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Neoadjuvant Chemotherapy, Tislelizumab With Afatinib for HNSCC (neoCHANCE-2)

Primary Purpose

Head and Neck Squamous Cell Carcinoma

Status
Not yet recruiting
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
Nab-paclitaxel
Cisplatin
Tislelizumab
Afatinib
Sponsored by
West China Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Head and Neck Squamous Cell Carcinoma focused on measuring Head and Neck Cancer, Neoadjuvant therapy, Immunotherapy, EGFR-TKI, Chemotherapy

Eligibility Criteria

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

Inclusion Criteria:

  1. Age 18 years or above.
  2. Patients with pathologically confirmed HNSCC (except for nasopharyngeal carcinoma) and meet the following conditions:

    • were newly diagnosed and without distant metastasis;
    • were deemed surgically resectable evaluated by a head and neck surgeon;
    • were willing to undergo surgery.
  3. Eastern Cooperative Oncology Group (ECOG) performance status 0-1.
  4. Adequate organ and bone marrow function:

    • absolute neutrophil count ≥ 1.5 × 10^9/L, hemoglobin ≥ 80 g/L, platelets ≥ 80 × 10^9/L;
    • ALT, AST and ALP < 2.5× upper limit of normal (ULN), total bilirubin ≤ 2×ULN;
    • albumin≥ 2.8 g/dL;
    • creatinine clearance ≥ 60 ml/min;
    • INR≤ 1.5;APTT≤ 1.5×ULN;
  5. Written informed consent.

Exclusion Criteria:

  1. History of other malignancies (except for the history of malignant tumors that have been cured and have not recurred within 5 years, such as skin basal cell carcinoma, skin squamous cell carcinoma, superficial bladder cancer, in situ cervical cancer, and gastrointestinal mucosal cancer, etc.)
  2. Have an active autoimmune disease requiring systemic treatment or a documented history of clinically severe autoimmune disease.
  3. Any history of allergic disease, or a sever hypersensitivity reaction to drugs, or allergy to the study drug components.
  4. Any of prior therapy with:

    • anti-PD-1, anti-PD-L1/2, anti-CTLA-4 antibody, anti-EGFR antibody or EGFR-TKIs;
    • antitumor vaccine;
    • any active vaccine against an infectious disease within 4 weeks prior to the first dose or planned during the study period;
    • major surgery or serious trauma within 4 weeks before the first dose;
    • toxicity from prior antitumor therapy has not recovered to ≤ CTCAE Version 5.0 Grade 1 or the level specified by the inclusion/exclusion criteria.
  5. With serious medical diseases, such as grade II and above cardiac dysfunction (NYHA criteria), ischemic heart disease, supraventricular or ventricular arrhythmia, poorly controlled diabetes mellitus, poorly controlled hypertension, echocardiographic ejection fraction < 50%, etc.
  6. With interstitial pneumonitis, non-infectious pneumonitis, active pulmonary tuberculosis, or history of pulmonary tuberculosis infection that were not controlled by treatment.
  7. With hyperthyroidism, or organic thyroid disease.
  8. With active infection, or unexplained fever during the screening period or 48 hours before the first dose.
  9. With active hepatitis B or C, or known history of positive HIV test, or acquired immunodeficiency syndrome.
  10. History of a clear neurological or psychiatric disorder.
  11. History of drug abuse or alcohol abuse.
  12. Women who are pregnant or breastfeeding, or have a reproductive plan from the screening period to 3 months after the end of the study, or have sex without contraceptive measures, or are unwilling to take appropriate contraceptive measures.
  13. Received any investigational drug within 4 weeks prior to the first dose, or concurrently enrolled in another clinical trial.
  14. Any other factors that are not suitable for inclusion in this study judged by investigators.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    Treatment Cohort

    Arm Description

    Participants will receive TP chemotherapy every 3 weeks x 2 cycles (Nab-paclitaxel 260mg/m^2 IV on day1, Cisplatin 75mg/m^2 IV on days 1-3); Tislelizumab 200mg IV every 3 weeks x 2 cycles; Afatinib 30mg PO everyday x 6 weeks.

    Outcomes

    Primary Outcome Measures

    Major Pathologic Response
    Major pathologic response was defined as fewer than 10% viable tumor cells.

