investigator decides before randomization to add chemotherapy with pembrolizumab, the chemotherapy will be composed of carboplatin area under the curve (AUC) 5 mg/mL/min or cisplatin 100 mg/m² every 3 weeks with 5-FU 1000 mg/m²/day during 4 days every 3 weeks for a maximum of 6 cycles	Drug: Pembrolizumab; Pembrolizumab 200 mg every 3 weeks until disease progression (as confirmed according to response evaluation criteria in solid tumors version 1.1 (RECIST v1.1)) or unacceptable toxicity. The treatment of pembrolizumab should not be delayed because of radiotherapy planning.; Other Names: KEYTRUDA; Drug: Chemotherapy; If the investigator decide to add chemotherapy with pembrolizumab, and depending on the radiotherapy timing: Start of radiotherapy planned before 3rd cycle: Chemotherapy could be delayed after the end of radiotherapy and start from cycle 3 or 4 of pembrolizumab. Administration of chemotherapy can be delayed in case of non resolved grade 3 or higher toxicity from radiotherapy.; Radiotherapy planned after 3rd cycle: Chemotherapy should start at the same time of pembrolizumab. Chemotherapy will combine carboplatin AUC 5mg/mL/min or cisplatin 100mg/m² every 3 weeks with 5-FU 1000mg/m²/j during 4 days every 3 weeks for a maximum of 6 cycles

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Progression-free survival (PFS)	The progression-free survival is the length of time during and after the treatment of a disease that a patient lives with the disease but it does not get worse.	From randomization to disease progression or death, up to 3 years.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall survival (OS)	The overall survival is the length of time from randomization that patients enrolled in the study are still alive. The outcome is to evaluate whether the radiotherapy improves overall survival compared to standard of care.	From randomization to death from any cause, up to 5 years.
Quality of life questionnaire - Core 30 (QLQ-C30)	Developed by the EORTC, this self-reported questionnaire assesses the health-related quality of life of cancer patients in clinical trials. The questionnaire includes five functional scales (physical, everyday activity, cognitive, emotional, and social), three symptom scales (fatigue, pain, nausea and vomiting), a health/quality of life overall scale, and a number of additional elements assessing common symptoms (including dyspnea, loss of appetite, insomnia, constipation, and diarrhea), as well as, the perceived financial impact of the disease. All of the scales and single-item measures range in score from 0 to 100. A high scale score represents a higher response level.	At baseline, 4 months, 6 months, 12 months, 18 months, 2 years, 3 years, and 4 years
Quality of Life Questionnaire - Head & Neck Cancer Module (QLQ-H&N35)	The head & neck cancer module is a 35-item questionnaire designed for use among a wide range of patients with head & neck cancer, varying in disease stage and treatment modality. It includes 7 multi-item scales that assess pain (4 items), swallowing (4 items), senses (2 items), speech (3 items), social eating (4 items), social contact (5 items), and sexuality (2 items). There are also 11 single items. Using a 4-point Likert scale (1 = "not at all", 2 = "a little", 3 = "quite a bit", and 4 = "very much"), patients indicate the degree to which they have experienced symptoms. For all items and scales, high scores indicate more problems.	At baseline, 4 months, 6 months, 12 months, 18 months, 2 years, 3 years, and 4 years
Loco-regional progression	Locoregional disease progression is defined as the time from randomization to the first documented locoregional progression evaluated by RECIST v1.1.	From randomization to loco-regional progression, up to 5 years.
Distant progression	Distant progression is defined as the time from randomization to the first documented distant disease progression evaluated by RECIST v1.1.	From randomization to distant progression, up to 5 years.
Progression-free survival 2 (PFS2)	Progression-free survival 2 is defined as time from randomization to a second tumor progression (according to RECIST V1.1) on next-line treatment (given after a first progression) or death from any cause. Patients who did not have a progression after the initial treatment are counted as an event at the time of death if they died whatever the cause of death or are censored at the time of last news if they are alive. Patients who had a progression after the initial treatment are counted as an event when they progressed again under or after the treatment of the first progression (if they start a new treatment, i.e. a third treatment, they are also counted as an event) or when they died whatever the cause of death or they are censored at the time of last news if they are alive without new progression after the first progression.	Up to 5 years after randomization.
Incidence of Treatment Adverse Events	The tolerance and safety will be evaluated by toxicity (acute [<1 months after the end of pembrolizumab] and late [≥1 month after the end of pembrolizumab]), assessed using the Common terminology criteria for adverse events version 5.0 (CTCAE v5.0).	Throughout study completion, up to 5 years.
Objective response rate (ORR)	The Objective response rate is defined as the presence of a partial response (PR) or complete response (CR) observed at week 18 and at week 27 after randomization. The investigator will evaluate the objective response using RECIST v1.1.	At 18 weeks and 27 weeks
Compliance to treatment	Compliance to treatment is defined by the difference on received study regimen compared to the planned study regimen.	Throughout study treatment, up to 5 years

Collaborators and Investigators

• Sponsor: UNICANCER
• Collaborators: National Cancer Institute, France; GORTEC
• Investigators: Principal Investigator: Yungan TAO, Dr, Gustave Roussy, Cancer Campus, Grand Paris; Principal Investigator: Caroline EVEN, Dr, Gustace Roussy

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2021
• Primary Completion (Estimated): October 1, 2025
• Study Completion (Estimated): October 1, 2029

Study Registration Dates

• First Submitted: February 5, 2021
• First Submitted That Met QC Criteria: February 9, 2021
• First Posted (Actual): February 10, 2021

Study Record Updates

• Last Update Posted (Actual): October 26, 2024
• Last Update Submitted That Met QC Criteria: October 22, 2024
• Last Verified: October 1, 2024

More Information

Terms related to this study

• Keywords: Carcinoma; Radiotherapy; Metastatic; Squamous Cell Carcinoma; pembrolizumab; Head and Neck
• Additional Relevant MeSH Terms: Neoplasms by Site; Neoplasms; Neoplasms by Histologic Type; Head and Neck Neoplasms; Neoplasms, Glandular and Epithelial; Neoplasms, Squamous Cell; Squamous Cell Carcinoma of Head and Neck; Carcinoma; Carcinoma, Squamous Cell; Antineoplastic Agents, Immunological; Immune Checkpoint Inhibitors; Antineoplastic Agents; Molecular Mechanisms of Pharmacological Action; Pembrolizumab
• Other Study ID Numbers: UC-HNG-2007; 2020-A02221-38 (Other Identifier: ANSM)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual Participant Data will not be shared at an individual level. Those data will be part of the study database including all enrolled patients.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No