Test af tilføjelsen af et immunterapilægemiddel, Cemiplimab (REGN2810), plus kirurgi til den sædvanlige kirurgi alene til behandling af avanceret hudkræft
Randomiseret fase III-forsøg med perioperativ immunterapi med responstilpasset behandling versus standardbehandling for resektabelt trin III/IV kutant planocellulært karcinom
This phase III trial compares the effect of adding cemiplimab to standard therapy (surgery with or without radiation) versus standard therapy alone in treating patients with stage III/IV squamous cell skin cancer that is able to be removed by surgery (resectable) and that may have come back after a period of improvement (recurrent). The usual treatment for patients with resectable squamous cell skin cancer is the removal of the cancerous tissue (surgery) with or without radiation, which uses high energy x-rays, particles, or radioactive seeds to kill cancer cells and shrink tumors. Immunotherapy with monoclonal antibodies, such as cemiplimab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Cemiplimab has been approved for the treatment of skin cancer that has spread or that cannot be removed by surgery, but it has not been approved for the treatment of skin cancer than can be removed by surgery. Adding cemiplimab to the usual treatment of surgery with or without radiation may be more effective in treating patients with stage III/IV resectable squamous cell skin cancer than the usual treatment alone.
Studieoversigt
Status
Status
Betingelser
Betingelser
- Trin IV Hoved- og hals -kutan pladecellecarcinom AJCC V8
- Trin III Hoved og hals kutan pladecellecarcinom AJCC V8
- Øjenlågsskivecellekarcinom
- Hud acantholytisk planocellulært karcinom
- Hudklar celle skivepitelcarcinom
- Hud Lymphoepitelialt Carcinom
- Hud Spindlecellet Pladeepitelcarcinom
- Hudcancer med pladecellekarikom og sarkomatoid differentiering
- Recidivierende øjenlågsskivecellekarcinom
- Tilbagevendende Hud Acantholytisk Pladecellecarcinom
- Recidiverende Hud Clear Cell Pladecellekarcinom
- Recidiverende Hud Lymphoepitelielt Carcinom
- Recidiverende Hud Spindlecelle Pladecellekarcinom
- Recidiverende Hudcarcinom Med Sarkomatoïd Differenciering
- Resekabelt Øjenlågssvulst af Pladecellecarcinom
- Resekabel Hud Acantholytisk Pladecellekarcinom
- Resekabel hudklarcelle spinocellulært karcinom
- Resekabel hudlymfoepitelialcarcinom
- Resekabel hudcancer med spoldecellede pladecellekarcinom
- Resekabel hudcancer med sarkomatoid differenciering
Intervention / Behandling
Intervention / Behandling
- Procedure: Magnetic Resonance Imaging
- Andet: Questionnaire Administration
- Procedure: Positron Emission Tomography
- Stråling: Intensity-Modulated Radiation Therapy
- Biologisk: Cemiplimab
- Procedure: Computed Tomography
- Procedure: Biospecimen Collection
- Stråling: Image Guided Radiation Therapy
- Procedure: Surgical Procedure
- Procedure: Surgical Procedure
Detaljeret beskrivelse
PRIMARY OBJECTIVE:
I. To determine if neoadjuvant immunotherapy combined with response-adapted oncologic surgery improves site-reported event-free survival (EFS) compared to standard-of-care surgery in resectable stage III/IV cutaneous squamous cell carcinoma (CSCC).
SECONDARY OBJECTIVES:
I. To compare utilization of adjuvant radiation between arms. II. To compare disease-free survival (DFS) between arms. III. To compare overall survival (OS) between arms. IV. To compare adverse events (Common Terminology Criteria for Adverse Events [CTCAE] version [v]5.0) between arms.
V. To assess pathologic complete response in arm 2.
PATIENT-REPORTED OUTCOMES:
I. Compare changes in patient reported quality of life as measured by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) at 1, 6, and 12 months after surgery between treatment arms. (Primary objective) II. To compare patient reported symptoms functioning, and quality of life, as measured by the Cutaneous Squamous Cell Carcinoma NeoAdjuvant, Adjuvant and Perioperative 32 question scale (CSCC NAAP-32), Patient Reported Outcomes Measurement Information System (PROMIS)-Short Form (SF)-Anxiety, PROMIS-SF-Fatigue, and EuroQol-5D (EQ-5D), between arms at 1, 6, and 12 months after surgery.
III. Develop a scoring algorithm and validate the CSCC-NAAP-32 for use in this patient population.
EXPLORATORY OBJECTIVES:
I. To compare disease-specific survival (DSS) between arms. II. To correlate pathologic response with DFS in arm 2. III. To assess overall response rate (ORR) in arm 2. IV. To compare patterns of failure between arms. V. To compare pathologic measurements of lymph node yield between arms. VI. To compare primary tumor specimen dimensions and volume between arms.
OUTLINE: Patients are randomized to 1 of 2 arms.
ARM 1: Patients undergo surgery per standard of care within 6 weeks of randomization. Starting within 6-12 weeks of surgery, patients may undergo image-guided radiation therapy (IGRT) with intensity modulated radiation therapy (IMRT) for 5 fractions per week for 6 weeks as clinically indicated. Patients also undergo computed tomography (CT), magnetic resonance imaging (MRI), and/or positron emission tomography (PET)/CT prior to treatment, and CT and/or MRI during follow up. Patients may also undergo optional collection of tissue, whole blood, and plasma on study.
