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Circulating Tumor DNA-Informed Adjuvant Therapy for Intermediate-Risk Head and Neck Cancer

27 octobre 2026 mis à jour par: Kevin Contrera

Phase II Trial of Drain Fluid Circulating Tumor DNA-Informed Adjuvant Therapy for Intermediate-Risk Head and Neck Cancer

This study is being done to determine whether an assay called LymphDetect™ Head and Neck is a useful tool to help guide treatment decisions for patients with head and neck cancer. The LymphDetect™ assay works to detect a certain kind of DNA that is released by tumors called circulating tumor DNA or ctDNA for short. In this study, the presence of ctDNA will be assessed in fluid collected from the surgical drain that will be placed during curative-intent surgical procedure performed as a part of patient standard care. Treatment after surgery is determined by a patient's disease risk category (low-risk, intermediate-risk, or high-risk). Having intermediate-risk with detection of ctDNA in the surgical drain fluid (SDF+) may mean that a patient is at greater risk of their cancer coming back. To reduce this risk, treatment will be more intensive than if ctDNA in the surgical drain fluid (SDF-) was not found.

Aperçu de l'étude

Statut

Pas encore de recrutement

Les conditions

Intervention / Traitement

Description détaillée

Patients who are Surgical Drain Fluid (SDF) positive have a more than eight-fold higher risk of Head and Neck Squamous Cell Carcinoma disease recurrence. Whether these pathologically intermediate-risk patients benefit from the addition of concurrent cisplatin to adjuvant radiotherapy is unknown. Various prognostic biomarkers have been proposed to identify patients at high risk of recurrence. Tissue-based biomarkers may be less prognostic after successful tumor extirpation. Several plasma-based ctDNA assays measuring treatment response in HPV- HNSCC are under investigation. However, data is limited on the role of such assays for the detection of molecular residual disease (MRD) after surgery, particularly for risk-informed adjuvant treatment decision making. Tumor-informed ctDNA from postoperative SDF, taken 24 hours after surgery, has been shown to be a promising biomarker for individualizing recurrence risk. The LymphDetect™ Head & Neck system, will be used to measure circulating tumor DNA (ctDNA) in surgical drain fluid, the most proximal biofluid to a recently resected tumor, to assess cancer recurrence risk at the source of potential spread - before it can travel to other parts of the body. There is a critical need to improve recurrence risk estimates for patients with HPV- HNSCC to inform the extent of adjuvant management, improve oncologic outcomes, and limit unnecessary treatment morbidity and mortality.

Type d'étude

Interventionnel

Inscription (Estimé)

140

Phase

  • Phase 2

Contacts et emplacements

Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.

Coordonnées de l'étude

  • Nom: Jennifer Ruth, RN, BSN
  • Numéro de téléphone: 412-623-8963
  • E-mail: ruthj2@upmc.edu

Sauvegarde des contacts de l'étude

  • Nom: Mel J Mendez, RN, BSN
  • Numéro de téléphone: 878-261-6071
  • E-mail: mendezmj@upmc.edu

Lieux d'étude

  • États-Unis
    • Pennsylvania
      • Pittsburgh, Pennsylvania, États-Unis, 15232
        • UPMC Hillman Cancer Center
        • Contact:
          • Jennifer Ruth, RN, BSN
          • Numéro de téléphone: 412-623-8963
          • E-mail: ruthj2@upmc.edu
        • Contact:
          • Mel J Mendez, RN, BSN
          • Numéro de téléphone: 878-261-6071
          • E-mail: mendezmj@upmc.edu
        • Chercheur principal:
          • Kevin J Contrera, MD

Critères de participation

Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.

Critère d'éligibilité

Âges éligibles pour étudier

18 ans et plus (Adulte, Adulte plus âgé)

Accepte les volontaires sains

Non

Sexes éligibles pour l'étude

Tout

La description

Inclusion Criteria:

  1. Must have histologically or cytologically confirmed newly diagnosed mucosal HNSCC (i.e., oral cavity, oropharynx, hypopharynx, or larynx).

    o Patients with intermediate-risk disease (stage cT2N0 with adverse pathologic features OR stage cT3-4Nany OR stage cTanyN1-3a) will be preferentially enrolled.

