The purpose of this study is to evaluate the results of treating patients with HPV-unrelated head and neck squamous cell carcinoma with neoadjuvant single-agent palbociclib, followed by chemoradiation (either cisplatin + IMRT or cetuximab + IMRT depending on patient characteristics), followed by adjuvant single-agent palbociclib.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
26
Palbociclib is an oral drug available as capsules (or as liquid suspension). The capsules should be taken with food
-Cetuximab must not be administered as an IV push or bolus
-Patients will receive cisplatin via intravenous (IV) infusion over 60 minutes.
-Once daily fractions Monday through Friday, with one additional fraction of RT administered on (preferably) Fridays
* Tumor tissue will be collected at baseline and then after two cycles of neoadjuvant palbociclib monotherapy * If the patient has been previously enrolled in Washington University's TAP protocol (head and neck bank, HRPO #201102323), tissue that has been banked may be accessed in lieu of fresh biopsy at baseline.
Baseline and post-treatment
Washington University School of Medicine
St Louis, Missouri, United States
Tumor Response Rate of Newly Diagnosed p16INK4a Negative, HPV-unrelated HNSCC to Neoadjuvant Palbociclib Monotherapy
* Tumor response rate is defined as the proportion of subjects who achieve a complete response (CR) or partial response (PR) based on RECIST criteria * CR: Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10 mm. Disappearance of all non-target lesions and normalization of tumor marker level. All lymph nodes must be non-pathological in size (\<10 mm short axis). * PR: At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters.
Time frame: 2 cycles (56 days)
Combined Local-regional Disease Relapse Risk and Distant Metastases Risk Following Completion of CRT
* Local-regional disease relapse, a binary variable (Yes vs. No). Local-regional disease relapse rate is defined as the proportion of subjects alive who have local-regional progressed disease at 18 months following completion of CRT, stratified by cohorts. * Distant metastases, a binary variable (Yes vs. No). Distant metastases rate is defined as the proportion of subjects alive who have distant metastases at 18 months following completion of CRT, stratified by cohorts.
Time frame: Through 18 months after completion of step 2
Median Progression-free Survival (PFS) (Stratified by Cohort) of Patients Treated With the Three Step Sequence of Palbociclib Monotherapy, CRT, and Adjuvant Palbociclib Monotherapy
-Progression-free survival (PFS), defined as the interval from the start of Step 2 (CRT) to the first documentation of disease progression or death from any cause or the end of follow-up, stratified by cohorts.
Time frame: Through 5 years after completion of step 2
Progression-free Survival (PFS) of Patients Treated With the Three Step Sequence of Palbociclib Monotherapy, CRT, and Adjuvant Palbociclib Monotherapy
-Progression-free survival (PFS), defined as the days from the start of Step 2 (CRT) to the first documentation of disease progression or death from any cause or the end of follow-up
Time frame: Through 2 years after completion of step 2
Median Overall Survival (OS) of Patients Treated With the Three Step Sequence of Palbociclib Monotherapy, CRT, and Adjuvant Palbociclib Monotherapy
-Overall survival (OS), defined as the days from the time of diagnosis to death from any cause or the end of follow-up
Time frame: Through 5 years after completion of step 2
Overall Survival of Patients Treated With the Three Step Sequence of Palbociclib Monotherapy, CRT, and Adjuvant Palbociclib Monotherapy
-Overall survival (OS), defined as the days from the time of diagnosis to death from any cause or the end of follow-up
Time frame: Through 2 years after completion of step 2
Change in Genomic Alterations in Tumor Tissue
Tumor genomic alterations at baseline and at relapse will be compared to assess for potential mechanisms of primary or secondary resistance to palbociclib.
Time frame: At baseline and at time of disease relapse (up to 5 years)
Association Between Baseline Tumor CDKN2A and CCND1 Alterations and Tumor Response to Palbociclib Given Before CRT and Relapse After CRT
Number of participants with altered versus wild-type at baseline will be compared with response.
Time frame: At baseline and at time of disease relapse (up to 5 years)
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