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Tolerance and Efficacy of Pembrolizumab or Cetuximab Combined With RT in Patients With Locally Advanced HNSCC (PembroRad)

Primary Purpose

Squamous Cell Carcinoma of the Head and Neck

Status
Completed
Phase
Phase 2
Locations
France
Study Type
Interventional
Intervention
Pembrolizumab
Cetuximab
Radiotherapy
Sponsored by
Groupe Oncologie Radiotherapie Tete et Cou
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Squamous Cell Carcinoma of the Head and Neck focused on measuring Determine the tolerance and efficacy of Pembrolizumab

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Written informed consent
  2. Age ≥18 ≤ 80 years.
  3. Performance Status ECOG 0-1
  4. Histologically confirmed diagnosis of previously untreated locally advanced HNSCC (Stage III, IVa and IVb according to the American Joint Committee on Cancer Staging System) of one or more of the following sites: oral cavity, oropharynx, hypopharynx and larynx
  5. Availability of pre-treatment tumour tissue (for biomarker analysis, PD -L1, TILs and immune-monitoring)
  6. p16 expression from tumor sample (immunohistochemistry)
  7. Recording of the smoking history
  8. No viral infection (HIV, Hepatitis B/C)
  9. No autoimmune disease
  10. No immunodeficiency or immunosuppressive therapy
  11. No active CNS disease
  12. No interstitial lung disease
  13. No active infection
  14. Women of child-bearing potential: negative serum pregnancy test at screening and use of appropriate contraception methods from study entry
  15. Patients not proposed cisplatin-based chemotherapy because of age, general condition, if medically unfit or patient refusal.
  16. Adequate organ laboratory values
  17. Health insurance coverage

Exclusion Criteria:

  1. Nasopharyngeal, paranasal sinuses, nasal cavity tumours or thyroid cancers;
  2. Squamous cell cancer involving cervical neck nodes with unknown primary site;
  3. Metastatic disease;
  4. Any prior or current treatment for invasive head and neck cancer. This will include but is not limited to: prior tyrosine kinase inhibitors, any monoclonal antibody, prior neoadjuvant therapy, prior surgical resection, or use of any investigational agent;
  5. Weight loss of >10% during the last 3 weeks prior the screening visit;
  6. Concurrent treatment with any other systemic anti-cancer therapy that is not specified in the protocol;
  7. Concomitant treatment with any drug on the prohibited medication list such as live vaccines (for details, see the protocol);
  8. History of another malignancy within the last 3 years (exception of in situ carcinoma and skin carcinomas);
  9. If female, pregnant or lactating;
  10. 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.
  11. Known hypersensitivity reaction to study medication;
  12. Any social, personal, medical 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.

Sites / Locations

  • Centre Guillaume le conquérant

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Pembrolizumab and radiotherapy

Cetuximab and radiotherapy

Arm Description

200 mg IV infusion every 3 weeks, i.e. on day 1, 22, 43 during the course of radiotherapy

Loading dose of 400 mg/m² IV on Day-8, followed by weekly dose of 250 mg/m² IV during the whole course of radiotherapy.

Outcomes

Primary Outcome Measures

Locoregional Control
To compare between the 2 arms the rate of patients achieving Locoregional Control (LRC) at 15 months from the end of radiation therapy

Secondary Outcome Measures

Progression free survival
Minimum time from randomization to progression/relapse at any site (local, regional or distant) as defined by RECIST 1.1 criteria or to death from any cause. Patients who don't have any of these events are censored at the date of last follow-up.
Locoregional progression and distant metastasis
To estimate the respective contribution of locoregional progression, distant progression and death as first event in the progression-free survival, the cumulative incidences of these three types of events were calculated within a competing risk framework.
Overall survival
Time to death from any cause measured from randomization.
Acute adverse events
According to NCI-CTCAE version 4, the maximal grade of each toxicity observed during immune-radiotherapy will be used. All grades of toxicity will be tabulated by type of toxicity and by treatment arm.
Delayed toxicity According to RTOG late toxicity scale
According to RTOG late toxicity scale
Duration of the feeding tube dependence
It will be presented by treatment arm and analysed by Student t-test.
Compliance to Pembrolizumab and Cetuximab
Insufficient compliance to cetuximab or Pembrolizumab is defined as a patient receiving less than 75% of the planned dose, even if the dose reduction is due to toxicity
Health related quality of life (QL)
Assessment by EORTC QLQ-C30 and H&N35 questionnaires
Impact of p16 / HPV tumor status on the efficacy of the 2 regimens in patients with oropharyngeal initial tumor
Assessment by CISH DNA method

