Head \& neck (H\&N) cancer is the eighth most common cancer in the UK. Advanced H\&N cancer which has come back after treatment or has spread to other parts of the body is incurable and the average life expectancy of these patients is less than a year. New drugs called immune checkpoint inhibitors work with the patient's own immune system to fight cancer. They are used in the clinic to treat a number of cancers, including H\&N cancer. It may be possible to make immune checkpoint inhibitors more effective by combining drugs that work in different ways. In effect, attacking the cancer from different angles. Cetuximab is a well-established drug that works by blocking signals that tell cancer cells to grow and divide into more cells. It also engages with the immune system within the tumour. The trial aims to see if giving cetuximab along with an immune checkpoint inhibitor drug called avelumab is better at treating advanced H\&N cancer than giving avelumab on its own. These two drugs have not been given together before, so to start with, the investigator plans to enrol a small number of patients and give the patients avelumab + cetuximab to make sure the combination is safe at the doses chosen. After this, the investigator plans to enrol 114 patients with advanced H\&N cancer. Half the patients will be treated with avelumab alone and the other half with avelumab + cetuximab. Both drugs are given intravenously in the hospital once every 2 weeks. Treatment lasts for up to a year and patients will be followed up for up to 2 years from the time they enter the study. Patients will be recruited from around 15 hospitals in the UK. Recruitment would be expected to start in the second quarter of 2018 and it will take about 29 months (Safety run-in: 5 months; Phase II: 24 months) to recruit all the patients.
This is a randomised phase II study comparing the efficacy of avelumab alone with avelumab + cetuximab combination in patients with platinum-resistant advanced or metastatic head \& neck cancer. The randomised phase II part of the trial will be preceded by a safety run-in.The objective of the safety run in is to make sure the combination of cetuximab and avelumab at the doses selected for the study are safe and tolerable. In phase II, the main question the investigator wants to answer is whether or not giving avelumab and cetuximab together is better than giving avelumab alone to treat patients with head and neck cancer that have had previous treatment with cisplatin and whose cancer has come back or spread to other parts of the body. The investigator will compare the number of patients in each group whose cancer has not gotten any worse 6 months after joining the study. The phase II part of the trial will recruit patients with head \& neck squamous cell carcinoma only. However, during the safety run-in, patients with other types of squamous cell carcinomas will also be eligible. Target accrual: Safety run-in: up to 16 patients with squamous cell carcinomas; Phase II: 114 patients with head \& neck squamous cell cancer The safety run-in will recruit patients in cohorts of 3 at a time and all patients will be treated with the combination. The safety run in is a dose de-escalation design. That is, patients will be given the dose that is planed for use in phase II and if this proves not tolerable, the dose of cetuximab will be de-escalated and another cohort of patients will be recruited. The investigator will conclude the combination is safe and tolerable if less than 33% of patients who are treated experience side effects that lead to a dose reduction. The purpose is to ensure the safety of the combination prior to starting phase II, as these drugs have not been given together before. However, there is evidence from previous studies that these types of drugs can be combined safely. The trial aims to complete the safety run-in within 5 months and the phase II study within 24 months. The entire duration of recruitment is expected to be 29 months.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
16
University College Hospital
London, United Kingdom
Safety run-in: Occurrence of dose limiting toxicity
Detailed adverse event monitoring will be conducted according to CTCAE v4.03. Patients experiencing any of the following adverse events related to either cetuximab or avelumab during the DLT period will be considered to have experienced a DLT: * Any grade 3 or 4 adverse reaction requiring a dose reduction of cetuximab * Any adverse reaction resulting in a more than a 14 day treatment delay for any agent.
Time frame: From start of cycle 1 (each cycle is 28 days) upto six weeks.
Phase II: Disease control rate at 24 weeks after randomisation
Assessed using iRECIST
Time frame: From randomisation upto 24 weeks
Objective response (iCR or iPR) at 6 and 12 months
Using iRECIST
Time frame: 6 months and 12 months after registration/randomisation
Disease control at 6 and 12 months
Using iRECIST
Time frame: 6 and 12 months after registration/randomisation
Best overall response
Using iRECIST
Time frame: From start of treatment to 24 months after registration, or upto start date of a new treatment for their disease, whichever came first, assessed up to 24 months.
Duration of response
Using iRECIST
Time frame: From the date of the first response assessment showing iCR or iPR to the date of the response assessment documenting iPD according to iRECIST, assessed up to 24 months.
Overall survival
Time frame: Time from registration/randomisation to death from any cause, assessed up to 24 months.
Time to Progression
Time frame: From date of registration/randomisation to date of first documented progression, assessed up to 24 months.
Progression free survival
Time frame: From date of registration/ randomisation to date of first documented progression, assessed up to 24 months.
Frequency and severity of adverse events
Time frame: From informed consent to 90 days post last IMP treatment
Treatment related dose delays or treatment discontinuation
Time frame: From start of treatment to end of treatment, assessed up to 12 months.
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