In phase I of the trial, the investigators aim to explore the safety and feasibility of abemaciclib in combination with nivolumab in patients with recurrent/metatstatic head and neck squamous cell carcinoma (RM-HNSCC). A dose de-escalation study design will be used to determine the recommended phase II dose (RP2D) of abemaciclib given with the standard dose of nivolumab. In phase II of the trial, the investigators aim to determine if abemaciclib and nivolumab will improve the one year survival from 36% (historical comparison with nivolumab) to 60% (abemaciclib + nivolumab) in patients with RM-HNSCC that had progressed or recurred within six months after platinum-based chemotherapy. Patients will be treated with abemaciclib at the recommended phase 2 dose (RP2D) in combination with standard doses of nivolumab. If this aim is met, genome sequencing, bulk and single cell RNAseq, and selected protein expression and deep cellular phenotyping will be performed on tumor tissue and blood obtained before and during treatment with abemaciclib and nivolumab. These biomarker data will be correlated with survival and tumor response to abemaciclib and nivolumab.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
6
Abemaciclib is an investigational agent for this trial and will be supplied by Lilly Oncology, free of charge to the patient.
Nivolumab is commercially available
* Phase II patients only * If the patient consents, fresh tumor tissue will be collected at baseline and then during Cycle 2 (between days 8-22) of abemaciclib and nivolumab.
* Phase II patients only * Peripheral blood will be collected at baseline, at the end of the Lead In (cycle 1 day 1 prior to treatment), during cycle 2 (between days 8-22), and during cycle 3 (between days 21-28). If patient does not have progression after cycle 3, patient will also have peripheral blood collected at time of progression.
* Phase II patients only * Screening , Cycle 2 D1, Cycle 4 D1, and End of treatment (EOT)
Washington University School of Medicine
St Louis, Missouri, United States
Phase I Only: Determine the Recommended Phase 2 Dose of Abemaciclib Combined With a Fixed Dose of Nivolumab
-The RP2D of abemaciclib is defined as the highest dose level at which fewer than 2 patients of a cohort of three patients experience a dose-limiting toxicity (DLT) during the first cycle.
Time frame: Completion of enrollment to Phase I portion of study (estimated to be 3 months)
Overall Survival (OS) Rate
* OS is defined as the time from the date of treatment to the date of death, censored at the last follow-up otherwise. * The mean survival time and standard error were underestimated because the largest observation was censored and the estimation was restricted to the largest event time.
Time frame: Until death (estimated average of 13 months)
Phase II Only: Best Overall Tumor Response
* Complete response: Complete Response (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. * Partial response: At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters. * The best overall response is the best response recorded from the start of the treatment until disease progression/recurrence (taking as reference for progressive disease the smallest measurements recorded since the treatment started). The patient's best response assignment will depend on the achievement of both measurement and confirmation criteria.
Time frame: Through completion of treatment (estimated to be 5 months)
Phase II Only: Duration of Tumor Response
-The duration of overall response is measured from the time measurement criteria are met for complete response (CR) or partial response (PR) (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded since the treatment started).
Time frame: Through completion of treatment (estimated to be 5 months)
Progression-free Survival (PFS)
-PFS is defined as the time from treatment to the date of progression or death, whichever occurs first. The alive patients without progression is censored at the last follow-up.
Time frame: Through completion of treatment (estimated to be 5 months)
Adverse Events (AEs) Associated With the Combination of Abemaciclib and Nivolumab.
-The descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 will be utilized for all toxicity reporting.
Time frame: Through 30 days after completion of treatment (estimated to be 6 months)
Phase II Lead-In Only: Changes in Peripheral Blood Lymphocyte Subsets
Time frame: Compare before and after one week of abemaciclib monotherapy
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