ARM 2: Patients receive cemiplimab intravenously (IV) over 30 minutes on day 1 of each cycle. Cycles repeat every 21 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Patients then undergo response-adaptive surgery 21 days after last dose of cemiplimab. Starting within 12 weeks of surgery, patients may undergo IGRT with IMRT for 5 fractions per week for 6 weeks as clinically indicated. Starting within 6 weeks of completion of surgery or radiation therapy (if indicated), patients without pathologic complete response (pCR) receive cemiplimab IV over 30 minutes on day 1 of each cycle. Cycles repeat every 42 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo CT, MRI, and/or PET/CT prior to treatment, and CT and/or MRI on study and during follow up. Patients may also undergo optional collection of tissue, whole blood, and plasma on study.
After completion of study treatment, patients are followed up at 1, 6, and 12 months post-surgery then every 3 months for 2 years, every 6 months in year 3, and then annually thereafter.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Fase 3
Kontakter og lokationer
Studiesteder
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New South Wales
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Camperdown, New South Wales, Australien, 2050
- Chris O'Brien Lifehouse
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Wollongong, New South Wales, Australien, 2500
- Wollongong Hospital
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Queensland
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Townsville, Queensland, Australien, 4814
- Townsville General Hospital
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Woolloongabba, Queensland, Australien, 4102
- Princess Alexandra Hospital
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Victoria
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Fitzroy, Victoria, Australien, 3065
- Saint Vincent's Hospital
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Melbourne, Victoria, Australien, 3000
- Peter MacCallum Cancer Centre
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Western Australia
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Murdoch, Western Australia, Australien, 6150
- Fiona Stanley Hospital
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British Columbia
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Vancouver, British Columbia, Canada, V5Z 4E6
- BCCA-Vancouver Cancer Centre
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Ontario
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Toronto, Ontario, Canada, M5G 2M9
- University Health Network-Princess Margaret Hospital
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Toronto, Ontario, Canada, M4N 3M5
- Odette Cancer Centre- Sunnybrook Health Sciences Centre
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Alabama
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Birmingham, Alabama, Forenede Stater, 35233
- University of Alabama at Birmingham Cancer Center
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Arizona
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Gilbert, Arizona, Forenede Stater, 85234
- Banner MD Anderson Cancer Center
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Phoenix, Arizona, Forenede Stater, 85054
- Mayo Clinic Hospital in Arizona
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California
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Beverly Hills, California, Forenede Stater, 90211
- Tower Cancer Research Foundation
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Duarte, California, Forenede Stater, 91010
- City of Hope Comprehensive Cancer Center
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Encinitas, California, Forenede Stater, 92024
- UC San Diego Health System - Encinitas
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Irvine, California, Forenede Stater, 92618
- City of Hope at Irvine Lennar
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La Jolla, California, Forenede Stater, 92093
- UC San Diego Moores Cancer Center
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Lancaster, California, Forenede Stater, 93534
- City of Hope Antelope Valley
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Los Angeles, California, Forenede Stater, 90033
- USC / Norris Comprehensive Cancer Center
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Los Angeles, California, Forenede Stater, 90048
- Cedars-Sinai Medical Center
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Los Angeles, California, Forenede Stater, 90025
- The Angeles Clinic and Research Institute - West Los Angeles Office
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Oakland, California, Forenede Stater, 94611
- Kaiser Permanente-Oakland
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Palo Alto, California, Forenede Stater, 94304
- Stanford Cancer Institute Palo Alto
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Sacramento, California, Forenede Stater, 95817
- University of California Davis Comprehensive Cancer Center
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Sacramento, California, Forenede Stater, 95823
- Kaiser Permanente-South Sacramento
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San Diego, California, Forenede Stater, 92103
- UC San Diego Medical Center - Hillcrest
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San Francisco, California, Forenede Stater, 94115
- Kaiser Permanente-San Francisco
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South Pasadena, California, Forenede Stater, 91030
- City of Hope South Pasadena
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Torrance, California, Forenede Stater, 90505
- Torrance Memorial Physician Network - Cancer Care
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Upland, California, Forenede Stater, 91786
- City of Hope Upland
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Walnut Creek, California, Forenede Stater, 94596
- Kaiser Permanente-Walnut Creek
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Colorado
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Aurora, Colorado, Forenede Stater, 80045
- UCHealth University of Colorado Hospital
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Colorado Springs, Colorado, Forenede Stater, 80909
- UCHealth Memorial Hospital Central
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Colorado Springs, Colorado, Forenede Stater, 80920
- Memorial Hospital North
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Connecticut
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Greenwich, Connecticut, Forenede Stater, 06830
- Smilow Cancer Hospital Care Center at Greenwich
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Guilford, Connecticut, Forenede Stater, 06437
- Smilow Cancer Hospital Care Center - Guilford
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New Haven, Connecticut, Forenede Stater, 06520
- Yale University
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Trumbull, Connecticut, Forenede Stater, 06611
- Smilow Cancer Hospital Care Center-Trumbull
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Waterbury, Connecticut, Forenede Stater, 06708
- Smilow Cancer Hospital-Waterbury Care Center
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Waterford, Connecticut, Forenede Stater, 06385
- Smilow Cancer Hospital Care Center - Waterford
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Delaware
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Newark, Delaware, Forenede Stater, 19713
- Helen F Graham Cancer Center
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Newark, Delaware, Forenede Stater, 19713
- Medical Oncology Hematology Consultants PA
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Florida
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Aventura, Florida, Forenede Stater, 33180
- UM Sylvester Comprehensive Cancer Center at Aventura
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Coral Gables, Florida, Forenede Stater, 33146
