- ICH GCP
- Registro de ensayos clínicos de EE. UU.
- Ensayo clínico NCT06568172
Prueba de la adición de un fármaco de inmunoterapia, cemiplimab (REGN2810), más cirugía a la cirugía habitual sola para el tratamiento del cáncer de piel avanzado
Ensayo aleatorizado de fase III de inmunoterapia perioperatoria con tratamiento adaptado a la respuesta versus tratamiento estándar para el carcinoma cutáneo de células escamosas resecable en estadio III / IV
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.
Descripción general del estudio
Estado
Condiciones
- Carcinoma de células escamosas cutáneas de cabeza IV en etapa IV y cuello Carcinoma de células escamosas AJCC V8
- Etapa III Carcinoma de células escamosas cutáneas de cabeza y cuello AJCC V8
- Carcinoma de Células Escamosas del Párpado
- Carcinoma de células escamosas acantolítico de piel
- Carcinoma de Células Escamosas de Células Claras de la Piel
- Carcinoma Linfoepitelial Cutáneo
- Carcinoma de Células Escamosas de Células Fusiformes de la Piel
- Carcinoma de Células Escamosas de Piel con Diferenciación Sarcomatoide
- Carcinoma de Células Escamosas Palpebral Recurrente
- Carcinoma de Células Escamosas Acantolítico de Piel Recurrente
- Carcinoma de Células Escamosas de Células Claras de Piel Recurrente
- Carcinoma Linfoepitelial Cutáneo Recurrente
- Carcinoma de Células Escamosas de Células Fusiformes de Piel Recurrente
- Carcinoma de células escamosas de piel recurrente con diferenciación sarcomatoide
- Carcinoma de Células Escamosas Resecable del Párpado
- Carcinoma de Células Escamosas Acantolítico de Piel Resecable
- Carcinoma de Células Escamosas de Células Claras de la Piel Resecable
- Carcinoma Linfoepitelial Cutáneo Resecable
- Carcinoma de Células Escamosas Fusocelular de Piel Resecable
- Carcinoma de Células Escamosas de Piel Resecable con Diferenciación Sarcomatoide
Intervención / Tratamiento
- Procedimiento: Magnetic Resonance Imaging
- Otro: Questionnaire Administration
- Procedimiento: Positron Emission Tomography
- Radiación: Intensity-Modulated Radiation Therapy
- Biológico: Cemiplimab
- Procedimiento: Computed Tomography
- Procedimiento: Biospecimen Collection
- Radiación: Image Guided Radiation Therapy
- Procedimiento: Surgical Procedure
- Procedimiento: Surgical Procedure
Descripción detallada
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.
Tipo de estudio
Inscripción (Estimado)
Fase
- Fase 3
Contactos y Ubicaciones
Ubicaciones de estudio
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New South Wales
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Camperdown, New South Wales, Australia, 2050
- Chris O'Brien Lifehouse
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Wollongong, New South Wales, Australia, 2500
- Wollongong Hospital
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Queensland
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Townsville, Queensland, Australia, 4814
- Townsville General Hospital
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Woolloongabba, Queensland, Australia, 4102
- Princess Alexandra Hospital
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Victoria
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Fitzroy, Victoria, Australia, 3065
- Saint Vincent's Hospital
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Melbourne, Victoria, Australia, 3000
- Peter MacCallum Cancer Centre
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Western Australia
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Murdoch, Western Australia, Australia, 6150
- Fiona Stanley Hospital
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British Columbia
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Vancouver, British Columbia, Canadá, V5Z 4E6
- BCCA-Vancouver Cancer Centre
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Ontario
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Toronto, Ontario, Canadá, M5G 2M9
- University Health Network-Princess Margaret Hospital
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Toronto, Ontario, Canadá, M4N 3M5
- Odette Cancer Centre- Sunnybrook Health Sciences Centre
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Alabama
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Birmingham, Alabama, Estados Unidos, 35233
- University of Alabama at Birmingham Cancer Center
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Arizona
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Gilbert, Arizona, Estados Unidos, 85234
- Banner MD Anderson Cancer Center
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Phoenix, Arizona, Estados Unidos, 85054
- Mayo Clinic Hospital in Arizona
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California
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Beverly Hills, California, Estados Unidos, 90211
- Tower Cancer Research Foundation
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Duarte, California, Estados Unidos, 91010
- City of Hope Comprehensive Cancer Center
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Encinitas, California, Estados Unidos, 92024
- UC San Diego Health System - Encinitas
