Recurrent or Metastatic PD-L1-positive Squamous Cell Carcinoma of the Head and Neck
Conditions
Keywords
Head and neck cancer; SCCHN
Brief summary
Primary Objective: To assess the efficacy of MEDI4736 monotherapy in terms of ORR
Detailed description
This is a phase II, multi-center, single-arm, global study of MEDI4736 monotherapy in patients with PD-L1 positive recurrent or metastatic Squamous Cell Carcinoma of the Head and Neck (SCCHN), who have progressed during or after treatment with only 1 systemic palliative regimen for recurrent or metastatic disease that must have contained a platinum agent.
Interventions
MEDI4736 monotherapy
Sponsors
Study design
Eligibility
Inclusion criteria
* Age ≥18 years * Written informed consent obtained from the patient/legal representative * Histologically confirmed recurrent or metastatic SCCHN * Tumor progression or recurrence during or after treatment with only 1 systemic palliative regimen for recurrent or metastatic disease that must have contained a platinum agent. * Written consent to provide newly acquired tumor tissue (preferred) or archival tissue for the purpose of establishing PD-L1 status. * Confirmed PD-L1-positive SCCHN by Ventana SP263 assay * WHO/ECOG performance status of 0 or 1 * At least 1 measurable lesion at baseline * No prior exposure to immune-mediated therapy * Adequate organ and marrow function * Evidence of post-menopausal status or negative urinary or serum pregnancy test.
Exclusion criteria
* Histologically confirmed squamous cell carcinoma of any other primary anatomic location in the head and neck * Received more than 1 systematic palliative regimen for recurrent or metastatic disease * Any concurrent chemotherapy, Investigational Product, biologic, or hormonal therapy for cancer treatment * Prior randomization or treatment in a previous MEDI4736 and/or tremelimumab clinical study regardless of treatment arm assignment or receipt of any investigational anticancer therapy within 28 days or 5 half-lives * Receipt of last dose of an approved (marketed) anticancer therapy (chemotherapy, targeted therapy, biologic therapy, mAbs, etc) within 21 days prior to the first dose of study treatment * Major surgical procedure within 28 days prior to the first dose of Investigational Product * Any unresolved toxicity NCI CTCAE Grade ≥2 from previous anticancer therapy with the exception of alopecia, vitiligo, and the laboratory values defined in the inclusion criterion * Current or prior use of immunosuppressive medication within 14 days before the first dose of MEDI4736 * History of allogeneic organ transplantation * Active or prior documented autoimmune or inflammatory disorders; * Uncontrolled intercurrent illness * Another primary malignancy * Patients with history of brain metastases, spinal cord compression, or leptomeningeal carcinomatosis * History of active primary immunodeficiency * Known history of previous tuberculosis * Active infection including hepatitis B, hepatitis C or human immunodeficiency virus (HIV) * Receipt of live, attenuated vaccine within 30 days prior to the first dose of MEDI4736 * Pregnant or breast-feeding female patients * Mean QT interval corrected for heart rate (QTc) ≥470 ms calculated from 3 electrocardiograms (ECGs) using Fridericia's Correction * Any condition that, in the opinion of the Investigator, would interfere with evaluation of the IP or interpretation of patient safety or study results
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Objective Response Rate (ORR) | 12 months | Objective response rate (per RECIST 1.1 as assessed by blinded independent central review \[BICR\]) is defined as the number (%) of patients with a confirmed complete response or confirmed partial response and will be based on all treated patients who are PD-L1-positive with measurable disease at baseline per BICR. Response Evaluation Criteria in Solid Tumors \[RECIST\] 1.1. criteria are: Complete response \[CR\] = disappearance of all target lesions since baseline; and partial response \[PR\] = at least a 30% decrease in the sum of the diameters of target lesions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of Response- Participants Remaining in Response | 12 months | Participants remaining in response - based on BICR assessments according to RECIST v1.1. An ongoing response was defined as a patient who had documented objective response and was still alive and progression-free at the time of the data cut-off. |
| Duration of Response | 12 months | Duration of objective response in patients with objective response based on BICR assessments according to RECIST v1.1. Duration of response was the time from the first documentation of complete or partial response until the date of progression (which was subsequently confirmed), death, or the last evaluable RECIST assessment for patients that did not progress. An ongoing response was defined as a patient who had documented objective response and was still alive and progression-free at the time of the data cut-off. |
| Time to Onset of Response From First Dose | 12 months | Time to onset of response in patients with objective response based on BICR assessments according to RECIST 1.1 |
| Best Objective Response | 12 months | Best objective response based on BICR assessments according to RECIST v1.1. Response required confirmation after 4 weeks. Unconfirmed complete (CR) or partial response (PR) refers to CR or PR achieved but either no confirmation assessment was performed or a confirmation assessment was performed but response was not confirmed. |
