Ficerafusp Alfa, Pembrolizumab y radioterapia corporal estereotáctica (SBRT) para el carcinoma de células escamosas de cabeza y cuello (HNSCC)
Ensayo de fase I/II de combinación neoadyuvante de Ficerafusp Alfa, Pembrolizumab y SBRT para el carcinoma de células escamosas de cabeza y cuello (HNSCC) localmente avanzado
The study is an open-label phase I/II clinical trial. The study will enroll patients to receive neoadjuvant SBRT plus 1 or 2 doses of neoadjuvant pembrolizumab with concurrent ficerafusp alfa (4 doses) prior to definitive surgical resection for high-risk, locoregionally advanced HPV-negative head and neck squamous cell carcinoma (HNSCC). Approximately 6 weeks after end of SBRT, patients will undergo standard of care (SOC) surgical resection followed by SOC adjuvant chemoradiation per National Comprehensive Cancer Network (NCCN) guidelines. Adjuvant therapy is not part of this study and therefore is not dictated by study protocol.
Descripción general del estudio
Estado
Condiciones
Intervención / Tratamiento
Tipo de estudio
Inscripción (Estimado)
Fase
- Fase 2
- Fase 1
Contactos y Ubicaciones
Estudio Contacto
- Nombre: Sana Karam, MD, PhD
- Número de teléfono: 314-362-9700
- Correo electrónico: sanadkaram@wustl.edu
Copia de seguridad de contactos de estudio
- Nombre: Sidharth Puram, MD, PhD
- Número de teléfono: 314-362-9700
- Correo electrónico: sidpuram@wustl.edu
Ubicaciones de estudio
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Missouri
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St Louis, Missouri, Estados Unidos, 63110
- Washington University School of Medicine
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Sub-Investigador:
- Peter Oppelt, MD
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Sub-Investigador:
- Esther Lu, PhD
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Sub-Investigador:
- Jesse Zaretsky, MD, PhD
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Contacto:
- Sana Karam, MD, PhD
- Número de teléfono: 314-362-9700
- Correo electrónico: sanadkaram@wustl.edu
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Contacto:
- Sidharth Puram, MD, PhD
- Número de teléfono: 314-362-9700
- Correo electrónico: sidpuram@wustl.edu
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Investigador principal:
- Sana Karam, MD, PhD
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Investigador principal:
- Sidharth Puram, MD, PhD
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Sub-Investigador:
- Douglas R Adkins, MD
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Sub-Investigador:
- Anthony J Apicelli, MD, PhD
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Sub-Investigador:
- Christine Auberle, MD
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Sub-Investigador:
- Jennifer De Los Santos, MD
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Sub-Investigador:
- Hiram Gay, MD
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Sub-Investigador:
- Lannis Hall, MD, MPH
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Sub-Investigador:
- Yao Hao, PhD
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Sub-Investigador:
- R Alex Harbison, MD, MS
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Sub-Investigador:
- Ryan S Jackson, MD
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Sub-Investigador:
- Brendan J Knapp, MD
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Sub-Investigador:
- Daniel Miller, MD, PhD
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Sub-Investigador:
- Patrick Pipkorn, MD
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Sub-Investigador:
- Nikhil Rammohan, MD, PhD
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Sub-Investigador:
- Jason T Rich, MD
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Sub-Investigador:
- Robert D Siegel, MD
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Sub-Investigador:
- Wade L Thorstad, MD
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Sub-Investigador:
- Gregory R Vlacich, MD, PhD
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Sub-Investigador:
- Paul Zolkind, MD
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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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Newly diagnosed histologically or cytologically confirmed locally advanced, OPC HPV-negative head and neck squamous cell carcinoma (OPSCC) or HNSCC arising from oral cavity, larynx, or hypopharynx.
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Baseline resectable disease per the judgment of the treating surgical oncologist.
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Clinical stage III, IVA, or IVB disease as defined using the 8th (2017) edition of the tumor, node, metastasis (TNM) staging system by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC):
- T1-2, N1-3 or
- T3, any N or
- T4, any N
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Documented tumor PD-L1 CPS ≥ 1 (by PD-L1 IHC pharmDx assay), determined locally.
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Willing to provide blood and newly obtained core or excisional biopsy of tumor lesion pre-treatment and at the time of surgery for pathologic and correlative analyses.