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Irvine, California, Estados Unidos, 92618
- City of Hope at Irvine Lennar
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La Jolla, California, Estados Unidos, 92093
- UC San Diego Moores Cancer Center
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Lancaster, California, Estados Unidos, 93534
- City of Hope Antelope Valley
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Los Angeles, California, Estados Unidos, 90033
- USC / Norris Comprehensive Cancer Center
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Los Angeles, California, Estados Unidos, 90048
- Cedars-Sinai Medical Center
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Los Angeles, California, Estados Unidos, 90025
- The Angeles Clinic and Research Institute - West Los Angeles Office
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Oakland, California, Estados Unidos, 94611
- Kaiser Permanente-Oakland
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Palo Alto, California, Estados Unidos, 94304
- Stanford Cancer Institute Palo Alto
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Sacramento, California, Estados Unidos, 95817
- University of California Davis Comprehensive Cancer Center
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Sacramento, California, Estados Unidos, 95823
- Kaiser Permanente-South Sacramento
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San Diego, California, Estados Unidos, 92103
- UC San Diego Medical Center - Hillcrest
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San Francisco, California, Estados Unidos, 94115
- Kaiser Permanente-San Francisco
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South Pasadena, California, Estados Unidos, 91030
- City of Hope South Pasadena
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Torrance, California, Estados Unidos, 90505
- Torrance Memorial Physician Network - Cancer Care
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Upland, California, Estados Unidos, 91786
- City of Hope Upland
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Walnut Creek, California, Estados Unidos, 94596
- Kaiser Permanente-Walnut Creek
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Colorado
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Aurora, Colorado, Estados Unidos, 80045
- UCHealth University of Colorado Hospital
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Colorado Springs, Colorado, Estados Unidos, 80909
- UCHealth Memorial Hospital Central
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Colorado Springs, Colorado, Estados Unidos, 80920
- Memorial Hospital North
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Connecticut
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Greenwich, Connecticut, Estados Unidos, 06830
- Smilow Cancer Hospital Care Center at Greenwich
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Guilford, Connecticut, Estados Unidos, 06437
- Smilow Cancer Hospital Care Center - Guilford
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New Haven, Connecticut, Estados Unidos, 06520
- Yale University
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Trumbull, Connecticut, Estados Unidos, 06611
- Smilow Cancer Hospital Care Center-Trumbull
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Waterbury, Connecticut, Estados Unidos, 06708
- Smilow Cancer Hospital-Waterbury Care Center
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Waterford, Connecticut, Estados Unidos, 06385
- Smilow Cancer Hospital Care Center - Waterford
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Delaware
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Newark, Delaware, Estados Unidos, 19713
- Helen F Graham Cancer Center
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Newark, Delaware, Estados Unidos, 19713
- Medical Oncology Hematology Consultants PA
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Florida
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Aventura, Florida, Estados Unidos, 33180
- UM Sylvester Comprehensive Cancer Center at Aventura
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Coral Gables, Florida, Estados Unidos, 33146
- UM Sylvester Comprehensive Cancer Center at Coral Gables
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Deerfield Beach, Florida, Estados Unidos, 33442
- UM Sylvester Comprehensive Cancer Center at Deerfield Beach
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Doral, Florida, Estados Unidos, 33166
- UM Sylvester Comprehensive Cancer Center at Doral
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Jacksonville, Florida, Estados Unidos, 32224-9980
- Mayo Clinic in Florida
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Miami, Florida, Estados Unidos, 33136
- University of Miami Miller School of Medicine-Sylvester Cancer Center
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Miami, Florida, Estados Unidos, 33176
- Miami Cancer Institute
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Miami, Florida, Estados Unidos, 33176
- UM Sylvester Comprehensive Cancer Center at Kendall
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N. Venice, Florida, Estados Unidos, 34275
