The primary objective of this study is to determine the clinical performance of UV1 vaccination as add on to standard pembrolizumab treatment in patients with recurrent or metastatic PD-L1 positive (CPS \>=1) head and neck squamous cell carcinoma. Secondary objectives are to determine the efficacy in terms of overall survival ,objective response rate and duration of response. Moreover, this study will explore patient subgroups most likely deriving benefit from a targeted immunotherapy approach combining a checkpoint inhibitor with a cancer vaccine and help to establish liquid biopsy tumor monitoring in HNSCC.
Overall survival of patients with metastatic or recurrent HNSCC has improved over the past decade but remains poor overall. Median overall survival is limited to less than 15 months, with the current standard of care (immune checkpoint blockade with or without chemotherapy). Many patients with HNSCC are frail and therefore cannot tolerate chemotherapy, reducing their treatment options to checkpoint inhibitor. Therefore, the development of effective and tolerable combination regimens is urgently needed, especially in first-line therapy. The FOCUS study will evaluate such a combination regimen in patients with metastatic or recurrent HNSCC. The experimental regimen evaluated in this study will test the first-line standard drug pembrolizumab in combination with the novel UV1 cancer vaccine. In the comparator arm, patients receive pembrolizumab as the standard of care. The aim is to assess whether the addition of UVI can increase the efficacy of the checkpoint inhibitor. Based on currently available data, a decrease in efficacy due to the combination of standard first-line therapy with pembrolizumab is unlikely. The FOCUS study could therefore establish a new 1st-line regimen with increased efficacy and acceptable tolerability, which would need to be compared with the standard of care in a larger phase III trial. Based on the biomarker data from the FOCUS study, a subsequent Phase 3 study would potentially test the regimen only in subpopulations with increased response probability. From the perspective of the individual patient, participants may benefit from the experimental combination through improved efficacy. On the other hand, this is a novel combination study for HNSCC, and there is a risk that efficacy may not improve.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
75
UV1 vaccination (300 μg) UV1 vaccination will be applied in a dense schedule with three vaccinations during one week before initiation of pembrolizumab, followed by 5 additional vaccinations every 3 weeks on d1 of each cycle (5 cycles in total, duration of treatment will be 13 weeks in total, regular EOT at week 14)
75 μg GM-CSF as adjuvant per vaccination. Applied in a dense schedule with three injections during one week before initiation of pembrolizumab, followed by 5 additional injections every 3 weeks on d1 of each cycle (5 cycles in total, duration of treatment will be 13 weeks in total, regular EOT at week 14).
200mg flat dose iv every 3 weeks. Pembrolizumab will be administered beyond the EOT visit at physician discretion until disease progression and up to a maximum of two years (standard of care)
Universitätsklinikum Aachen, Klinik für Hämatologie, Onkologie, Hämostaseologie
Aachen, Germany
NOT_YET_RECRUITINGCharité Universitätsmedizin, Comprehensive Cancer Center, Medizinische Klinik m.S. Hämatologie, Onkologie und Tumorimmunologie
Berlin, Germany
NOT_YET_RECRUITINGUniversitätsklinikum Greifswald, Klinik für Hals-, Nasen-, Ohrenkrankheiten, Kopf- und Halschirurgie
Greifswald, Germany
NOT_YET_RECRUITINGUniversitätsklinikum Halle (Saale), Klinik und Poliklinik für Innere Medizin IV
Halle, Germany
RECRUITINGUniversitätsklinikum Hamburg, Universitäres Cancer Center Hamburg UCCH, Hubertus Wald Tumorzentrum
Hamburg, Germany
NOT_YET_RECRUITINGKlinikum St. Georg gGmbH
Leipzig, Germany
NOT_YET_RECRUITINGUniversitätsklinikum Leipzig, Klinik und Poliklinik für HNO Heilkunde
Leipzig, Germany
RECRUITINGUniversitätsklinikum Mainz, III. Medizinische Klinik und Poliklinik
Mainz, Germany
RECRUITINGKlinikum Stuttgart, Klinik für Hämatologie, Onkologie und Palliativmedizin
Stuttgart, Germany
RECRUITINGUniversitätsklinikum Würzburg, Comprehensive Cancer Center Mainfranken
Würzburg, Germany
NOT_YET_RECRUITINGProgression free survival rate
according to iRECIST
Time frame: 6 months after first administration of study medication
Progression free survival
according to iRECIST
Time frame: every three months, until progression of disease, maximum 12 months from the date of LPI (last patient in)
Overall survival
Time frame: every three months, until death, maximum 12 months from the date of LPI (last patient in)
Objective Response Rate
Complete Remission (CR) + Partial Remission (PR) according to iRECIST
Time frame: every three months, until death, maximum 12 months from the date of LPI (last patient in)
Duration of Response
according to iRECIST
Time frame: every three months, until death, maximum 12 months from the date of LPI (last patient in)
Rate of immune responses against hTERT peptides
measured by 3H-Thymidine proliferation and IFNgamma ELISPOT assays
Time frame: Baseline, up to 8 weeks, time of progression (max. 12 months after LPI)
Rate of clearance of ctDNA from blood on treatment
Time frame: Baseline, week 5, week 8 and 1, 3, 6 months after EOT (max. 14 weeks), time of progression (max. 12 months after LPI)
Adverse Events
according to NCI CTC AE v5.0
Time frame: 3 months after EOT (maximum 25 weeks after start of treatment)
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