188 Participants Needed

Pembrolizumab + Radiation vs Chemotherapy + Radiation for Head and Neck Cancer

Recruiting at 149 trial locations
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)
Prior Safety DataThis treatment has passed at least one previous human trial

What You Need to Know Before You Apply

What is the purpose of this trial?

This phase II trial studies the effect of pembrolizumab alone compared to the usual approach (chemotherapy \[cisplatin and carboplatin\] plus radiation therapy) after surgery in treating patients with head and neck squamous cell carcinoma that has come back (recurrent) or patients with a second head and neck cancer that is not from metastasis (primary). Radiation therapy uses high energy radiation or protons to kill tumor cells and shrink tumors. Cisplatin is in a class of medications known as platinum-containing compounds. It works by killing, stopping or slowing the growth of cancer cells. Carboplatin is also in a class of medications known as platinum-containing compounds. It works in a way similar to the anticancer drug cisplatin, but may be better tolerated than cisplatin. Carboplatin works by killing, stopping or slowing the growth of cancer cells. Immunotherapy with monoclonal antibodies, such as pembrolizumab, may help the body's immune system attack the cancer and may interfere with the ability of tumor cells to grow and spread. Giving pembrolizumab alone after surgery may work better than the usual approach in shrinking recurrent or primary head and neck squamous cell carcinoma.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, you must not be on immunosuppressive medication within 7 days before starting the trial, except for certain types like low-dose steroids or specific premedications.

Is the combination of pembrolizumab and radiation safe for head and neck cancer patients?

Pembrolizumab, when used with radiation or chemotherapy, has been generally considered safe for head and neck cancer patients, though it can cause serious side effects like pneumonia, liver inflammation, and thyroid issues. In studies, most patients experienced mild side effects, but some had more severe reactions like anemia and high blood pressure.12345

What makes the drug pembrolizumab unique for head and neck cancer treatment?

Pembrolizumab is unique because it is an immune checkpoint inhibitor that helps the body's immune system attack cancer cells by blocking the PD-1 pathway, and it is being studied in combination with radiation and chemotherapy for locally advanced head and neck cancer, offering a potential alternative for patients who cannot tolerate cisplatin.15678

What data supports the effectiveness of the drug pembrolizumab when used with radiation for head and neck cancer?

Research shows that pembrolizumab, when combined with radiation, can stimulate the immune system to fight head and neck cancer. It has been effective in treating recurrent or metastatic head and neck cancer and is being studied for use in locally advanced cases, showing promise in early trials.15679

Who Is on the Research Team?

DP

Dan P Zandberg

Principal Investigator

ECOG-ACRIN Cancer Research Group

Are You a Good Fit for This Trial?

Adults aged 18-79 with recurrent or second primary head and neck squamous cell carcinoma, who've had surgery and prior radiation, can join this trial. They must have no distant disease spread, a specific protein (PD-L1) score >=1, and proper organ function. Those with severe allergies to pembrolizumab, active infections requiring systemic treatment, recent live vaccines, certain heart conditions or transplants are excluded.

Inclusion Criteria

I haven't had any live vaccines in the last 30 days.
I haven't taken strong immune-suppressing drugs in the last week, except for low-dose or topical steroids.
My tumor area previously received high-dose radiation.
See 27 more

Exclusion Criteria

I do not have hepatitis B or active hepatitis C.
NOTE: No testing for hepatitis B and hepatitis C is required unless mandated by a local health authority

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Patients receive either pembrolizumab or chemotherapy with radiation therapy

12 months
Pembrolizumab: 9 visits (every 6 weeks); Chemotherapy: 6 visits (weekly) with daily radiation

Follow-up

Participants are monitored for safety and effectiveness after treatment

5 years
Follow-up at 30 days post-treatment, then every 6 months

What Are the Treatments Tested in This Trial?

Interventions

  • Carboplatin
  • Cisplatin
  • Pembrolizumab
  • Proton Beam Radiation Therapy
Trial Overview The trial is testing the effectiveness of pembrolizumab alone versus the usual treatment of chemotherapy combined with radiation after surgery for patients with head and neck cancer that has returned. Pembrolizumab is an immunotherapy drug designed to boost the body's immune response against cancer cells.
How Is the Trial Designed?
2Treatment groups
Experimental Treatment
Active Control
Group I: Arm C (pembrolizumab)Experimental Treatment3 Interventions
Patients receive pembrolizumab IV over 30 minutes on day 1. Treatment repeats every 6 weeks for 9 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo CT or MRI throughout the trial.
Group II: Arm B (cisplatin, carboplatin, IMRT, PBRT)Active Control6 Interventions
Patients receive cisplatin or carboplatin IV on day 1. Treatment repeats every 7 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo IMRT or PBRT QD for a total of 30 fractions in the absence of disease progression or unacceptable toxicity. Patients also undergo CT or MRI throughout the trial.