- Sarasota Memorial Hospital-Venice
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Plantation, Florida, Estados Unidos, 33324
- UM Sylvester Comprehensive Cancer Center at Plantation
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Sarasota, Florida, Estados Unidos, 34239
- Sarasota Memorial Hospital
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Sarasota, Florida, Estados Unidos, 34232
- Florida Cancer Specialists - Sarasota
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Sarasota, Florida, Estados Unidos, 34243
- Sarasota Memorial Health Care Center at University Parkway
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Sarasota, Florida, Estados Unidos, 34239
- First Physicians Group - Silverstein Institute at Floyd Street
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Sarasota, Florida, Estados Unidos, 34239
- Florida Cancer Specialists - Sarasota Downtown
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Tampa, Florida, Estados Unidos, 33612
- Moffitt Cancer Center
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Tampa, Florida, Estados Unidos, 33607
- Moffitt Cancer Center-International Plaza
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Tampa, Florida, Estados Unidos, 33612
- Moffitt Cancer Center - McKinley Campus
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Venice, Florida, Estados Unidos, 34285
- Florida Cancer Specialists - Venice Island
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Venice, Florida, Estados Unidos, 34275
- Florida Cancer Specialists - Venice Pinebrook
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Georgia
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Atlanta, Georgia, Estados Unidos, 30308
- Emory University Hospital Midtown
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Atlanta, Georgia, Estados Unidos, 30322
- Emory University Hospital/Winship Cancer Institute
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Illinois
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Alton, Illinois, Estados Unidos, 62002
- Alton Memorial Hospital
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Chicago, Illinois, Estados Unidos, 60611
- Northwestern University
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Chicago, Illinois, Estados Unidos, 60612
- University of Illinois
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Chicago, Illinois, Estados Unidos, 60612
- Rush MD Anderson Cancer Center
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DeKalb, Illinois, Estados Unidos, 60115
- Northwestern Medicine Cancer Center Kishwaukee
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Decatur, Illinois, Estados Unidos, 62526
- Decatur Memorial Hospital
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Geneva, Illinois, Estados Unidos, 60134
- Northwestern Medicine Cancer Center Delnor
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Orland Park, Illinois, Estados Unidos, 60462
- Northwestern Medicine Orland Park
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Shiloh, Illinois, Estados Unidos, 62269
- Memorial Hospital East
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Warrenville, Illinois, Estados Unidos, 60555
- Northwestern Medicine Cancer Center Warrenville
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Indiana
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Carmel, Indiana, Estados Unidos, 46032
- IU Health North Hospital
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Goshen, Indiana, Estados Unidos, 46526
- Goshen Center for Cancer Care
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Indianapolis, Indiana, Estados Unidos, 46237
- Franciscan Health Indianapolis
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Indianapolis, Indiana, Estados Unidos, 46202
- Indiana University/Melvin and Bren Simon Cancer Center
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Iowa
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Council Bluffs, Iowa, Estados Unidos, 51503
- Heartland Oncology and Hematology LLP
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Council Bluffs, Iowa, Estados Unidos, 51503
- Methodist Jennie Edmundson Hospital
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Kansas
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Kansas City, Kansas, Estados Unidos, 66160
- University of Kansas Cancer Center
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Overland Park, Kansas, Estados Unidos, 66210
- University of Kansas Cancer Center-Overland Park
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Overland Park, Kansas, Estados Unidos, 66211
- University of Kansas Hospital-Indian Creek Campus
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Westwood, Kansas, Estados Unidos, 66205
- University of Kansas Hospital-Westwood Cancer Center
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Kentucky
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Lexington, Kentucky, Estados Unidos, 40536
- University of Kentucky/Markey Cancer Center
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Louisville, Kentucky, Estados Unidos, 40202
- The James Graham Brown Cancer Center at University of Louisville
