This study is a prospective open label, multicenter, phase II, window-of-opportunity preoperative, single-agent trial. This study aims to evaluate the efficacy, the safety and tolerability profile of bintrafusp alfa in patients with histologically or cytologically confirmed squamous cell carcinoma of the oral cavity, oropharynx, larynx or hypopharynx, previously untreated, with indication of primary surgery. Patients with a diagnosis of head and neck squamous cell carcinoma (HNSCC) from unknown primary will not be enrolled.
The study plans to enrol up to 59 patients in total. Eligible patients who have provided their written informed consent for study participation will be assigned to one the 2 cohorts described below: Cohort A (43 patients): Non-oropharyngeal HNSCC, or Oropharyngeal squamous cell carcinoma (SCC) that are human papillomavirus (HPV) negative, or Oropharyngeal SCC that are HPV positive and smoker ≥20 pack year (PY). A Minimax two-stage Simon design will be used with an unacceptable rate of pathological response of 30% or less and a hypothesized actual pathological response rate of 50% or more. In the first stage, 28 patients will be accrued. If the observed number of patients with a pathological response is 7 or less, then the study for the cohort A will conclude to inefficacy and patient recruitment in this cohort will be stopped. Cohort B (16 patients): Oropharyngeal SCC that are HPV positive and non-smoker or smoker \<20 PY (former or active). The design for this cohort will be a single-stage design. All trial-related interventions will be strictly similar for these 2 cohorts.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
7
bintrafusp alfa will be administered by intravenous infusion over 60 minutes at a dose of 1200 mg on Day1 and Day15
CHU de Bordeaux
Bordeaux, France
Centre Antoine Lacassagne
Cagnes-sur-Mer, France
Centre Léon Bérard
Lyon, France
CHU La Timone
Marseille, France
Pathological response (PathR)
Pathological tumor response will be evaluated as the percentage of the tumor area showing evidence of anti-tumor activity, such as tumor cell necrosis and/or giant cell/histolytic reaction to keratinous debris
Time frame: From inclusion to 1 month after surgery
Pathological response using a threshold of 50% (PathR50), 70% (PathR70) and 90% (PathR90)
Will be considered as responders, the patients presenting 50% or more, 70% or more, and 90% or more, respectively, of tumor cell death.
Time frame: From inclusion to 1 month after surgery
Response rate, using primary endpoint criteria, by PD-L1 status
The response rate using primary endpoint criteria, by PD-L1 status using Combined Positive Score (CPS) thresholds of 1 and 20. CPS is the number of PD-L1 staining cells (tumor cells and immune cells) divided by the total number of viable tumor cells, multiplied by 100.
Time frame: 3 years
Response rate, using primary endpoint criteria, by HPV status in cohort A
The response rate, using primary endpoint criteria, by HPV status determined by p16 staining in cohort A. Two categories will be defined: HPV- and HPV+ (smokers ≥20 PY). HPV+ non-smoker or smoker \<20 PY will be included in cohort B.
Time frame: 2 years
Clinical response
Efficacy of bintrafusp alfa by clinical response will be evaluated by measuring changes in tumor size in response to treatment; measured by Magnetic resonance Imaging (MRI) or positron emission tomography (PET) scan and assessed by RECIST v1.1
Time frame: From inclusion to post-treatment imaging visit, an average of 21 days
Disease-free survival (DFS)
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Institut Curie
Paris, France
Institut Claudius Régaud
Toulouse, France
Institut de cancérologie de Lorraine
Vandœuvre-lès-Nancy, France
Gustave Roussy Cancer Campus
Villejuif, France
DFS defined as the delay between the date of the surgery and the occurrence of a loco-regional recurrence and/or a distant metastasis due to the cancer or death whatever the cause for which the patient was included, whichever comes first.
Time frame: 12, 18, 24, and 36 months after surgery
Overall survival (OS)
OS defined as the delay between the date of the surgery and the occurrence of death, whatever the cause.
Time frame: 12, 18, 24, and 36 months after surgery
Loco-regional disease-free survival (LR-DFS)
LR-DFS defined as the delay between the date of the surgery and the first occurrence of a loco-regional recurrence due to the cancer or death whatever the cause for which the patient was included.
Time frame: 12, 18, 24, and 36 months after surgery
Distant disease-free survival (D-DFS)
D-DFS defined as the delay between the date of the surgery and the first occurrence of a distant metastasis due to the cancer or death whatever the cause for which the patient was included.
Time frame: 12, 18, 24, and 36 months after surgery
Treatment-Emergent Adverse Events (Safety and Tolerability) profile of bintrafusp alfa
The National Cancer Institute-Common Terminology Criteria for Adverse Events version 5 (NCI-CTCAE v5) is widely accepted in the community of oncology research as the leading rating scale for adverse events. This scale will assess the severity of sensory neuropathic disorders, this derivative into 5 grades determined by the investigator.
Time frame: From inclusion to 12 weeks after the last administration of the investigational product
Evaluation of the impact of inking the tumor margins during baseline endoscopy to avoid surgical plan changes putatively induced by tumor shrinking under therapy
Just before the beginning of the surgery, surgeons will answer a question (4-level: Yes, No, Not evaluable, Unknown) to indicate if their surgical plan would have been different in the absence of ink labelling.
Time frame: From inclusion to surgery, an average of 21 days