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Age 18 years or older at the time of informed consent.
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Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
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Adequate organ and marrow function as defined below:
- Absolute neutrophil count ≥ 1.5 K/cumm
- Platelets ≥ 100 K/cumm
- Hemoglobin ≥ 9 g/dL (without PRBC transfusion in the prior 7 days)
- Total serum bilirubin ≤ 1.5 x IULN (except for subjects with documented diagnosis of Gilbert syndrome). For subjects with a documented diagnosis of Gilbert's syndrome, total bilirubin must be ≤ 3.0 × ULN, provided that direct bilirubin is within normal limits
- AST(SGOT)/ALT(SGPT) ≤ 2.5 x IULN
- Creatinine clearance (measured or calculated via the Cockcroft-Gault equation or per institutional standards) ≥ 30 mL/min
- PT/INR or aPTT ≤ 1.5 x IULN (except for subjects receiving anticoagulant therapy)
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The effects of pembrolizumab and ficerafusp alfa on the developing human fetus are unknown. For this reason, people of childbearing potential and people able to father a child must agree to use adequate contraception prior to study entry, for the duration of study participation, and for 120 days (women) or 90 days (men) after completion of study treatment.
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Ability to understand and the willingness to sign a written informed consent document. Legally authorized representatives may sign and give informed consent on behalf of study participants.
Exclusion Criteria:
- Currently receiving any other investigational agents.
- Prior history of grade ≥ 2 intolerance or hypersensitivity reactions to other murine proteins, or the active substances of ficerafusp alfa, pembrolizumab, or any of their excipients.
- At higher risk of bleeding, including known bleeding diathesis or current active major bleeding, or recent major bleeding episode (within 4 weeks prior to enrollment).
- Any of the following within 6 months prior to starting study treatment: ST-elevation myocardial infarction, severe/unstable angina, uncontrolled cardiac ventricular arrhythmia, coronary/peripheral artery bypass graft or stent, cerebrovascular accident/stroke less than 6 months prior to enrollment, or congestive heart failure. Subjects with deep vein thrombosis who are hemodynamically stable can enroll if they are on a stable dose of anticoagulants for at least 3 months.
- Active autoimmune disease requiring systemic treatment in the past 2 years (i.e., with use of disease modifying agents, corticosteroids, or immunosuppressive drugs). Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment.
- Active systemic infection requiring either hospitalization or parenteral anti-infective therapy within 2 weeks before first dose of study treatment.
- Chronic hepatitis B virus (HBV) infection with active disease meeting the criteria for anti-HBV therapy but not on a suppressive antiviral therapy prior to initiation of study treatment. HBV testing not required in the absence of known history of infection. Note: Subjects who are hepatitis B surface antigen positive are eligible if they have received HBV antiviral therapy for at least 4 weeks and have undetectable HBV viral load prior to randomization. These subjects should remain on antiviral therapy throughout the study treatment period and follow local guidelines for HBV antiviral therapy post completion of study treatment.
- Known history of hepatitis C virus (HCV) infection that has not been cured or that has a detectable viral load. Patients with a history of HCV that has been treated and cured are eligible provided they completed curative antiviral therapy at least 4 weeks prior to initiation of study treatment. Patients with HCV infection who are currently on treatment and have an undetectable HCV viral load are eligible. HCV testing not required in the absence of known history of infection.
- Known history of human immunodeficiency virus (HIV) (HIV 1/2 antibodies) with viral load >0 or CD4<350. HIV testing is not required in the absence of known history of infection.
- Receipt of any organ transplantation, including autologous and allogeneic stem cell transplantation, except for transplants that do not require immunosuppression.
- Known to be diagnosed and/or treated for any other additional malignancy within 2 years prior to randomization with the exception of the following: curatively treated basal cell carcinoma or squamous cell carcinoma of the skin, and curatively resected in situ cervical cancer, and curatively resected in situ breast cancer, and low-risk early stage prostate cancer defined as follows: Stage T1c or T2a with a Gleason score ≤ 6 and prostatic-specific antigen < 10 ng/mL either treated with definitive intent or untreated in active surveillance that has been stable for the past year prior to study entry. Other exceptions may be considered with the PI's consultation. The time requirement for no malignancy for 2 years does not apply to the cancer for which a subject is enrolled in the study.
