Avelumab in Treating Patients with Recurrent, Metastatic EBV-Related Nasopharyngeal Carcinoma

Inclusion Criteria

• Patient has the ability to understand and the willingness to sign a written informed consent
• Patient has histologically/cytologically confirmed, non-keratinizing/undifferentiated, EBV-related nasopharyngeal carcinoma, not amenable to curative intent therapy; EBV testing may be completed per institutional standards
• Patient must have at least one measurable site of disease as defined by RECIST version (v)1.1, determined by investigator review
• Patient has received at least one prior line of systemic therapy in the recurrent/metastatic setting; the study chair may grant exceptions to the mandatory biopsy should the treating physician deem that a biopsy is not feasible or unsafe for the patient, and archival tissue is available and provided for study purposes; a conversation with the study chair is required to obtain an exception
• Patient is willing to undergo a fresh tumor biopsy (core or excisional) for correlative analyses (ie. PD-L1 expression)
• Eastern Cooperative Oncology Group (ECOG) performance status of 0-2
• Absolute neutrophil count >= 1.0 x 10^9/L
• Platelet count >= 75 x 10^9/L
• Hemoglobin >= 8.0 g/dL
• Total bilirubin =< 1.5 x institution's upper limit of normal
• Aspartate aminotransferase (AST)/serum glutamic oxaloacetic transaminase (SGOT) and alanine aminotransferase (ALT)/serum glutamic pyruvic transaminase (SPGT) =< 2.5 x institution's upper limit of normal
• Albumin >= 2.0 g/dL
• Serum creatinine =< 1.5 x institution's upper limit of normal (ULN), or creatinine clearance >= 30 ml/min (according to Cockroft-Gault formula, or local institutional standard method)
• Female patient of childbearing potential has a negative serum or urine pregnancy within 72 hours prior to receiving the first dose of study medication
• Female patient of childbearing potential agrees to use 2 methods of birth control or be surgically sterile, or abstain from heterosexual activity for the course of the study through 120 days after the last dose of study medication; note: females of childbearing potential are those who have not been surgically sterilized or have not been free from menses for > 1 year
• Male patient with a partner of childbearing potential agrees to use an adequate method of contraception starting with the first dose of study therapy through 120 days after the last dose of study therapy

Exclusion Criteria

• Patient is currently receiving or has received another investigational agent within 4 weeks prior to day 1 of study
• Patient has received chemotherapy or radiotherapy within 4 weeks prior to day 1 of study; prior palliative radiotherapy to metastatic lesion(s) is permitted, provided there is at least one measurable lesion that has not been radiated
• Patient has received prior immunotherapy with inhibitors of PD-1/PD-L1 axis
• Patient has had major surgery or insufficient recovery from surgical-related trauma or wound healing within 14 days of study day 1
• Patient has had a prior grade >= 3 immune-related adverse event (irAE) while receiving any previous immunotherapy agent, or any unresolved irAE > grade 1
• Patient has a known additional malignancy that is progressing or requires active treatment; exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of the skin that has undergone potentially curative therapy or in situ cervical cancer
• Patient has known active central nervous system (CNS) metastases and/or carcinomatous meningitis; note: patients with previously treated brain metastases may participate provided they are stable (without evidence of progression by imaging for at least four weeks prior to the first dose of trial treatment and any neurologic symptoms have returned to baseline), have no evidence of new or enlarging brain metastases, and are off steroids or on a stable or decreasing dose of =< 10 mg daily prednisone (or equivalent); this exception does not include carcinomatous meningitis which is excluded regardless of clinical stability
• Patient has an active autoimmune disease that has required systemic treatment in the past 2 years (i.e. with use of disease modifying agents, corticosteroids or immunosuppressive drugs) * Notes: ** Patients with vitiligo, Grave’s disease, or psoriasis not requiring systemic treatment within the past 2 years are not excluded ** 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
• Patient has a diagnosis of immunodeficiency, or is receiving systemic steroid therapy (> 10 mg prednisone daily, or steroid equivalent) or any other form of immunosuppressive therapy within 7 days prior to the first dose of avelumab
• Patient has a known history of active TB (Baccillus tuberculosis)
• Patient has a known history of, or any evidence of active, non-infectious pneumonitis
• Patient has a known history of chronic interstitial lung disease
• Patient has an active infection requiring systemic therapy
• Patient 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
• Patient has a known psychiatric or substance abuse disorder that would interfere with cooperation with the requirements of the trial
• Patient is pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial
• Patient has known active hepatitis B infection (defined as presence of hepatitis B surface antigen [HepB sAg] and/ or hepatitis B [Hep B] deoxyribonucleic acid [DNA]), active hepatitis C infection (defined as presence of Hep C RNA) and/or known human immunodeficiency virus (HIV); patients with HIV who have a normal CD4 count (>= 200) and an undetectable viral load are not excluded
• Patient has received a live vaccine within 30 days of study day 1; note: seasonal influenza vaccines for injection are generally inactivated flu vaccines and are allowed; however intranasal influenza vaccines (e.g., Flu-Mist) are live attenuated vaccines, and are not allowed