| Progression-free Survival | 12 months | Progression status based on BICR assessments according to RECIST v1.1 at time of PFS analysis. Progression was defined as the time from the date of first dose until the date of objective disease progression or death (by any cause in the absence of progression) regardless of whether the patient withdrew from therapy or received another anti-cancer therapy prior to progression. |
| Overall Survival (OS) | 12 months | Survival status at time of overall survival analysis. 'Still in survival follow-up' includes patients known to be alive at data cut-off. 'Terminated prior to death' includes patients with unknown survival status, or who were lost to follow-up. |
| Quality of Life | 12 months | Improvement in quality of life was assessed using European Organisation for Research and Treatment of Cancer (EORTC) questionnaires: * The impact of treatment on Health-Related Quality of Life, functioning, and symptoms was evaluated using the EORTC QLQ-C30 v3. * Head and neck cancer-specific symptoms were evaluated using the EORTC QLQ-H&N35. Function or global health status/quality of life improvement was defined as patients with 2 consecutive assessments at least 14 days apart that showed a clinically meaningful improvement (an increase from baseline score ≥10). Symptom improvement was defined as 2 consecutive assessments at least 14 days apart that showed a clinically meaningful improvement (a decrease from baseline score ≥10). Scale improvement was defined as patients with 2 consecutive assessments at least 14 days apart that showed a clinically meaningful improvement (a decrease from baseline score ≥10). |
| Disease Control at 6 Months | 6 months | Disease control (DCR) at 6 months based on BICR assessments according to RECIST v1.1. DCR at 6 months was evaluated using 2 different approaches to the length of stable disease (SD): * Method 1: Patients who had a best objective response of complete response (CR) or partial response (PR) within 24 weeks or had demonstrated SD for a minimum interval of 24 weeks following the start of study treatment. * Method 2: Patients who had a best objective response of CR or PR within 24 weeks or had demonstrated SD for a minimum interval of 16 weeks following the start of study treatment. |
Countries
Belgium, Canada, Czechia, France, Georgia, Germany, Hungary, Israel, Malaysia, South Korea, Spain, Taiwan, United Kingdom, United States
Participant flow
Recruitment details
110 sites in 14 countries enrolled and screened patients. The study was conducted and managed by PRA, a contract research organization.
Participants by arm
| Arm | Count |
|---|---|
| MEDI4736 10 mg/kg MEDI4736 monotherapy: Durvalumab was provided at a dose of 10 mg/kg using an intravenous solution every 2 weeks until 12 months, disease progression, toxicity, or patient decision to stop therapy | 112 |
| Total | 112 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 8 |
| Overall Study | Patient decision to stop study treatment | 5 |
| Overall Study | Worsening condition under investigation | 78 |
Baseline characteristics
| Characteristic | MEDI4736 10 mg/kg |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 29 Participants |
| Age, Categorical Between 18 and 65 years | 83 Participants |
| Age, Continuous | 60.0 Years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 1 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 109 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 2 Participants |
| HPV status Negative | 65 Participants |
| HPV status Positive | 34 Participants |
| HPV status Unknown/ Not reported | 3 Participants |
| Nicotine Use Current | 10 Participants |
| Nicotine Use Former | 59 Participants |
| Nicotine Use Never | 43 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 4 Participants |
| Race (NIH/OMB) Black or African American | 5 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 3 Participants |
| Race (NIH/OMB) White | 100 Participants |
| Sex: Female, Male Female | 32 Participants |
| Sex: Female, Male Male | 80 Participants |
| Smoking/ Nicotine status <=10 pack years | 53 Participants |
| Smoking/ Nicotine status >10 Pack years | 49 Participants |
| Smoking/ Nicotine status Unknown/ Not reported | 10 Participants |
| WHO/ECOG performance status (0) Normal activity | 34 Participants |
| WHO/ECOG performance status (1) Restricted activity | 77 Participants |
| WHO/ECOG performance status Missing | 1 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 78 / 112 |
| other Total, other adverse events | 93 / 112 |
| serious Total, serious adverse events | 43 / 112 |
Outcome results
Objective Response Rate (ORR)
Objective response rate (per RECIST 1.1 as assessed by blinded independent central review \[BICR\]) is defined as the number (%) of patients with a confirmed complete response or confirmed partial response and will be based on all treated patients who are PD-L1-positive with measurable disease at baseline per BICR. Response Evaluation Criteria in Solid Tumors \[RECIST\] 1.1. criteria are: Complete response \[CR\] = disappearance of all target lesions since baseline; and partial response \[PR\] = at least a 30% decrease in the sum of the diameters of target lesions.