  2. Must have received no prior therapies for current malignancy, except for neoadjuvant pembrolizumab.

  3. Must be able to undergo curative-intent surgical resection with neck dissection and placement of a drain.

  4. Patient is considered a candidate for adjuvant chemotherapy (cisplatin) and radiation based on the clinical judgment of the treating investigator. This decision should be made based upon the patient's pre-operative assessment performed as part of the standard of care.

  5. Age ≥18 years.

  6. Performance status ECOG 0-2

  7. Sexually active, fertile subjects and their partners must agree to use highly effective methods of contraception prior to study entry, during the course of the study, and for 30 days after the last dose of chemotherapy and/or radiation (whichever is later). In addition, men must agree not to donate sperm and women must agree not to donate eggs (ova, oocyte) for the purpose of reproduction during these same periods.

  8. Female subjects of childbearing potential must not be pregnant or breastfeeding at screening. Female subjects are considered to be of childbearing potential unless one of the following criteria is met:

    o Permanent sterilization (hysterectomy, bilateral salpingectomy, or bilateral oophorectomy) or documented postmenopausal status (defined as 12 months of amenorrhea in a woman > 45 years of age in the absence of other biological or physiological causes). Note: Documentation may include review of medical records, medical examination, or medical history interview by study site staff.

  9. Must have the ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

  1. HPV-related oropharyngeal cancer
  2. Nasopharyngeal cancer
  3. Sinonasal cancer
  4. Prior or recurrent HNSCC
  5. Distant metastasis
  6. Other active malignancy, other than nonmetastatic skin, prostate, or thyroid malignancy
  7. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject's participation for the full duration of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating investigator.

Plan d'étude

Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.

Comment l'étude est-elle conçue ?

Détails de conception

  • Objectif principal: Traitement
  • Répartition: Non randomisé
  • Modèle interventionnel: Affectation parallèle
  • Masquage: Aucun (étiquette ouverte)

Armes et Interventions

Groupe de participants / Bras
Intervention / Traitement
Expérimental: Low-Risk
Test diagnostique: LymphDetect assay

A tumor-informed ctDNA assay that uses Surgical Drain Fluid (SDF) collected 24 hours after the end of surgery to direct therapeutic intervention.

Procédure: Surgery +/- neoadjuvant pembrolizumab

Performed within 28 days after baseline assessment to remove Head and Neck Cancer tumor(s).
Expérimental: Intermediate Risk - Surgical Drain Fluid (negative)

IMRT or IMPT to 60 Gy in 30 fractions (2Gy/FX) ± Pembrolizumab - 200 mg q3w - Restart post-surgery (can begin prior to or at the same time as radiation therapy) and continue for up to 17 cycles (including neoadjuvant cycles).

[IMRT / IMPT Schedule to be determined by radiation oncologist, should be completed within 42 days of start date]
Test diagnostique: LymphDetect assay

A tumor-informed ctDNA assay that uses Surgical Drain Fluid (SDF) collected 24 hours after the end of surgery to direct therapeutic intervention.

Procédure: Surgery +/- neoadjuvant pembrolizumab

Performed within 28 days after baseline assessment to remove Head and Neck Cancer tumor(s).

Radiation: Intensity-modulated radiation therapy (IMRT) or Intensity-modulated proton therapy (IMPT)

Advanced type of radiation therapy that uses powerful energy beams to kill cancer cells. The energy can come from X-rays, protons or other sources, in which the beams of radiation are carefully customized.

Médicament: Pembrolizumab

Humanized monoclonal antibody and a PD-1 inhibitor used in cancer immunotherapy that differs from chemotherapy as it does not directly kill cancer cells but stimulates the immune system, particularly T-cells, to recognize and attack cancer cells more effectively.

Autres noms:
  • Keytruda®
Expérimental: Intermediate Risk - Surgical Drain Fluid (positive)

IMRT or IMPT to 60 Gy in 30 fractions (2Gy/FX) with concurrent cisplatin 40 mg/m^2 weekly for 6 doses or 3-weekly 100mg/m2 dose for 3 doses ± Pembrolizumab - 200 mg q3w - Restart post-surgery (can begin prior to or at the same time as radiation therapy) and continue for up to 17 cycles (including neoadjuvant cycles).

