This is a non-comparative randomized Phase 2 study using the INITIUM regimen with or without elective nodal irradiation (ENI) delivered before surgery for resectable head and neck squamous cell carcinoma (HNSCC).
Patients with surgically resectable HPV-negative HNSCC with no prior history of head and neck radiation and a life expectancy of at least 12 months will be enrolled. Patients will undergo pre-radiation pembrolizumab for two cycles followed by pre-operative radiotherapy and two additional cycles of pembrolizumab. Radiation will be given to a total dose of 35 Gy in 5 fractions to gross disease, followed by response-directed surgery approximately eight weeks after completion of radiation. Patients randomized to ENI will concurrently receive 27 Gy in 5 fractions to elective nodal regions during radiation to gross disease. Baseline symptom evaluation will be obtained using validated surveys for head and neck cancer patients: the Functional Assessment of Cancer Therapy for the Head and Neck (FACT-HN) and the MD Anderson Dysphagia Inventory for Head and Neck (MDADI-HN). Tumor biopsies will be performed serially across treatment for translational study at the following time points: baseline, after induction pembrolizumab, on the final day of radiation, and at the time of surgery. If patients sign a secondary consent, quantitative MRI (qMRI) will be performed prior to radiation, on the day of the last fraction of radiation and six weeks after the completion of radiation, prior to surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
20
All patients will undergo induction with pembrolizumab (200 mg) given intravenously every three weeks for two cycles prior to radiation and two cycles after radiation.
All patients will receive 7 Gy daily for 5 fractions to gross disease.
Patients receiving ENI will be treated to 5.4 Gy daily to the elective nodal basins for 5 fractions concurrent with treatment to gross disease.
Froedtert & the Medical College of Wisconsin
Milwaukee, Wisconsin, United States
Pathologic complete response (pCR) rate to INITIUM-HN with and without ENI.
pCR is defined as no viable tumor in primary tumor or lymph nodes on pathological examination.
Time frame: Up to 10 weeks post-radiation therapy
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Patients will be scheduled for surgery at ten weeks (-7 days) after radiation to allow for maximal tumor regression and healing of any radiation-related mucositis. Surgical resection will be tailored to the treatment response.