The primary objective of the phase II trial is to determine the efficacy and safety of a combination of Durvalumab with the Carboplatin/Paclitaxel as first line treatment in patients with recurrent/metastatic SCCHN not eligible to standard chemotherapy.
For recurrent or metastatic Squamous Cell Carcinoma of the Head and Neck (SCCHN), the standard first-line treatment is chemotherapy by cisplatin-fluorouracil and cetuximab which allows a median overall survival of 10.1 months. Due to its toxicity, this combination could be proposed only to patients younger than 70 years, good PS (ECOG PS0 or PS1) and adequate renal function. In routine practice it is estimated that the proportion of eligible patients is about two third. One third of patients were ineligible to first-line chemotherapy by cisplatin-fluorouracil-cetuximab. Among them, 25% due to PS2 and the others for various reasons (older than 70 years, renal insufficiency….). For these ineligible patients, an alternative chemotherapy should be proposed. The carboplatin-paclitaxel scheme with weekly paclitaxel is safe for poor population and demonstrated efficacy in head and neck cancers with overall survival varying from 4.9 months to 12.8 months in first line. The response rate varies from 20% to 52% and is about 25% in our experience. Even for frail patients it should be a safe and active treatment. Nivolumab, a monoclonal antibody targeting PD1 demonstrated survival benefit compared with chemotherapy in patients with SCCHN who progressed after platinum-based first line (median OS of 7.5 months versus 5.1 months and 12-month OS rate of 36.0% versus 16.6%). Safety data confirm these antibodies are of interest in a population of frail patients. Only 58.9% of patients experienced treatment-related adverse events with nivolumab arm and 13% of grade 3/4. Durvalumab, an anti-PDL1 antibody is currently tested in SCCHN with promising results. Head and neck cancers are rapidly progressive and due to the delayed action of immunotherapy, and the recent demonstration that immunotherapy with anti-PD1 or anti-PDL1 can be responsible of hyperprogression, patients will probably benefit from addition of chemotherapy to immunotherapy, mostly for patients unfit for cisplatin-fluorouracil because their poor condition is often related to the cancer and a rapid response is needed. This trial proposes to study the addition of Durvalumab to chemotherapy in first line treatment for frail patients with recurrent/metastatic SCCHN. Prior to this evaluation, a run-in tolerance study in a limited number of patients to ensure that the experimental treatment combination is safe.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
104
Durvalumab associated with Carboplatin / Paclitaxel as first line treatment in patients with recurrent/metastatic SCCHN not eligible to standard chemotherapy
CHU d'Amiens
Amiens, France
ICO - Centre Paul Papin
Angers, France
Institut Sainte-Catherine
Avignon, France
Evaluation of efficacy and safety of Durvalumab with the Carboplatin/Paclitaxel as first line treatment in patients with recurrent/metastatic SCCHN not eligible to standard chemotherapy
Number of patients still alive 12 months after the first study drug administration (overall survival)
Time frame: 12 months after study treatment initiation
Progression-Free Survival
Defined as the time from the date of the first study drug administration to the date of first documented progression or death due to any cause
Time frame: 12 months after study treatment initiation
Time to Treatment Failure
Defined as the time from the date of inclusion to the date of permanent study treatment discontinuation
Time frame: 12 months after study treatment initiation
Overall survival
Defined as the time from the date of inclusion to the date of death due to any cause
Time frame: Up to 36 months
Objective Response Rate
Defined as the proportion of patients with a best overall response of Complete or Partial Response
Time frame: 12 months after study treatment initiation
Best Response Rate
Defined as proportion of patients who achieve a best response of CR, PR, SD or PD
Time frame: 12 months after study treatment initiation
Duration of response
Defined as the time from the date of first documented response (CR or PR) to the date of the first documented subsequent progression or death due to any cause
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Dijon, France
Clinique des Ormeaux
Le Havre, France
Groupe hospitalier Bretagne Sud
Lorient, France
Hôpital de la Croix-Rousse
Lyon, France
Centre Léon Bérard
Lyon, France
Hôpital de la Timone
Marseille, France
ICM - Centre Val d'Aurelle
Montpellier, France
...and 7 more locations
Time frame: 12 months after study treatment initiation
Quality of life using European Organisation for Research and Treatment of Cancer (EORTC) questionnaire
Using the EORTC QLQ-C30 (Quality of Life Questionnaire) - Scale range: 1 (better outcome) to 4 (worse outcome) for 28 variables and from 1 (better outcome) to 7 (worse outcome) for 2 variables
Time frame: 12 months after study treatment initiation
Quality of life using European Organisation for Research and Treatment of Cancer (EORTC) questionnaire
Using the EORTC QLQ-H\&N35 questionnaire (Quality of Life Questionnaire) - Scale range: 1 (better outcome) to 4 (worse outcome) for 30 variables and from 1 (better outcome) to 2 (worse outcome) for 5 variables
Time frame: 12 months after study treatment initiation
Tolerance profile: Incidence of treatment emergent adverse events and serious adverse events
Incidence of Treatment Emergent Adverse Events, Serious Adverse Events (SAE) and death assessed according to the NCI-CTC AE version 5
Time frame: 12 months after study treatment initiation