- Any condition requiring systemic treatment with either corticosteroids (>10 mg daily of prednisone or equivalent) or other immunosuppressive medication within 7 days prior to the first dose of study treatment, except for topical, intranasal, intrabronchial, or ocular steroids. Corticosteroid use as premedication for allergic reactions (e.g., intravenous contrast), or as a prophylactic management of AEs related to the therapies specified in the protocol is allowed. The use of physiologic doses of corticosteroids may be approved after consultation with the principle-Investigator.
- Use of a live or live attenuated vaccine within 4 weeks prior to Screening. Note: Administration of killed, recombinant, or inactivated vaccines is allowed.
- Pregnant or breastfeeding. People of childbearing potential must have a negative pregnancy test at screening and within 7 days of first dose of study treatment.
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: No aleatorizado
- Modelo Intervencionista: Asignación Secuencial
- Enmascaramiento: Ninguno (etiqueta abierta)
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
|---|---|
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Experimental: Phase 1 Dose Level 1: Dose De-Escalation Neoadjuvant SBRT and pembrolizumab plus ficerafusp alfa
Treatment during the Phase 1 Level 1 consists of Stereotactic Body Radiotherapy (SBRT) at 8 Gy x 3 fractions over one week (given on Days 1, 3, and 5), 2 doses of neoadjuvant pembrolizumab at 200 mg (given on D1 and D22), and 4 weekly doses of ficerafusp alfa at 750 mg (given on D1, D8, D15, and D22). Six weeks after end of SBRT, patients will undergo standard of care (SOC) surgical resection, or biopsy for patients who do not undergo resection, followed by standard of care (SOC) adjuvant chemoradiation per National Comprehensive Cancer Network (NCCN) guidelines. |
1-3 fractions given over 1 week as assigned in phase I and as determined to be the maximum tolerated dose (MTD) in phase II 200 mg intravenously (IV) given on Day 1 or Days 1 and 22 as assigned in phase I and as determined to be the maximum tolerated dose (MTD) in phase II.
Otros nombres:
750mg intravenously (IV) on Days 1, 8, 15, and 22.
Otros nombres:
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Experimental: Phase 1 Dose Level -1: Dose De-Escalation Neoadjuvant SBRT and pembrolizumab plus ficerafusp alfa
Treatment during the Phase 1 Level -1 consists of Stereotactic Body Radiotherapy (SBRT) at 8 Gy x 3 fractions over one week (given on Days 1, 3, and 5), 1 dose of neoadjuvant pembrolizumab at 200 mg (given on D1), and 4 weekly doses of ficerafusp alfa at 750 mg (given on D1, D8, D15, and D22). Six weeks after end of SBRT, patients will undergo standard of care (SOC) surgical resection, or biopsy for patients who do not undergo resection, followed by standard of care (SOC) adjuvant chemoradiation per National Comprehensive Cancer Network (NCCN) guidelines. |
1-3 fractions given over 1 week as assigned in phase I and as determined to be the maximum tolerated dose (MTD) in phase II 200 mg intravenously (IV) given on Day 1 or Days 1 and 22 as assigned in phase I and as determined to be the maximum tolerated dose (MTD) in phase II.
Otros nombres:
750mg intravenously (IV) on Days 1, 8, 15, and 22.
Otros nombres:
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Experimental: Phase 1 Dose Level -2: Dose De-Escalation Neoadjuvant SBRT and pembrolizumab plus ficerafusp alfa
Treatment during the Phase 1 Level -2 consists of Stereotactic Body Radiotherapy (SBRT) at 8 Gy x 3 fractions over one week (given on Days 1 and 4), 1 dose of neoadjuvant pembrolizumab at 200 mg (given on D1), and 4 weekly doses of ficerafusp alfa at 750 mg (given on D1, D8, D15, and D22). Six weeks after end of SBRT, patients will undergo standard of care (SOC) surgical resection, or biopsy for patients who do not undergo resection, followed by standard of care (SOC) adjuvant chemoradiation per National Comprehensive Cancer Network (NCCN) guidelines. |
1-3 fractions given over 1 week as assigned in phase I and as determined to be the maximum tolerated dose (MTD) in phase II 200 mg intravenously (IV) given on Day 1 or Days 1 and 22 as assigned in phase I and as determined to be the maximum tolerated dose (MTD) in phase II.
