Study on the Efficacy of Treatment by Radiotherapy and Pembrolizumab in Newly Diagnosed Metastatic Head & Neck Cancers

Official title

Randomized Trial of Loco-regional Radiotherapy Added to Pembrolizumab Alone or With Chemotherapy Versus Systemic Treatment Alone for Patients With Newly Diagnosed Head and Neck Squamous Cell Carcinoma With Synchronous Metastases

Overview

Study to evaluate the efficacy of treatment by radiotherapy and pembrolizumab in newly diagnosed metastatic head \& neck cancers

Detailed description

Comparative interventional prospective phase 3, randomised, open-label, multicentric trial comparing the combination of radiotherapy and pembrolizumab alone or with chemotherapy to systemic treatment as first line treatment of patients with newly diagnosed head and neck squamous cell carcinoma with synchronous metastases.

Interventions

• Drug Pembrolizumab
  Pembrolizumab 200 mg every 3 weeks until disease progression (as confirmed according to response evaluation criteria in solid tumors version 1.1 (RECIST v1.1)) or unacceptable toxicity. The treatment of pembrolizumab should not be delayed because of radiotherapy planning.
• Radiation Loco-regional radiotherapy
  Depending on the choice of radiotherapy timing: * Before 3 cycles of pembrolizumab with or without chemotherapy : radiotherapy could start at any time between one week after the first administration of pembrolizumab and the first day of the 3rd cycle. * After 3 cycles of pembrolizumab with or without chemotherapy : radiotherapy could start at any time after 3rd cycle (C3D1) and up to a maximum of 4 weeks after the 6th cycle of pembrolizumab. Dose/fraction of radiotherapy: 54 Gy/18 fractions (r
• Drug Chemotherapy
  If the investigator decide to add chemotherapy with pembrolizumab, and depending on the radiotherapy timing: * Start of radiotherapy planned before 3rd cycle: Chemotherapy could be delayed after the end of radiotherapy and start from cycle 3 or 4 of pembrolizumab. Administration of chemotherapy can be delayed in case of non resolved grade 3 or higher toxicity from radiotherapy. * Radiotherapy planned after 3rd cycle: Chemotherapy should start at the same time of pembrolizumab. Chemotherapy wil

Primary outcome measures

• Progression-free survival (PFS) [Time frame: From randomization to disease progression or death, up to 3 years.]

Secondary outcome measures (9)

• Overall survival (OS) [Time frame: From randomization to death from any cause, up to 5 years.]
• Quality of life questionnaire - Core 30 (QLQ-C30) [Time frame: At baseline, 4 months, 6 months, 12 months, 18 months, 2 years, 3 years, and 4 years]
• Quality of Life Questionnaire - Head & Neck Cancer Module (QLQ-H&N35) [Time frame: At baseline, 4 months, 6 months, 12 months, 18 months, 2 years, 3 years, and 4 years]
• Objective response rate (ORR) [Time frame: At 18 weeks and 27 weeks]
• Loco-regional progression [Time frame: From randomization to loco-regional progression, up to 5 years.]
• Distant progression [Time frame: From randomization to distant progression, up to 5 years.]
• Progression-free survival 2 (PFS2) [Time frame: Up to 5 years after randomization.]
• Incidence of Treatment Adverse Events [Time frame: Throughout study completion, up to 5 years.]
• Compliance to treatment [Time frame: Throughout study treatment, up to 5 years]

Eligibility criteria

Inclusion criteria

• Patient must have signed a written informed consent form prior to any study specific procedures. When the patient is physically unable to give their written consent, a trusted person of their choice, independent from the investigator or the sponsor, can confirm in writing the patient's consent.
• Histologically confirmed squamous cell carcinoma of head and neck (oral cavity, oropharynx, hypopharynx, and larynx) including unknown primary head and neck lymph nodes with distant metastases at presentation (T1-4 N0-3 M1). Histological confirmation is required in case of a single metastatic lesion.
• Eligible for treatment by pembrolizumab according to the European Marketing Authorization
• Patient ≥18 years old
• Performance status: 0-1 (WHO)
• Combined Positive Score (CPS) ≥1 for primary tumor (as determined per local practice)
• Subjects must have at least one measurable lesion as per RECIST v1.1 to assess efficacy
• Adequate hematologic and end-organ function, defined by the following laboratory test results, obtained within 14 days prior to randomization:

a. If randomization is done before treatment start: i. Absolute neutrophil count ≥1.5 × 10⁹/L ii. Platelet ≥100 × 10⁹/L iii. Hemoglobin ≥90 g/L iv. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT), ≤3 × upper limit of normal (ULN), (unless documented liver metastases where ≤5 x ULN is permitted) v. Bilirubin ≤1.5 × ULN. vi. Serum albumin ≥25 g/L vii. Creatinine clearance ≥30 mL/min (calculated per institutional guidelines or by Cockcroft-Gault or Modification of Diet in Renal Disease (MDRD) formula) viii. Corrected serum calcium of ≤11.5 mg/dL or ≤2.6 mmol/L. b. If randomization if done after treatment start i. Absolute neutrophil count ≥1.0 × 10⁹/L ii. Platelet ≥75 × 10⁹/L iii. Hemoglobin ≥85 g/L

• Patient must agree to use adequate contraception methods for the duration of the study treatment and up to 4 months after the last dose of pembrolizumab administration
• Patients must be affiliated to a Social Security System (or equivalent)
• No disease progression during systemic treatment if the randomization is done after the start of pembrolizumab for the current disease

Exclusion criteria

• Symptomatic central nervous system (CNS) metastases and / or carcinomatous meningitis
• History of another malignancy within 2 years prior to study inclusion, with the exception of completely resected basal or squamous cell skin cancer, or successfully treated in-situ carcinoma
• Prior radiotherapy in the head and neck region
• Any prior or current non-surgical treatment for invasive head and neck cancer. (except for pembrolizumab +/- chemotherapy for the current cancer for a maximum of 6 cycles). This will include but is not limited to: prior tyrosine kinase inhibitors, any monoclonal antibody, chemotherapy, anti-PD-1/PD-L1 and CTLA-4, prior radiotherapy (RT), or use of any investigational agent. Loco-regional recurrent or second primary head and neck cancer after prior surgical treatment alone in the head and neck region could be eligible.
• Known Acquired Immune Deficiency Syndrome (AIDS)
• Known currently active infection including hepatitis B or hepatitis C
• Patient having received live attenuated vaccine within 28 days prior to enrolment
• Pregnant or breast feeding woman
• Active autoimmune disease except vitiligo, type-1 diabetes, hypothyroid stabilized with hormonal substitution, or psoriasis which do not require systemic treatment
• Active immunodeficiency or ongoing immunosuppressive therapy
• Active symptomatic interstitial lung disease
• Significant disease which, in the judgment of the investigator, as a result of the medical interview, physical examinations, or screening investigations would make the patient inappropriate for entry into the trial
• Any social, personal, medical, geographic and/or psychologic factor(s) that could interfere with the observance of the patient to the protocol and/or the follow-up and/or the signature of the informed consent
• Prior organ transplantation including allogenic stem-cell transplantation
• Other severe acute or chronic medical conditions including colitis, pneumonitis, pulmonary fibrosis or psychiatric conditions including active suicidal ideation; or laboratory abnormalities that may increase the risk associated with study participation and, in the judgment of the investigator, would make the patient inappropriate for entry into this study
• Person deprived of their liberty or under protective custody or guardianship
• Patient who have taken any investigational medicinal product or have used an investigational device within 30 days prior to study inclusion

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

France · 26 centers

• Institut Sainte Catherine — Avignon
• CHU Jean Minjoz — Besançon
• CHU Bordeaux — Bordeaux
• Institut Bergonié — Bordeaux
• Centre François Baclesse — Caen
• CH Carcassonne — Carcassonne
• Centre Jean Perrin — Clermont-Ferrand
• Centre Georges François Leclerc — Dijon
• … and 18 more centers

Identifiers

NCT: NCT04747054 · UC-HNG-2007 · 2020-A02221-38

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