[Cisplatin: 40 mg/m^2 weekly (6 total doses) - Day 1, 8, 15, 22, 29, and 36 of radiation therapy or Cisplatin: 100 mg/m^2 q3w (3 total doses) - Day 1, 22, and 43 of radiation therapy (last dose of cisplatin may be after the last dose of radiation)] (If Cisplatin is not tolerated, Carboplatin AUC 2 weekly for 6 doses may be given.)
Test diagnostique: LymphDetect assay

A tumor-informed ctDNA assay that uses Surgical Drain Fluid (SDF) collected 24 hours after the end of surgery to direct therapeutic intervention.

Procédure: Surgery +/- neoadjuvant pembrolizumab

Performed within 28 days after baseline assessment to remove Head and Neck Cancer tumor(s).

Radiation: Intensity-modulated radiation therapy (IMRT) or Intensity-modulated proton therapy (IMPT)

Advanced type of radiation therapy that uses powerful energy beams to kill cancer cells. The energy can come from X-rays, protons or other sources, in which the beams of radiation are carefully customized.

Médicament: Pembrolizumab

Humanized monoclonal antibody and a PD-1 inhibitor used in cancer immunotherapy that differs from chemotherapy as it does not directly kill cancer cells but stimulates the immune system, particularly T-cells, to recognize and attack cancer cells more effectively.

Autres noms:
  • Keytruda®
Médicament: Cisplatin or carboplatin

An alkylating agent that contains platinum, which binds to DNA in cancer cells, causing cross-links that prevent DNA replication and repair, leading to cell death, particularly in rapidly dividing cancer cells.

Autres noms:
  • Platinol®
Expérimental: High Risk

IMRT or IMPT to 60 Gy in 30 fractions (2Gy/FX) with concurrent cisplatin 40 mg/m^2 weekly for 6 doses or 3-weekly 100mg/m2 dose for 3 doses ± Pembrolizumab - 200 mg q3w - Restart post-surgery (can begin prior to or at the same time as radiation therapy) and continue for up to 17 cycles (including neoadjuvant cycles).

[Cisplatin: 40 mg/m^2 weekly (6 total doses) - Day 1, 8, 15, 22, 29, and 36 of radiation therapy or Cisplatin: 100 mg/m^2 q3w (3 total doses) - Day 1, 22, and 43 of radiation therapy (last dose of cisplatin may be after the last dose of radiation)]

(If Cisplatin is not tolerated, Carboplatin AUC 2 weekly for 6 doses may be given.)
Test diagnostique: LymphDetect assay

A tumor-informed ctDNA assay that uses Surgical Drain Fluid (SDF) collected 24 hours after the end of surgery to direct therapeutic intervention.

Procédure: Surgery +/- neoadjuvant pembrolizumab

Performed within 28 days after baseline assessment to remove Head and Neck Cancer tumor(s).

Radiation: Intensity-modulated radiation therapy (IMRT) or Intensity-modulated proton therapy (IMPT)

Advanced type of radiation therapy that uses powerful energy beams to kill cancer cells. The energy can come from X-rays, protons or other sources, in which the beams of radiation are carefully customized.

Médicament: Pembrolizumab

Humanized monoclonal antibody and a PD-1 inhibitor used in cancer immunotherapy that differs from chemotherapy as it does not directly kill cancer cells but stimulates the immune system, particularly T-cells, to recognize and attack cancer cells more effectively.

Autres noms:
  • Keytruda®
Médicament: Cisplatin or carboplatin

An alkylating agent that contains platinum, which binds to DNA in cancer cells, causing cross-links that prevent DNA replication and repair, leading to cell death, particularly in rapidly dividing cancer cells.

Autres noms:
  • Platinol®

Que mesure l'étude ?