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Louisville, Kentucky, Estados Unidos, 40245
- UofL Health Medical Center Northeast
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Louisiana
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Baton Rouge, Louisiana, Estados Unidos, 70805
- LSU Health Baton Rouge-North Clinic
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Baton Rouge, Louisiana, Estados Unidos, 70808
- Our Lady of the Lake Physician Group
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New Orleans, Louisiana, Estados Unidos, 70112
- University Medical Center New Orleans
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Michigan
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Ann Arbor, Michigan, Estados Unidos, 48109
- University of Michigan Rogel Cancer Center
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Brighton, Michigan, Estados Unidos, 48116
- University of Michigan - Brighton Center for Specialty Care
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Detroit, Michigan, Estados Unidos, 48202
- Henry Ford Hospital
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Grand Rapids, Michigan, Estados Unidos, 49503
- Corewell Health Grand Rapids Hospitals - Butterworth Hospital
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West Bloomfield, Michigan, Estados Unidos, 48322
- Henry Ford West Bloomfield Hospital
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Wyoming, Michigan, Estados Unidos, 49519
- University of Michigan Health - West
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Minnesota
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Minneapolis, Minnesota, Estados Unidos, 55455
- University of Minnesota/Masonic Cancer Center
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Rochester, Minnesota, Estados Unidos, 55905
- Mayo Clinic in Rochester
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Missouri
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City of Saint Peters, Missouri, Estados Unidos, 63376
- Siteman Cancer Center at Saint Peters Hospital
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Columbia, Missouri, Estados Unidos, 65212
- MU Health - University Hospital/Ellis Fischel Cancer Center
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Creve Coeur, Missouri, Estados Unidos, 63141
- Siteman Cancer Center at West County Hospital
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Kansas City, Missouri, Estados Unidos, 64154
- University of Kansas Cancer Center - North
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Lee's Summit, Missouri, Estados Unidos, 64064
- University of Kansas Cancer Center - Lee's Summit
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St Louis, Missouri, Estados Unidos, 63110
- Washington University School of Medicine
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St Louis, Missouri, Estados Unidos, 63129
- Siteman Cancer Center-South County
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St Louis, Missouri, Estados Unidos, 63136
- Siteman Cancer Center at Christian Hospital
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Nebraska
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Bellevue, Nebraska, Estados Unidos, 68123
- Nebraska Medicine-Bellevue
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Omaha, Nebraska, Estados Unidos, 68114
- Nebraska Methodist Hospital
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Omaha, Nebraska, Estados Unidos, 68198
- University of Nebraska Medical Center
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Omaha, Nebraska, Estados Unidos, 68118
- Nebraska Medicine-Village Pointe
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Omaha, Nebraska, Estados Unidos, 68114
- Nebraska Cancer Specialists/Oncology Hematology West PC - MECC
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New Hampshire
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Lebanon, New Hampshire, Estados Unidos, 03756
- Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
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New Jersey
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Basking Ridge, New Jersey, Estados Unidos, 07920
- Memorial Sloan Kettering Basking Ridge
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Middletown, New Jersey, Estados Unidos, 07748
- Memorial Sloan Kettering Monmouth
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Montvale, New Jersey, Estados Unidos, 07645
- Memorial Sloan Kettering Bergen
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New Mexico
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Albuquerque, New Mexico, Estados Unidos, 87106
- University of New Mexico Cancer Center
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New York
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Commack, New York, Estados Unidos, 11725
- Memorial Sloan Kettering Commack
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Harrison, New York, Estados Unidos, 10604
- Memorial Sloan Kettering Westchester
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Lake Success, New York, Estados Unidos, 11042