- UM Sylvester Comprehensive Cancer Center at Coral Gables
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Deerfield Beach, Florida, Forenede Stater, 33442
- UM Sylvester Comprehensive Cancer Center at Deerfield Beach
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Doral, Florida, Forenede Stater, 33166
- UM Sylvester Comprehensive Cancer Center at Doral
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Jacksonville, Florida, Forenede Stater, 32224-9980
- Mayo Clinic in Florida
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Miami, Florida, Forenede Stater, 33136
- University of Miami Miller School of Medicine-Sylvester Cancer Center
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Miami, Florida, Forenede Stater, 33176
- Miami Cancer Institute
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Miami, Florida, Forenede Stater, 33176
- UM Sylvester Comprehensive Cancer Center at Kendall
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N. Venice, Florida, Forenede Stater, 34275
- Sarasota Memorial Hospital-Venice
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Plantation, Florida, Forenede Stater, 33324
- UM Sylvester Comprehensive Cancer Center at Plantation
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Sarasota, Florida, Forenede Stater, 34239
- Sarasota Memorial Hospital
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Sarasota, Florida, Forenede Stater, 34232
- Florida Cancer Specialists - Sarasota
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Sarasota, Florida, Forenede Stater, 34243
- Sarasota Memorial Health Care Center at University Parkway
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Sarasota, Florida, Forenede Stater, 34239
- First Physicians Group - Silverstein Institute at Floyd Street
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Sarasota, Florida, Forenede Stater, 34239
- Florida Cancer Specialists - Sarasota Downtown
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Tampa, Florida, Forenede Stater, 33612
- Moffitt Cancer Center
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Tampa, Florida, Forenede Stater, 33607
- Moffitt Cancer Center-International Plaza
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Tampa, Florida, Forenede Stater, 33612
- Moffitt Cancer Center - McKinley Campus
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Venice, Florida, Forenede Stater, 34285
- Florida Cancer Specialists - Venice Island
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Venice, Florida, Forenede Stater, 34275
- Florida Cancer Specialists - Venice Pinebrook
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Georgia
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Atlanta, Georgia, Forenede Stater, 30308
- Emory University Hospital Midtown
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Atlanta, Georgia, Forenede Stater, 30322
- Emory University Hospital/Winship Cancer Institute
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Illinois
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Alton, Illinois, Forenede Stater, 62002
- Alton Memorial Hospital
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Chicago, Illinois, Forenede Stater, 60611
- Northwestern University
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Chicago, Illinois, Forenede Stater, 60612
- University of Illinois
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Chicago, Illinois, Forenede Stater, 60612
- Rush MD Anderson Cancer Center
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DeKalb, Illinois, Forenede Stater, 60115
- Northwestern Medicine Cancer Center Kishwaukee
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Decatur, Illinois, Forenede Stater, 62526
- Decatur Memorial Hospital
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Geneva, Illinois, Forenede Stater, 60134
- Northwestern Medicine Cancer Center Delnor
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Orland Park, Illinois, Forenede Stater, 60462
- Northwestern Medicine Orland Park
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Shiloh, Illinois, Forenede Stater, 62269
- Memorial Hospital East
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Warrenville, Illinois, Forenede Stater, 60555
- Northwestern Medicine Cancer Center Warrenville
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Indiana
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Carmel, Indiana, Forenede Stater, 46032
- IU Health North Hospital
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Goshen, Indiana, Forenede Stater, 46526
- Goshen Center for Cancer Care
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Indianapolis, Indiana, Forenede Stater, 46237
- Franciscan Health Indianapolis
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Indianapolis, Indiana, Forenede Stater, 46202
- Indiana University/Melvin and Bren Simon Cancer Center
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Iowa
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Council Bluffs, Iowa, Forenede Stater, 51503
- Heartland Oncology and Hematology LLP
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Council Bluffs, Iowa, Forenede Stater, 51503
- Methodist Jennie Edmundson Hospital
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Kansas
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Kansas City, Kansas, Forenede Stater, 66160
- University of Kansas Cancer Center
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Overland Park, Kansas, Forenede Stater, 66210
- University of Kansas Cancer Center-Overland Park
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Overland Park, Kansas, Forenede Stater, 66211
- University of Kansas Hospital-Indian Creek Campus
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Westwood, Kansas, Forenede Stater, 66205
- University of Kansas Hospital-Westwood Cancer Center
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Kentucky
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Lexington, Kentucky, Forenede Stater, 40536
- University of Kentucky/Markey Cancer Center
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Louisville, Kentucky, Forenede Stater, 40202
- The James Graham Brown Cancer Center at University of Louisville
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Louisville, Kentucky, Forenede Stater, 40245
- UofL Health Medical Center Northeast
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Louisiana
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Baton Rouge, Louisiana, Forenede Stater, 70805
- LSU Health Baton Rouge-North Clinic
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Baton Rouge, Louisiana, Forenede Stater, 70808
- Our Lady of the Lake Physician Group
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New Orleans, Louisiana, Forenede Stater, 70112
- University Medical Center New Orleans
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Michigan
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Ann Arbor, Michigan, Forenede Stater, 48109
- University of Michigan Rogel Cancer Center
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Brighton, Michigan, Forenede Stater, 48116
- University of Michigan - Brighton Center for Specialty Care
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Detroit, Michigan, Forenede Stater, 48202
- Henry Ford Hospital
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Grand Rapids, Michigan, Forenede Stater, 49503
- Corewell Health Grand Rapids Hospitals - Butterworth Hospital
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West Bloomfield, Michigan, Forenede Stater, 48322
- Henry Ford West Bloomfield Hospital
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Wyoming, Michigan, Forenede Stater, 49519
- University of Michigan Health - West
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Minnesota
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Minneapolis, Minnesota, Forenede Stater, 55455
- University of Minnesota/Masonic Cancer Center
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Rochester, Minnesota, Forenede Stater, 55905
- Mayo Clinic in Rochester
