This is a Phase II, single-centre, non-randomized, single-arm clinical trial to investigate the efficacy and safety of neoadjuvant nivolumab therapy in adult participants with resectable, locoregionally advanced Oral Squamous Cell Carcinoma (OSCC) tumors. Identification of predictive molecular biomarkers of tumor response to treatment will also be performed.
Patients 18 years old and above, any gender, naïve to immunotherapy, and with histologically confirmed T2-4 N0-3 M0 resectable Oral Squamous Cell Carcinoma tumors will be eligible for this clinical trial. Enrolled patients must be fit and eligible for the primary treatment of curative surgery at the primary tumor site with sentinel node identification and removal. Total 60 patients fulfilling eligibility criteria will be included during the period of three years and will receive a total of 2 doses (240 mg per dose) of nivolumab at day 1 and day 15 prior to the curative standard of care surgery. After the study treatment and standard of care surgery, the study participants will be offered evidence-based adjuvant therapy, such as radiotherapy, chemoradiotherapy and checkpoint inhibitors or combination treatments, according to the existing evidence. The study duration per participant after inclusion is approximately 27 weeks including two study-related follow-up visits at 3 and 6 months after the second nivolumab dose. Survival status and disease status of every participant will be also reviewed in medical records at 1, 2, 3 and 5 years after the second nivolumab dose.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
60
Nivolumab at day 1 and day 15 prior to the curative standard of care surgery.
Karolinska University Hospital, Head-, neck-, lung- and skin cancer, Theme Cancer
Stockholm, Sweden
Frequency of response
Frequency of tumor response measured as Objective Response Rate (ORR) based on the standard RECIST v1.1 criteria, assessed using radiographic images.
Time frame: From start of neoadjuvant treatment to end of neoadjuvant treatment (before surgery), up to approximately 4 weeks
Frequency of pathological response
Tumour pathological response, defined as percentage residual tumour cells after treatment, measured as Pathologic Complete Response, pCR (no residual tumour cells in tumor bed or lymph nodes), Major Pathological Response, MPR (≤10% residual viable tumour), Pathological Partial Response, pPR (≤50% residual viable tumour).
Time frame: From start of neoadjuvant treatment to end of neoadjuvant treatment (before surgery), up to approximately 4 weeks
Frequency of volumetric tumour response
Volumetric tumour response, measured by radiographic images and/or physical measurements and assessments.
Time frame: From start of neoadjuvant treatment to end of neoadjuvant treatment (before surgery), up to approximately 4 weeks
Incidence of treatment-related Adverse events (TRAEs)
Incidence of treatment related adverse events classified according to the definitions in NCI CTCAE version 5.0.
Time frame: From start of neoadjuvant treatment up to and including 6 months.
Incidence of Serious adverse events (SAE)
Incidence of serious adverse events
Time frame: From start of neoadjuvant treatment up to and including 6 months.
Change from baseline in hematology parameters
Change from baseline in white blood cells (WBC), white blood cell differentiation, absolute neutrophil count (ANC), thrombocytes/platelets, erythrocytes (haematocrit), (B)Erc-MCH, (B)Erc-MCV, haemoglobin (Hb).
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Time frame: From screening visit, assessed at regular intervals up to 6 months after first neoadjuvant treatment
Change from baseline in clinical chemistry parameters
Change from baseline in Electrolyte status: sodium (Na), potassium (K), calcium (Ca), creatinine, Liver status: albumin, bilirubin, alkaline phosphatase (ALP), alanine aminotransferase (ALAT), aspartate aminotransferase (ASAT), lactate dehydrogenase (LD), gamma-glutamyl transferase (GGT), Amylase, glucose, and c-reactive protein (CRP).
Time frame: From screening visit, assessed at regular intervals up to 6 months after first neoadjuvant treatment
Change from baseline in vital signs
Change in vital signs including heart rate, systolic and diastolic blood pressure, body temperature, respiratory rate.
Time frame: From screening visit up to 6 months after first neoadjuvant treatment
Change from baseline in Electrocardiogram (ECG) values
Change from baseline in ECG values, including ECG QT interval, heart rhythm and rate, ST segment and T wave
Time frame: From screening visit up to 6 months after first neoadjuvant treatment
Rate of postoperative complications
Rate of postoperative complications
Time frame: From surgery to date of any postoperative complication, assessed up to 5 months post surgery
Incidence of surgery delays or surgery cancelation
Incidence of surgery delays/cancellations due to disease progression or treatment related adverse reactions during the neoadjuvant treatment period.
Time frame: From start of neoadjuvant treatment to date of surgery, assessed up to 6 months
Incidence of reduced extent of surgical intervention
Incidence of reduced extent of surgical intervention with achieved negative/clear surgical margins (SM) or spared from surgery due to complete response to neoadjuvant therapy.
Time frame: At surgery, 3 weeks after start of neoadjuvant treatment
Incidence of immunogenicity
Incidence of immunogenicity as measured by the presence of antidrug antibody (ADA) and neutralizing antibodies (NAb) to nivolumab
Time frame: From pre-screening to 5 months after surgery
Proportion of participants with progression-free survival (PFS) and event-free survival (EFS) at distinct timepoints
Number of patients that had not experienced disease progression (PFS) or any event (EFS) such as recurrence, treatment-related complications, or death at distinct time points.
Time frame: From second dose of neoadjuvant treatment, assessed one, two, three, four and five years after the second dose of neoadjuvant treatment
Rate of overall survival at distinct timepoints up to 5-year follow-up
Number of patients that survived at distinct time points up to 5-year follow-up
Time frame: From second dose of neoadjuvant treatment, assessed one, two, three, four and five years after second dose of neoadjuvant treatment.
Effect of neoadjuvant nivolumab treatment on a quality of life (QOL)
Time to clinically relevant changes defined as ≥10-point change for all scales in European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35 (EORTC QLQ-H\&N35).
Time frame: From screening visit assessed up to 6 months
Incidence of HPV status in tumour
HPV status assessment of tumor and incidence reporting during pre-screening.
Time frame: At pre-screening visit, 1-5 weeks before first neoadjuvant treatment
Correlation of HPV status and response to neoadjuvant therapy
Correlation of HPV status and response to neoadjuvant therapy as defined RECIST 1.1
Time frame: From pre-screening visit to end of neoadjuvant treatment, up to 8 weeks
Proportion of patients with response at lymph nodes
Lymph node response, according to the RECIST v1.1 criteria
Time frame: From pre-screening to surgery, up to 8 weeks
Change in the number of metastatic lymph nodes
Number of metastatic lymph nodes, defined according to the RECIST v1.1 criteria.
Time frame: From prescreening to surgery, up to 8 weeks