- Northwell Health/Center for Advanced Medicine
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Mineola, New York, Estados Unidos, 11501
- NYU Langone Hospital - Long Island
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New York, New York, Estados Unidos, 10065
- Memorial Sloan Kettering Cancer Center
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New York, New York, Estados Unidos, 10016
- Laura and Isaac Perlmutter Cancer Center at NYU Langone
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New York, New York, Estados Unidos, 10075
- Lenox Hill Hospital
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New York, New York, Estados Unidos, 10065
- Manhattan Eye Ear and Throat Hospital
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Rochester, New York, Estados Unidos, 14642
- University of Rochester
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Stony Brook, New York, Estados Unidos, 11794
- Stony Brook University Medical Center
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Syracuse, New York, Estados Unidos, 13210
- State University of New York Upstate Medical University
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Syracuse, New York, Estados Unidos, 13215
- SUNY Upstate Medical Center-Community Campus
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The Bronx, New York, Estados Unidos, 10461
- Montefiore Medical Center-Einstein Campus
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The Bronx, New York, Estados Unidos, 10467
- Montefiore Medical Center - Moses Campus
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The Bronx, New York, Estados Unidos, 10461
- Montefiore Medical Center-Weiler Hospital
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Uniondale, New York, Estados Unidos, 11553
- Memorial Sloan Kettering Nassau
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Webster, New York, Estados Unidos, 14580
- Wilmot Cancer Institute at Webster
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North Carolina
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Albemarle, North Carolina, Estados Unidos, 28002
- Atrium Health Stanly/LCI-Albemarle
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Chapel Hill, North Carolina, Estados Unidos, 27599
- UNC Lineberger Comprehensive Cancer Center
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Charlotte, North Carolina, Estados Unidos, 28203
- Carolinas Medical Center/Levine Cancer Institute
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Charlotte, North Carolina, Estados Unidos, 28210
- Atrium Health Pineville/LCI-Pineville
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Charlotte, North Carolina, Estados Unidos, 28262
- Atrium Health University City/LCI-University
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Concord, North Carolina, Estados Unidos, 28025
- Atrium Health Cabarrus/LCI-Concord
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Durham, North Carolina, Estados Unidos, 27710
- Duke University Medical Center
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Gastonia, North Carolina, Estados Unidos, 28054
- Levine Cancer Institute-Gaston
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Monroe, North Carolina, Estados Unidos, 28112
- Atrium Health Union/LCI-Union
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Raleigh, North Carolina, Estados Unidos, 27609
- Duke Cancer Center Raleigh
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Shelby, North Carolina, Estados Unidos, 28150
- Atrium Health Cleveland/LCI-Cleveland
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Winston-Salem, North Carolina, Estados Unidos, 27157
- Wake Forest University Health Sciences
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Ohio
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Avon, Ohio, Estados Unidos, 44011
- UH Seidman Cancer Center at UH Avon Health Center
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Beachwood, Ohio, Estados Unidos, 44122
- UHHS-Chagrin Highlands Medical Center
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Centerville, Ohio, Estados Unidos, 45459
- Miami Valley Hospital South
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Cincinnati, Ohio, Estados Unidos, 45219
- University of Cincinnati Cancer Center-UC Medical Center
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Cleveland, Ohio, Estados Unidos, 44106
- Case Western Reserve University
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Cleveland, Ohio, Estados Unidos, 44109
- MetroHealth Medical Center
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Columbus, Ohio, Estados Unidos, 43210
- Ohio State University Comprehensive Cancer Center
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Dayton, Ohio, Estados Unidos, 45415
- Miami Valley Hospital North
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Franklin, Ohio, Estados Unidos, 45005-1066
- Atrium Medical Center-Middletown Regional Hospital
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Greenville, Ohio, Estados Unidos, 45331
- Miami Valley Cancer Care and Infusion
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Mentor, Ohio, Estados Unidos, 44060