Carboplatin is already approved in United States, European Union, Canada for the following indications:

🇺🇸
Approved in United States as Paraplatin for:
  • Ovarian cancer
  • Testicular cancer
  • Lung cancer
  • Head and neck cancer
  • Brain cancer
🇪🇺
Approved in European Union as Carboplatin for:
  • Ovarian cancer
  • Small cell lung cancer
🇨🇦
Approved in Canada as Carboplatin for:
  • Ovarian cancer
  • Small cell lung cancer
  • Testicular cancer

Find a Clinic Near You

Who Is Running the Clinical Trial?

National Cancer Institute (NCI)

Lead Sponsor

Trials
14,080
Recruited
41,180,000+

Published Research Related to This Trial

In a phase II study involving 29 patients with locally advanced head and neck squamous cell carcinoma who were ineligible for cisplatin, the combination of pembrolizumab and radiotherapy showed promising efficacy, with a 24-month progression-free survival rate of 71%.
The treatment was generally well-tolerated, although a significant number of patients experienced grade 3/4 lymphopenia (58.6%), indicating the need for monitoring immune cell changes during therapy.
Concurrent Definitive Immunoradiotherapy for Patients with Stage III-IV Head and Neck Cancer and Cisplatin Contraindication.Weiss, J., Sheth, S., Deal, AM., et al.[2023]
The Phase III trial KEYNOTE-412 is designed to evaluate the efficacy and safety of pembrolizumab, an immune checkpoint inhibitor, when used alongside chemoradiation therapy (CRT) in patients with locally advanced head and neck squamous cell carcinoma (HNSCC).
Previous Phase Ib studies have indicated that combining pembrolizumab with CRT is safe and feasible, supporting its potential use in this larger trial to improve treatment outcomes for patients with locally advanced HNSCC.
Pembrolizumab given concomitantly with chemoradiation and as maintenance therapy for locally advanced head and neck squamous cell carcinoma: KEYNOTE-412.Machiels, JP., Tao, Y., Burtness, B., et al.[2021]
In a phase III trial involving 891 patients with stage III or IV head and neck carcinoma, adding cetuximab to the radiation-cisplatin treatment did not improve progression-free survival (PFS) or overall survival (OS) compared to radiation-cisplatin alone.
Patients with p16-positive oropharyngeal carcinoma had significantly better PFS and OS compared to those with p16-negative tumors, indicating that p16 status is a more important factor for outcomes than the addition of cetuximab.
Randomized phase III trial of concurrent accelerated radiation plus cisplatin with or without cetuximab for stage III to IV head and neck carcinoma: RTOG 0522.Ang, KK., Zhang, Q., Rosenthal, DI., et al.[2022]

Citations

Concurrent Definitive Immunoradiotherapy for Patients with Stage III-IV Head and Neck Cancer and Cisplatin Contraindication. [2023]
Pembrolizumab given concomitantly with chemoradiation and as maintenance therapy for locally advanced head and neck squamous cell carcinoma: KEYNOTE-412. [2021]
Randomized phase III trial of concurrent accelerated radiation plus cisplatin with or without cetuximab for stage III to IV head and neck carcinoma: RTOG 0522. [2022]
Safety and Efficacy of Pembrolizumab With Chemoradiotherapy in Locally Advanced Head and Neck Squamous Cell Carcinoma: A Phase IB Study. [2022]
Pembrolizumab and its use in the treatment of recurrent or metastatic head and neck cancer. [2019]
Effects of Pembrolizumab in Recurrent/Metastatic Squamous Cell Head and Neck Carcinoma: A Multicenter Retrospective Study. [2023]
FDA Approval Summary: Pembrolizumab for the Treatment of Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma with Disease Progression on or After Platinum-Containing Chemotherapy. [2019]
Safety and preliminary activity of pembrolizumab-carboplatin-paclitaxel in heavily pretreated and/or fragile patients with PDL1-positive recurrent/metastatic head and neck cancer. [2023]
Pembrolizumab versus cetuximab concurrent with radiotherapy in patients with locally advanced squamous cell carcinoma of head and neck unfit for cisplatin (GORTEC 2015-01 PembroRad): a multicenter, randomized, phase II trial. [2023]
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