Head and Neck Squamous Cell Carcinoma
Conditions
Brief summary
This is a phase 1b/2 study to evaluate the safety and efficacy of metronomic combination therapy in subjects with HNSCC who have progressed on or after previous chemotherapy and anti-PD-1/PD-L1 therapy.
Detailed description
Treatment will be administered in two phases, an induction and a maintenance phase. Subjects will continue induction treatment for up to 1 year or until they experience progressive disease (PD) or unacceptable toxicity (not correctable with dose reduction), withdraw consent, or if the Investigator feels it is no longer in the subject's best interest to continue treatment. Those who have a complete response (CR) in the induction phase will enter the maintenance phase of the study. Subjects may remain in the maintenance phase of the study for up to 1 year. Treatment will continue in the maintenance phase until the subject experiences PD or unacceptable toxicity (not correctable with dose reduction), withdraws consent, or if the Investigator feels it is no longer in the subject's best interest to continue treatment.
Interventions
BIOLOGICALAvelumab
Fully human anti-PD-L1 IgG1 lambda monoclonal antibody
BIOLOGICALBevacizumab
Recombinant human anti-vascular endothelial growth factor (VEGF) immunoglobulin (Ig) G1 monoclonal antibody
DRUGCapecitabine
5'-deoxy-5-fluoro-N-\[(pentyloxy) carbonyl\]-cytidine
BIOLOGICALCetuximab
Recombinant human/mouse chimeric anti-epidermal growth factor receptor (EGFR) IgG1 monoclonal antibody
DRUGCisplatin
(SP-4-2)-diamminedichloroplatinum(II)
DRUGcyclophosphamide
2-\[bis(2-chloroethyl)amino\]tetrahydro-2H-1,3,2-oxazaphosphorine 2-oxide monohydrate
DRUG5-Fluorouracil (5-FU)
5-fluoro-2,4 (1H,3H)-pyrimidinedione
DRUGfulvestrant
7-alpha-\[9-(4,4,5,5,5-pentafluoropentylsulphinyl) nonyl\]estra-1,3,5-(10)- triene-3,17-beta-diol
DRUGleucovorin
Calcium N-\[p-\[\[\[(6RS)-2-amino-5-formyl-5,6,7,8-tetrahydro-4-hydroxy-6-pteridinyl\]methyl\]amino\]benzoyl\]-L-glutamate (1:1)
DRUGnab-paclitaxel
5β,20-Epoxy-1,2α,4,7β,10β,13α-hexahydroxytax-11-en-9-one 4,10-diacetate 2-benzoate 13-ester with (2R,3S)-N-benzoyl-3-phenylisoserine
BIOLOGICALnivolumab
Human anti-PD-1 IgG4 kappa monoclonal antibody
DRUGLovaza
Omega-3-acid ethyl esters
RADIATIONStereotactic Body Radiation Therapy
(SRBT)
BIOLOGICALALT-803
recombinant human super agonist interleukin-15 (IL-15) complex \[also known as IL 15N72D:IL-15RαSu/IgG1 Fc complex\]
BIOLOGICALETBX-011
adenovirus serotype-5 \[Ad5\] \[E1-, E2b-\]-carcinoembryonic antigen (CEA) vaccine
BIOLOGICALETBX-021
Ad5 \[E1-, E2b-\]-human epidermal growth factor receptor 2 (HER2) vaccine
BIOLOGICALETBX-051
Ad5 \[E1-, E2b-\]-Brachyury vaccine
BIOLOGICALETBX-061
Ad5 \[E1-, E2b-\]-mucin 1 (MUC1) vaccine
BIOLOGICALGI-4000
Ras yeast vaccine
BIOLOGICALGI-6207
CEA yeast vaccine
BIOLOGICALGI-6301
Brachyury yeast vaccine
BIOLOGICALhaNK
NK-92 \[CD16.158V, ER IL-2\], Suspension for Intravenous \[IV\] Infusion
Sponsors
ImmunityBio, Inc.
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Age ≥ 18 years. 2. Able to understand and provide a signed informed consent that fulfills the relevant Institutional Review Board (IRB) or Independent Ethics Committee (IEC) guidelines. 3. Histologically-confirmed HNSCC with progression on or after chemotherapy and anti-PD-1/PD-L1 therapy. 4. Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2. 5. Have at least 1 measurable lesion of ≥ 1.5 cm. 6. Must have a tumor biopsy specimen following the conclusion of the most recent anticancer treatment. If an historic specimen is not available, the subject must be willing to undergo a biopsy during the screening period. 7. Must be willing to provide blood samples and, if considered safe by the Investigator, a tumor biopsy specimen at 8 weeks after the start of treatment. 8. Ability to attend required study visits and return for adequate follow-up, as required by this protocol. 9. Agreement to practice effective contraception for female subjects of child-bearing potential and non-sterile males. Female subjects of child-bearing potential must agree to use effective contraception for up to 1 year after completion of therapy, and non-sterile male subjects must agree to use a condom for up to 4 months after treatment.