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Missouri
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City of Saint Peters, Missouri, Forenede Stater, 63376
- Siteman Cancer Center at Saint Peters Hospital
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Columbia, Missouri, Forenede Stater, 65212
- MU Health - University Hospital/Ellis Fischel Cancer Center
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Creve Coeur, Missouri, Forenede Stater, 63141
- Siteman Cancer Center at West County Hospital
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Kansas City, Missouri, Forenede Stater, 64154
- University of Kansas Cancer Center - North
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Lee's Summit, Missouri, Forenede Stater, 64064
- University of Kansas Cancer Center - Lee's Summit
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St Louis, Missouri, Forenede Stater, 63110
- Washington University School of Medicine
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St Louis, Missouri, Forenede Stater, 63129
- Siteman Cancer Center-South County
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St Louis, Missouri, Forenede Stater, 63136
- Siteman Cancer Center at Christian Hospital
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Nebraska
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Bellevue, Nebraska, Forenede Stater, 68123
- Nebraska Medicine-Bellevue
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Omaha, Nebraska, Forenede Stater, 68114
- Nebraska Methodist Hospital
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Omaha, Nebraska, Forenede Stater, 68198
- University of Nebraska Medical Center
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Omaha, Nebraska, Forenede Stater, 68118
- Nebraska Medicine-Village Pointe
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Omaha, Nebraska, Forenede Stater, 68114
- Nebraska Cancer Specialists/Oncology Hematology West PC - MECC
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New Hampshire
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Lebanon, New Hampshire, Forenede Stater, 03756
- Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
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New Jersey
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Basking Ridge, New Jersey, Forenede Stater, 07920
- Memorial Sloan Kettering Basking Ridge
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Middletown, New Jersey, Forenede Stater, 07748
- Memorial Sloan Kettering Monmouth
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Montvale, New Jersey, Forenede Stater, 07645
- Memorial Sloan Kettering Bergen
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New Mexico
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Albuquerque, New Mexico, Forenede Stater, 87106
- University of New Mexico Cancer Center
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New York
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Commack, New York, Forenede Stater, 11725
- Memorial Sloan Kettering Commack
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Harrison, New York, Forenede Stater, 10604
- Memorial Sloan Kettering Westchester
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Lake Success, New York, Forenede Stater, 11042
- Northwell Health/Center for Advanced Medicine
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Mineola, New York, Forenede Stater, 11501
- NYU Langone Hospital - Long Island
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New York, New York, Forenede Stater, 10065
- Memorial Sloan Kettering Cancer Center
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New York, New York, Forenede Stater, 10016
- Laura and Isaac Perlmutter Cancer Center at NYU Langone
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New York, New York, Forenede Stater, 10075
- Lenox Hill Hospital
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New York, New York, Forenede Stater, 10065
- Manhattan Eye Ear and Throat Hospital
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Rochester, New York, Forenede Stater, 14642
- University of Rochester
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Stony Brook, New York, Forenede Stater, 11794
- Stony Brook University Medical Center
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Syracuse, New York, Forenede Stater, 13210
- State University of New York Upstate Medical University
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Syracuse, New York, Forenede Stater, 13215
- SUNY Upstate Medical Center-Community Campus
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The Bronx, New York, Forenede Stater, 10461
- Montefiore Medical Center-Einstein Campus
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The Bronx, New York, Forenede Stater, 10467
- Montefiore Medical Center - Moses Campus
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The Bronx, New York, Forenede Stater, 10461
- Montefiore Medical Center-Weiler Hospital
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Uniondale, New York, Forenede Stater, 11553
- Memorial Sloan Kettering Nassau
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Webster, New York, Forenede Stater, 14580
- Wilmot Cancer Institute at Webster
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North Carolina
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Albemarle, North Carolina, Forenede Stater, 28002
- Atrium Health Stanly/LCI-Albemarle
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Chapel Hill, North Carolina, Forenede Stater, 27599
- UNC Lineberger Comprehensive Cancer Center
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Charlotte, North Carolina, Forenede Stater, 28203
- Carolinas Medical Center/Levine Cancer Institute
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Charlotte, North Carolina, Forenede Stater, 28210
- Atrium Health Pineville/LCI-Pineville
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Charlotte, North Carolina, Forenede Stater, 28262
- Atrium Health University City/LCI-University
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Concord, North Carolina, Forenede Stater, 28025
- Atrium Health Cabarrus/LCI-Concord
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Durham, North Carolina, Forenede Stater, 27710
- Duke University Medical Center
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Gastonia, North Carolina, Forenede Stater, 28054
- Levine Cancer Institute-Gaston
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Monroe, North Carolina, Forenede Stater, 28112
- Atrium Health Union/LCI-Union
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Raleigh, North Carolina, Forenede Stater, 27609
- Duke Cancer Center Raleigh
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Shelby, North Carolina, Forenede Stater, 28150
- Atrium Health Cleveland/LCI-Cleveland
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Winston-Salem, North Carolina, Forenede Stater, 27157
- Wake Forest University Health Sciences
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Ohio
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Avon, Ohio, Forenede Stater, 44011
- UH Seidman Cancer Center at UH Avon Health Center
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Beachwood, Ohio, Forenede Stater, 44122
- UHHS-Chagrin Highlands Medical Center
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Centerville, Ohio, Forenede Stater, 45459
- Miami Valley Hospital South
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Cincinnati, Ohio, Forenede Stater, 45219
- University of Cincinnati Cancer Center-UC Medical Center
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Cleveland, Ohio, Forenede Stater, 44106
- Case Western Reserve University
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Cleveland, Ohio, Forenede Stater, 44109
- MetroHealth Medical Center
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Columbus, Ohio, Forenede Stater, 43210
- Ohio State University Comprehensive Cancer Center
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Dayton, Ohio, Forenede Stater, 45415
