The study is an open-label phase I/II clinical trial. The study will enroll patients to receive neoadjuvant SBRT plus 1 or 2 doses of neoadjuvant pembrolizumab with concurrent ficerafusp alfa (4 doses) prior to definitive surgical resection for high-risk, locoregionally advanced HPV-negative head and neck squamous cell carcinoma (HNSCC). Approximately 6 weeks after end of SBRT, patients will undergo standard of care (SOC) surgical resection followed by SOC adjuvant chemoradiation per National Comprehensive Cancer Network (NCCN) guidelines. Adjuvant therapy is not part of this study and therefore is not dictated by study protocol.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
45
1-3 fractions given over 1 week as assigned in phase I and as determined to be the maximum tolerated dose (MTD) in phase II
200 mg intravenously (IV) given on Day 1 or Days 1 and 22 as assigned in phase I and as determined to be the maximum tolerated dose (MTD) in phase II.
750mg intravenously (IV) on Days 1, 8, 15, and 22.
Washington University School of Medicine
St Louis, Missouri, United States
Phase I only: Maximum tolerated dose (MTD) of SBRT in combination with pembrolizumab plus ficerafusp alfa
The maximum tolerated dose (MTD) is defined as the highest dose level at which 0 or 1 patients of a cohort experience dose-limiting toxicity during the dose limiting toxicity (DLT) window. DLTs are defined in the protocol.
Time frame: From start of treatment until date of surgery (total estimated time of 7 weeks)
Phase II only: Rate of pathologic complete response (pCR)
Response will be defined according to the systematic pTR system. pTR is defined as the presence of tumor cell necrosis and keratinous debris with giant cell/histiocytic reaction, quantified as a percentage of the overall tumor bed (area pathologic response/area pathologic response plus viable tumor). pCR is defined as follows: 100% of sample characterized by tumor necrosis, keratinous debris, and/or giant cells/histiocytes
Time frame: At the time of surgery (estimated to be week 7)
Phase II only: Number and types of Adverse Events (AEs)
As defined by CTCAE v5.0.
Time frame: From start of treatment through 5 years after completion of treatment (estimated to be 5 years and 2 months)
Phase II only: Pathological response rate (PRR)
PRR is categorized as pCR, mPR, and others (pTR-0, pTR-1, pTR-2). Simon's two-stage optimal design will be used for a rate of pCR in phase II. Response will be defined according to the systematic pTR system. pTR is defined as the presence of tumor cell necrosis and keratinous debris with giant cell/histiocytic reaction, quantified as a percentage of the overall tumor bed (area pathologic response/area pathologic response plus viable tumor). pTR is defined as follows: pTR-0: \< 10% of sample characterized by tumor necrosis, keratinous debris, and/or giant cells/histiocytes, pTR-1: 10-49%, pTR-2: 50-89%, pTR-3: 90-99% (also referred to as mPR), and pTR-4: 100% (also referred to as pCR).
Time frame: At time of surgery (estimated to be week 7)
Phase II only: Event-free survival (EFS)
EFS is defined as the time from the first date of treatment to the date of disease progression or death, whichever occurs first.
Time frame: From start of treatment through 5 years after completion of treatment (estimated to be 5 years and 2 months)
Phase II only: Rate of clinical to pathologic down staging (and extent of surgical plan modifications, if any)
Time frame: At time of surgery (estimated to be week 7)
Phase II only: Overall survival (OS)
OS is defined as the time from the first date of treatment to the date of death. Alive patients are censored at the last follow-up otherwise.
Time frame: From start of treatment through 5 years after completion of treatment (estimated to be 5 years and 2 months)
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