Biomarker-based Study in R/M SCCHN

Carcinoma, Squamous Cell of Head and Neck Clinical Trial

— UPSTREAM  

Official title:

A Pilot Study of Personalized Biomarker-based Treatment Strategy or Immunotherapy in Patients With Recurrent/Metastatic Squamous Cell Carcinoma of the Head and Neck

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT03088059
• Other study ID #: EORTC-1559-HNCG
• Secondary ID: 2017-000086-74
• Status: Active, not recruiting
• Phase: Phase 2
• Start date: November 16, 2017
• Est. completion date: December 2025

Study information

• Verified date: November 2023
• Source: European Organisation for Research and Treatment of Cancer - EORTC
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a biomarker-driven trial that will enroll patients with recurrent or metastatic squamous cell carcinoma of the head and neck progressing after first-line platinum-based chemotherapy. Based on potential biomarkers and molecular alterations identified in the biopsy from the central platform, patients will be allocated in different cohorts. There will be biomarker-positive patient cohorts and immunotherapy cohorts.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 340
• Est. completion date: December 2025
• Est. primary completion date: June 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

General Inclusion Criteria:

• Histologically confirmed recurrent and/or metastatic SCCHN of the oral cavity, oropharynx, hypopharynx or larynx not amenable to curative treatment.
• At least one measurable lesion by MRI or CT-scan according to RECIST 1.1, evaluated within 2 weeks prior to registration. Such lesion must not have been previously irradiated; if the measurable lesion(s) have been irradiated, clear progression must be documented.
• Progressive disease after first line platinum-based chemotherapy with or without cetuximab given as palliative treatment or progressive disease within 1 year if platinum-based chemotherapy was given as a part of the multimodal curative treatment. Patients pre-treated with anti-PD1/anti-PDL1 are allowed.
• ECOG performance status 0 -1 with a life expectancy of at least 12 weeks.
• Tumor core biopsy from any accessible tumor at the recurrent or metastatic site available for central testing.
• Patients must have adequate organ function, evaluated within 14 days prior to cohort

allocation:

• Hemoglobin = 9 g/100 ml,
• Neutrophils = 1,500/mm3,
• Platelets = 100,000/mm3,
• Total bilirubin <1.5 times the upper limit of normal (ULN) (< 3 times the upper limit of normal for Gilbert's disease),
• Serum ALT and AST = 2.5 x ULN,
• Adequate renal function measured by:
• Estimated creatinine clearance =45ml using Cockcroft and Gault formula or Creatinine = 1.5 ULN
• International Normalized Ratio (INR) or Prothrombin Time (PT) must be within the normal ranges as per institution's standard. A window of 5% is allowed.
• Patients receiving anticoagulant therapy are allowed to participate as long as the PT/INR values are within the expected target range of their current dose.
• Clinically normal cardiac function based on -left ventricular ejection fraction (= 50%) as assessed either by multi-gated acquisition scan or cardiac ultrasound and 12 lead ECG without clinically relevant abnormalities.
• Patients = 18 years old and must be able to give written informed consent.
• Patients = 70 years old must undergo the G8 screening.
• Women of child-bearing potential must have a negative pregnancy test (serum or urine within the 72 hours prior to cohort allocation).
• Patients of childbearing / reproductive potential must agree to use highly effective methods of contraception based on the Clinical Trial Facilitation Group (CTFG) guidance as of registration and up to 6 months after the last treatment dose. Highly effective methods can achieve failure rate of less than 1% per year when used consistently and correctly. Such methods include: For Women: combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation (oral, intravaginal and transdermal), progestogen-only hormonal contraception associated with inhibition of ovulation (oral, injectable, implantable), intrauterine device, intrauterine hormone-releasing system, bilateral tubal occlusion, vasectomized partner and sexual abstinence. For Men: condoms, sexual abstinence (the reliability of sexual abstinence needs to be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the patient) and no sperm donations during treatment and up to 6 months after last dose of treatment.
• Female subjects who are breast feeding should agree to discontinue nursing prior to the first dose of study treatment and up to 6 months after the last study treatment.
• Before patient registration/randomization, written informed consent must be given according to ICH/GCP, and national/local regulations.

