Palbociclib and Cetuximab Versus Cetuximab Monotherapy for Patients With CDKN2A-altered, HPV-unrelated Head and Neck Squamous Cell Carcinoma Who Experienced Disease Progression on a PD-1/L1 Inhibitor

Palbociclib and Cetuximab Versus Cetuximab Monotherapy for Patients With CDKN2A-altered, HPV-unrelated Head and Neck Squamous Cell Carcinoma Who Experienced Disease Progression on a PD-1/L1 Inhibitor: A Multicenter, Open-Label, Randomized Phase 3 Trial

This multicenter, open-label, randomized phase 3 trial will determine if palbociclib and cetuximab (Arm 1) improves overall survival (OS) in comparison to cetuximab monotherapy (Arm 2) in patients with CDKN2A-altered, HPV-unrelated recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) who experienced disease progression on a PD-1/L1 inhibitor (given as monotherapy or in combination with other therapy).

Study Overview

• Status: Recruiting
• Conditions: HPV-unrelated Head and Neck Squamous Cell Carcinoma
• Intervention / Treatment: Drug: Palbociclib; Drug: Cetuximab

• Study Type: Interventional
• Enrollment (Anticipated): 81
• Phase: Phase 3

Contacts and Locations

• Study Contact: Name: Douglas Adkins, M.D.; Phone Number: 314-747-8475; Email: dadkins@wustl.edu

Study Locations

• United States
  • Missouri
    • Saint Louis, Missouri, United States, 63110
      • Recruiting
      • Washington University School of Medicine
      • Contact: Douglas Adkins, M.D.; Phone Number: 314-747-8475; Email: dadkins@wustl.edu
      • Principal Investigator: Douglas Adkins, M.D.
      • Sub-Investigator: Peter Oppelt, M.D.
      • Sub-Investigator: Esther Lu, Ph.D.

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Histologically or cytologically confirmed RM-HNSCC that is HPV-unrelated disease; defined as SCC of the oral cavity, larynx, or hypopharynx and p16 negative SCC of the oropharynx or p16 negative non-cutaneous SCC unknown primary of the neck.
• CDKN2A loss-of-function (LOF) alteration: mutation or homozygous deletion described on genomic sequencing report.
• Measurable disease defined as lesions that can be accurately measured in at least one dimension (longest diameter to be recorded) as ≥ 10 mm with CT scan, as ≥ 20 mm by chest x-ray, or ≥ 10 mm with calipers by clinical exam, per RECIST 1.1.
• Disease progression on a PD-1/L1 inhibitor-containing regimen (given as monotherapy or in combination with other therapy).
• Received no more than three lines of prior therapy for RM-HNSCC.
• At least 18 years of age.
• ECOG performance status ≤ 1.

• Normal bone marrow and organ function as defined below:

  • Hemoglobin ≥ 8 g/L
  • Absolute neutrophil count ≥ 1,000/mcl
  • Platelets ≥ 100,000/mcl
  • Total bilirubin ≤ 3 x institutional upper limit of normal (IULN)
  • AST(SGOT)/ALT(SGPT) ≤ 5 x IULN (for cases involving liver metastases, AST/ALT ≤ 10 x IULN)
  • Serum creatinine < 3 x IULN or creatinine clearance > 30 mL/min by Cockcroft-Gault
• The effects of palbociclib and cetuximab on the developing human fetus are unknown. For this reason and because CDK 4/6 inhibitors are known to be teratogenic, women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control, abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately. Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of the study, and 30 days after completion of the study
• Ability to understand and willingness to sign an IRB approved written informed consent document (or that of legally authorized representative, if applicable).

