Combining pembrolizumab and lenvatinib for advanced head and neck cancer after chemotherapy

Combined Pembrolizumab and Lenvatinib After Definitive Chemoradiation of Locally Advanced HNSCC in PD-L1 Positive Patients (CPS≥1)

This study is testing if combining two drugs, pembrolizumab and lenvatinib, can help people with advanced head and neck cancer feel better after chemotherapy compared to using pembrolizumab alone.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 50 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Universität des Saarlandes (Academic / other)
• Drugs / interventions: pembrolizumab, lenvatinib, chemotherapy, radiation, prednisone
• Locations: 10 sites (Ulm, Baden-Württemberg and 9 other locations)
• Trial ID: NCT05433116 on ClinicalTrials.gov

What this trial studies

This clinical trial evaluates the effectiveness and safety of combining pembrolizumab and lenvatinib compared to pembrolizumab alone as maintenance therapy for patients with locally advanced head and neck squamous cell carcinoma (HNSCC) following definitive chemoradiotherapy. It is an open-label, two-arm, multicenter phase II trial where eligible participants will be randomized to receive either the combination treatment or pembrolizumab alone. Patients must have PD-L1 positive tumors and no disease progression after initial treatment. The trial aims to assess outcomes based on disease progression and adverse events.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18 and older with newly diagnosed, pathologically confirmed HNSCC and PD-L1 positive tumors who have completed definitive chemoradiotherapy.

Not a fit: Patients with disease progression during initial treatment or those with PD-L1 negative tumors may not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could improve treatment outcomes for patients with advanced head and neck cancer.

How similar studies have performed: Other studies have shown promising results with similar immunotherapy and targeted therapy combinations, indicating potential for success in this approach.

Eligibility criteria

Inclusion Criteria:

Participants are eligible to be included in the study only if all of the following criteria apply:

1. Male/female participants who are at least 18 years of age on the day of signing informed consent
2. Pathologically proven new diagnosis of squamous cell carcinoma (HNSCC) of the oral cavity, oropharynx, hypopharynx or supraglottic larynx stage III-IVB according to TMM 8th edition
3. PD-L1 combined positive score (CPS) ≥1 (in sample prior to radiochemotherapy) by central pathology review
4. Completed definitive radiochemotherapy up to at least 68Gy with at least 200mg/m² body surface area concomitant Cisplatin.
5. No progression during radiochemotherapy. Study screening CT has to be compared to radiochemotherapy baseline CT. (Study screening CT may be performed before the end of radiochemotherapy, whereas a minimum radiation dose of 50Gy has to be administered at the time point of the study screening CT.)
6. Male participants:

   A male participant must agree to use a contraception as detailed in Appendix 3 of this protocol during the treatment period and for at least 120 days after the last dose of study treatment (pembrolizumab or lenvatinib, whichever is administered last) and refrain from donating sperm during this period. In addition, contraception has to be used for 180 days after the last dose of cisplatin.
7. Female participants:

   A female participant is eligible to participate if she is not pregnant, not breastfeeding, and at least one of the following conditions applies: a. Not a woman of childbearing potential (WOCBP) OR b. A WOCBP who agrees to follow the contraceptive guidance during the treatment period and for at least 120 days after the last dose of study treatment (pembrolizumab or lenvatinib, whichever is administered last). In addition, contraception has to be used for 180 days after the last dose of cisplatin.
8. The participant provides written informed consent for the trial.
9. Have measurable disease based on RECIST 1.1.
10. Have provided archival tumor tissue sample with sufficient tumor content. Formalin-fixed, paraffin embedded (FFPE) tissue blocks are preferred to slides.
11. Have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1. Evaluation of ECOG is to be performed within 7 days prior to the first dose of study intervention.
12. Have adequate organ function. Specimens must be collected within 10 days prior to the start of study intervention.

Exclusion Criteria:

Participants are excluded from the study if any of the following criteria apply:

1. Have tumor infiltration/perforation of the skin or cervical fistula (either at timepoint of study inclusion or prior to radiochemotherapy)
2. Have radiographic evidence of major blood vessel invasion/infiltration or tumor demonstrates \>90-degree abutment or encasement of a major blood vessel.
3. Had prior radical surgery for the head and neck cancer under study or induction chemotherapy with more than one cycle prior to definitive radiochemotherapy. Patients with single cycle induction chemotherapy prior radiochemotherapy can be included.
4. WOCBP who have a positive urine or serum pregnancy test within 72 hours prior to. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required.
5. Have received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor (eg, CTLA-4, OX-40, CD137).
6. Have received prior systemic anti-cancer therapy including investigational agents within 4 weeks prior to study drug administration (except from cisplatin concomitant to radiochemotherapy).
7. Have received a live vaccine or live-attenuated vaccine within 30 days prior to the first dose of study drug. Administration of killed vaccines is allowed.
8. Are currently participating in or have participated in a study of an investigational agent or have used an investigational device within 4 weeks prior to the first dose of study intervention.
9. Have a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior to the first dose of study drug.
10. Have a known additional malignancy that is progressing or have required active treatment within the past 3 years. Participants with basal cell carcinoma of the skin, squamous cell carcinoma of the skin, or carcinoma in situ (eg, breast carcinoma, cervical cancer in situ) that have undergone potentially curative therapy are not excluded.
11. Have distant metastases.
12. Have severe hypersensitivity (≥Grade 3) to pembrolizumab, lenvatinib and/or any of their excipients.
13. Have active autoimmune disease that has required systemic treatment in the past 2 years (i.e. with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (eg., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment and is allowed.
14. Have a history of (non-infectious) pneumonitis/interstitial lung disease that required steroids or has current pneumonitis/interstitial lung disease.
15. Have an active infection requiring systemic therapy.
16. Have a known history of Human Immunodeficiency Virus (HIV) infection.
17. Have a known history of Hepatitis B (defined as Hepatitis B surface antigen \[HBsAg\] reactive) or known active Hepatitis C virus (defined as HCV RNA is detected) infection.
18. Have a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the participant's participation for the full duration of the study, or is not in the best interest of the participant to participate, in the opinion of the treating investigator.
19. Have known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.
20. Are pregnant or breastfeeding or expecting to conceive or father children within the projected duration of the study, starting with the screening visit through 120 days after the last dose of trial treatment. (as documented by a positive beta-human chorionic gonadotropin \[ß-hCG\] (or human chorionic gonadotropin \[hCG\]) test with a minimum sensitivity of 25 IU/L or equivalent units of ß-hCG \[or hCG\]).
21. Have had an allogenic tissue/solid organ transplant.
22. Have uncontrolled blood pressure (Systolic BP\>140 mmHg or diastolic BP \>90 mmHg) in spite of an optimized regimen of antihypertensive medication.
23. Have clinically relevant electrolyte abnormalities that have not been corrected.
24. Have significant cardiovascular impairment: history of congestive heart failure greater than New York Heart Association (NYHA) Class II, unstable angina, myocardial infarction or stroke within 6 months of the first dose of study drug, or cardiac arrhythmia requiring medical treatment at Screening.
25. Have/had bleeding or thrombotic disorders or subjects at risk for severe hemorrhage. The degree of tumor invasion/infiltration of major blood vessels (e.g. carotid artery) should be considered because of the potential risk of severe hemorrhage associated with tumor shrinkage/necrosis following lenvatinib therapy.
26. Have \> 1+ proteinuria on urine dipstick testing unless a 24-hour urine collection for quantitative assessment indicates that the urine protein is \<1 g/24 hours.
27. Have not recovered adequately from any toxicity from other anti- cancer treatment regimens and/or complications from major surgery prior to starting therapy. Withhold lenvatinib for at least 1 week prior to elective surgery. Do not administer for at least 2 weeks following major surgery and until adequate wound healing.
28. Have prolongation of QTc interval to \>480 ms in the ECG.
29. Have a LVEF below the institutional (or local laboratory) normal range, as determined by multigated acquisition (MUGA) or echocardiogram (ECHO).
30. Active hemoptysis (bright red blood of at least 0.5 teaspoon) within 3 weeks prior to the first dose of study drug.

Where this trial is running

Ulm, Baden-Württemberg and 9 other locations

• University Hospital Ulm, Otolaryngology & Head and Neck Surgery — Ulm, Baden-Württemberg, Germany (Recruiting)
• University Hospital Regensburg, Clinic and Polyclinic for Radiotherapy — Regensburg, Bavaria, Germany (Recruiting)
• University Hospital Augsburg, Radiation Oncology — Augsburg, By, Germany (Recruiting)
• University Hospital Erlangen, Radiation Oncology — Erlangen, By, Germany (Recruiting)
• University Hospital Frankfurt/M, Center for Radiology — Frankfurt, Hesse, Germany (Recruiting)
• University Hospital Giessen; Ear, nose and throat clinic — Gießen, Hesse, Germany (Recruiting)
• University Hospital Düsseldorf, Radiation Oncology — Düsseldorf, Northrhine-Westphalia, Germany (Recruiting)
• Saarland University Medical Center and Saarland University Faculty of Medicine, Clinic for Radiotherapy and Radiooncology — Homburg, Saarland, Germany (Recruiting)
• Hospital Chemnitz, Radiation Oncology — Chemnitz, Saxony, Germany (Recruiting)
• Gemeinschaftspraxis Hämatologie-Onkologie — Dresden, Saxony, Germany (Recruiting)

Study contacts

• Principal investigator: Markus Hecht, Prof. — Saarland University Medical Center, Clinic for Radiotherapy and Radiooncology
• Study coordinator: Wiebke Pirschel, M. Sc.

Conditions Head and Neck Squamous Cell Carcinoma