Exclusion criteria
1. History of persistent grade 2 or higher (CTCAE Version 4.03) hematologic toxicity resulting from previous therapy. 2. History of other active malignancies or brain metastasis except for controlled basal cell carcinoma; prior history of in situ cancer (eg, breast, melanoma, and cervical); prior history of prostate cancer that is not under active systemic treatment (except hormonal therapy) and with undetectable prostate-specific antigen (PSA) (\< 0.2 ng/mL); and bulky (≥ 1.5 cm) disease with metastasis in the central hilar area of the chest and involving the pulmonary vasculature. Subjects with a history of another malignancy must have \> 5 years without evidence of disease. and Neck Squamous Cell Carcinoma Vaccine NantCell, Inc. Clinical Trial Protocol: QUILT-3.047 3. Serious uncontrolled concomitant disease that would contraindicate the use of the investigational drug used in this study or that would put the subject at high risk for treatment-related complications. 4. Systemic autoimmune disease (eg, lupus erythematosus, rheumatoid arthritis, Addison's disease, and autoimmune disease associated with lymphoma). 5. History of organ transplant requiring immunosuppression. 6. History of or active inflammatory bowel disease (eg, Crohn's disease and ulcerative colitis). 7. Requires whole blood transfusion to meet eligibility criteria. 8. Inadequate organ function, evidenced by the following laboratory results: 1. White blood cell (WBC) count \< 3,500 cells/mm3 2. Absolute neutrophil count \< 1,500 cells/mm3. 3. Platelet count \< 100,000 cells/mm3. 4. Hemoglobin \< 9 g/dL. 5. Total bilirubin greater than the upper limit of normal (ULN; unless the subject has documented Gilbert's syndrome). 6. Aspartate aminotransferase (AST \[SGOT\]) or alanine aminotransferase (ALT \[SGPT\]) \> 2.5 × ULN (\> 5 × ULN in subjects with liver metastases). 7. Alkaline phosphatase (ALP) levels \> 2.5 × ULN (\> 5 × ULN in subjects with liver metastases, or \>10 × ULN in subjects with bone metastases). 8. Serum creatinine \> 2.0 mg/dL or 177 μmol/L. 9. International normalized ratio (INR), activated partial thromboplastin time (aPTT), or partial thromboplastin time (PTT) \>1.5 × ULN (unless on therapeutic anti-coagulation). 9. Uncontrolled hypertension (systolic \> 150 mm Hg and/or diastolic \> 100 mm Hg) or clinically significant (ie, active) cardiovascular disease, cerebrovascular accident/stroke, or myocardial infarction within 6 months prior to first study medication; unstable angina; congestive heart failure of New York Heart Association grade 2 or higher; or serious cardiac arrhythmia requiring medication. 10. Dyspnea at rest due to complications of advanced malignancy or other disease requiring continuous oxygen therapy. 11. Positive results of screening test for human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV). 12. Current chronic daily treatment (continuous for \> 3 months) with systemic corticosteroids (dose equivalent to or greater than 10 mg/day methylprednisolone), excluding inhaled steroids. Short-term steroid use to prevent IV contrast allergic reaction or anaphylaxis in subjects who have known contrast allergies is allowed. 13. Known hypersensitivity to any component of the study medication(s). 14. Subjects taking any medication(s) (herbal or prescribed) known to have an adverse drug reaction with any of the study medications. 15. Concurrent or prior use of a strong cytochrome P450 (CYP)3A4 inhibitor (including ketoconazole, itraconazole, posaconazole, clarithromycin, indinavir, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, voriconazole, and grapefruit products) or strong CYP3A4 inducers (including phenytoin, carbamazepine, rifampin, rifabutin, rifapentin, phenobarbital, and St John's Wort) within 14 days before study day 1. 16. Concurrent or prior use of a strong CYP2C8 inhibitor (gemfibrozil) or moderate CYP2C8 inducer (rifampin) within 14 days before study day 1. 17. Participation in an investigational drug study or history of receiving any investigational treatment within 14 days prior to screening for this study, except for testosterone-lowering therapy in men with prostate cancer. 18. Assessed by the Investigator to be unable or unwilling to comply with the requirements of the protocol. 19. Concurrent participation in any interventional clinical trial. 20. Pregnant and nursing women.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| ORR by Immune-related response criteria (irRC ) | 1 year | Phase 2 primary endpoint (ORR by irRC) |
| Incidence of treatment-emergent adverse events (AEs) and serious AEs (SAEs), graded using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) Version 4.03. | 1 year | Phase 1b primary endpoint (safety) |
| Objective response rate (ORR) by Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.1 | 1 year | Phase 2 primary endpoint (ORR by RECIST) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| ORR by irRC | 1 year | Phase 1b secondary endpoint (ORR by irRC) |
| Progression-free survival (PFS) by RECIST Version 1.1 | 2 year | Phase 1b and 2 secondary endpoint (PFS by RECIST) |
| Duration of response (DR): time from the date of first response (partial response (PR) or complete response (CR)) to the date of disease progression or death (any cause) whichever occurs first | 2 years | Phase 1b and 2 secondary endpoint (DR) |
| Overall survival (OS): time from the date of first treatment to the date of death (any cause) | 2 years | Phase 1b and 2 secondary endpoint (OS) |
| Quality of life (QoL) by patient-reported outcome using the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) questionnaire | 2 years | Phase 1b and 2 secondary endpoint (QoL) |
| Incidence of treatment-emergent Adverse Events (AEs) and Serious Adverse Events (SAEs), graded using the NCI CTCAE Version 4.03 | 1 year | Phase 2 secondary endpoint (AEs) |
| Disease control rate (DCR): confirmed complete response, partial response, or stable disease lasting for at least 2 months | 2 months | Phase 1b and 2 secondary endpoint (DCR) |
| PFS by irRC | 2 years | Phase 1b and 2 secondary endpoint (PFS by irRC) |
| ORR by RECIST Version 1.1 | 1 year | Phase 1b secondary endpoint (ORR by RECIST) |
Outcome results
None listed