Head and Neck Neoplasms
Conditions
Keywords
Recurrent Head and Neck Cancer, Recurrent Head and Neck Neoplasms
Brief summary
The study is a pilot study to explore the feasibility and efficacy of immunotherapy following salvage surgery for recurrent head and neck cancer.
Detailed description
Approximately 30-40% of patients treated with a curative intent for locally advanced squamous cell carcinoma of the head and neck cancer will experience an isolated loco-regional recurrence or a second primary tumor in the previously radiated tissues1-5. Patients with recurrent head and neck cancer frequently recur locally and are still amenable for curative interventions. The current recommendations for treatment of these recurrent and second primary tumors includes surgical resection whenever possible as this has been shown to have a significantly better outcome as compared to patients treated non-surgically with radiation therapy with or without concurrent chemotherapy. Immunotherapy is expected to be more effective with smaller amounts of disease and application of therapy when disease burden is minimal is expected to yield improved outcomes. Many trials underway at the present time explore the use of immunotherapy in earlier stages of head and neck cancer than the ones already studied. However, patients undergoing salvage therapy are understudied and no major cooperative group or industry trial is addressing this group of patients.
Interventions
Patients will receive 17 cycles of pembrolizumab via IV infusion of 200 mg over a period of 30 minutes, every 3 weeks starting no later than 90 days from the date of salvage head and neck therapy.
Sponsors
Henry Ford Health System
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Pilot study
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Patients must be 18 years or older, of either gender, with the ability to consent to participation in the study. * Patients must have a history of squamous cell carcinoma of the head and neck involving any sub-site in the head and neck area except nasopharynx, paranasal sinuses, and salivary gland tumors. * All patients must have recurred following definitive therapy with any combination of surgery, radiation, and/or chemotherapy. * All patients must have undergone salvage surgery in an attempt to excise all recurrent disease. * Salvage radiation therapy must not be an option available to the patient. * Patients must have high risk features such extra nodal invasion, positive margins, perineural invasion or vascular embolism.
Exclusion criteria
* Patients with macroscopic residual disease * Patient is eligible for radiation therapy. * Performance status more than 2. * Contraindications for immunotherapy, autoimmune disease, allergy to medication, steroid use at baseline. * Patients with other previous cancers excluding CIN, DCIS, non-melanoma skin cancers * Patients previously treated with immunotherapy \<12months prior * Patients with synchronous cancers not included in the inclusion criteria
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rate of recurrence at 1 year, will be measured by RECIST 1.1 as the primary measure for assessment of tumor, date of disease progression, and as a basis for all protocol guidelines related to disease status (e.g., discontinuation of study treatment). | 1 year | Primary objective |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Determine the feasibility of immunotherapy for head and neck cancer following salvage surgery to produce preliminary data for 15 patients regarding efficacy. All side effects and symptoms will be assessed by CTCAE v5.0. | 1 year | Study endpoint |
| Rate of completion of all planned therapy. All drug related toxicities will be graded by CTCAE v5.0. | through study completion, an average of 1 year | Study endpoint |
| Toxicity rates measured by laboratory assessments and all adverse events and serious adverse events will be assessed by CTCAE v5.0. | through study completion, an average of 1 year | Study endpoint |
Countries
United States
Outcome results
None listed