Locally Advanced Head and Neck Squamous Cell Carcinoma
Conditions
Keywords
Resectabl locally advanced head and neck squamous cell carcinoma, Becotatug Vedotin, perioperative neoadjuvant and adjuvant therapy
Brief summary
This study is a randomized, open-label, multicenter phase III trial designed to systematically evaluate the efficacy and safety of perioperative neoadjuvant and adjuvant therapy with Becotatug vedotin in combination with PD-1 inhibitor versus PD-1 inhibitor alone in patients with EGFR-positive, CPS ≥ 1 resectable locally advanced head and neck squamous cell carcinoma .
Interventions
DRUGNeoadjuvant and Adjuvant Becotatug Vedotin
Neoadjuvant therapy with Becotatug Vedotin (Day 1, Q3W, 2 cycles); Adjuvant therapy after radiotherapy with Becotatug Vedotin ( Day 1, Q3W, for a total of 12 cycles).
Neoadjuvant immunotherapy with pucotenlimab (200mg, Day 1, Q3W, 2 cycles); Adjuvant immunotherapy duiring and after radiotherapy with pucotenlimab (200mg, Day 1, Q3W, for a total of 15 cycles).
PROCEDURESurgery
Radical surgery performed 3-4 weeks after neoadjuvant therapy, following a re-evaluation of surgical indications by the surgeon.
RADIATIONAdjuvant Radiotherapy
Radiotherapy is initiated 4-6 weeks after surgery. For the low-risk group, a total dose of 60 Gy in 30 fractions is delivered using intensity-modulated radiation therapy (IMRT). For the high-risk group, 66 Gy in 33 fractions is prescribed, or 70 Gy in 35 fractions for residual lesions, also using IMRT.
High-risk group：Cisplatin 100 mg/m² is administered via intravenous infusion on Day 1 of every 21-day cycle during radiotherapy, for a total of 3 cycles.
Sponsors
Ming-Yuan Chen
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
1. Voluntarily sign the informed consent form; 2. Untreated, histologically confirmed head and neck squamous cell carcinoma (oral cavity, oropharynx, hypopharynx, or larynx), EGFR-positive, CPS ≥ 1, with clinical stage (AJCC 8th edition): p16-positive oropharynx: Stage III (T4N0-2M0); p16-negative oropharynx: Stage III or IVA; larynx/hypopharynx/oral cavity: Stage III or IVA; 3. Eligible for curative-intent surgery as determined by the surgeon; 4. Age: 18 to 75 years; 5. ECOG performance status 0-1; 6. Life expectancy greater than 6 months; 7. At least one measurable lesion per RECIST 1.1; 8. Adequate organ function, based on meeting all of the following criteria (no receipt of blood components or hematopoietic growth factors within 14 days prior to testing): hemoglobin ≥ 90 g/L; absolute neutrophil count ≥ 1.5 × 10⁹/L; platelet count ≥ 100 × 10⁹/L; serum albumin ≥ 28 g/L; total bilirubin ≤ 1.5 × upper limit of normal (ULN); ALT and AST ≤ 2.5 × ULN; serum creatinine ≤ 1.5 × ULN, with creatinine clearance ≥ 50 mL/min; activated partial thromboplastin time and international normalized ratio (INR) ≤ 1.5 × ULN (patients receiving a stable dose of anticoagulant therapy, such as low molecular weight heparin or warfarin, may be enrolled if INR is within the expected therapeutic range for the anticoagulant). Thyroid-stimulating hormone (TSH) ≤ ULN; if abnormal, T3 and T4 levels should be assessed, and patients with normal T3 and T4 levels may be enrolled; 9. Baseline left ventricular ejection fraction (LVEF) ≥ 50% as measured by multigated acquisition (MUGA) scan or echocardiography (ECHO); 10. Women of childbearing potential must agree to use contraception (e.g., intrauterine device, contraceptive pill, or condom) during the treatment period and for 3 months after the last dose; 11. Good compliance.