    Secondary Outcome Measures

    Pathologic Complete Response
    Pathologic complete response was defined as the absence of viable tumor cells.
    Objective Response Rate
    Objective response rate was defined as the percentage of participants with a best overall response of CR or PR using RECIST Criteria
    Adverse Events
    Adverse events included adverse events using CTCAE Criteria and unplanned surgery delays.
    Disease-free Survival
    Disease-free survival was defined as the time from the administration of the first dose to first disease progression or death.

    Full Information

    First Posted
    August 19, 2022
    Last Updated
    August 23, 2022
    Sponsor
    West China Hospital
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05516589
    Brief Title
    Neoadjuvant Chemotherapy, Tislelizumab With Afatinib for HNSCC
    Acronym
    neoCHANCE-2
    Official Title
    Neoadjuvant Chemotherapy, Tislelizumab With Afatinib for the Treatment of Resectable Head and Neck Squamous Cell Carcinoma: A Single-Arm Phase 2 Trial (neoCHANCE-2 Trial)
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    August 2022
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    August 20, 2022 (Anticipated)
    Primary Completion Date
    August 19, 2023 (Anticipated)
    Study Completion Date
    August 19, 2024 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    West China Hospital

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No
    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    To explore the efficiency and safety of TP chemotherapy, tislelizumab, combined with afatinib as a new neoadjuvant treatment regimen for patients with resectable HNSCC.
    Detailed Description
    More than 60% of patients with Head and neck squamous cell carcinoma (HNSCC) have locally advanced or metastatic disease at the time of diagnosis, with a 5-year overall survival rate of less than 60%. The clinical outcomes of those patients still need to be improved. Neoadjuvant therapy theoretically could reduce tumor volume, increase organ retention rate, and improve clinical prognosis. However, results from several phase III clinical trials have not proved a significant survival benefit of neoadjuvant chemotherapy for patients with resectable HNSCC except for nasopharyngeal carcinoma. There is an urgent need to explore new neoadjuvant treatment options for those patients. Immunotherapy such as PD-1/PD-L1 inhibitors have shown excellent efficiency in the treatment of malignancies. Anti-PD-1 therapy is approved as the first-line treatment of recurrent/metastatic HNSCC. Neoadjuvant immunotherapy for the treatment of locally advanced and resectable HNSCC has been demonstrated to be feasible in some trials. Afatinib, as an irreversible ErbB tyrosine kinase inhibitor (TKI), has been used as the second-line treatment for recurrent and/or metastatic HNSCC. A previous study published in 2018 confirmed that afatinib can be administered safely before surgery. In summary, we designed this study to explore the efficiency and safety of chemotherapy (TP regimen), anti-PD1 immunotherapy (tislelizumab), combined with EGFR-TKI (afatinib) as a new neoadjuvant treatment regimen for patients with resectable HNSCC, aiming to provide a new treatment option for those patients.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Head and Neck Squamous Cell Carcinoma
    Keywords
    Head and Neck Cancer, Neoadjuvant therapy, Immunotherapy, EGFR-TKI, Chemotherapy

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 2
    Interventional Study Model
    Single Group Assignment
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    28 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Treatment Cohort
    Arm Type
    Experimental
    Arm Description
    Participants will receive TP chemotherapy every 3 weeks x 2 cycles (Nab-paclitaxel 260mg/m^2 IV on day1, Cisplatin 75mg/m^2 IV on days 1-3); Tislelizumab 200mg IV every 3 weeks x 2 cycles; Afatinib 30mg PO everyday x 6 weeks.
    Intervention Type
    Drug
    Intervention Name(s)
    Nab-paclitaxel
    Other Intervention Name(s)
    Albumin-bound paclitaxel, Abraxane
    Intervention Description
    260mg/m^2 IV Q3W
    Intervention Type
    Drug
    Intervention Name(s)
    Cisplatin
    Other Intervention Name(s)
    CDDP
    Intervention Description
    75mg/m^2 IV Q3W
    Intervention Type
    Biological
    Intervention Name(s)
    Tislelizumab
    Other Intervention Name(s)
    BGB-A317
    Intervention Description
    200mg IV Q3W
    Intervention Type
    Drug
    Intervention Name(s)
    Afatinib
    Intervention Description
    30mg PO QD
    Primary Outcome Measure Information:
    Title
    Major Pathologic Response
    Description
    Major pathologic response was defined as fewer than 10% viable tumor cells.
    Time Frame
    Time of surgery
    Secondary Outcome Measure Information:
    Title
    Pathologic Complete Response
    Description
    Pathologic complete response was defined as the absence of viable tumor cells.
    Time Frame
    Time of surgery
    Title
    Objective Response Rate
    Description
    Objective response rate was defined as the percentage of participants with a best overall response of CR or PR using RECIST Criteria
    Time Frame
    Up to 8 weeks
    Title
    Adverse Events
    Description
    Adverse events included adverse events using CTCAE Criteria and unplanned surgery delays.
    Time Frame
    Up to 12 weeks
    Title
    Disease-free Survival
    Description
    Disease-free survival was defined as the time from the administration of the first dose to first disease progression or death.
    Time Frame
    1 year

