Alpha Radiation Emitters Device (DaRT) in Combination With Check Point Inhibitor for the Treatment of Recurrent Unresectable or mHNSCC

Official title

A Safety and Efficacy Study of Intratumoral Diffusing Alpha Radiation Emitters in Recurrent Unresectable or Metastatic Head and Neck Squamous Cell Carcinoma

Overview

A unique combinational treatment for cancer employing intratumoral diffusing alpha radiation emitter device with check point inhibitor for recurrent unresectable or metastatic Head and Neck Squamous Cell Carcinoma

Detailed description

This will be a prospective, open-label, one arm, single center two-stage adaptive trial designed to stop for either futility or efficacy after the first stage.

This approach will combine Diffusing Alpha Radiation Emitters seeds implantation along with standard treatment of Pembrolizumab for patients with recurrent unresectable or metastatic Head and Neck Squamous Cell Carcinoma (mHNSCC).

The DaRT seeds will be implanted in the target lesion and removed 15-22 days after implantation. Concurrently, patient will receive standard treatment of Pembrolizumab.

Disease evaluation will be assessed by a radiological imaging every 6 weeks starting at day 42 after the DaRT insertion procedure.

Interventions

• Device Diffusing Alpha Radiation Emitters Therapy (DaRT)
  An intratumoral insertion of a seed(s), loaded with Radium-224, securely fixed in the seeds. The seeds release by recoil into the tumor short-lived alpha-emitting atoms.
• Drug Pembrolizumab
  200 mg administered as an intravenous infusion over 30 minutes every 3 weeks

Primary outcome measures

• Evaluation of Efficacy of DaRT Treatment in Combination with Pembrolizumab [Time frame: From Day 26 to date of documented best response, assessed up to 24 months]

Secondary outcome measures (4)

• Adverse Events [Time frame: Until completion of the last study-related procedure, approximately 2 years]
• Progression Free Survival (PFS) [Time frame: From first dose of Pembrolizumab until progressive disease is recorded (up to 24 months)]
• Overall Survival (OS) [Time frame: From Pembrolizumab treatment start date to death or lost to follow-up (up to 24 months)]
• Duration of Response (DOR) [Time frame: From first record of response until the first date recurrent or progressive disease is documented (up to 24 months)]

Eligibility criteria

Inclusion criteria

• Pathologically confirmed, metastatic, or recurrent unresectable squamous cell carcinoma of the head and neck.
• Ability to provide tissue sample, either from an archive or undergo another biopsy to provide a fresh sample
• Targetable lesion must be technically amenable for the DaRT seeds implantation
• Brachytherapy indication validated by a multidisciplinary team
• Targetable lesion according to RECIST v1.1
• Age ≥ 18 years old
• Eastern Cooperative Oncology Group (ECOG) Performance Status Scale ≤ 2
• Subjects' life expectancy is more than 6 months
• White Blood Count (WBC) ≥ 3500/µl, granulocyte ≥ 1500/µl
• Platelet count ≥ 100,000/µl
• Hemoglobin ≥ 9 g/dl
• Calculated or measured creatinine clearance ≥ 60 cc/min
• Aspartate Aminotransferase (AST) and Alanine Transaminase (ALT) ≤ 2.5 X Upper Limit of Normal (ULN) or ≤ 5 X ULN for subjects with liver metastases
• International normalized ratio (INR) <1.4 for patients not on Warfarin
• Subjects are willing and able to sign an informed consent form
• Women of childbearing potential (WOCBP) will have evidence of negative pregnancy test before the Ra-224 implantation and are required to use an acceptable contraceptive method to prevent pregnancy for 3 months after brachytherapy.

Exclusion criteria

• Previous treatment for metastatic disease (for recurrent unresectable disease, previous treatment is allowed given that 6 months had elapsed from completion of treatment for primary disease)
• Patients with brain metastases
• Combined Positive Scores (CPS) <1
• Patients with known contraindications to radiotherapy
• Any prior therapy with anti-PD-L1 (Programmed death-ligand), anti-PD-L2, anti-CTLA-4 (Cytotoxic T lymphocyte antigen) antibody, etc.
• Any history of a sever hypersensitivity reaction to any monoclonal antibody.
• Known hypersensitivity to any of the components of the DaRT.
• Has a known history of active TB (Tuberculosis Bacillus )
• 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.
• Any diagnosis of immunodeficiency or current immunosuppressive therapy including >10mg/day of prednisone within 14 days of enrollment is not permitted
• Clinically significant cardiovascular disease, e.g. cardiac failure of New York Heart Association classes III-IV, uncontrolled coronary artery disease, cardiomyopathy, uncontrolled arrhythmia, uncontrolled hypertension, or history of myocardial infarction in the last 12 months.
• Patients with uncontrolled intercurrent illnesses including, but not limited to an active infection requiring systemic therapy or a known psychiatric or substance abuse disorder(s) that would interfere with cooperation with the requirements of the trial or interfere with the study endpoints.
• Patient requires treatment which may conflict with the endpoints of this study including evaluation of response or toxicity of DaRT.
• Has a known history of Human immunodeficiency virus (HIV) (HIV 1/2 antibodies).
• Has known active hepatitis B (e.g., HBsAg reactive) or hepatitis C (e.g., HCV RNA \[qualitative\] is detected)
• Pregnancy or lactation.
• Patients must agree to use adequate contraception (abstinence, barrier method of birth control, or any other medically acceptable form of contraception) prior to study entry, for the duration of study participation and for 6 months after last dose of Pembrolizumab.

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

Healthy volunteers: No

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Treatment

Study locations

Israel · 3 centers

• Sharett institute, Hadassah University Hospital - Ein-Kerem — Jerusalem
• Sheba Medical Center — Ramat Gan
• Tel-Aviv Medical Center — Tel Aviv

Identifiers

NCT: NCT05047094 · CTP-HNCPI-00

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