Exclusion criteria
1. Pregnant or breastfeeding women. 2. History of allergy to PD-1 inhibitors. 3. History of other malignancies within the past 5 years or at enrollment, with the exception of cured basal cell carcinoma of the skin, carcinoma in situ of the cervix, and thyroid papillary tumors. 4. Residual toxicity from prior anti-tumor therapy (including immunotherapy, targeted therapy, chemotherapy, or radiotherapy, etc.) other than alopecia, fatigue, and grade 2 hypothyroidism, or clinically significant laboratory abnormalities greater than grade 1 (CTCAE v5.0). 5. Uncontrolled cardiac conditions or diseases, such as: ① NYHA Class II or greater heart failure, ② unstable angina, ③ myocardial infarction within 1 year, and ④ patients with clinically significant ventricular arrhythmias requiring intervention. 6. Grade ≥ 2 peripheral neuropathy (per CTCAE v5.0). 7. Pulmonary embolism or deep vein thrombosis within 3 months prior to enrollment (excluding catheter-related thrombosis from infusion ports or PICC lines). 8. Active bleeding, history of coagulation disorders, or patients receiving coumarin anticoagulant therapy. 9. Known hypersensitivity to any component or excipient of vibecotamab (citric acid monohydrate, sodium citrate dihydrate, trehalose dihydrate, sodium chloride, and polysorbate 80), or known grade ≥ 3 hypersensitivity reaction to other prior anti-EGFR agents (including investigational drugs) or other monoclonal antibodies. 10. Receipt of any of the following treatments: ① Any investigational drug prior to the first dose of the current study drug. ② Concurrent participation in another clinical study, unless it is an observational (non-interventional) clinical study or during the follow-up period. ③ Use of systemic corticosteroids (more than 10 mg of prednisone or equivalent per day) or other immunosuppressive agents within 2 weeks prior to the first dose of study drug, except for the use of corticosteroids for localized inflammation, prevention of allergies, or nausea and vomiting. In the absence of active autoimmune disease, inhaled or topical steroids and adrenal corticosteroid replacement doses greater than 10 mg prednisone equivalent per day are permitted. ④ Administration of live vaccines within 4 weeks prior to the first dose of study drug. ⑤ Major surgery or severe trauma within 4 weeks prior to the first dose of study drug. 11. Severe infection (greater than grade 2 per CTCAE), such as severe pneumonia requiring hospitalization, bacteremia, or infectious complications, occurring within 4 weeks prior to the first dose of study drug; baseline chest imaging indicating active pulmonary inflammation or signs and symptoms of infection within 2 weeks prior to the first dose of study drug, or indicating the need for oral or intravenous antibiotic therapy (excluding prophylactic antibiotic use). 12. History of or concurrent severe chronic obstructive pulmonary disease with respiratory failure, severe pulmonary insufficiency, symptomatic bronchospasm, etc. 13. History of active autoimmune diseases or syndromes (including but not limited to interstitial pneumonia, colitis, hepatitis, hypophysitis, vasculitis, nephritis, hyperthyroidism, and hypothyroidism). Patients with vitiligo that did not require any intervention in adulthood, or childhood asthma/allergy that has resolved, are not excluded. 14. History of immunodeficiency, including HIV-positive status or other acquired/congenital immunodeficiency diseases, or history of organ transplantation or bone marrow transplantation. 15. Patients with active tuberculosis infection by history or CT findings, or history of active tuberculosis infection within 1 year prior to enrollment, or history of active tuberculosis infection more than 1 year prior without receiving formal treatment. 16. Active hepatitis B (HBV DNA ≥ 2,000 IU/mL or 10,000 copies/mL) or hepatitis C (positive HCV antibody test with HCV RNA above the lower limit of detection). 17. Uncontrolled pleural, peritoneal, pelvic, or pericardial effusion requiring drainage ≥ 1 time per month. 18. Known history of substance abuse, alcoholism, or drug use. 19. Inappropriate for inclusion based on the investigator's judgment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Event-Free Survival Rate (EFS) | 3 years | Defined as the time from randomization to the first occurrence of disease progression, relapse, or death from any cause. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) | 3 years | Defined as the time interval from randomization to death due to any cause. |
| Distant Metastasis-Free Survival (DMFS) | 3 years | Defined as the time interval from randomisation to the date of first distant metastases. |
| Locoregional Relapse-Free Survival (LRRFS) | 3 years | Defined as the time from randomisation to the date of first locoregional relapse. |
| Objective Response Rate (ORR) | After the completion of neoadjuvant therapy, prior to surgery. | The proportion of patients achieving an objective response (complete response and partial response) by imaging assessment after the completion of neoadjuvant therapy, prior to surgery. |
| Disease Control Rate (DCR) | After the completion of neoadjuvant therapy, prior to surgery. | The proportion of patients achieving predefined efficacy evaluation criteria (complete response, partial response, and stable disease) by imaging assessment after the completion of neoadjuvant therapy, prior to surgery. |
| Major Pathologic Response Rate (mPR): | 1 week post-surgery | The proportion of patients with less than 10% residual viable tumor cells in the tumor bed, assessed at 1 week post-surgery. |
| Pathologic Complete Response Rate (pCR) | 1 week post-surgery | The proportion of patients with no microscopic residual viable tumor cells, assessed at 1 week post-surgery. |
| Incidence of treatment related acute complications | up to 1 year | The proportion of patients with treatment related acute complications according to NCI-CTC5.0 criteria and RTOG criteria. |
| Incidence of treatment related late complications | up to 3 years | The proportion of patients with treatment related late complications according to NCI-CTC5.0 criteria and RTOG criteria. |
| Non-Surgery Delay Rate | 8 weeks after two cycles of neoadjuvant therapy | The proportion of patients whose surgery is delayed by more than 4 weeks from the planned date, assessed at 8 weeks after two cycles of neoadjuvant therapy. |
| R0 Resection Rate | 1 week post-surgery. | The proportion of patients undergoing surgical resection who achieve R0 resection (complete tumor resection with negative histopathological margins), assessed at 1 week post-surgery. |
| General Quality of Life | Baseline, week 4 (post-neoadjuvant), week 6 (preoperative), week 8 (postoperative), week 10 (pre-radiotherapy), week 17 (post-radiotherapy), every 2 cycles of adjuvant therapy (each cycle is 21 days), and at each follow-up, up to 3 years | Changes from baseline in general patient-reported quality of life were assessed using the EORTC QLQ-C30 . The scores range from 0 to 100, with higher scores indicating a better quality of life outcome and lower scores indicating worse symptoms or functions. |
| Head and Neck Cancer-Specific Quality of Life | Baseline, week 4 (post-neoadjuvant), week 6 (preoperative), week 8 (postoperative), week 10 (pre-radiotherapy), week 17 (post-radiotherapy), every 2 cycles of adjuvant therapy (each cycle is 21 days), and at each follow-up, up to 3 years. | Changes from baseline in head and neck cancer-specific quality of life assessed by EORTC QLQ-H\&N35. The scores range from 0 to 100, with higher scores indicating a better quality of life outcome and lower scores indicating worse symptoms or functions. |
Countries
China
Contacts
CONTACTMingyuan Chen
CONTACTRui You
Outcome results
None listed