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Multimodality Therapy before and after Surgery in Patients with Squamous Cell Carcinoma of the Head and Neck

Trial Status: Active

This phase II clinical trial studies how well multimodality therapy works before and after surgery in patients with squamous cell carcinoma of the head and neck. Immunotherapy with monoclonal antibodies, such as durvalumab, may induce changes in body’s immune system and may interfere with the ability of tumor cells to grow and spread. Drugs used in chemotherapy, such as carboplatin, nab-paclitaxel, and cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Radiation therapy uses high energy x-rays to kill tumor cells and shrink tumors. Giving carboplatin, nab-paclitaxel, and durvalumab before surgery and using durvalumab with or without radiation therapy and cisplatin after surgery may kill more tumor cells in patients with head and neck cancer.

Inclusion Criteria

  • Previously untreated, histologically proven, surgically resectable primary squamous cell carcinoma of the head and neck, stage III or IV (human papilloma virus [HPV] positive or negative non-metastatic disease) according to the American Joint Committee on Cancer (AJCC) Cancer Staging Manual, 7th edition; SCCHN of unknown primary is excluded; SCCHN of the oral cavity is allowed; unambiguously squamous Epstein-Barr virus (EBV)-negative nasopharynx cancer will not be excluded nor will unambiguously squamous cancers of the skull base that are clearly surgically resectable and clearly squamous; squamous skin cancer occurring in the head/neck region will not be eligible nor will EBV+ nasopharynx cancer *Note: induction chemotherapy is not considered standard therapy for SCCHN of the oral cavity and participation on this trial will lead to a delay in time to definitive, potentially curative therapy i.e, surgery
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0-1
  • Measurable disease as per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST1.1)
  • Absolute neutrophil count (ANC) >= 1,500 cells/mm^3
  • Hemoglobin (Hgb) >= 10 g/dL (use of transfusion to reach this threshold prior to study initiation is acceptable)
  • Platelet count >= 100 x 10^9/L
  • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 2.5 x upper limit of normal (ULN)
  • Total serum bilirubin =< 1.5 ULN
  • Creatinine clearance (CrCL) > 40 mL/min as measured via Cockcroft-Gault
  • Negative serum beta-human chorionic gonadotropin (hCG) pregnancy test within 72 hours of day 1 of induction chemotherapy in women of child-bearing potential
  • All males and females of childbearing potential must agree to use adequate contraception during the study; adequate contraception is defined as any medically recommended method (or combination of methods) as per standard of care; females of non-childbearing potential are those who are postmenopausal greater than 1 year or who have had a bilateral tubal ligation or hysterectomy or bilateral oophorectomy
  • Signed an institutional review board (IRB)-approved informed consent and Health Insurance Portability and Accountability Act (HIPAA) authorization
  • Subject is willing and able to comply with the protocol for the duration of the study including undergoing treatment and scheduled visits and examinations including follow up
  • Subjects must agree to allow use of any pre-treatment tissue remaining after definitive diagnosis is made (ie, archival and or fresh tissue) for research purposes; in addition, subjects must consent to allow use of their residual post-operative tissue for research purposes

