Cetuximab and Nivolumab in Treating Patients with Recurrent or Metastatic Oral Cavity, Oropharyngeal, Paranasal Sinus, Hypopharyngeal, or Laryngeal Cancer

Inclusion Criteria

• Patients must have histologically or cytologically confirmed squamous cell carcinoma of oral cavity, oropharynx, paranasal sinuses, nasal cavity, hypopharynx, or larynx; squamous cell carcinoma of unknown primary in cervical lymph node can be included only if p16 status is positive
• COHORT A: Patients must have recurrent or metastatic HNSCC that is not amenable to local therapy with curative intent (surgery or radiation therapy with or without chemotherapy)
• COHORT A: Patients with persistent disease following radiation therapy administered with a chemotherapy sensitizer may also be included
• COHORT A: Patients must have progressed on at least one prior line of chemotherapy, targeted therapy, palliative radiation and/or biological therapy regimen for their recurrent and/or metastatic HNSCC; however, if patients are likely to be intolerant to standard first-line systemic chemotherapy, the patients are eligible to enroll to this study as the first-line therapy; additionally, patients with persistent disease or platinum-refractory recurrent disease (recurs within 6 months of last dose of chemotherapy given as a sensitizer to definitive radiation) may enroll in this study as a first-line therapy
• COHORT A: Prior treatment with a combination of cetuximab and a PD-1/PD-L1 inhibitor is excluded. Prior treatment with cetuximab or a PD-1/PD-L1 inhibitor is allowed as long as not previously given in combination
• COHORT B: Patients must have recurrent or metastatic HNSCC that is not amenable to local therapy with curative intent (surgery or radiation therapy with or without chemotherapy).
• COHORT B: Patients with persistent disease following radiation therapy administered with a chemotherapy sensitizer may also be included
• COHORT B: Patient must NOT have any systemic therapy for recurrent and/or metastatic disease except if given as a part of a multimodality treatment (i.e. re-irradiation and systemic therapy for curable intent of locally recurrent disease).
• COHORT B: Patients that refuse potentially curative salvage surgery for recurrent disease are ineligible
• COHORT B: Prior treatment with a combination of cetuximab and a PD-1/PD-L1 inhibitor is NOT included
• COHORT B: Prior treatment with a PD-1/PD-L1 inhibitor is NOT included
• COHORT B: Prior treatment with cetuximab or EGFR inhibitors given concurrently with radiation as a radiation sensitizer is included. However, cetuximab or EGFR inhibitors given in the recurrent and/or metastatic setting is NOT included
• Patients must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as outlined in Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1
• Life expectancy of greater than 3 months
• Eastern Cooperative Oncology Group (ECOG) performance status =< 2
• Absolute neutrophil count > 1,500/uL
• Hemoglobin > 9 g/dL
• Platelets > 100,000/uL
• Total bilirubin =< 1.5 mg/dL X institutional upper limits of normal (ULN)
• Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 3 X institutional ULN (or 5.0 X the ULN in the setting of liver metastasis)
• Serum creatinine of =< 1.5 X ULN or creatinine clearance > 40 mL/minute (using Cockcroft/Gault formula)
• Because the teratogenicity of cetuximab is not known, the patient, if sexually active, must be postmenopausal, surgically sterile, or using effective contraception (hormonal or barrier methods)
• Female patients of childbearing potential must have a negative serum pregnancy test within 7 days prior to enrollment
• Ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria

• Patients who experienced grade 3 or above skin toxicity from prior EGFR inhibiting therapy
• Patients who have experienced grade 3 or above toxicity from prior anti-PD1 therapy
• Patients who have p16 negative squamous cell carcinoma of unknown primary in cervical lymph node
• Patients with primary nasopharynx or salivary gland cancers are excluded
• Patients who have had chemotherapy, biological therapy or definitive radiation within 4 weeks of the study enrollment or those who have not recovered from adverse events to =< grade 1 due to agents administered more than 4 weeks earlier
• Patients who had undergone any major surgery within 4 weeks of study enrollment
• Patients who had undergone any palliative radiation within 2 weeks of study enrollment
• Patients who have had other investigational agents within 4 weeks or 5 half-lives, whichever is shorter, of the study enrollment
• Patients who have known leptomeningeal metastases or untreated or symptomatic brain metastases; treated, asymptomatic brain metastasis can be included
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, autoimmune disease requiring systemic steroids, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
• Subjects with a condition requiring systemic treatment with either corticosteroids (> 10 mg daily prednisone equivalents) or other immunosuppressive medications within 14 days of study drug administration; inhaled or topical steroids and adrenal replacement doses > 10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease
• The patient has clinically relevant coronary artery disease or history of myocardial infarction in the last 12 months or high risk of uncontrolled arrhythmia or uncontrolled cardiac insufficiency
• The patient has uncontrolled or poorly controlled hypertension (> 180 mmHg systolic or > 130 mmHg diastolic) at the time of enrollment
• The patient has a history of allergic reactions attributed to compounds of chemical or biologic composition similar to those of cetuximab and/or nivolumab
• The patient is pregnant or breast-feeding
• Patients with known active human immunodeficiency virus (HIV), hepatitis (Hep) B, or Hep C infection will be excluded; if not clinically indicated, the patients do not need to be tested