Proton Spatially Fractionated Radiotherapy or Photon Stereotactic Body Radiotherapy in Combination With Pembrolizumab Before Surgery for the Treatment of Locally Advanced and Radiation-Naive Locoregionally Recurrent Oral Cavity Cancer, OSPRI Trial
Phase II: Randomized Neoadjuvant Treatment of Oral Cavity Cancer With Spatially Fractionated Proton Radiotherapy and Immunotherapy (OSPRI)
This phase II trial compares the effect of adding proton spatially fractionated radiotherapy (SFRT) or photon stereotactic body radiotherapy (SBRT) to standard immunotherapy pembrolizumab before surgery (neoadjuvant) in treating patients with oral cavity squamous cell cancer that has spread to nearby tissue or lymph nodes (locally advanced) or that has come back where it first started (primary site) or near it (locoregionally recurrent) and have not had (naive) prior radiation. Radiation therapy uses high energy x-rays, particles, or radioactive seeds to kill tumor cells and shrink tumors. Proton SFRT is a type of external beam radiation treatment that uses streams of protons (tiny particles with a positive charge) to deliver different doses of radiation to different parts of the tumor in a grid like pattern. This type of radiation kills tumor cells but does not damage nearby tissues. SBRT is a type of external radiation therapy that uses special equipment to position a patient and precisely deliver radiation to tumors in the body (except the brain). The total dose of radiation is divided into smaller doses given over several days. This type of radiation therapy helps spare normal tissue. Immunotherapy with monoclonal antibodies, such as pembrolizumab, may help the body's immune system attack the tumor, and may interfere with the ability of tumor cells to grow and spread. Giving neoadjuvant proton SFRT or SBRT in combination with pembrolizumab may be safe and tolerable and may be an effective approach to shrink the tumor, reduce the extent of surgery and/or the need for further treatment in patients with locally advanced or locoregionally recurrent oral cavity squamous cell cancer.
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
- Procédure: Biospecimen Collection
- Biologique: Pembrolizumab
- Procédure: Computed Tomography
- Procédure: Biopsy Procedure
- Procédure: Surgical Procedure
- Procédure: Magnetic Resonance Imaging
- Procédure: Positron Emission Tomography
- Radiation: Spatially-fractionated Radiation Therapy
- Radiation: Photon Stereotactic Body Radiation Therapy
Type d'étude
Inscription (Estimé)
Phase
- Phase 2
Contacts et emplacements
Coordonnées de l'étude
- Nom: Clinical Trials Referral Office
- Numéro de téléphone: 855-776-0015
- E-mail: mayocliniccancerstudies@mayo.edu
Lieux d'étude
-
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Minnesota
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Rochester, Minnesota, États-Unis, 55905
- Recrutement
- Mayo Clinic in Rochester
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Contact:
- Clinical Trials Referral Office
- Numéro de téléphone: 855-776-0015
- E-mail: mayocliniccancerstudies@mayo.edu
-
Chercheur principal:
- Daniel K. Ebner, MD, MPH
-
-
Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
Inclusion Criteria:
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Patients with histologically confirmed human papillomavirus (HPV)/p16-unrelated squamous cell carcinoma of the oral cavity and:
- Either locally advanced (T3-T4) non-metastatic disease, or
- Radiation-naïve locoregionally recurrent disease (prior radiation to a site outside of the treatment fields is permitted)
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Age ≥ 18 years old
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Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≤ 2
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Eligible to receive immunotherapy on multidisciplinary evaluation
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Ability to complete questionnaire(s) by themselves or with assistance
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Provide signed written informed consent in accordance with ethical, regulatory, and institutional requirements
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Willing to return to enrolling institution for follow-up (during the active monitoring phase of the study)
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Willing to consent to and provide tissue and blood samples for correlative research purposes (not the optional Riskguard and OncoExtra testing)
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PD-L1 combined positive score ≥ 1
Exclusion Criteria:
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Participation in another clinical study with an investigational product during the last 3 months (12 weeks)
- Exception: Unless it is an observational (non-interventional) clinical study during the follow-up period of the study
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Contraindications to pembrolizumab
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Prior radiation therapy to the head and neck
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Previous anticancer therapeutic received ≤ 30 days prior to registration, or adequate washout period on a per-agent basis, or concurrent anti-cancer therapeutic not specified by this protocol
