Ficerafusp Alfa, Pembrolitsumabi ja stereotaktinen kehosädehoito (SBRT) pään ja kaulan okasolusyövässä (HNSCC)
I/II-vaiheen kokeilu Ficerafusp Alfa -hoidon, pembrolitsumabin ja SBRT-hoidon yhdistelmän neoadjuvanttikäytöstä paikallisesti edenneessä pään ja kaulan levyepiteelikarsinoomassa (HNSCC)
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.
Tutkimuksen yleiskatsaus
Tila
Opintotyyppi
Ilmoittautuminen (Arvioitu)
Vaihe
- Vaihe 2
- Vaihe 1
Yhteystiedot ja paikat
Opiskeluyhteys
- Nimi: Sana Karam, MD, PhD
- Puhelinnumero: 314-362-9700
- Sähköposti: sanadkaram@wustl.edu
Tutki yhteystietojen varmuuskopiointi
- Nimi: Sidharth Puram, MD, PhD
- Puhelinnumero: 314-362-9700
- Sähköposti: sidpuram@wustl.edu
Opiskelupaikat
-
-
Missouri
-
St Louis, Missouri, Yhdysvallat, 63110
- Washington University School of Medicine
-
Alatutkija:
- Peter Oppelt, MD
-
Alatutkija:
- Esther Lu, PhD
-
Alatutkija:
- Jesse Zaretsky, MD, PhD
-
Ottaa yhteyttä:
- Sana Karam, MD, PhD
- Puhelinnumero: 314-362-9700
- Sähköposti: sanadkaram@wustl.edu
-
Ottaa yhteyttä:
- Sidharth Puram, MD, PhD
- Puhelinnumero: 314-362-9700
- Sähköposti: sidpuram@wustl.edu
-
Päätutkija:
- Sana Karam, MD, PhD
-
Päätutkija:
- Sidharth Puram, MD, PhD
-
Alatutkija:
- Douglas R Adkins, MD
-
Alatutkija:
- Anthony J Apicelli, MD, PhD
-
Alatutkija:
- Christine Auberle, MD
-
Alatutkija:
- Jennifer De Los Santos, MD
-
Alatutkija:
- Hiram Gay, MD
-
Alatutkija:
- Lannis Hall, MD, MPH
-
Alatutkija:
- Yao Hao, PhD
-
Alatutkija:
- R Alex Harbison, MD, MS
-
Alatutkija:
- Ryan S Jackson, MD
-
Alatutkija:
- Brendan J Knapp, MD
-
Alatutkija:
- Daniel Miller, MD, PhD
-
Alatutkija:
- Patrick Pipkorn, MD
-
Alatutkija:
- Nikhil Rammohan, MD, PhD
-
Alatutkija:
- Jason T Rich, MD
-
Alatutkija:
- Robert D Siegel, MD
-
Alatutkija:
- Wade L Thorstad, MD
-
Alatutkija:
- Gregory R Vlacich, MD, PhD
-
Alatutkija:
- Paul Zolkind, MD
-
-
Osallistumiskriteerit
Kelpoisuusvaatimukset
Opintokelpoiset iät
Hyväksyy terveitä vapaaehtoisia
Sukupuolet, jotka voivat opiskella
Kuvaus
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.
-
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
-
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.
Opintosuunnitelma
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Hoito
- Jako: Ei satunnaistettu
- Inventiomalli: Peräkkäinen tehtävä
- Naamiointi: Ei mitään (avoin tarra)
Aseet ja interventiot
Osallistujaryhmä / Arm |
Interventio / Hoito |
|---|---|
|
Kokeellinen: 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.
Muut nimet:
750mg intravenously (IV) on Days 1, 8, 15, and 22.
Muut nimet:
|
|
Kokeellinen: 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.
Muut nimet:
750mg intravenously (IV) on Days 1, 8, 15, and 22.
Muut nimet:
|
|
Kokeellinen: 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.
Muut nimet:
750mg intravenously (IV) on Days 1, 8, 15, and 22.
Muut nimet:
|
|
Kokeellinen: 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.
Muut nimet:
750mg intravenously (IV) on Days 1, 8, 15, and 22.
Muut nimet:
|
|
Kokeellinen: 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.
Muut nimet:
750mg intravenously (IV) on Days 1, 8, 15, and 22.
Muut nimet:
|
Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
Phase I only: Maximum tolerated dose (MTD) of SBRT in combination with pembrolizumab plus ficerafusp alfa
Aikaikkuna: From start of treatment until date of surgery (total estimated time of 7 weeks)
|
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)
|
|
Phase II only: Rate of pathologic complete response (pCR)
Aikaikkuna: At the time of surgery (estimated to be week 7)
|
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)
|
Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
Vaihe II: vain: Kliinisen ja patologisen alentumisen aste (ja mahdolliset leikkaussuunnitelman muutokset)
Aikaikkuna: Leikkauksen ajankohtana (arviolta viikolla 7)
|
Leikkauksen ajankohtana (arviolta viikolla 7)
|
|
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Phase II only: Number and types of Adverse Events (AEs)
Aikaikkuna: From start of treatment through 5 years after completion of treatment (estimated to be 5 years and 2 months)
|
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)
|
|
Phase II only: Pathological response rate (PRR)
Aikaikkuna: At time of surgery (estimated to be week 7)
|
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)
|
|
Phase II only: Event-free survival (EFS)
Aikaikkuna: From start of treatment through 5 years after completion of treatment (estimated to be 5 years and 2 months)
|
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)
|
|
Phase II only: Overall survival (OS)
Aikaikkuna: From start of treatment through 5 years after completion of treatment (estimated to be 5 years and 2 months)
|
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)
|
Yhteistyökumppanit ja tutkijat
Yhteistyökumppanit
Tutkijat
- Päätutkija: Sana Karam, MD, PhD, Washington University School of Medicine
- Päätutkija: Sidharth Puram, MD, PhD, Washington University School of Medicine
Julkaisuja ja hyödyllisiä linkkejä
Opintojen ennätyspäivät
Opi tärkeimmät päivämäärät
Opiskelun aloitus (Arvioitu)
Ensisijainen valmistuminen (Arvioitu)
Opintojen valmistuminen (Arvioitu)
Opintoihin ilmoittautumispäivät
Ensimmäinen lähetetty
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen Lähetetty (Todellinen)
Tutkimustietojen päivitykset
Viimeisin päivitys julkaistu (Todellinen)
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeksi vahvistettu
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Muita asiaankuuluvia MeSH-ehtoja
- Luun sairaudet
- Tuki- ja liikuntaelinten sairaudet
- Suun sairaudet
- Stomatognaattiset sairaudet
- Neoplasmat sivustoittain
- Neoplasmat
- Leuan sairaudet
- Hengityselinten sairaudet
- Neoplasmat histologisen tyypin mukaan
- Luun kasvaimet
- Kasvaimet, rauhas- ja epiteelikasvaimet
- Hengitysteiden kasvaimet
- Karsinooma
- Kasvaimet, okasolusolut
- Otorinolaryngologiset sairaudet
- Nielun kasvaimet
- Otorinolaryngologiset kasvaimet
- Nielun sairaudet
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- Kallon kasvaimet
- Kielen sairaudet
- Pään ja kaulan okasolusyöpä
- Karsinooma, okasolusolu
- Pään ja kaulan kasvaimet
- Kurkunpään kasvaimet
- Suun kasvaimet
- Huulten kasvaimet
- Suunnielun kasvaimet
- Kielen kasvaimet
- Hypofaryngeaaliset kasvaimet
- Leuan kasvaimet
- pembrolitsumabi
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