Time frame: 12 months
Population: Evaluable analysis set - all patients who received at least one dose of study treatment, who had a baseline tumor assessment, and had measurable disease at baseline according to BICR
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| MEDI4736 10 mg/kg | Objective Response Rate (ORR) | Smoking/nicotine status >10 pack years | 14.6 % of participants |
| MEDI4736 10 mg/kg | Objective Response Rate (ORR) | Smoking/nicotine status <=10 pack years | 18.9 % of participants |
| MEDI4736 10 mg/kg | Objective Response Rate (ORR) | Substance user-Former | 15.3 % of participants |
| MEDI4736 10 mg/kg | Objective Response Rate (ORR) | HPV status-Positive | 29.4 % of participants |
| MEDI4736 10 mg/kg | Objective Response Rate (ORR) | Overall | 16.2 % of participants |
| MEDI4736 10 mg/kg | Objective Response Rate (ORR) | Smoking/nicotine status - Missing | 10.0 % of participants |
| MEDI4736 10 mg/kg | Objective Response Rate (ORR) | Substance user-Current | 11.1 % of participants |
| MEDI4736 10 mg/kg | Objective Response Rate (ORR) | Substance user-Never | 18.6 % of participants |
| MEDI4736 10 mg/kg | Objective Response Rate (ORR) | HPV status-Negative | 10.9 % of participants |
| MEDI4736 10 mg/kg | Objective Response Rate (ORR) | HPV status-Missing | 7.7 % of participants |
Best Objective Response
Best objective response based on BICR assessments according to RECIST v1.1. Response required confirmation after 4 weeks. Unconfirmed complete (CR) or partial response (PR) refers to CR or PR achieved but either no confirmation assessment was performed or a confirmation assessment was performed but response was not confirmed.
Time frame: 12 months
Population: Evaluable analysis set - included all patients who received at least one dose of study treatment who had a baseline tumor assessment and had measurable disease at baseline according to BICR.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| MEDI4736 10 mg/kg | Best Objective Response | Response-Partial response (PR) | 15.3 % of participants |
| MEDI4736 10 mg/kg | Best Objective Response | Response-Complete response (CR) | 0.9 % of participants |
| MEDI4736 10 mg/kg | Best Objective Response | NR-SD≥8 weeks-Unconfirmed CR or PR | 2.7 % of participants |
| MEDI4736 10 mg/kg | Best Objective Response | NR-Stable disease (SD) ≥8 weeks-SD | 6.3 % of participants |
| MEDI4736 10 mg/kg | Best Objective Response | NR-Progression-Total | 52.3 % of participants |
| MEDI4736 10 mg/kg | Best Objective Response | NR-Progression-RECIST 1.1 progression | 25.2 % of participants |
| MEDI4736 10 mg/kg | Best Objective Response | NR-Progression-Death | 27.0 % of participants |
| MEDI4736 10 mg/kg | Best Objective Response | NR-Not evaluable-SD<8 weeks | 19.8 % of participants |
| MEDI4736 10 mg/kg | Best Objective Response | Response-Total | 16.2 % of participants |
| MEDI4736 10 mg/kg | Best Objective Response | Non-response (NR)-Total | 83.8 % of participants |
| MEDI4736 10 mg/kg | Best Objective Response | NR-Stable disease (SD)≥8 weeks-Total | 9.0 % of participants |
| MEDI4736 10 mg/kg | Best Objective Response | NR-Not evaluable-Total | 22.5 % of participants |
| MEDI4736 10 mg/kg | Best Objective Response | NR-Not evaluable-Incomplete post-baseline tests | 2.7 % of participants |
Disease Control at 6 Months
Disease control (DCR) at 6 months based on BICR assessments according to RECIST v1.1. DCR at 6 months was evaluated using 2 different approaches to the length of stable disease (SD): * Method 1: Patients who had a best objective response of complete response (CR) or partial response (PR) within 24 weeks or had demonstrated SD for a minimum interval of 24 weeks following the start of study treatment. * Method 2: Patients who had a best objective response of CR or PR within 24 weeks or had demonstrated SD for a minimum interval of 16 weeks following the start of study treatment.
