Adelbelimab Combination Chemotherapy in Neoadjuvant Therapy for Squamous Cell Carcinoma of the Head and Neck

Sponsor

Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University (Other)

Overall Status

Not yet recruiting

CT.gov ID

NCT06016413

Collaborator

(none)

Enrollment

Location

Arm

Anticipated Duration (Months)

0.8

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

This study explored the efficacy of adelbelimab (PD-L1 inhibitor) combined with chemotherapy in preoperative induction chemotherapy in patients with locally advanced head and neck squamous cell carcinoma

Condition or Disease	Intervention/Treatment	Phase
Head and Neck Squamous Cell Carcinoma	Drug: Nab paclitaxel Drug: Carboplatin Drug: adelbelimumab	Phase 2

Detailed Description

According to the latest data from the International Agency for Research on Cancer, the new incidence of head and neck cancer in the world in 2022 will be among the top ten new incidences of cancer in the world. In the latest WHO classification of head and neck tumors, head and neck cancers include nasopharyngeal cancer, oral cavity cancer, oropharyngeal cancer, thyroid cancer, laryngeal cancer and other malignant tumors that occur in the head and neck, of which more than 90% are squamous cells cancer. Currently, the standard of care for locally advanced head and neck squamous cell carcinoma (HNSCC) is surgical resection followed by risk-adapted adjuvant radiotherapy, with or without platinum-based chemotherapy, or definitive concurrent chemoradiotherapy. With this aggressive combination therapy, the risk of recurrence, distant metastasis, and death remains high in patients with locally advanced human papillomavirus (HPV)-negative HNSCC. In terms of preoperative induction chemotherapy, clinical studies have shown that patients with tumor remission after preoperative induction chemotherapy have a higher survival rate and a lower risk of distant metastasis, but the postoperative pathological complete remission rate of the tumor is lower , it is difficult to be satisfactory. With the rise of tumor immunology, more and more immunotherapy methods are applied to the clinical treatment of tumors. Current immunotherapies come in many forms, including immune checkpoint inhibitors, co-stimulatory point agonists, antigen vaccines, oncolytic virus therapy, adoptive T cell transfer (ACT) and epidermal growth factor receptor ( Epidermal growth factor receptor, EGFR) targeted therapy. Among them, immune checkpoint inhibitors have been widely used in the clinical treatment of tumors, and the molecular mechanisms of immune checkpoints (immune checkpoint inhibitors, ICIs) are mainly such as programmed cell death 1 (PD-1) and cytotoxic T lymphocytes. Cellular antigen 4 (CTLA-4) is a co-inhibitory receptor expressed on the surface of T cells to negatively regulate T cell-mediated immune responses; however, tumor cells utilize these inhibitory molecules to induce tumor tolerance and T cell exhaustion. Therefore, ICIs such as anti-CTLA-4, anti-PD-1, and anti-PD-L1 can attach to these co-inhibitory receptors to reactivate the immune response against tumor cells. In head and neck squamous cell carcinoma, immune checkpoint inhibitors have been widely used clinically, among which PD-1 inhibitors are the most widely used. A clinical study (KEYNOTE-048) showed that pembrolizumab combined with chemotherapy can significantly improve the survival time of recurrent and metastatic head and neck squamous cell carcinoma. And this is also included in the first-line recommendation of the NCCN guidelines for the treatment of patients with recurrent and metastatic head and neck squamous cell carcinoma. In terms of preoperative neoadjuvant chemotherapy for head and neck squamous cell carcinoma, camrelizumab combined with chemotherapy neoadjuvant chemotherapy in the treatment of locally advanced HNSCC showed high objective response rate and pathological response rate. PD-L1 and PD-L2 are two ligands of PD-1. Both tumor and immune cells can express PD-L1, and PD-L1 is a useful biomarker to predict the response to PD-1/PD-L1 antibodies in patients with different types of cancer. PD-L1 plays a role in inhibiting the cancer-immune cycle by binding to negative regulators of T cell activation such as PD-1 and B7.1. However, PD-L1 inhibitors are currently less used in clinical tumor treatment, mainly focusing on small cell lung cancer. Among them, adelbelimab is a human monoclonal antibody against programmed death ligand 1 (PD-L1), and its safety has been verified to some extent. In a multicenter, randomized, double-blind, placebo-controlled phase 3 clinical trial, the median follow-up time of the test group was 13.5 months and the placebo group was 12.8 months; the hazard ratio was 0.72 [95% confidence interval 0.58-0.90]; Compared with one-sided p=0.017), the median overall survival rate of the adelbelimab group was significantly improved (median 15.3 months [95% CI 13.2-17.5]) . In terms of head and neck squamous cell carcinoma, only phase I clinical studies have confirmed the safety and tumor activity of PD-L1 inhibitors in treatment. On this basis, this study will further verify the efficacy of preoperative neoadjuvant chemotherapy in patients with resectable locally advanced head and neck squamous cell carcinoma with PD-L1 inhibitors combined with chemotherapy.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

