Pembrolizumab Combined With Cetuximab for Treatment of Recurrent/Metastatic Head & Neck Squamous Cell Carcinoma
The purpose of this study is to find out if pembrolizumab with cetuximab will slow or stop cancer from getting worse and whether it causes side effects. Pembrolizumab is a type of drug called a monoclonal antibody. Monoclonal antibodies are made to recognize, target, and bind to specific proteins on cells which are the building blocks making up your tissues. Pembrolizumab is designed to block the interaction between PD-1 and PD-L1 and PD-L2 which are important components of cancer.
Pembrolizumab (also known as Keytruda) is a drug that has already been approved for the treatment of a type of skin cancer called metastatic melanoma, as well as non-small cell lung cancer. Pembrolizumab is considered experimental because it is not approved by the FDA for the treatment of head and neck cancer. Merck, the manufacturer of pembrolizumab, is collaborating with UCSD on this research study and will be proving the study drug.
Cetuximab (also known as ERBITUX) is a drug that has been approved by the FDA for the treatment of colorectal cancer and head and neck cancer. Pembrolizumab in combination with cetuximab is considered experimental because it is not approved by the FDA for the treatment of head and neck cancer.
If the exams, tests and procedures show that a patient can be in the study and they choose to take part, then they will receive cetuximab and pembrolizumab, which will be given intravenously (IV).
Cetuximab will be given on Days 1, 8 and 15 of each 21-day dosing cycle. Pembrolizumab will be given on Day 1 of each 21-day dosing cycle.
About 5 people will take part in this study at UCLA. Up to 83 people are expected to participate in this study.
Patients will be followed for safety (exams & labs) every 3 weeks. Scans will be performed every 8 weeks.
Adult subjects diagnosed with head and neck squamous cell cancer (HNSCC) which has spread from its area of origin (metastatic) or has come back after a period of being undetected (recurrent). For more information about the eligibility criteria for this trial, refer to the Health Professional version.
Patients must meet all of the inclusion criteria to participate in this study.
- Ability to understand and the willingness to sign a written informed consent.
- Histologically or cytologically proven squamous cell carcinoma of the head and neck (lip, oral cavity, oropharynx, larynx, hypopharynx, non-EBV related nasopharynx, sinonasal, cutaneous), not amenable to curative intent therapy.
- Platinum-refractory disease, or ineligible/unfit for platinum-based therapy
- Patients must have at least one measurable site of disease as defined by RECIST v.1.1, determined by investigator review
- Age ≥ 18 years.
- Eastern Cooperative Oncology Group (ECOG) Performance status 0 or 1.
- Patient has adequate hematologic, hepatic and renal function
- Female patient of childbearing potential has a negative serum or urine pregnancy within 72 hours prior to receiving the first dose of study medication.
- Female patient of childbearing potential agrees to use 2 methods of birth control or be surgically sterile, or abstain from heterosexual activity for the course of the study through 120 days after the last dose of study medication.
- Male patient with a partner of childbearing potential agrees to use an adequate method of contraception starting with the first dose of study therapy through 120 days after the last dose of study therapy. Additional Inclusion Criterion for Cohort 1 (PD-1/PD-L1 Inhibitor-naïve, Cetuximab-naïve) and Cohort 2 (PD-1/PD-L1 Inhibitor-refractory, Cetuximab-naïve):
- Cetuximab-naïve patients may not have received cetuximab therapy in the recurrent/metastatic setting (treatment in curative setting permitted) Additional Inclusion Criterion for Cohorts 2 and 3 (PD-1/PD-L1 Inhibitor-refractory):
- PD-1/PD-L1 inhibitor-refractory patients must have documented disease progression after prior response to anti-PD-1/PD-L1 therapy (response defined as stable disease, partial or complete response) Additional Inclusion Criterion for Cohort 4 (Cutaneous HNSCC):
- Cutaneous HNSCC must not be amenable to local treatment modalities, including surgery and/or radiation.
Patients meeting any of the exclusion criteria at baseline will be excluded from study
- Patient has salivary gland primary.
- Patient is currently receiving or has received another investigational agent within 4 weeks prior to Day 1 of study.
- Patient has received chemotherapy or radiotherapy within 4 weeks prior to Day 1 of study. Prior palliative radiotherapy to metastatic lesion(s) is permitted, provided there is at least one measurable lesion that has not been radiated.
- Patient has received a prior anti-cancer monoclonal antibody (mAb) within 4 weeks prior to study Day 1 or who has not recovered (i.e., ≤ Grade 1 or baseline) from adverse events due to a previously administered agents.
- Patient has had major surgery or insufficient recovery from surgical-related trauma or wound healing within 14 days of Study Day 1.
- Patient has had a prior Grade ≥ 3 immune-related adverse event (irAE) while receiving any previous immunotherapy agent, or any unresolved irAE > Grade 1.
- Patient has had prior Grade 4 infusion reaction to cetuximab.
- Patient has a known additional malignancy that is progressing or requires active treatment. Exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of the skin that has undergone potentially curative therapy or in situ cervical cancer.
- Patient has known active central nervous system (CNS) metastases and/or carcinomatous meningitis. Note: Patients with previously treated brain metastases may participate provided they are stable (without evidence of progression by imaging for at least four weeks prior to the first dose of trial treatment and any neurologic symptoms have returned to baseline), have no evidence of new or enlarging brain metastases, and are not using steroids for at least 7 days prior to trial treatment. This exception does not include carcinomatous meningitis which is excluded regardless of clinical stability.
- Patient has an active autoimmune disease that has required systemic treatment in the
past 2 years (i.e. with use of disease modifying agents, corticosteroids or
- Patients with vitiligo, Grave's disease, or psoriasis not requiring systemic treatment within the past 2 years are not excluded.
- Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment.
- Patient has a diagnosis of immunodeficiency or is receiving systemic steroid therapy (>10mg prednisone daily, or steroid equivalent) or any other form of immunosuppressive therapy within 7 days prior to the first dose of pembrolizumab.
- Patient has a known history of active TB (Baccillus Tuberculosis).
- Patient has a known history of, or any evidence of active, non-infectious pneumonitis.
- Patient has a known history of chronic interstitial lung disease.
- Patient has an active infection requiring systemic therapy.
- Patient has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject's participation for the full duration of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating investigator.
- Patient has a known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.
- Patient is pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial.
- Patient has known active Hepatitis B infection (defined as presence of HepB sAg and/ or Hep B DNA), active hepatitis C infection (defined as presence of Hep C RNA) and/or known Human Immunodeficiency Virus (HIV) carrier (HIV 1/2 antibodies).
- Patient has received a live vaccine within 30 days of study Day 1. Note: Seasonal influenza vaccines for injection are generally inactivated flu vaccines and are allowed; however intranasal influenza vaccines (e.g., Flu-Mist®) are live attenuated vaccines, and are not allowed. Additional Exclusion Criterion for Cohorts 1 (PD-1/PD-L1 inhibitor-naïve, cetuximab-naïve) and 4 (cutaneous):
- Patient has received any prior immunotherapy with inhibitors of PD-1 or PD-L1.
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