Full Information

First Posted
February 29, 2016
Last Updated
February 27, 2023
Sponsor
Groupe Oncologie Radiotherapie Tete et Cou
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1. Study Identification

Unique Protocol Identification Number
NCT02707588
Brief Title
Tolerance and Efficacy of Pembrolizumab or Cetuximab Combined With RT in Patients With Locally Advanced HNSCC
Acronym
PembroRad
Official Title
A Phase II Randomized Study to Determine the Tolerance and Efficacy of Pembrolizumab or Cetuximab Combined With Radiation Therapy in Patients With Locally Advanced Squamous Cell Carcinoma of the Head and Neck
Study Type
Interventional

2. Study Status

Record Verification Date
August 2022
Overall Recruitment Status
Completed
Study Start Date
May 18, 2016 (Actual)
Primary Completion Date
October 2022 (Actual)
Study Completion Date
October 17, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Groupe Oncologie Radiotherapie Tete et Cou

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The general aim of the study is to evaluate the anti-tumour activity and the tolerance profile of Pembrolizumab + RT in comparison to cetuximab + RT in patients with locally advanced HNSCC and to explore potential correlations between treatment outcome and the immune landscape.
Detailed Description
A majority of HNSCC are locally advanced and commonly treated with concomitant chemo-radiotherapy (CT-RT). However, a large proportion of patients with locally advanced stage are not suitable for receiving cisplatinum-based chemotherapy (CT) concomitant with radiotherapy (RT) either due to age, general and/or medical condition(s). An alternative standard treatment has been established, combining RT and cetuximab. However, both CT-RT and cetuximab-RT which are considered as standard approaches in locally advanced non operated HNSCC are associated with poor outcome in patients with the most advanced T stage (T4) and/or N stage (>=N2) and/or HPV negative tumours. A new and promising approach could target immune response. Pembrolizumab is a high-affinity monoclonal anti-PD1 antibody which showed antitumor activity in melanoma and NSCLC. In the KEYNOTE-012 (multi-center, nonrandomized Phase Ib HNSCC), Pembrolizumab was well tolerated and safe with no serious drug related AEs reported. About 51% (26/51) of patients had decreased tumor burden which was seen both in HPV (-) and HPV(+) HNSCC. This observation led to the hypothesis generated in the current study that Pembrolizumab is potentially a very active drug in HNSCC and that the combination of Pembrolizumab with radiotherapy will be well tolerated, given the very good toxicity profile of the drug and will improve the outcome of patients with locally advanced HNSCC non suitable for CT-RT, as compared to the treatment of reference combining cetuximab and RT.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Squamous Cell Carcinoma of the Head and Neck
Keywords
Determine the tolerance and efficacy of Pembrolizumab