Otros nombres:
750mg intravenously (IV) on Days 1, 8, 15, and 22.
Otros nombres:
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Experimental: Phase 1 Dose Level -3: Dose De-Escalation Neoadjuvant SBRT and pembrolizumab plus ficerafusp alfa
Treatment during the Phase 1 Level -3 consists of Stereotactic Body Radiotherapy (SBRT) at 8 Gy x 3 fractions over one week (given on Day 1), 1 dose of neoadjuvant pembrolizumab at 200 mg (given on D1), and 4 weekly doses of ficerafusp alfa at 750 mg (given on D1, D8, D15, and D22). Six weeks after end of SBRT, patients will undergo standard of care (SOC) surgical resection, or biopsy for patients who do not undergo resection, followed by standard of care (SOC) adjuvant chemoradiation per National Comprehensive Cancer Network (NCCN) guidelines. |
1-3 fractions given over 1 week as assigned in phase I and as determined to be the maximum tolerated dose (MTD) in phase II 200 mg intravenously (IV) given on Day 1 or Days 1 and 22 as assigned in phase I and as determined to be the maximum tolerated dose (MTD) in phase II.
Otros nombres:
750mg intravenously (IV) on Days 1, 8, 15, and 22.
Otros nombres:
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Experimental: Phase 2: Maximum Tolerable Dose (MTD) Neoadjuvant SBRT and pembrolizumab plus ficerafusp alfa
Treatment consists of SBRT beginning on D1 at the dose and number of fractions established in phase I, neoadjuvant pembrolizumab 200 mg at the number of doses established in phase I, and 4 weekly doses of ficerafusp alfa 750 mg (given on D1, D8, D15, and D22). Six weeks after end of SBRT, patients will undergo standard of care (SOC) surgical resection, or biopsy for patients who do not undergo resection, followed by standard of care (SOC) adjuvant chemoradiation per National Comprehensive Cancer Network (NCCN) guidelines. |
1-3 fractions given over 1 week as assigned in phase I and as determined to be the maximum tolerated dose (MTD) in phase II 200 mg intravenously (IV) given on Day 1 or Days 1 and 22 as assigned in phase I and as determined to be the maximum tolerated dose (MTD) in phase II.
Otros nombres:
750mg intravenously (IV) on Days 1, 8, 15, and 22.
Otros nombres:
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¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Phase I only: Maximum tolerated dose (MTD) of SBRT in combination with pembrolizumab plus ficerafusp alfa
Periodo de tiempo: From start of treatment until date of surgery (total estimated time of 7 weeks)
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The maximum tolerated dose (MTD) is defined as the highest dose level at which 0 or 1 patients of a cohort experience dose-limiting toxicity during the dose limiting toxicity (DLT) window. DLTs are defined in the protocol. |
From start of treatment until date of surgery (total estimated time of 7 weeks)
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Phase II only: Rate of pathologic complete response (pCR)
Periodo de tiempo: At the time of surgery (estimated to be week 7)
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Response will be defined according to the systematic pTR system. pTR is defined as the presence of tumor cell necrosis and keratinous debris with giant cell/histiocytic reaction, quantified as a percentage of the overall tumor bed (area pathologic response/area pathologic response plus viable tumor). pCR is defined as follows: 100% of sample characterized by tumor necrosis, keratinous debris, and/or giant cells/histiocytes |
At the time of surgery (estimated to be week 7)
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Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Fase II solamente: Tasa de reducción de estadio clínico a patológico (y la extensión de las modificaciones del plan quirúrgico, si las hubiera)
Periodo de tiempo: En el momento de la cirugía (estimado para la semana 7)
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En el momento de la cirugía (estimado para la semana 7)
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Phase II only: Number and types of Adverse Events (AEs)
Periodo de tiempo: From start of treatment through 5 years after completion of treatment (estimated to be 5 years and 2 months)
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As defined by CTCAE v5.0. |
From start of treatment through 5 years after completion of treatment (estimated to be 5 years and 2 months)
