To determine if it is feasible to use neoadjuvant immunotherapy (or immunotherapy plus chemotherapy) to reduce treatment intensity and improve long-term quality of life while maintaining very high cure rates.
Eligible patients will receive 3 cycles/9 weeks of Cemiplimab (IV infusion) prior to curative treatment, with or without Carboplatin/Paclitaxel. The addition of carboplatin and paclitaxel depends on the presence of measurable benefit to participant. Assessments of patient progress are conducted weekly by multidisciplinary team and at week 9 or 10 a de-escalation decision will also be used to determine if patient receives de-escalated or non-minimally de-escalated treatment. De-Escalated Treatment: Transoral Robotic Surgery (TORS) or Low Dose Radiation Therapy (42Gy) Non-Minimally De-Escalated Treatment: Surgery + Post-Operative Radiation Therapy or 60 Gy Chemoradiation Therapy Curative intent will be followed by adjuvant Cemiplimab for 4 months (5 doses every 21 days).
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
32
Cemiplimab for 9 weeks +/- Carboplatin + Paclitaxel
Johns Hopkins University
Baltimore, Maryland, United States
RECRUITING2-year progression free survival rate
Time frame: Up to 2 years
Change in Quality of life as measured by MD Anderson Dysphagia Inventory (MDADI)
The MD Anderson Dysphagia Inventory (MDADI) is a 20 item quality of life instrument specifically focusing on swallowing. The total score ranges from 20 to 100 with the higher score indicating higher level of function. Each item is scored on a 5 point Likert scale (strongly disagree, disagree, no opinion, agree, strongly agree).
Time frame: Up to 2 years
Change in quality of life as measured by the Sydney Swallow Questionnaire (SSQ).
The SSQ consists of 17 questions, (16 visual analogue scales (VAS) and one question scored on a Likert scale (0-5). The score for each VAS question is the distance in mm from the origin (left extremity) to the patient's mark on the visual analogue scale. The total score is calculated by summing the 16 individual VAS scores and the Likert scale (0-5) multiplied by 20. Thus converting the range of possible scores for Likert question from 0-5 to 0-100, consistent with the remaining 16 questions, to yield a total score out of a possible maximum of 1700. Higher scores indicate higher symptomatic severity of oral-pharyngeal dysphagia.
Time frame: Up to 2 years
Change in swallow function as measured by the Sydney Swallow Questionnaire (SSQ).
Desirable swallowing function at 1 year for this study will be defined as SSQ ≤ 250 and MDADI ≥ 70
Time frame: Up to 2 years
Change in swallow function as measured by the MD Anderson Dysphagia Inventory.
Desirable swallowing function at 1 year for this study will be defined as SSQ ≤ 250 and MDADI ≥ 70
Time frame: Up to 2 years
To determine 2-year overall survival (OS) for the entire cohort
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
OS will be estimated by Kaplan-Meier methodology and comparisons will be made using the log-rank test. OS is defined as the time between the date of registration and the date of death.
Time frame: From the date of registration to the date of death or date of last follow-up, up to 2 years
To determine 2-year rates of locoregional and distant control for the entire cohort
Locoregional and distant control will be assessed by immune response criteria using Response Evaluation Criteria in Solid Tumors (RECIST) criteria 1.1
Time frame: Time of registration to time of disease progression in head and neck or below clavicles for distant failure, assessed up to two years
Number of grade 3 toxicities
We will report the number of grade 3 toxicities using Common Terminology Criteria for Adverse Events (CTCAE).
Time frame: 100 days after last dose of study drug(s).
Number of grade 4 toxicities
We will report the number of grade 4 toxicities using Common Terminology Criteria for Adverse Events (CTCAE).
Time frame: 100 days after last dose of study drug(s).
Number of grade 3 Immune-related adverse events (irAE)
We will report the number of 3 Immune-related adverse events (irAE) using Common Terminology Criteria for Adverse Events (CTCAE).
Time frame: 100 days after last dose of study drug(s).
Number of grade 4 Immune-related adverse events (irAE)
We will report the number of grade 4 Immune-related adverse events (irAE) using Common Terminology Criteria for Adverse Events (CTCAE).
Time frame: 100 days after last dose of study drug(s).