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
133 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Pembrolizumab and radiotherapy
Arm Type
Experimental
Arm Description
200 mg IV infusion every 3 weeks, i.e. on day 1, 22, 43 during the course of radiotherapy
Arm Title
Cetuximab and radiotherapy
Arm Type
Active Comparator
Arm Description
Loading dose of 400 mg/m² IV on Day-8, followed by weekly dose of 250 mg/m² IV during the whole course of radiotherapy.
Intervention Type
Drug
Intervention Name(s)
Pembrolizumab
Other Intervention Name(s)
antibody
Intervention Description
200mg IV infusion every 3 weeks, i.e. on day 1, 22, 43 during the course of radiotherapy. Radiotherapy will be delivered daily for 5 days per week to a total dose of 69.96 Gy in 2.12 Gy daily fractions over 6.5 weeks (33 fractions).
Intervention Type
Drug
Intervention Name(s)
Cetuximab
Other Intervention Name(s)
antibody
Intervention Description
Loading dose of 400 mg/m² IV on Day-8, followed by weekly dose of 250 mg/m² IV during the whole course of radiotherapy. Radiotherapy will be delivered daily for 5 days per week to a total dose of 69.96 Gy in 2.12 Gy daily fractions over 6.5 weeks (33 fractions).
Intervention Type
Radiation
Intervention Name(s)
Radiotherapy
Other Intervention Name(s)
Conventional Radiotherapy
Intervention Description
Radiotherapy will be delivered daily for 5 days per week to a total dose of 69.96 Gy in 2.12 Gy daily fractions over 6.5 weeks (33 fractions).
Primary Outcome Measure Information:
Title
Locoregional Control
Description
To compare between the 2 arms the rate of patients achieving Locoregional Control (LRC) at 15 months from the end of radiation therapy
Time Frame
15 months from the end of radiation therapy
Secondary Outcome Measure Information:
Title
Progression free survival
Description
Minimum time from randomization to progression/relapse at any site (local, regional or distant) as defined by RECIST 1.1 criteria or to death from any cause. Patients who don't have any of these events are censored at the date of last follow-up.
Time Frame
At 24 months after treatment initiation
Title
Locoregional progression and distant metastasis
Description
To estimate the respective contribution of locoregional progression, distant progression and death as first event in the progression-free survival, the cumulative incidences of these three types of events were calculated within a competing risk framework.
Time Frame
At 24 months after treatment initiation
Title
Overall survival
Description
Time to death from any cause measured from randomization.
Time Frame
At 24 months after treatment initiation
Title
Acute adverse events
Description
According to NCI-CTCAE version 4, the maximal grade of each toxicity observed during immune-radiotherapy will be used. All grades of toxicity will be tabulated by type of toxicity and by treatment arm.
Time Frame
At 24 months after treatment initiation
Title
Delayed toxicity According to RTOG late toxicity scale
Description
According to RTOG late toxicity scale
Time Frame
At 24 months after treatment initiation
Title
Duration of the feeding tube dependence
Description
It will be presented by treatment arm and analysed by Student t-test.
Time Frame
At 24 months after treatment initiation
Title
Compliance to Pembrolizumab and Cetuximab
Description
Insufficient compliance to cetuximab or Pembrolizumab is defined as a patient receiving less than 75% of the planned dose, even if the dose reduction is due to toxicity
Time Frame
At 24 months after treatment initiation
Title
Health related quality of life (QL)
Description
Assessment by EORTC QLQ-C30 and H&N35 questionnaires
Time Frame
At 24 months after treatment initiation
Title
Impact of p16 / HPV tumor status on the efficacy of the 2 regimens in patients with oropharyngeal initial tumor
Description
Assessment by CISH DNA method
Time Frame
At 24 months after treatment initiation

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Written informed consent Age ≥18 ≤ 80 years. Performance Status ECOG 0-1 Histologically confirmed diagnosis of previously untreated locally advanced HNSCC (Stage III, IVa and IVb according to the American Joint Committee on Cancer Staging System) of one or more of the following sites: oral cavity, oropharynx, hypopharynx and larynx Availability of pre-treatment tumour tissue (for biomarker analysis, PD -L1, TILs and immune-monitoring) p16 expression from tumor sample (immunohistochemistry) Recording of the smoking history No viral infection (HIV, Hepatitis B/C) No autoimmune disease No immunodeficiency or immunosuppressive therapy No active CNS disease No interstitial lung disease No active infection Women of child-bearing potential: negative serum pregnancy test at screening and use of appropriate contraception methods from study entry Patients not proposed cisplatin-based chemotherapy because of age, general condition, if medically unfit or patient refusal. Adequate organ laboratory values Health insurance coverage Exclusion Criteria: Nasopharyngeal, paranasal sinuses, nasal cavity tumours or thyroid cancers; Squamous cell cancer involving cervical neck nodes with unknown primary site; Metastatic disease; Any prior or current treatment for invasive head and neck cancer. This will include but is not limited to: prior tyrosine kinase inhibitors, any monoclonal antibody, prior neoadjuvant therapy, prior surgical resection, or use of any investigational agent; Weight loss of >10% during the last 3 weeks prior the screening visit; Concurrent treatment with any other systemic anti-cancer therapy that is not specified in the protocol; Concomitant treatment with any drug on the prohibited medication list such as live vaccines (for details, see the protocol); History of another malignancy within the last 3 years (exception of in situ carcinoma and skin carcinomas); If female, pregnant or lactating; 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. Known hypersensitivity reaction to study medication; Any social, personal, medical 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.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jean Pr BOURHIS, MD
Organizational Affiliation
CHU Vaudois, Rue du Bugnon 46, CH-1011 Lausanne, Suisse
Official's Role
Principal Investigator
Facility Information:
Facility Name
Centre Guillaume le conquérant
City
Le Havre
ZIP/Postal Code
76000
Country
France

12. IPD Sharing Statement

Plan to Share IPD
Yes

Learn more about this trial

Tolerance and Efficacy of Pembrolizumab or Cetuximab Combined With RT in Patients With Locally Advanced HNSCC

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