- Miami Valley Hospital North
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Franklin, Ohio, Forenede Stater, 45005-1066
- Atrium Medical Center-Middletown Regional Hospital
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Greenville, Ohio, Forenede Stater, 45331
- Miami Valley Cancer Care and Infusion
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Mentor, Ohio, Forenede Stater, 44060
- UH Seidman Cancer Center at Lake Health Mentor Campus
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Troy, Ohio, Forenede Stater, 45373
- Upper Valley Medical Center
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West Chester, Ohio, Forenede Stater, 45069
- University of Cincinnati Cancer Center-West Chester
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Oklahoma
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Oklahoma City, Oklahoma, Forenede Stater, 73104
- University of Oklahoma Health Sciences Center
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Oregon
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Portland, Oregon, Forenede Stater, 97213
- Providence Portland Medical Center
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Pennsylvania
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Chadds Ford, Pennsylvania, Forenede Stater, 19317
- Christiana Care Health System-Concord Health Center
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Erie, Pennsylvania, Forenede Stater, 16505
- UPMC Hillman Cancer Center Erie
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Erie, Pennsylvania, Forenede Stater, 16544
- Saint Vincent Hospital
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Hershey, Pennsylvania, Forenede Stater, 17033-0850
- Penn State Milton S Hershey Medical Center
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Johnstown, Pennsylvania, Forenede Stater, 15901
- UPMC-Johnstown/John P. Murtha Regional Cancer Center
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Monroeville, Pennsylvania, Forenede Stater, 15146
- Forbes Hospital
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Philadelphia, Pennsylvania, Forenede Stater, 19111
- Fox Chase Cancer Center
-
Philadelphia, Pennsylvania, Forenede Stater, 19107
- Thomas Jefferson University Hospital
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Pittsburgh, Pennsylvania, Forenede Stater, 15212
- Allegheny General Hospital
-
Pittsburgh, Pennsylvania, Forenede Stater, 15224
- West Penn Hospital
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Pittsburgh, Pennsylvania, Forenede Stater, 15232
- UPMC Hillman Cancer Center
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Wexford, Pennsylvania, Forenede Stater, 15090
- Wexford Health and Wellness Pavilion
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South Carolina
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Charleston, South Carolina, Forenede Stater, 29425
- Medical University of South Carolina
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Rock Hill, South Carolina, Forenede Stater, 29732
- Levine Cancer Institute-Rock Hill
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Rock Hill, South Carolina, Forenede Stater, 29730
- Rock Hill Radiation Therapy Center
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Tennessee
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Nashville, Tennessee, Forenede Stater, 37232
- Vanderbilt University/Ingram Cancer Center
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Texas
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Conroe, Texas, Forenede Stater, 77384
- UT MD Anderson - The Woodlands
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Dallas, Texas, Forenede Stater, 75390
- UT Southwestern/Simmons Cancer Center-Dallas
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Dallas, Texas, Forenede Stater, 75237
- UT Southwestern Simmons Cancer Center - RedBird
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Fort Worth, Texas, Forenede Stater, 76104
- UT Southwestern/Simmons Cancer Center-Fort Worth
-
Houston, Texas, Forenede Stater, 77030
- UT MD Anderson Cancer Center
-
Houston, Texas, Forenede Stater, 77079
- UT MD Anderson - West Houston
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League City, Texas, Forenede Stater, 77573
- UT MD Anderson - League City
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Richardson, Texas, Forenede Stater, 75080
- UT Southwestern Clinical Center at Richardson/Plano
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San Antonio, Texas, Forenede Stater, 78229
- University of Texas Health Science Center at San Antonio
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Sugar Land, Texas, Forenede Stater, 77478
- UT MD Anderson - Sugar Land
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Utah
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Salt Lake City, Utah, Forenede Stater, 84112
- Huntsman Cancer Institute/University of Utah
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Vermont
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Berlin Corners, Vermont, Forenede Stater, 05602
- Central Vermont Medical Center/National Life Cancer Treatment
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Burlington, Vermont, Forenede Stater, 05401
- University of Vermont Medical Center
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Burlington, Vermont, Forenede Stater, 05405
- University of Vermont and State Agricultural College
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Saint Johnsbury, Vermont, Forenede Stater, 05819
- Dartmouth Cancer Center - North
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Virginia
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Charlottesville, Virginia, Forenede Stater, 22908
- University of Virginia Cancer Center
-
Fairfax, Virginia, Forenede Stater, 22031
- Inova Schar Cancer Institute
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Richmond, Virginia, Forenede Stater, 23298
- VCU Massey Comprehensive Cancer Center
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Washington
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Seattle, Washington, Forenede Stater, 98101
- Virginia Mason Medical Center
-
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Wisconsin
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La Crosse, Wisconsin, Forenede Stater, 54601
- Gundersen Lutheran Medical Center
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Madison, Wisconsin, Forenede Stater, 53705
- William S Middleton VA Medical Center
-
Madison, Wisconsin, Forenede Stater, 53792
- University of Wisconsin Carbone Cancer Center - University Hospital
-
Madison, Wisconsin, Forenede Stater, 53718
- University of Wisconsin Carbone Cancer Center - Eastpark Medical Center
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Marshfield, Wisconsin, Forenede Stater, 54449
- Marshfield Medical Center-Marshfield
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Menomonee Falls, Wisconsin, Forenede Stater, 53051
- Froedtert Menomonee Falls Hospital
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Milwaukee, Wisconsin, Forenede Stater, 53226
- Medical College of Wisconsin
-
Oak Creek, Wisconsin, Forenede Stater, 53154
- Drexel Town Square Health Center
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West Bend, Wisconsin, Forenede Stater, 53095
- Froedtert West Bend Hospital/Kraemer Cancer Center
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Weston, Wisconsin, Forenede Stater, 54476
- Marshfield Medical Center - Weston
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Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
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Pathologically (histologically or cytologically) proven diagnosis of invasive cutaneous squamous cell carcinoma (CSCC) or regional lymph node or in-transit metastasis of CSCC
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The following CSCC subtypes are eligible according to World Health Organization (WHO) classification if the predominant histology is confirmed CSCC.