Exclusion Criteria:

• Prior treatment with cetuximab for recurrent or metastatic disease (however, prior cetuximab given as a component of multimodality therapy for newly diagnosed, locally advanced, non-metastatic HNSCC is allowable).
• Prior treatment with a CDK4/6 inhibitor for RM-HNSCC.
• Rb (retinoblastoma) loss: mutation or homozygous deletion described on genomic sequencing report.
• Currently receiving any other investigational agents.
• A history of other malignancy with the exception of malignancies for which all treatment was completed at least 1 year before registration and the patient has no evidence of recurrent/persistent disease.
• Patients with treated brain metastases are eligible if there is no evidence of progression for at least 4 weeks after CNS-directed treatment, as ascertained by clinical examination and brain imaging (MRI or CT scan) during the screening period
• A history of allergic reactions attributed to compounds of similar chemical or biologic composition to palbociclib or other agents used in the study (excluding cetuximab).
• Prior grade 3 or 4 (per CTCAE 5.0) hypersensitivity reaction to cetuximab.
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active serious infection, symptomatic congestive heart failure, unstable angina pectoris, or cardiac arrhythmia.
• QTc >500 msec (using Bazette formula).
• Patients with HIV are eligible unless their CD4+ T-cell counts are < 350 cells/mcL or they have a history of AIDS-defining opportunistic infection within the 12 months prior to registration. Concurrent treatment with effective ART according to DHHS treatment guidelines is recommended. Recommend exclusion of specific ART agents based on predicted drug-drug interactions (i.e. for sensitive CYP3A4 substrates, concurrent strong CYP3A4 inhibitors (ritonavir and cobicistat) or inducers (efavirenz) should be contraindicated).

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: Arm 1: Palbociclib + Cetuximab; Palbociclib by mouth 125 mg/daily on Days 1-21 of each 28 day cycle; Cetuximab: Initial dose 400mg/m^2 intravenous (IV); Subsequent doses 250 mg/m^2 IV, weekly	Drug: Palbociclib; Administered on an outpatient basis; Other Names: Ibrance; Drug: Cetuximab; Given intravenously over approximately 60 minutes; Other Names: Erbitux
Active Comparator: Arm 2: Cetuximab; -Cetuximab: Initial dose 400mg/m^2 intravenous (IV); Subsequent doses 250 mg/m^2 IV, weekly	Drug: Cetuximab; Given intravenously over approximately 60 minutes; Other Names: Erbitux

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall survival (OS)	-Defined as the time from the date of treatment to the date of death, censored at the last follow-up otherwise.	Through completion of follow-up (estimated to be 15 months)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall response rate (ORR) - (complete response + partial response)	Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm. Disappearance of all non-target lesions and normalization of tumor marker level.; Partial Response (PR): At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters.	Through completion of treatment (estimated to be 12 weeks)
Duration of response (DoR)	-The duration of response is measured from the time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded since the treatment started).	Through completion of treatment (estimated to be 12 weeks)
Progression-free survival (PFS)	Defined as the days from the date of treatment start to progression or death. The alive patients without progression are censored at the last follow-up.; Progressive Disease (PD): At least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. ): Appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions.	Through completion of follow-up (estimated to be 15 months)
Frequency of adverse events	-Will be measured by CTCAE v. 5.0	From start of treatment through 30 days after completion of treatment (estimated to be 16 weeks)
Dose delivery as measured by percent of full doses given over time		Through completion of treatment (estimated to be 12 weeks)

Collaborators and Investigators

• Sponsor: Washington University School of Medicine
• Collaborators: Pfizer; The Joseph Sanchez Foundation
• Investigators: Principal Investigator: Douglas Adkins, M.D., Washington University School of Medicine

Publications and helpful links

Helpful Links

• Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

Study record dates

Study Major Dates

• Study Start (Actual): April 6, 2022
• Primary Completion (Anticipated): February 28, 2027
• Study Completion (Anticipated): February 28, 2027

Study Registration Dates

• First Submitted: July 7, 2021
• First Submitted That Met QC Criteria: July 7, 2021
• First Posted (Actual): July 19, 2021

Study Record Updates

• Last Update Posted (Actual): May 9, 2023
• Last Update Submitted That Met QC Criteria: May 8, 2023
• Last Verified: May 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Neoplasms by Histologic Type; Neoplasms; Neoplasms by Site; Neoplasms, Glandular and Epithelial; Disease Attributes; Head and Neck Neoplasms; Neoplasms, Squamous Cell; Disease Progression; Carcinoma; Carcinoma, Squamous Cell; Squamous Cell Carcinoma of Head and Neck; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antineoplastic Agents; Antineoplastic Agents, Immunological; Protein Kinase Inhibitors; Palbociclib; Cetuximab
• Other Study ID Numbers: 202108203

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: Yes