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Phase II only: Pathological response rate (PRR)
Periodo de tiempo: At time of surgery (estimated to be week 7)
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PRR is categorized as pCR, mPR, and others (pTR-0, pTR-1, pTR-2). Simon's two-stage optimal design will be used for a rate of pCR in phase II. Response will be defined according to the systematic pTR system. pTR is defined as the presence of tumor cell necrosis and keratinous debris with giant cell/histiocytic reaction, quantified as a percentage of the overall tumor bed (area pathologic response/area pathologic response plus viable tumor). pTR is defined as follows: pTR-0: < 10% of sample characterized by tumor necrosis, keratinous debris, and/or giant cells/histiocytes, pTR-1: 10-49%, pTR-2: 50-89%, pTR-3: 90-99% (also referred to as mPR), and pTR-4: 100% (also referred to as pCR). |
At time of surgery (estimated to be week 7)
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Phase II only: Event-free survival (EFS)
Periodo de tiempo: From start of treatment through 5 years after completion of treatment (estimated to be 5 years and 2 months)
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EFS is defined as the time from the first date of treatment to the date of disease progression or death, whichever occurs first. |
From start of treatment through 5 years after completion of treatment (estimated to be 5 years and 2 months)
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Phase II only: Overall survival (OS)
Periodo de tiempo: From start of treatment through 5 years after completion of treatment (estimated to be 5 years and 2 months)
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OS is defined as the time from the first date of treatment to the date of death. Alive patients are censored at the last follow-up otherwise. |
From start of treatment through 5 years after completion of treatment (estimated to be 5 years and 2 months)
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Colaboradores e Investigadores
Patrocinador
Colaboradores
Investigadores
- Investigador principal: Sana Karam, MD, PhD, Washington University School of Medicine
- Investigador principal: Sidharth Puram, MD, PhD, Washington University School of Medicine
Publicaciones y enlaces útiles
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio (Estimado)
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
Palabras clave
- Inhibidor de puntos de control
- Inmunoterapia
- Terapia dirigida
- Keytruda
- HNSCC
- Inhibidor de EGFR
- Radioterapia
- Cáncer oral
- Cáncer orofaríngeo
- Cáncer de cabeza y cuello
- Terapia neoadyuvante
- Inhibidor de PD-1
- OPSCC
- Carcinoma de células escamosas
- Radioterapia corporal estereotáctica
- Cáncer de lengua
- Cáncer de laringe
- Tratamiento preoperatorio
- Cáncer de cavidad oral
- Cáncer de hipofaringe
- Avance localmente
- Cáncer de garganta
- Tratamiento curativo
- BCA101
- Radiación con fraccionamiento acortado
- "Cáncer de encía"
- Cáncer de mandíbula
- Cáncer de paladar
- Cáncer de labio
- cáncer de boca
- Cáncer de laringe
- Cáncer mandibular
- Cáncer de cresta alveolar
- OCC
- OCSCC
- HP-negativo
Términos MeSH relevantes adicionales
- Enfermedades óseas
- Enfermedades musculoesqueléticas
- Enfermedades de la Boca
- Enfermedades Estomatognáticas
- Neoplasias por sitio
- Neoplasias
- Enfermedades de la mandíbula
- Enfermedades de las vías respiratorias
- Neoplasias por tipo histológico
- Neoplasias Óseas
- Neoplasias Glandulares y Epiteliales
- Neoplasias de las vías respiratorias
- Carcinoma
- Neoplasias De Células Escamosas
- Enfermedades Otorrinolaringológicas
- Neoplasias faríngeas
- Neoplasias Otorrinolaringológicas
- Enfermedades faríngeas
- Enfermedades de la laringe
- Enfermedades de los labios
- Neoplasias de cráneo
- Enfermedades de la lengua
- Carcinoma de células escamosas de cabeza y cuello
- Carcinoma De Células Escamosas
- Neoplasias de Cabeza y Cuello
- Neoplasias Laríngeas
- Neoplasias de la Boca
- Neoplasias del Labio
- Neoplasias orofaríngeas
- Neoplasias de la lengua
- Neoplasias Hipofaríngeas
- Neoplasias de Mandíbula
- pembrolizumab
Otros números de identificación del estudio
- 202604179
Plan de datos de participantes individuales (IPD)
¿Planea compartir datos de participantes individuales (IPD)?
Información sobre medicamentos y dispositivos, documentos del estudio
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