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Spindle cell squamous cell carcinoma (SCC)
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Squamous cell carcinoma with sarcomatoid differentiation
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Acantholytic SCC
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Clear cell SCC
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Lymphoepithelial carcinoma
- Note: Keratoacanthoma SCC and Verrucous SCC subtypes are not eligible.
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For patients with regional metastasis without a primary tumor at screening: a clinical history of CSCC that drains to the involved regional lymph nodes or in-transit metastases in question is required
- For example, a parotid mass shown to be SCC by cytologic analysis of a fine needle aspirate in a patient with a clinical history of CSCC on the ipsilateral scalp would be eligible
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For patients with regional metastases without a primary tumor and an ambiguous clinical history: tumor genomic sequencing suggesting a primary tumor of cutaneous origin would be acceptable evidence to establish eligibility
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NOTE: Tumor genomic sequencing is not required to determine eligibility, but may be part of the routine evaluation of patients with cancers of unknown primary at some institutions. For example, a parotid mass shown to be SCC by cytologic analysis of fine needle aspirate without a primary tumor and an ambiguous clinical history, but with a tumor genomic sequencing assay demonstrating a high tumor mutation burden (≥ 10 mutations/Mb) and/or a high fraction of ultraviolet (UV) related mutations (> 50% of mutations [cytosine (C)/thymine (T)]C > T or CC > TT) and/or the presence of "signature 7" mutations would be eligible (Chang 2021)
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Previously untreated or recurrent CSCC
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Clinical American Joint Committee on Cancer (AJCC) 8th Edition (eyelid, head and neck sites) or Union for International Cancer Control (UICC) (non-head and neck sites) stage III or IV
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Primary tumor site must be in the head and neck cutaneous region, other non-head and neck cutaneous regions, or eyelid cutaneous region
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No mucosal squamous cell carcinoma (vermillion lip, nasal, oral, sinonasal, conjunctival, anogenital)
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Tumor must be resectable with curative intent. Note: Tumor with bony skull base invasion and/or skull base foramen involvement (T4b) is not eligible. (Patients with T4b eyelid tumors using UICC Staging, and not involving the brain, are eligible.)
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At least 1 lesion that is measurable by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1
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No definitive clinical or radiologic evidence of distant metastatic disease (M1), visceral and/or distant nodal disease
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Age ≥ 18
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Eastern Cooperative Oncology Group (ECOG) performance status of 0-2
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Not pregnant and not nursing
- Negative urine or serum pregnancy test (in persons of childbearing potential) within 14 days prior to registration. Childbearing potential is defined as any person who has experienced menarche and who has not undergone surgical sterilization (hysterectomy or bilateral oophorectomy) or who is not postmenopausal
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Absolute neutrophil count (ANC) ≥ 1,000 cells/mm^3
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Platelets ≥ 75,000 cells/mm^3
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Hemoglobin ≥ 8.0 g/dl (Note: The use of transfusion or other intervention to achieve hemoglobin [Hgb] ≥ 8.0 g/dl is acceptable)
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Creatinine clearance (CrCL) > 30mL/min by the Cockcroft-Gault formula
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Total bilirubin ≤ 1.5 x institutional upper limit of normal (ULN) (NOTE: For patients with Gilbert's syndrome, total bilirubin ≤ 3 x ULN. Gilbert's syndrome must be documented appropriately as past medical history.)
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Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) ≤ 3 x institutional ULN
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No prior systemic therapy for the study cancer (including patients currently receiving immunotherapy for a separate malignancy)
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No prior radiotherapy to the region of the study cancer that would result in cumulative doses of radiation to organs at risk for radiation injury that exceed protocol limitations
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No history of myocardial infarction/unstable angina within the last 6 months
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New York Heart Association functional classification IIb or better (New York Heart Association [NYHA] functional classification III/IV are not eligible) (Note: Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association functional classification)
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No active infection requiring systemic antibiotics, antiviral, or antifungal treatments
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No history of allogeneic stem cell transplantation, or autologous stem cell transplantation
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No history of a solid organ transplant (other than corneal transplant)
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No active, known, or suspected autoimmune disease
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Active or known disease is defined as:
- Requiring higher than physiologic steroid levels (> 10mg prednisone/day or equivalent) or
- Requiring disease-modifying agents or
- Ongoing or recent (within 5 years prior to registration) evidence of significant autoimmune disease that required treatment with systemic immunosuppressive treatments, which may suggest risk for immune-related adverse events (irAEs)
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NOTES:
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Patients meeting the following criteria are not considered immunosuppressed and are eligible to enroll:
- Patients who require a brief course of steroids (eg, prophylaxis for imaging assessments due to hypersensitivity to contrast agents) are not excluded
- Patients with type I diabetes mellitus, and endocrinopathies (including hypothyroidism due to autoimmune thyroiditis) only requiring hormone replacement, or skin disorders (such as vitiligo, psoriasis, or alopecia) not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger are permitted to enroll
- Physiologic replacement doses ≤ 10 mg prednisone/day or equivalent allowed, as long as they are not being administered for immunosuppressive intent. Inhaled or topical steroids are permitted