Time frame: 6 months
Population: Evaluable analysis set - included all patients who received at least one dose of study treatment who had a baseline tumor assessment and had measurable disease at baseline according to BICR.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| MEDI4736 10 mg/kg | Disease Control at 6 Months | METHOD 1: Disease control at 6 months | 23.4 % of participants |
| MEDI4736 10 mg/kg | Disease Control at 6 Months | METHOD 1: No disease control at 6 months | 76.6 % of participants |
| MEDI4736 10 mg/kg | Disease Control at 6 Months | METHOD 1: No disease control:Not evaluable/missing | 27.0 % of participants |
| MEDI4736 10 mg/kg | Disease Control at 6 Months | METHOD 2: Disease control at 6 months | 33.3 % of participants |
| MEDI4736 10 mg/kg | Disease Control at 6 Months | METHOD 2: No disease control at 6 months | 66.7 % of participants |
| MEDI4736 10 mg/kg | Disease Control at 6 Months | METHOD 2: No disease control:Not evaluable/missing | 27.0 % of participants |
Duration of Response
Duration of objective response in patients with objective response based on BICR assessments according to RECIST v1.1. Duration of response was the time from the first documentation of complete or partial response until the date of progression (which was subsequently confirmed), death, or the last evaluable RECIST assessment for patients that did not progress. An ongoing response was defined as a patient who had documented objective response and was still alive and progression-free at the time of the data cut-off.
Time frame: 12 months
Population: Evaluable analysis set - included all patients who received at least one dose of study treatment who had a baseline tumor assessment and had measurable disease at baseline according to BICR.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| MEDI4736 10 mg/kg | Duration of Response | No. progressed or died within 12 months | 6 Participants |
| MEDI4736 10 mg/kg | Duration of Response | No. progressed or died after 12 months | 2 Participants |
Duration of Response- Participants Remaining in Response
Participants remaining in response - based on BICR assessments according to RECIST v1.1. An ongoing response was defined as a patient who had documented objective response and was still alive and progression-free at the time of the data cut-off.
Time frame: 12 months
Population: Evaluable analysis set - included all patients who received at least one dose of study treatment who had a baseline tumor assessment and had measurable disease at baseline according to BICR.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| MEDI4736 10 mg/kg | Duration of Response- Participants Remaining in Response | Remaining in response-12 months | 37.1 % of participants |
| MEDI4736 10 mg/kg | Duration of Response- Participants Remaining in Response | Remaining in response-3 months | 100 % of participants |
| MEDI4736 10 mg/kg | Duration of Response- Participants Remaining in Response | Remaining in response-6 months | 76.5 % of participants |
| MEDI4736 10 mg/kg | Duration of Response- Participants Remaining in Response | Remaining in response-9 months | 61.8 % of participants |
| MEDI4736 10 mg/kg | Duration of Response- Participants Remaining in Response | Ongoing response | 55.6 % of participants |
Overall Survival (OS)
Survival status at time of overall survival analysis. 'Still in survival follow-up' includes patients known to be alive at data cut-off. 'Terminated prior to death' includes patients with unknown survival status, or who were lost to follow-up.
Time frame: 12 months
Population: Full analysis set - included all treated patients who had a baseline tumor assessment and had measurable disease at baseline according to the Investigator site assessment.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| MEDI4736 10 mg/kg | Overall Survival (OS) | Death | 69.6 % of participants |
| MEDI4736 10 mg/kg | Overall Survival (OS) | Still in survival follow-up | 24.1 % of participants |
| MEDI4736 10 mg/kg | Overall Survival (OS) | Terminated prior to death | 6.3 % of participants |
| MEDI4736 10 mg/kg | Overall Survival (OS) | Voluntary discontinuation by subject | 6.3 % of participants |
Progression-free Survival
Progression status based on BICR assessments according to RECIST v1.1 at time of PFS analysis. Progression was defined as the time from the date of first dose until the date of objective disease progression or death (by any cause in the absence of progression) regardless of whether the patient withdrew from therapy or received another anti-cancer therapy prior to progression.