- UH Seidman Cancer Center at Lake Health Mentor Campus
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Troy, Ohio, Estados Unidos, 45373
- Upper Valley Medical Center
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West Chester, Ohio, Estados Unidos, 45069
- University of Cincinnati Cancer Center-West Chester
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Oklahoma
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Oklahoma City, Oklahoma, Estados Unidos, 73104
- University of Oklahoma Health Sciences Center
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Oregon
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Portland, Oregon, Estados Unidos, 97213
- Providence Portland Medical Center
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Pennsylvania
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Chadds Ford, Pennsylvania, Estados Unidos, 19317
- Christiana Care Health System-Concord Health Center
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Erie, Pennsylvania, Estados Unidos, 16505
- UPMC Hillman Cancer Center Erie
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Erie, Pennsylvania, Estados Unidos, 16544
- Saint Vincent Hospital
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Hershey, Pennsylvania, Estados Unidos, 17033-0850
- Penn State Milton S Hershey Medical Center
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Johnstown, Pennsylvania, Estados Unidos, 15901
- UPMC-Johnstown/John P. Murtha Regional Cancer Center
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Monroeville, Pennsylvania, Estados Unidos, 15146
- Forbes Hospital
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Philadelphia, Pennsylvania, Estados Unidos, 19111
- Fox Chase Cancer Center
-
Philadelphia, Pennsylvania, Estados Unidos, 19107
- Thomas Jefferson University Hospital
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Pittsburgh, Pennsylvania, Estados Unidos, 15212
- Allegheny General Hospital
-
Pittsburgh, Pennsylvania, Estados Unidos, 15224
- West Penn Hospital
-
Pittsburgh, Pennsylvania, Estados Unidos, 15232
- UPMC Hillman Cancer Center
-
Wexford, Pennsylvania, Estados Unidos, 15090
- Wexford Health and Wellness Pavilion
-
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South Carolina
-
Charleston, South Carolina, Estados Unidos, 29425
- Medical University of South Carolina
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Rock Hill, South Carolina, Estados Unidos, 29732
- Levine Cancer Institute-Rock Hill
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Rock Hill, South Carolina, Estados Unidos, 29730
- Rock Hill Radiation Therapy Center
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Tennessee
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Nashville, Tennessee, Estados Unidos, 37232
- Vanderbilt University/Ingram Cancer Center
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Texas
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Conroe, Texas, Estados Unidos, 77384
- UT MD Anderson - The Woodlands
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Dallas, Texas, Estados Unidos, 75390
- UT Southwestern/Simmons Cancer Center-Dallas
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Dallas, Texas, Estados Unidos, 75237
- UT Southwestern Simmons Cancer Center - RedBird
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Fort Worth, Texas, Estados Unidos, 76104
- UT Southwestern/Simmons Cancer Center-Fort Worth
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Houston, Texas, Estados Unidos, 77030
- UT MD Anderson Cancer Center
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Houston, Texas, Estados Unidos, 77079
- UT MD Anderson - West Houston
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League City, Texas, Estados Unidos, 77573
- UT MD Anderson - League City
-
Richardson, Texas, Estados Unidos, 75080
- UT Southwestern Clinical Center at Richardson/Plano
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San Antonio, Texas, Estados Unidos, 78229
- University of Texas Health Science Center at San Antonio
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Sugar Land, Texas, Estados Unidos, 77478
- UT MD Anderson - Sugar Land
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Utah
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Salt Lake City, Utah, Estados Unidos, 84112
- Huntsman Cancer Institute/University of Utah
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Vermont
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Berlin Corners, Vermont, Estados Unidos, 05602
- Central Vermont Medical Center/National Life Cancer Treatment
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Burlington, Vermont, Estados Unidos, 05401
- University of Vermont Medical Center
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Burlington, Vermont, Estados Unidos, 05405
- University of Vermont and State Agricultural College
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Saint Johnsbury, Vermont, Estados Unidos, 05819
- Dartmouth Cancer Center - North
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Virginia