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Patients with the following immunosuppressed conditions are eligible to enroll:
- Patients with HIV infection on effective anti-retroviral therapy with undetectable viral load within 6 months prior to registration are eligible
- Patients with chronic lymphocytic leukemia (CLL) with no history of anti-CLL therapy within 6 months prior to registration are eligible
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No history of interstitial lung disease (eg, idiopathic pulmonary fibrosis, organizing pneumonia)
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No active, noninfectious pneumonitis requiring immune-suppressive therapy
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No active tuberculosis
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No live vaccines within 28 days prior to registration
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No history of allergic reaction to the study agent, compounds of similar chemical or biologic composition to the study agent (or any of its excipients)
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Enkelt
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
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Aktiv komparator: Arm 1 (surgery, radiation)
Patients undergo surgery per standard of care within 6 weeks of randomization. Starting within 6-12 weeks of surgery, patients may undergo IGRT with IMRT for 5 fractions per week for 6 weeks as clinically indicated. Patients also undergo CT, MRI, and/or PET/CT prior to treatment, and CT and/or MRI during follow up. Patients may also undergo optional collection of tissue, whole blood, and plasma on study. |
Undergo MRI
Andre navne:
Ancillary studies Undergo PET/CT
Andre navne:
Undergo IMRT
Andre navne:
Undergo CT and/or PET/CT
Andre navne:
Undergo collection of blood and/or plasma
Andre navne:
Undergo IGRT
Andre navne:
Undergo surgery per SOC
Andre navne:
Undergo response-adaptive surgery
Andre navne:
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Eksperimentel: Arm 2 (cemiplimab, surgery, radiation)
Patients receive cemiplimab IV over 30 minutes on day 1 of each cycle. Cycles repeat every 21 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Patients then undergo response-adaptive surgery 21 days after last dose of cemiplimab. Starting within 12 weeks of surgery, patients may undergo IGRT with IMRT for 5 fractions per week for 6 weeks as clinically indicated. Starting within 6 weeks of completion of surgery or radiation therapy (if indicated), patients without pCR receive cemiplimab IV over 30 minutes on day 1 of each cycle. Cycles repeat every 42 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo CT, MRI, and/or PET/CT prior to treatment, and CT and/or MRI on study and during follow up. Patients may also undergo optional collection of tissue, whole blood, and plasma on study. |
Undergo MRI
Andre navne:
Ancillary studies Undergo PET/CT
Andre navne:
Undergo IMRT
Andre navne:
Given IV
Andre navne:
Undergo CT and/or PET/CT
Andre navne:
Undergo collection of blood and/or plasma
Andre navne:
Undergo IGRT
Andre navne:
Undergo surgery per SOC
Andre navne:
Undergo response-adaptive surgery
Andre navne:
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Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Event-free survival (EFS)
Tidsramme: Up to 6 years
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Defined as the time from randomization to any of the following events: progression of disease that precludes surgery, toxic effects related to treatment that preclude surgery, inability to resect all gross disease), disease recurrence (local, regional, or distant) after surgery (or after radiographic complete response), disease progression after radiographic partial response or stable disease without surgery (or biopsy, as applicable), or death due to any cause, whichever occurs first. EFS rates will be estimated using the Kaplan-Meier method, and the stratified log-rank test will be used to assess whether perioperative immunotherapy (neoadjuvant/adjuvant) with response-adapted oncologic surgery improves EFS as recorded by the site compared to standard-of-care surgery in resectable stage III/IV cutaneous squamous cell carcinoma (CSCC). |
Up to 6 years
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Utilization of adjuvant radiation
Tidsramme: Up to 6 years
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Rates of utilization of adjuvant radiation for each arm will be computed using a binomial distribution assumption. A 95% confidence interval (CI) for the rate difference between arms will be calculated using the stratified Newcombe (Wilson) method (Yan 2010). |
Up to 6 years
|
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Disease-free survival (DFS)
Tidsramme: From randomization to recurrent or death, assessed up to 6 years
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DFS will use the same analytic methods as EFS. |
From randomization to recurrent or death, assessed up to 6 years
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Overall survival (OS)
Tidsramme: From randomization to death, assessed up to 6 years
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OS will use the same analytic methods as EFS. |
From randomization to death, assessed up to 6 years
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Incidence of adverse events
Tidsramme: At 30 days and then up to 6 years
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Adverse events (AEs) will be graded using Common Terminology Criteria for Adverse Events version (v) 5.0. Counts and frequencies of all AEs by grade will be provided by each treatment arm. For the experimental arm, AEs will be summarized for each treatment phase (neoadjuvant, adjuvant, and post-treatment [after adjuvant]). Counts and frequencies will be provided for the worst grade AE experienced by the patient by treatment arm. The proportion of patients with at least one grade 3 or higher AE, serious AEs, AEs leading to discontinuation or death will be reported for each treatment arm. These analyses will be descriptive. |
At 30 days and then up to 6 years
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Pathologic complete response
Tidsramme: At 1 and 2 years
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Site-reported pathologic response will be assessed using the following categories: pathological complete, major, and partial response, no pathological response (i.e., no complete, major, or partial response), and no pathological evaluation. Pathological responses at 1 and 2 years will be summarized using frequencies and percentages and tested using a chi-square test at a two-sided 5% significance level. |
At 1 and 2 years
|
Andre resultatmål
Andre resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Quality of life
Tidsramme: From baseline up to 12 months after surgery