30 participants

Allocation:

N/A

Intervention Model:

Single Group Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

A Prospective, Single-arm, Phase II Study of Adelbelimab Combined With Carboplatin and Nab-paclitaxel in Neoadjuvant Therapy for Patients With Resectable Locally Advanced Squamous Cell Carcinoma of the Head and Neck

Anticipated Study Start Date :

Sep 1, 2023

Anticipated Primary Completion Date :

Dec 1, 2024

Anticipated Study Completion Date :

Dec 1, 2026

Arms and Interventions

Arm	Intervention/Treatment
Experimental: intervention group All patients received nab-paclitaxel 260 mg/m2, carboplatin AUC=5 and adelbelimumab 1200 mg intravenously on day 1 of each 3-week cycle for 3 cycles. All patients were given conventional drugs to prevent vomiting in each cycle, and intravenous dexamethasone was given to prevent allergy before each dose	Drug: Nab paclitaxel All patients received nab-paclitaxel 260 mg/m2 intravenously on day 1 of each 3-week cycle for 3 cycles. Drug: Carboplatin All patients received carboplatin AUC=5 intravenously on day 1 of each 3-week cycle for 3 cycles. Drug: adelbelimumab All patients received carboplatin AUC=5 intravenously on day 1 of each 3-week cycle for 3 cycles.

Arm

Intervention/Treatment

Experimental: intervention group

All patients received nab-paclitaxel 260 mg/m2, carboplatin AUC=5 and adelbelimumab 1200 mg intravenously on day 1 of each 3-week cycle for 3 cycles. All patients were given conventional drugs to prevent vomiting in each cycle, and intravenous dexamethasone was given to prevent allergy before each dose

Drug: Nab paclitaxel

All patients received nab-paclitaxel 260 mg/m2 intravenously on day 1 of each 3-week cycle for 3 cycles.

Drug: Carboplatin

All patients received carboplatin AUC=5 intravenously on day 1 of each 3-week cycle for 3 cycles.

Drug: adelbelimumab

All patients received carboplatin AUC=5 intravenously on day 1 of each 3-week cycle for 3 cycles.

Outcome Measures

Primary Outcome Measures

Postoperative pathological complete response rate [one week after operative]
The postoperative specimens were sent to the pathology department for fixation, sectioning, and observation. Two pathologists judge whether the subject's tumor remains. If there is a disagreement between the two, the third senior pathologist will discuss and decide

Secondary Outcome Measures

Major pathological response rate [one week after operative]
The postoperative specimens were sent to the pathology department for fixation, sectioning, and observation. Two pathologists judge whether the subject's tumor remains. If there is a disagreement between the two, the third senior pathologist will discuss and decide
Two years overall Survival [Two years after investigator enrollment]

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years to 75 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Age between 18-75 years old
According to the 8th edition of the guidelines of the American Joint Committee on Cancer (AJCC), patients with stage III-IVB tumors of non-oropharyngeal cancers confirmed by pathology as head and neck squamous cell carcinoma (oral cavity, oropharynx, hypopharynx or larynx) and HPV-negative oropharyngeal cancer patients, or HPV-positive oropharyngeal cancer patients with stage II-III tumors
Resectable tumors were evaluated by head and neck surgeons before enrollment to exclude clinical evidence of distant metastasis
According to RECIST 1.1, there is at least one measurable tumor lesion
The performance status of the Eastern Cooperative Oncology Group (ECOG) is 0-1
Blood routine: white blood cell count (WBC) ≥ 3.0×109/L; absolute neutrophil count (ANC) ≥ 1.5×109/L; platelet (PLT) ≥ 100×109/L; hemoglobin level (HGB) ≥ 9.0 g/dL (without corresponding supportive treatment such as blood transfusion and leukocytosis within 7 days).
Liver function: aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in patients without liver metastasis ≤ 2.5 times the upper limit of the reference value (ULN); albumin (ALB) ≥ 30 g /L.
Renal function: serum creatinine ≤ 1.5 times ULN or creatinine clearance (CrCl) ≥ 50mL/min (using the Cockcroft/Galter formula); urine protein (UPRO) < (++), or 24 Hourly urine protein < 1.0 g.
Determination of HPV status in oropharyngeal cancers using p16 IHC. A sample was considered p16 positive if >70% of tumor cells exhibited intense diffuse nuclear and cytoplasmic staining
Have not participated in other clinical trial projects in the past 30 days;
Patients who voluntarily participate in the project and sign the informed consent.

Exclusion Criteria:

The patient has abnormal blood indicators, abnormal liver and kidney function, and cannot tolerate the clinical research process after multidisciplinary consultation evaluation
The patient has previously suffered from other tumors, or has previously undergone anti-tumor treatments such as surgery, chemotherapy, and radiotherapy
The entire clinical research process cannot be completed due to personal, social and economic reasons
Serious systemic diseases in the past and the diseases cannot be cured or controlled by drugs -