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Uncontrolled pre-existing condition(s), such as infection, congestive heart failure, hypertension, angina, arrhythmia, chronic diarrhea, psychiatric conditions, or others, that in the opinion of the treating investigator limits the ability to provide consent or longitudinal participation in this study
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Inability to place 2 or more SFRT spheres within the tumor target
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Prophylactic placement of feeding tubes is not allowed
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
|
Expérimental: Arm A (proton SFRT, pembrolizumab, surgery)
Patients receive proton SFRT QOD for up to 3 treatment fractions over 1 week. Starting within 7 days of initiating SFRT, patients receive pembrolizumab IV on day 1 of each cycle. Cycles repeat every 3 weeks for up to 2 cycles in the absence of disease progression or unacceptable toxicity. Within 8 weeks of completing pembrolizumab, patients undergo surgical resection per standard of care. Patients also undergo blood sample collection, CT, and PET/MRI or PET/CT throughout the study. Additionally, patients may also undergo tissue biopsy at baseline and/or on study. |
Undergo blood sample collection
Autres noms:
Given IV
Autres noms:
Undergo CT or PET/CT
Autres noms:
Undergo tissue biopsy
Autres noms:
Undergo surgical resection
Autres noms:
Undergo PET/MRI
Autres noms:
Undergo PET/CT or PET/MRI
Autres noms:
Receive proton SFRT
Autres noms:
|
|
Expérimental: Arm B (photon SBRT, pembrolizumab, surgery)
Patients receive photon SBRT QOD for up to 3 treatment fractions over 1 week. Starting within 7 days of initiating SBRT, patients receive pembrolizumab IV on day 1 of each cycle. Cycles repeat every 3 weeks for up to 2 cycles in the absence of disease progression or unacceptable toxicity. Within 8 weeks of completing pembrolizumab, patients undergo surgical resection per standard of care. Patients also undergo blood sample collection, CT, and PET/MRI or PET/CT throughout the study. Additionally, patients may also undergo tissue biopsy at baseline and/or on study. |
Undergo blood sample collection
Autres noms:
Given IV
Autres noms:
Undergo CT or PET/CT
Autres noms:
Undergo tissue biopsy
Autres noms:
Undergo surgical resection
Autres noms:
Undergo PET/MRI
Autres noms:
Undergo PET/CT or PET/MRI
Autres noms:
Receive photon SBRT
Autres noms:
|
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Improvement in major pathologic response rate (MPR)
Délai: At the time of surgical resection
|
MPR is defined from pathologic evaluation of the surgically resected tumor, demonstrating less than 10% of residual tumor in the resection sample (≥90% disease reduction). Will be assessed using a Bayesian pick-the-winner randomized phase-II clinical trial design. |
At the time of surgical resection
|
Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Pathologic complete response rate
Délai: At the time of surgical resection
|
Pathologic complete response rate is defined from pathologic evaluation of the surgically resected tumor, demonstrating no signs of residual disease following immuno-radiation. This will be calculated separately for Arm A and for Arm B. |
At the time of surgical resection
|
|
Percent of patients receiving the prescribed therapy
Délai: Up to 1 year
|
Will be defined as the number of patients who received the prescribed therapy divided by the number of evaluable patients who signed a consent form and began treatment. This will be calculated separately for Arm A and Arm B. |
Up to 1 year
|
|
Incidence of Adverse Events (AEs) Prior to Surgery:
Délai: From the time of registration until surgery
|
Overall AEs, overall toxicities, and by maximum grade per type of AE per patient of the AEs that occur before surgery will be explored and summarized descriptively, mainly through the use of frequency tables. Toxicity is defined as an adverse event that is classified as possibly, probably, or definitely related to study treatment. AEs are graded per National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 6.0. |
From the time of registration until surgery
|
Collaborateurs et enquêteurs
Parrainer
Les enquêteurs
- Chercheur principal: Daniel K. Ebner, MD, MPH, Mayo Clinic in Rochester
Publications et liens utiles
Liens utiles
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude (Réel)
Achèvement primaire (Estimé)
Achèvement de l'étude (Estimé)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Réel)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Termes MeSH pertinents supplémentaires
- Tumeurs par site
- Tumeurs
- Tumeurs par type histologique
- Tumeurs de la tête et du cou
- Tumeurs, glandulaires et épithéliales
- Carcinome
- Carcinome épidermoïde
- Carcinome épidermoïde de la tête et du cou
- Techniques d'investigation
- Techniques de laboratoire clinique
- Techniques et procédures de diagnostic
- Diagnostic
- Techniques cytologiques
- Cytodiagnostic
- Techniques de diagnostic, chirurgicale
- Techniques de chimie, analytique
- Analyse du spectre
- Biopsie
- Manipulation des échantillons
- pembrolizumab
- Spectroscopie de résonance magnétique
- Procédures chirurgicales, opératoires
Autres numéros d'identification d'étude
- GMROR2472
- NCI-2026-05918 (Identificateur de registre: CTRP (Clinical Trial Reporting Program))
- 24-011038 (Autre identifiant: Mayo Clinic Institutional Review Board)
Plan pour les données individuelles des participants (IPD)
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Informations sur les médicaments et les dispositifs, documents d'étude
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