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The primary patient-reported outcome (PRO) is the global health status score as measured by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30. For all PRO scheduled assessment visits, patient disposition will be summarized. PRO completion rate and available data rate will be computed and reported at each timepoint. Mixed effects model with repeated measures (MMRM) will be performed for the global health status score incorporating all PRO assessment timepoints. The adjusted means for each treatment and the estimated treatment differences for the treatment comparisons will be presented together with 95% CIs. |
From baseline up to 12 months after surgery
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Validation and scoring of Cutaneous Squamous Cell Carcinoma NeoAdjuvant, Adjuvant and Perioperative 32 question scale (CSCC NAAP-32)
Tidsramme: From baseline up to 12 months after surgery
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Item response distributions, inter-item correlations, factor analysis and internal consistency will be assessed. Confirmatory factor analyses will be used to confirm the underlying structure hypothesized by the conceptual framework. Items capturing perceptions and effect of treatments will be evaluated with single-item scores. Completion rate and available data rate will be computed and reported at each timepoint. CSCC-NAAP-32 item responses will be described at baseline to evaluate floor/ceiling effects, missingness, outliers, and multi-modal distributions. Internal consistency reliability for multi-item scales will be evaluated at baseline using both Cronbach's alpha and McDonald Omega coefficients. Test-retest reliability will be assessed using intraclass correlation coefficients between two time points. Construct validity and ability to detect change over time will be assessed. |
From baseline up to 12 months after surgery
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Change in patient-reported symptoms, functioning, and quality of life
Tidsramme: From baseline up to 12 months after surgery
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PRO instruments will be scored based on their respective scoring algorithms. Descriptive statistics, MMRMs, and assessment of missing data will be performed. |
From baseline up to 12 months after surgery
|
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Disease-specific survival (DSS)
Tidsramme: From randomization to death due to study cancer, date of precluding event, or last follow up, assessed up to 6 years
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The cause-specific log-rank test and cause-specific Cox models will also be used to compare cause-specific HRs between treatment arms and estimate cause-specific treatment-effect HRs, respectively. The cumulative incidence method will be used to estimate the incidence of cancer-specific mortality with between-arm differences tested using the stratified Gray's test. Stratified sub-distribution HR and 95% CI for treatment effect from Fine-Gray models will be computed to supplement the DSS analysis. |
From randomization to death due to study cancer, date of precluding event, or last follow up, assessed up to 6 years
|
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Pathologic response
Tidsramme: Up to 6 years
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Will evaluate the association of pathologic response with DFS in the experimental arm. Will compare EFS between patients with complete response versus others (major/partial/no response/not evaluable) using a log-rank test. DFS rates for each pathological response subgroup will be estimated using the Kaplan-Meier method. Furthermore, DFS rates for each pathological response subgroup will be calculated using the Kaplan-Meier method as an exploratory analysis. |
Up to 6 years
|
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Overall response rate
Tidsramme: Up to 6 years
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Will be assessed using Response Evaluation Criteria in Solid Tumors v. 1.1 and summarized by time-point using frequencies and relative frequencies. The best objective response (complete response + partial response) rate will be estimated using a 95% confidence interval obtained using the normal approximation for a binomial proportion. |
Up to 6 years
|
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Failure patterns
Tidsramme: Up to 6 years
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Failure patterns (local, regional, and distant metastasis) for EFS will be summarized for each treatment arm. |
Up to 6 years
|
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Lymph node yield
Tidsramme: At time of surgery
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The pathologic measurements of lymph node yield (i.e., number of lymph nodes) will be compared between arms using the Mann-Whitney test. |
At time of surgery
|
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Primary tumor specimen dimensions
Tidsramme: At time of surgery
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The pathologic measurements of the primary tumor specimens' length, width, and volume will be compared between arms using the t-test for independent samples. A Mann-Whitney test will be used if the distribution of a variable does not pass the normality test. |
At time of surgery
|
|
Treatment effect HR estimates
Tidsramme: Up to 6 years
|
Treatment effect HR estimates and 95% CIs for the primary and secondary endpoints (EFS, DFS, DSS, OS) will be calculated using a (cause-specific) Cox model with treatment by factor interaction for the following subgroups:
|
Up to 6 years
|
|
Treatment effect estimates by sex
Tidsramme: Up to 6 years
|
Estimates of the primary outcome treatment effect and the corresponding 95% CIs by sex will be provided. |
Up to 6 years
|
|
Treatment effect estimates by race
Tidsramme: Up to 6 years
|
Estimates of the primary outcome treatment effect and the corresponding 95% CIs by race will be provided. |
Up to 6 years
|
|
Treatment effect estimates by ethnicity
Tidsramme: Up to 6 years
|
Estimates of the primary outcome treatment effect and the corresponding 95% CIs by ethnicity will be provided. |
Up to 6 years
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Efterforskere
Efterforskere
- Ledende efterforsker: Neil D Gross, NRG Oncology
Publikationer og nyttige links
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
- Undersøgelsesteknikker
- Terapeutik
- Kliniske laboratorieteknikker
- Diagnostiske teknikker og procedurer
- Diagnose
- Kemiteknikker, analytisk
- Spektrumanalyse
- Strålebehandling
- Strålebehandling, konform
- Strålebehandling, computerassisteret
- Håndtering af eksemplar
- Magnetisk resonansspektroskopi
- Kirurgiske procedurer, operative
- Strålebehandling, intensitetsmoduleret
- cemiplimab
- Strålebehandling, billedstyret
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- NCI-2024-03425
- U10CA180868 (U.S. NIH-bevilling/kontrakt)
- NCI-2024-03425 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
- NRG-HN014 (Anden identifikator: CTEP)
- NRG-HN014 (Anden identifikator: NRG Oncology)
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
IPD-planbeskrivelse
NCI is committed to sharing data in accordance with NIH policy. For more details on how clinical trial data is shared, access the link to the NIH data sharing policy page.
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