This is a Phase 1 study of the use of an investigational drug that selectively delivers radiation to malignant tumor cells, CLR 131, in combination with external beam radiation therapy (EBRT) in subjects with locoregionally recurrent head and neck cancer. The trial will enroll up to 12 participants who are amenable to retreatment with radiation therapy. Participants who also have distant metastatic disease may be enrolled on this clinical trial, but they must have evaluable disease that will be clinically treated with radiation therapy, as per standard of care. All participants will receive a dosimetry test dose of CLR 131 to establish drug uptake by the tumor and enable Monte Carlo dose estimation based on CLR 131 SPECT/CT imaging evaluation. Participants showing uptake will receive a cumulative tumor dose of 60-70 Gy using personalized dose calculation (via Monte Carlo methods) of CLR 131 combined with external beam radiation.
Following informed consent, all participants will receive a dosimetry test dose of 15 mCi CLR 131 to establish drug uptake by the tumor and enable Monte Carlo dose estimation based on CLR 131 SPECT/CT imaging evaluation. Participants who have uptake of the CLR 131 dosimetry test dose at their disease site as determined by the study radiologist will be eligible to participate on the treatment portion of this clinical trial. Participants showing uptake will receive a cumulative tumor dose of 60-70 Gy using personalized dose calculation of CLR 131 (via Monte Carlo) combined with external beam radiation. In this study, we are also studying a subset of up to 6 patients who do not uptake after the CLR 131 test dose, who will still proceed with treatment with CLR 131. This clinical trial involves two cohorts of subjects: (a) dose escalation and (b) dose expansion. In the dose escalation phase, an mTPI-2 design, an extension of modified toxicity probability interval (mTPI-2), will be used to identify the maximum tolerated dose (MTD) using cohorts of 4 participants and up to 3 dose levels of CLR 131. Participants in the dose escalation phase will receive 2 doses of CLR 131 with the first dose on day 1 followed by the second dose on day 8. Treatment with CLR 131 on the dose escalation cohort will begin at dose level 1 (15.6 mCi/m2). Participants at dose level 1 will receive an intravenous infusion of CLR 131 at 15.6 mCi/m2 on day 1 followed by a second dose on day 8. Participants at dose level 2 will receive an intravenous infusion of CLR 131 at 18.75 mCi/m2 on day 1 followed by a second dose on day 8. Once the MTD is determined by the dose escalation phase, participants will be enrolled on the dose expansion cohort. Participants on the dose expansion cohort will receive 2 doses of CLR 131 with the first dose on day 1 followed by the second dose on day 8, with the dose determined by the dose escalation phase. SPECT/CT imaging will be performed on days 2, 3, 4-6, and 7-8 of the treatment period to visualize and quantitate the biodistribution of CLR 131. Based on these SPECT/CT imaging scans, the Bednarz lab will utilize the Monte Carlo method to predict absorbed dose of CLR 131 to tumors and normal structures. All participants will start thyroid-protection medication the day prior to the CLR 131 dosimetry test dose and will continue to take thyroid protection medication for 14 days after the last CLR 131 dose. Based on the calculated absorbed dose of CLR 131 to the specific targeted tissue, the participant will undergo external beam radiation therapy (EBRT) to complete the designated radiation dose outlined in the re-irradiation plan, as per standard of care. Prior to CLR 131 administration and at 3 and 6 months post EBRT, participants will be assessed for changes to swallow function. Prior to CLR 131 administration and at 3, 6 and 12 months post EBRT, quality of life measures and salivary characteristics will be assessed. The investigators anticipate the total study (baseline, CLR 131 administration, EBRT and 3, 6, 12 and 24 month follow up assessments) to take 27 months per participant.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
12
CLR 131 is a radiopharmaceutical dosed intravenously over a period of approximately 30 minutes, dose will be based on total body surface area calculated from actual body weight and height
UW Cancer Center Johnson Creek
Johnson Creek, Wisconsin, United States
University of Wisconsin Carbone Cancer Center
Madison, Wisconsin, United States
Incidence of Treatment Related Adverse Events
Incidence of adverse events assessed using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Adverse Events Grading (1 = mild, 2 = moderate, 3 = severe, 4 = life threatening, and 5 = death)
Time frame: up to 18 weeks
Summary of Adverse Events Possibly Related to Treatment
Adverse Events Grading (1 = mild, 2 = moderate, 3 = severe, 4 = life threatening, and 5 = death)
Time frame: up to 18 weeks
CLR 131 Tumor Uptake Via SPECT/CT Imaging
Investigators will use SPECT/CT imaging scans to predict the adsorbed dose of CLR 131 to tumors with the Monte Carlo method.
Time frame: Up to 8 days
Median Radiation Treatment Time
Time frame: up to 14 weeks
Number of Dose Delays
Time frame: up to 14 weeks
Response Rates
Complete response (CR), disappearance of all tumors; Partial response (PR), at least 30% decrease in the sum of the longest diameter of target tumors; Stable disease (SD), no increase or decrease to tumor size; Progressive disease (PD), increasing tumor size. RECIST v1.1, Response Evaluation Criteria in Solid Tumors version 1.
Time frame: 6 months post completion of EBRT, up to 9 months on study
Overall Response Rate (ORR)
ORR defined as the proportion of subjects who experience either a partial response or complete response within 6 months post completion of EBRT as measured by standard of care imaging (e.g. CT, MR, PET-MR).
Time frame: 6 months post completion of EBRT, up to 9 months on study
Swallow Function: DIGEST Scale
Swallow function assessed by Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale before and after treatment. The DIGEST scale cross references a clinician determined 'safety' grade with an 'efficiency' grade for an overall score between 0-4 where 0 is asymptomatic and 4 is life threatening. Data collected at baseline, 3 months, and 6 months post completion of external beam radiation therapy (EBRT).
Time frame: up to 6 months post completion of EBRT (up to 9 months on study)
Quality of Life: MDADI Score
Quality of life assessed by MD Anderson Dysphagia Inventory score (MDADI) before and after treatment. MDADI is a 36-item self-assessment with global, emotional, functional, and physical sub-scales. Total possible composite score range is 20-100 where 20 is extremely low functioning and 100 is high functioning. Data collected at baseline, 3 months, and 6 months, and 12 months post EBRT.
Time frame: Assessed at 3 months and 6 months post EBRT (6 months and 9 months post-baseline). Originally pre-specified to be assessed at 12 months post EBRT, data not collected
Stimulated Salivary Flow
Stimulated Salivary Flow before and after treatment (mL/min). Data collected at baseline, 3 months, and 6 months post EBRT.
Time frame: up to 6 months post completion of EBRT (up to 9 months on study)
EORTC QLQ-C30 Scores
The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) is a 30-item instrument measures quality of life in cancer patients. It is scored from 0-100 where higher scores indicate higher level of response in function, symptomatology, or global health.
Time frame: up to 6 months post completion of EBRT (up to 9 months on study)
Xerostomia Quality-of-Life Scale (XeQoLS) Scores
The XeQoLS questionnaire measures the effects of xerostomia on oral health-related quality of life. The questionnaire consists of 15 items, each rated on a 0-to-4 point Likert scale, for a total possible range of scores from 0 to 60, with higher scores indicating more severe symptom burden.
Time frame: up to 6 months post completion of EBRT (up to 9 months on study)
Xerostomia Inventory Score
The Xerostomia Inventory is an 11-item survey scored on a 5 point-likert scale (never, hardly ever, occasionally, fairly often, very much). Total possible range of scores is from 11-55, with higher scores indicating increased mouth dryness.
Time frame: up to 6 months post completion of EBRT (up to 9 months on study)
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