Exclusion Criteria

  • Involvement in the planning and/or conduct of the study (applies to staff at the study site) or previous enrollment in the present study
  • Any metastatic disease
  • Known history of previous clinical diagnosis of tuberculosis
  • History and/or confirmed pneumonitis
  • Low-risk HPV+ disease of the oropharynx, defined as meeting all of the following criteria: * Patients with known HPV+ by fluorescence in situ hybridization (FISH) and/or p16 * Smoking history =< 10 pack years * Stage T1-2N0-2b, T3N0
  • Not considered eligible for any of the chemotherapy agents included in the induction regimen
  • Current active hepatic or biliary disease (with exception of patients with Gilbert's syndrome, asymptomatic gallstones, or stable chronic liver disease per investigator assessment)
  • Major surgery within 28 days prior to day 1 of study treatment from which the patient has not completely recovered
  • Receiving any investigational agent currently or within 28 days or 5 half-lives of day 1 of treatment on this study
  • Active, serious infection, medical, or psychiatric condition that would represent an inappropriate risk to the patient or would likely compromise achievement of the primary study objective, including unstable angina, serious uncontrolled cardiac arrhythmia, uncontrolled infection, or myocardial infarction =< 6 months prior to study entry
  • Active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease [e.g., colitis, Crohn’s disease], diverticulitis with the exception of a prior episode that has resolved or diverticulosis, celiac disease, irritable bowel disease, or other serious gastrointestinal chronic conditions associated with diarrhea; systemic lupus erythematosus; Wegener’s syndrome [granulomatosis with polyangiitis]; myasthenia gravis; rheumatoid arthritis; hypophysitis, uveitis; etc) within the past 2 years prior to the start of treatment NOTE: Subjects with vitiligo, Grave’s disease, or psoriasis not requiring systemic treatment (within the past 2 years) are not excluded
  • Known mean QT interval corrected for heart rate (QTc) >= 470 ms calculated from 3 electrocardiograms (ECGs) using Fridericia’s correction. (Note that ECG is not required for study entry and is not part of study procedures)
  • Other prior or concomitant malignancies with the exception of: * Non-melanoma skin cancer * In-situ malignancy * Low-risk prostate cancer after curative therapy * Other cancer for which the patient has been disease free for >= 5 years before the first dose of study drug and of low potential risk for recurrence
  • Any concurrent chemotherapy, investigational product (IP), biologic or hormonal therapy for cancer treatment; concurrent use of hormonal therapy for non-cancer-related conditions (e.g. hormone replacement therapy) is acceptable
  • Current or prior use of immunosuppressive medication within 14 days prior to the first dose of durvalumab; the following are exceptions to this criterion: intranasal, inhaled, topical or local steroid injections (eg. intra-articular injection); steroids as premedication for hypersensitivity reactions; systemic corticosteroid at physiologic doses not to exceed 10mg/day of prednisone or equivalent; (NOTE: If systemic corticosteroids are part of the treatment regimen for the indication under study, the systemic corticosteroid is permitted)
  • Known human immunodeficiency virus (HIV), hepatitis C virus (HCV) or evidence of active hepatitis B virus (HBV)
  • History of hypersensitivity to durvalumab or any excipient
  • Receipt of live attenuated vaccination within 30 days prior the first dose of durvalumab (NOTE: If a vaccine is part of the treatment regimen for the indication under study, the vaccine is permitted)
  • Female subjects who are pregnant, breast-feeding or female patients of reproductive potential who are not employing an effective method of birth control from starting dose of study medications (cycle 1 day 1), including dosing interruptions through 90 days after receipt of the last dose of durvalumab; refrain from egg cell donation while taking durvalumab and for at least 90 days after the last dose of durvalumab
  • Male subjects who are not employing an effective method of birth control from starting dose of study medications (cycle 1 day 1), including dosing interruptions through 6 months after receipt of study treatment; male subjects should agree to refrain from sperm donation while taking study treatment and for at least 6 months after the last dose of nab-paclitaxel and at least 90 days after the last dose of durvalumab; should a female partner of a male patient become pregnant or suspect she is pregnant while participating in the study, he should inform his treating physician and the female partner should call her physician immediately
  • Any previous treatment with a PD1 or PD-L1 inhibitor, including durvalumab
  • History of primary immunodeficiency
  • History of organ transplant
  • Any condition that, in the opinion of the investigator, would interfere with evaluation of study treatment or interpretation of patient safety or study results (eg, uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, active peptic ulcer disease or gastritis, active bleeding diatheses or psychiatric illness/social situations that would limit compliance with study requirements or compromise the ability of the subject to give written informed consent)
  • Subjects with known contraindications to radiotherapy including inherited syndromes associated with hypersensitivity to ionizing radiation (e.g., ataxia telangiectasia, Nijmegen breakage syndrome)

North Carolina

Chapel Hill
UNC Lineberger Comprehensive Cancer Center
Status: ACTIVE
Contact: Jared M. Weiss
Phone: 919-966-3856

Pennsylvania

Philadelphia
Fox Chase Cancer Center
Status: ACTIVE
Contact: Jessica Ruth Bauman
Phone: 215-214-4297

Tennessee

Nashville
Vanderbilt University / Ingram Cancer Center
Status: APPROVED
Contact: Michael Kevin Gibson
Phone: 615-222-4967

PRIMARY OBJECTIVES:

I. Estimate the pathologic complete response rate (pCRR) after induction chemotherapy with carboplatin, nab-paclitaxel, and durvalumab in previously untreated stage III and IV squamous cell carcinoma of the head and neck (SCCHN) amenable to surgical resection.

SECONDARY OBJECTIVES:

I. Report the clinical complete response rate (cCRR) and clinical response rate (cRR) following induction chemotherapy.

II. Estimate the percent of patients who have a change in estimated risk level.

III. Estimate the overall survival (OS) and progression-free survival (PFS) associated with 3 part therapy consisting of induction chemotherapy, surgery and risk-adapted use of chemoradiation.

IV. Characterize the toxicity profile associated with both induction therapy and total 3 part therapy consisting of induction chemotherapy, surgery and risk-adapted use of chemoradiation.

TRANSLATIONAL/EXPLORATORY OBJECTIVES:

I. Correlative studies will evaluate cellular correlates of response and changes in the tumor microenvironment across therapy.

II. Explore correlation between measures of clinical response to induction chemotherapy and long term outcomes (PFS and OS) and compare them to pathologic measures of response (pCRR).

OUTLINE:

PART I: Patients receive carboplatin intravenously (IV) over 30 minutes and nab-paclitaxel IV over 30 minutes weekly for 6 courses in the absence of disease progression or unacceptable toxicity. Patients also receive durvalumab IV once every two weeks for 5 courses in the absence of disease progression or unacceptable toxicity.

PART II: Patients undergo surgical resection. After surgery, patients are assigned to a treatment group based on pathologic findings and risk.

PART III: Patients in the low risk category receive durvalumab IV once every two weeks for 3 courses. Patients in the medium risk category undergo radiation and receive cisplatin IV weekly for 6 courses per standard of care (SOC) followed by durvalumab IV once every two weeks for 3 courses. Patients in the high risk category receive bilateral radiation and cisplatin IV every three weeks per SOC followed by durvalumab IV once every two weeks for 3 courses.

After completion of study treatment, patients are followed up at 8-12 weeks, every 3 months for 2 years, and then periodically for 5 years.

Trial Phase Phase II

Trial Type Treatment

Lead Organization
UNC Lineberger Comprehensive Cancer Center

Principal Investigator
Jared M. Weiss

  • Primary ID LCCC1621
  • Secondary IDs NCI-2017-01128
  • Clinicaltrials.gov ID NCT03174275