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Age 18 years or above. Patients with pathologically confirmed HNSCC (except for nasopharyngeal carcinoma) and meet the following conditions: were newly diagnosed and without distant metastasis; were deemed surgically resectable evaluated by a head and neck surgeon; were willing to undergo surgery. Eastern Cooperative Oncology Group (ECOG) performance status 0-1. Adequate organ and bone marrow function: absolute neutrophil count ≥ 1.5 × 10^9/L, hemoglobin ≥ 80 g/L, platelets ≥ 80 × 10^9/L; ALT, AST and ALP < 2.5× upper limit of normal (ULN), total bilirubin ≤ 2×ULN; albumin≥ 2.8 g/dL; creatinine clearance ≥ 60 ml/min; INR≤ 1.5;APTT≤ 1.5×ULN; Written informed consent. Exclusion Criteria: History of other malignancies (except for the history of malignant tumors that have been cured and have not recurred within 5 years, such as skin basal cell carcinoma, skin squamous cell carcinoma, superficial bladder cancer, in situ cervical cancer, and gastrointestinal mucosal cancer, etc.) Have an active autoimmune disease requiring systemic treatment or a documented history of clinically severe autoimmune disease. Any history of allergic disease, or a sever hypersensitivity reaction to drugs, or allergy to the study drug components. Any of prior therapy with: anti-PD-1, anti-PD-L1/2, anti-CTLA-4 antibody, anti-EGFR antibody or EGFR-TKIs; antitumor vaccine; any active vaccine against an infectious disease within 4 weeks prior to the first dose or planned during the study period; major surgery or serious trauma within 4 weeks before the first dose; toxicity from prior antitumor therapy has not recovered to ≤ CTCAE Version 5.0 Grade 1 or the level specified by the inclusion/exclusion criteria. With serious medical diseases, such as grade II and above cardiac dysfunction (NYHA criteria), ischemic heart disease, supraventricular or ventricular arrhythmia, poorly controlled diabetes mellitus, poorly controlled hypertension, echocardiographic ejection fraction < 50%, etc. With interstitial pneumonitis, non-infectious pneumonitis, active pulmonary tuberculosis, or history of pulmonary tuberculosis infection that were not controlled by treatment. With hyperthyroidism, or organic thyroid disease. With active infection, or unexplained fever during the screening period or 48 hours before the first dose. With active hepatitis B or C, or known history of positive HIV test, or acquired immunodeficiency syndrome. History of a clear neurological or psychiatric disorder. History of drug abuse or alcohol abuse. Women who are pregnant or breastfeeding, or have a reproductive plan from the screening period to 3 months after the end of the study, or have sex without contraceptive measures, or are unwilling to take appropriate contraceptive measures. Received any investigational drug within 4 weeks prior to the first dose, or concurrently enrolled in another clinical trial. Any other factors that are not suitable for inclusion in this study judged by investigators.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Xingchen Peng, Professor
    Phone
    +8618980606753
    Email
    pxx2014@scu.edu.cn
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Xingchen Peng, Professor
    Organizational Affiliation
    West China Hospital
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Learn more about this trial

    Neoadjuvant Chemotherapy, Tislelizumab With Afatinib for HNSCC

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