Principaux critères de jugement

Mesure des résultats
Description de la mesure
Délai
2-year Locoregional Control (LRC): SDF+ intermediate risk
Délai: At 2 years

Proportion of patients without locoregional recurrence (growth or recurrence of the primary tumor or other nearby structures within the same anatomical region or nearby regional lymph nodes) at 2 years from the initiation of study treatment in patients who are SDF+ intermediate risk.
At 2 years

Mesures de résultats secondaires

Mesure des résultats
Description de la mesure
Délai
2-year Locoregional Control (LRC): SDF- intermediate risk
Délai: At 2 years

Proportion of patients without locoregional recurrence (growth or recurrence of the primary tumor or other nearby structures within the same anatomical region or nearby regional lymph nodes) at 2 years from the initiation of study treatment in patients who are SDF-intermediate risk.
At 2 years
2-year Locoregional Control (LRC)
Délai: At 2 years

Proportion of all patients without disease recurrence (growth or recurrence of the primary tumor or other nearby structures within the same anatomical region or nearby regional lymph nodes) at 2 years from the initiation of study treatment.
At 2 years
2-year Event-free Survival (EFS): SDF+ intermediate risk
Délai: At 2 years

Proportion of patients without disease recurrence (growth or recurrence of the primary tumor and nearby regional lymph nodes or other nearby structures within the same anatomical region), progression, or death from any cause in SDF+ intermediate risk patients at 2 years from the initiation of study treatment.
At 2 years
2-year Event-free Survival (EFS): SDF- intermediate risk
Délai: At 2 year

Proportion of patients without disease recurrence (growth or recurrence of the primary tumor and nearby regional lymph nodes or other nearby structures within the same anatomical region), progression, or death from any cause in SDF- intermediate risk patients at 2 years from the initiation of study treatment.
At 2 year
2-year Event-free Survival (EFS)
Délai: At 2 years

Proportion of all patients without disease recurrence (growth or recurrence of the primary tumor and nearby regional lymph nodes or other nearby structures within the same anatomical region), progression, or death from any cause at 2 years from the initiation of study treatment.
At 2 years
2-year Overall Survival (OS): SDF+ intermediate risk
Délai: At 2 years

Proportion of SDF+ intermediate risk patients alive at 2 years from the initiation of study treatment.
At 2 years
2-year Overall Survival (OS): SDF- intermediate risk
Délai: At 2 years

Proportion of SDF- intermediate risk patients alive at 2 years from the initiation of study treatment.
At 2 years
2-year Overall Survival (OS)
Délai: At 2 year

Proportion of all patients alive at 2 years from the initiation of study treatment.
At 2 year
Incidence of Grade ≥ 3 Treatment-related Adverse Events (AE)
Délai: up to 30 days post-treatment

Number of (distinct) HNSCC patients with grade ≥ 3 Treatment-related Adverse Events (AE)s per CTCAE v5.0.
up to 30 days post-treatment

Collaborateurs et enquêteurs

C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.

Parrainer

Kevin Contrera

Collaborateurs

Droplet Biosciences, Inc.

Les enquêteurs

  • Chercheur principal: Kevin J Contrera, MD, UPMC Cancer Center Hillman

Dates d'enregistrement des études

Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.

Dates principales de l'étude

Début de l'étude (Estimé)

15 novembre 2026

Achèvement primaire (Estimé)

15 novembre 2028

Achèvement de l'étude (Estimé)

15 novembre 2030

Dates d'inscription aux études

Première soumission

27 octobre 2026

Première soumission répondant aux critères de contrôle qualité

27 octobre 2026

Première publication (Réel)

12 novembre 2026

Mises à jour des dossiers d'étude

Dernière mise à jour publiée (Réel)

12 novembre 2026

Dernière mise à jour soumise répondant aux critères de contrôle qualité

27 octobre 2026

Dernière vérification

1 octobre 2026

Plus d'information

Termes liés à cette étude

Mots clés

Termes MeSH pertinents supplémentaires

Autres numéros d'identification d'étude

  • HCC 26-056

Plan pour les données individuelles des participants (IPD)

Prévoyez-vous de partager les données individuelles des participants (DPI) ?

NON

Informations sur les médicaments et les dispositifs, documents d'étude

Étudie un produit pharmaceutique réglementé par la FDA américaine

Oui

Étudie un produit d'appareil réglementé par la FDA américaine

Non

produit fabriqué et exporté des États-Unis.

Non

Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .

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