General Exclusion Criteria:

• Unresolved and significant toxicity CTCAE version 4.03 grade = 2 from previous anticancer therapy other than alopecia.
• History of any of the following cardiovascular conditions within 6 months prior to

registration:

• myocardial infarction,
• severe/unstable angina,
• ongoing cardiac dysrhythmias of CTCAE version 4.03 Grade 2 or more,
• atrial fibrillation of any grade,
• coronary/peripheral artery bypass graft,
• symptomatic congestive heart failure according to New York Heart Association (NYHA) Class III or Class IV,
• significant active cardiac disease including uncontrolled high blood pressure defined as systolic =150 and diastolic =100.
• cerebrovascular accident including transient ischemic attack
• thromboembolic events like symptomatic pulmonary embolism.
• Nasopharynx and sino-nasal tumor.
• Surgery or investigational drugs or chemotherapy or other anticancer therapy within 3 weeks before cohort allocationor or for investigational drugs, within a time interval less than at least 5 half-lives of the investigational agent, whichever is shorter. Participant must have recovered from any surgical procedure. Curative radiation therapy (60-70 Gy) within 6 weeks of cohort allocation. Palliative radiation therapy (e.g. 8 Gy on a painful lesion) will be allowed.
• Known untreated and uncontrolled brain metastases or leptomeningeal carcinomatosis.
• Known diagnosis of immune deficiency or a positive serology of Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies).
• Active Hepatitis B (e.g., HBsAg reactive) or Hepatitis C (e.g., HCV RNA [qualitative] is detected) or pre-existing liver cirrhosis.
• Known pre-existing interstitial lung disease (ILD). Bronchoemphysema is not considered as ILD.
• Other uncontrolled active illnesses or nonmalignant systemic disease (examples include, but are not limited to active infections requiring antibiotics, bleeding disorders, uncontrolled diabetes, uncontrolled ventricular arrhythmia, uncontrolled major seizure disorder, unstable spinal cord compression, superior vena cava syndrome …).
• Any psychiatric, psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule.
• Any malignancy (other than SCCHN, non-melanoma skin cancer or localized cervical cancer or localized and presumed cured prostatic cancer or basal cell carcinoma of the skin and carcinoma in situ of the cervix or bladder) within the last 3 years prior to treatment allocation.

Related Conditions & MeSH terms

• Carcinoma
• Carcinoma, Squamous Cell
• Carcinoma, Squamous Cell of Head and Neck
• Squamous Cell Carcinoma of Head and Neck

Intervention

Drug:
• Afatinib
Afatinib 40 mg given orally, once daily, 1 cycle is 28 days
• Palbociclib
Palbociclib 125 mg given orally, once daily, 1 cycle is 28 days (21 days on treatment, then 7 days off)
• standard of care
Methotrexate, Paclitaxel, Docetaxel, Carboplatin, 5-Fluorouracil, Bleomycine, Gemcitabine, Mitomycine or Best supportive care
• IPH2201
protocol v2.0 and 2.1 : Monalizumab 10mg/kg given intravenously over 60 minutes, once every 14 days, 1 cycle is 14 days protocol v4.0 : Monalizumab 750mg given intravenously over 60 minutes, once every 28 days, 1 cycle is 28 days
• Durvalumab
Durvalumab 1500mg given intravenously over 60 minutes, once every 28 days, 1 cycle is 28 days
• Niraparib
Niraparib 300 mg given orally, once daily, 1 cycle is 28 days
• INCAGN01876
INCAGN01876 300 mg given intravenously over 30 minutes, once every 14 days, 1 cycle is 28 days