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Charlottesville, Virginia, Estados Unidos, 22908
- University of Virginia Cancer Center
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Fairfax, Virginia, Estados Unidos, 22031
- Inova Schar Cancer Institute
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Richmond, Virginia, Estados Unidos, 23298
- VCU Massey Comprehensive Cancer Center
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Washington
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Seattle, Washington, Estados Unidos, 98101
- Virginia Mason Medical Center
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Wisconsin
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La Crosse, Wisconsin, Estados Unidos, 54601
- Gundersen Lutheran Medical Center
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Madison, Wisconsin, Estados Unidos, 53705
- William S Middleton VA Medical Center
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Madison, Wisconsin, Estados Unidos, 53792
- University of Wisconsin Carbone Cancer Center - University Hospital
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Madison, Wisconsin, Estados Unidos, 53718
- University of Wisconsin Carbone Cancer Center - Eastpark Medical Center
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Marshfield, Wisconsin, Estados Unidos, 54449
- Marshfield Medical Center-Marshfield
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Menomonee Falls, Wisconsin, Estados Unidos, 53051
- Froedtert Menomonee Falls Hospital
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Milwaukee, Wisconsin, Estados Unidos, 53226
- Medical College of Wisconsin
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Oak Creek, Wisconsin, Estados Unidos, 53154
- Drexel Town Square Health Center
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West Bend, Wisconsin, Estados Unidos, 53095
- Froedtert West Bend Hospital/Kraemer Cancer Center
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Weston, Wisconsin, Estados Unidos, 54476
- Marshfield Medical Center - Weston
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Criterios de participación
Criterio de elegibilidad
Edades elegibles para estudiar
Acepta Voluntarios Saludables
Géneros elegibles para el estudio
Descripción
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.
-
-
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
-
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
-
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)
-
-
Previously untreated or recurrent CSCC
-
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
-
Primary tumor site must be in the head and neck cutaneous region, other non-head and neck cutaneous regions, or eyelid cutaneous region
-
No mucosal squamous cell carcinoma (vermillion lip, nasal, oral, sinonasal, conjunctival, anogenital)
-
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.)
-
At least 1 lesion that is measurable by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1
-
No definitive clinical or radiologic evidence of distant metastatic disease (M1), visceral and/or distant nodal disease
-
Age ≥ 18
-
Eastern Cooperative Oncology Group (ECOG) performance status of 0-2
-
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
-
Absolute neutrophil count (ANC) ≥ 1,000 cells/mm^3
-
Platelets ≥ 75,000 cells/mm^3
-
Hemoglobin ≥ 8.0 g/dl (Note: The use of transfusion or other intervention to achieve hemoglobin [Hgb] ≥ 8.0 g/dl is acceptable)
-
Creatinine clearance (CrCL) > 30mL/min by the Cockcroft-Gault formula
-
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.)
-
Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) ≤ 3 x institutional ULN
-
No prior systemic therapy for the study cancer (including patients currently receiving immunotherapy for a separate malignancy)
-
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
-
No history of myocardial infarction/unstable angina within the last 6 months
-
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)
-
No active infection requiring systemic antibiotics, antiviral, or antifungal treatments
-
No history of allogeneic stem cell transplantation, or autologous stem cell transplantation
-
No history of a solid organ transplant (other than corneal transplant)
-
No active, known, or suspected autoimmune disease
-
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)
-
NOTES:
-
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
-
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
-
-
-
No history of interstitial lung disease (eg, idiopathic pulmonary fibrosis, organizing pneumonia)
-
No active, noninfectious pneumonitis requiring immune-suppressive therapy
-
No active tuberculosis
-
No live vaccines within 28 days prior to registration
-
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)
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Único
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
|---|---|
|
Comparador activo: 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
Otros nombres:
Ancillary studies Undergo PET/CT
Otros nombres:
Undergo IMRT
Otros nombres:
Undergo CT and/or PET/CT
Otros nombres:
Undergo collection of blood and/or plasma
Otros nombres:
Undergo IGRT
Otros nombres:
Undergo surgery per SOC
Otros nombres:
Undergo response-adaptive surgery
Otros nombres:
|
|
Experimental: 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
Otros nombres:
Ancillary studies Undergo PET/CT
Otros nombres:
Undergo IMRT
Otros nombres:
Given IV
Otros nombres:
Undergo CT and/or PET/CT
Otros nombres:
Undergo collection of blood and/or plasma
Otros nombres:
Undergo IGRT
Otros nombres:
Undergo surgery per SOC
Otros nombres:
Undergo response-adaptive surgery
Otros nombres:
|
¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
|
Event-free survival (EFS)
Periodo de tiempo: Up to 6 years
|
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
|
Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
|
Utilization of adjuvant radiation
Periodo de tiempo: Up to 6 years
|
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
|
|
Disease-free survival (DFS)
Periodo de tiempo: From randomization to recurrent or death, assessed up to 6 years
|
DFS will use the same analytic methods as EFS. |
From randomization to recurrent or death, assessed up to 6 years
|
|
Overall survival (OS)
Periodo de tiempo: From randomization to death, assessed up to 6 years
|
OS will use the same analytic methods as EFS. |
From randomization to death, assessed up to 6 years
|
|
Incidence of adverse events
Periodo de tiempo: At 30 days and then up to 6 years
|
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
|
|
Pathologic complete response
Periodo de tiempo: At 1 and 2 years
|
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
|
Otras medidas de resultado
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
|
Quality of life
Periodo de tiempo: From baseline up to 12 months after surgery
|
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
|
|
Validation and scoring of Cutaneous Squamous Cell Carcinoma NeoAdjuvant, Adjuvant and Perioperative 32 question scale (CSCC NAAP-32)
Periodo de tiempo: From baseline up to 12 months after surgery
|
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
|
|
Change in patient-reported symptoms, functioning, and quality of life
Periodo de tiempo: From baseline up to 12 months after surgery
|
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
|
|
Disease-specific survival (DSS)
Periodo de tiempo: From randomization to death due to study cancer, date of precluding event, or last follow up, assessed up to 6 years
|
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
|
|
Pathologic response
Periodo de tiempo: Up to 6 years
|
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
|
|
Overall response rate
Periodo de tiempo: Up to 6 years
|
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
|
|
Failure patterns
Periodo de tiempo: Up to 6 years
|
Failure patterns (local, regional, and distant metastasis) for EFS will be summarized for each treatment arm. |
Up to 6 years
|
|
Lymph node yield
Periodo de tiempo: At time of surgery
|
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
|
|
Primary tumor specimen dimensions
Periodo de tiempo: At time of surgery
|
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
Periodo de tiempo: 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
Periodo de tiempo: 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
Periodo de tiempo: 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
Periodo de tiempo: 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
|
Colaboradores e Investigadores
Patrocinador
Investigadores
- Investigador principal: Neil D Gross, NRG Oncology
Publicaciones y enlaces útiles
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio (Actual)
Finalización primaria (Estimado)
Finalización del estudio (Estimado)
Fechas de registro del estudio
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Actual)
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Más información
Términos relacionados con este estudio
Términos MeSH relevantes adicionales
- Técnicas de investigación
- Terapéutica
- Técnicas de laboratorio clínico
- Técnicas y procedimientos de diagnóstico
- Diagnóstico
- Técnicas de química, analítica
- Análisis de espectro
- Radioterapia
- Radioterapia, conforme
- Radioterapia, asistida por computadora
- Manejo de muestras
- Espectroscopía de resonancia magnética
- Procedimientos quirúrgicos, operativo
- Radioterapia, modulada por intensidad
- cemiplimab
- Radioterapia, guiada por imágenes
Otros números de identificación del estudio
- NCI-2024-03425
- U10CA180868 (Subvención/contrato del NIH de EE. UU.)
- NCI-2024-03425 (Identificador de registro: CTRP (Clinical Trial Reporting Program))
- NRG-HN014 (Otro identificador: CTEP)
- NRG-HN014 (Otro identificador: NRG Oncology)
Plan de datos de participantes individuales (IPD)
¿Planea compartir datos de participantes individuales (IPD)?
Descripción del plan IPD
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.
Información sobre medicamentos y dispositivos, documentos del estudio
Estudia un producto farmacéutico regulado por la FDA de EE. UU.
Estudia un producto de dispositivo regulado por la FDA de EE. UU.
producto fabricado y exportado desde los EE. UU.
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