Time frame: 12 months
Population: Full analysis set - included all treated patients who had a baseline tumor assessment and had measurable disease at baseline according to the Investigator site assessment.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| MEDI4736 10 mg/kg | Progression-free Survival | Death in absence of RECIST 1.1 progression | 33.0 % of participants |
| MEDI4736 10 mg/kg | Progression-free Survival | No progression + under follow-up | 12.5 % of participants |
| MEDI4736 10 mg/kg | Progression-free Survival | No progression | 17.0 % of participants |
| MEDI4736 10 mg/kg | Progression-free Survival | Progression-Total | 83.0 % of participants |
| MEDI4736 10 mg/kg | Progression-free Survival | RECIST 1.1 progression | 50.0 % of participants |
Quality of Life
Improvement in quality of life was assessed using European Organisation for Research and Treatment of Cancer (EORTC) questionnaires: * The impact of treatment on Health-Related Quality of Life, functioning, and symptoms was evaluated using the EORTC QLQ-C30 v3. * Head and neck cancer-specific symptoms were evaluated using the EORTC QLQ-H&N35. Function or global health status/quality of life improvement was defined as patients with 2 consecutive assessments at least 14 days apart that showed a clinically meaningful improvement (an increase from baseline score ≥10). Symptom improvement was defined as 2 consecutive assessments at least 14 days apart that showed a clinically meaningful improvement (a decrease from baseline score ≥10). Scale improvement was defined as patients with 2 consecutive assessments at least 14 days apart that showed a clinically meaningful improvement (a decrease from baseline score ≥10).
Time frame: 12 months
Population: Full analysis set - included all treated patients who had a baseline tumor assessment and had measurable disease at baseline according to the Investigator site assessment.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| MEDI4736 10 mg/kg | Quality of Life | EORTC QLQ-C30 Function-Physical | 17.1 % of participants |
| MEDI4736 10 mg/kg | Quality of Life | EORTC QLQ-C30 Function-Cognitive | 21.0 % of participants |
| MEDI4736 10 mg/kg | Quality of Life | EORTC QLQ-H&N35 Scale-Pain in the mouth | 24.6 % of participants |
| MEDI4736 10 mg/kg | Quality of Life | EORTC QLQ-C30 Function-Role | 22.9 % of participants |
| MEDI4736 10 mg/kg | Quality of Life | EORTC QLQ-C30 Function-Emotional | 15.9 % of participants |
| MEDI4736 10 mg/kg | Quality of Life | EORTC QLQ-C30 Function-Social | 34.7 % of participants |
| MEDI4736 10 mg/kg | Quality of Life | EORTC QLQ-C30 Symptom-Fatigue | 21.3 % of participants |
| MEDI4736 10 mg/kg | Quality of Life | EORTC QLQ-C30 Symptom-Pain | 26.8 % of participants |
| MEDI4736 10 mg/kg | Quality of Life | EORTC QLQ-C30 Symptom-Nausea/vomiting | 32.3 % of participants |
| MEDI4736 10 mg/kg | Quality of Life | EORTC QLQ-C30 Global health status/QoL | 13.5 % of participants |
| MEDI4736 10 mg/kg | Quality of Life | EORTC QLQ-H&N35 Scale-Swallowing | 19.4 % of participants |
| MEDI4736 10 mg/kg | Quality of Life | EORTC QLQ-H&N35 Scale-Senses | 34.3 % of participants |
| MEDI4736 10 mg/kg | Quality of Life | EORTC QLQ-H&N35 Scale-Speech | 28.4 % of participants |
| MEDI4736 10 mg/kg | Quality of Life | EORTC QLQ-H&N35 Scale-Social eating | 22.4 % of participants |
| MEDI4736 10 mg/kg | Quality of Life | EORTC QLQ-H&N35 Scale-Social contact | 17.2 % of participants |
| MEDI4736 10 mg/kg | Quality of Life | EORTC QLQ-H&N35 Scale-Sexuality | 25.7 % of participants |
Time to Onset of Response From First Dose
Time to onset of response in patients with objective response based on BICR assessments according to RECIST 1.1
Time frame: 12 months
Population: Evaluable analysis set - included all patients who received at least one dose of study treatment who had a baseline tumor assessment and had measurable disease at baseline according to BICR.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| MEDI4736 10 mg/kg | Time to Onset of Response From First Dose | 2.00 Months |