Locations

Country	Name	City	State
Belgium	Cliniques Universitaires Saint-Luc	Brussel
Belgium	Hopitaux Universitaires Bordet-Erasme - Institut Jules Bordet	Brussel
Belgium	CHU Saint-Pierre-Site Porte de Hal	Brussels
Belgium	Grand Hopital de Charleroi - Grand Hôpital de Charleroi - Site Notre Dame	Charleroi
Belgium	Universitair Ziekenhuis Antwerpen	Edegem
Belgium	Universitair Ziekenhuis Gent	Gent
Belgium	Hopital De Jolimont	Haine-Saint-Paul
Belgium	AZ Groeninge Kortrijk - Campus Kennedylaan	Kortrijk
Belgium	U.Z. Leuven - Campus Gasthuisberg	Leuven
Belgium	U.Z. Leuven - Campus Gasthuisberg	Leuven
Belgium	GasthuisZusters Antwerpen - Sint-Augustinus	Wilrijk
Belgium	CHU Dinant Godinne - UCL Namur	Yvoir
France	CHU de Bordeaux - Groupe Hospitalier Saint-André - Hopital Saint-Andre	Bordeaux
France	Centre Georges-Francois-Leclerc	Dijon
France	Centre Oscar Lambret	Lille
France	Institut de Cancerologie de l'Ouest (ICO) - Centre Rene Gauducheau	Nantes
France	Centre Antoine Lacassagne	Nice
France	Institut Curie	Paris
France	Institut de Cancerologie Strasbourg Europe	Strasbourg
France	Institut de Cancérologie de Lorraine	Vandoeuvre Les Nancy
France	Gustave Roussy	Villejuif
Italy	Azienda Ospedaliero-Universitaria Careggi	Firenze
Italy	Azienda Ospedaliero-Universitaria Careggi	Firenze
Italy	Fondazione IRCCS Istituto Nazionale dei Tumori	Milano
Italy	IRCCS - Fondazione G. Pascale	Napoli
Italy	Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale"	Napoli
Spain	ICO L'Hospitalet - Hospital Duran i Reynals (Institut Catala D'Oncologia)	Barcelona
Spain	Hospital Universitario 12 De Octubre	Madrid
Spain	Hospital Clinico Universitario De Valencia	Valencia
United Kingdom	University Hospitals Birmingham NHS Foundation Trust (UHB) - UHB-Queen Elisabeth Medical Centre	Birmingham
United Kingdom	NHS Lothian - Western General Hospital	Edinburgh
United Kingdom	NHS Lothian - Western General Hospital	Edinburgh
United Kingdom	NHS Greater Glasgow and Clyde - Beatson West of Scotland Cancer Centre - Gartnavel General Hospital	Glasgow
United Kingdom	Guy's and St Thomas' NHS - Guy s and St Thomas' NHS - Guy's Hospital	London
United Kingdom	Oxford University Hospitals NHS Trust - Churchill Hospital	Oxford
United Kingdom	Sheffield Teaching Hospitals NHS Foundation Trust - Weston Park Hospital	Sheffield

Sponsors (1)

Lead Sponsor	Collaborator
European Organisation for Research and Treatment of Cancer - EORTC

Countries where clinical trial is conducted

Belgium,  France,  Italy,  Spain,  United Kingdom, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Progression Free Survival Rate (PFSR) at week 16	Progression Free Survival Rate (PFSR) at week 16 will be assessed as primary endpoint for all patients from cohorts 1, 2 and 3.	The Progression Free Survival Rate (PFSR) analysis will be performed at week 16 for each patient in cohorts 1, 2 and 3.
Primary	Objective response Rate (ORR) at week 16	Objective response Rate (ORR) during the first 16 weeks of study treatment will be assessed as primary endpoint for all patients from cohort 4-8.	Objective response Rate (ORR) at week 16 will be performed at week 16 for each patient in cohort 4.
Secondary	Progression Free Survival (PFS)		54 months after first patient in
Secondary	Objective Response Rate	Objective Response Rate will be measured according to both RECIST 1.1 and iRECIST	48 months after first patient in
Secondary	Response duration		54 months after first patient in
Secondary	Overall Survival (OS)		54 months after first patient in
Secondary	Toxicity according CTCAE version 4.03	This study will use the International Common Terminology Criteria for Adverse Events (CTCAE), version 4.03, for adverse event reporting.	54 months after first patient in
Secondary	Percentage of patients included in each patient cohort according the biomarker testing		42 months after first patient in
Secondary	The percentage of patients with an evaluable fresh tumor biopsy		42 months after first patient in