Using T-DM1 with chemotherapy and radiation for HER2-positive salivary gland cancer after surgery
A Phase II Study of Adjuvant Ado-trastuzumab Emtansine (T-DM1) in HER2-positive Salivary Gland Carcinomas
This study is testing if adding a new drug called T-DM1 to regular chemotherapy and radiation can help people with HER2-positive salivary gland cancer stay cancer-free after surgery.
Quick facts
| Phase | Phase 2 |
|---|---|
| Study type | Interventional |
| Enrollment | 37 (estimated) |
| Ages | 18 Years and up |
| Sex | All |
| Sponsor | Dana-Farber Cancer Institute Academic / other |
| Drugs / interventions | chemotherapy, radiation, trastuzumab |
| Locations | 13 sites (Atlanta, Georgia and 12 other locations) |
| Trial ID | NCT04620187 on ClinicalTrials.gov |
What this trial studies
This phase II clinical trial investigates the safety and effectiveness of ado-trastuzumab emtansine (T-DM1) in combination with standard chemoradiation for patients with HER2-positive salivary gland carcinoma following surgery. The study aims to evaluate the effectiveness of T-DM1 in preventing cancer recurrence and its safety profile. Participants will receive T-DM1 for up to one year after surgery, with follow-up evaluations conducted over three years. The trial is open-label and non-randomized, allowing for a comprehensive assessment of treatment outcomes.
Who should consider this trial
Good fit: Ideal candidates include adults aged 18 and older with resectable stage II to IVB HER2-positive salivary gland carcinoma.
Not a fit: Patients with non-HER2-positive salivary gland cancer or those with unresectable disease may not benefit from this study.
Why it matters
Potential benefit: If successful, this treatment could significantly reduce the risk of cancer recurrence in patients with HER2-positive salivary gland cancer.
How similar studies have performed: While T-DM1 has shown success in treating other HER2-positive cancers, its application in salivary gland cancer is novel and has not been extensively tested.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria: * Subject must have histologically or cytologically confirmed, resectable stage II (with positive margins), III, IVA, or IVB locoregionally advanced salivary gland carcinoma (including any histologic subtype), as defined by 2017 American Joint Committee on Cancer (AJCC), 8th edition. * Willing to provide tissue from a diagnostic biopsy or at the time of cancer resection, and blood samples before, during, and after treatment. * HER2 positive disease as defined by any of the following: * Tumor HER2 expression staining intensity of 2 or 3+ by IHC (from either a preoperative biopsy or resection specimen at the time of oncologic surgery) * HER2 amplification as determined by FISH (HER2/CEP 17 ratio greater than or equal to 2.0 or HER2 mean copy number greater than or equal to 4.0) * HER2 or ERBB2 mutated on tumor genomic sequencing assay (see Section 9.1 for permitted HER2 mutations) * Age 18 years or older * ECOG performance status ≤ 1 (Karnofsky ≥ 60%, see Appendix A) * Participant must have normal organ and marrow function as defined below within 14 days prior to study registration: * leukocytes ≥ 3,000/mcL * absolute neutrophil count ≥ 1,000/mcL * hemoglobin ≥ 9.0 g/dL * platelets ≥ 100,000/mcL * total bilirubin ≤ 2.0 g/dL * AST(SGOT)/ALT(SGPT) ≤ 2.5× institutional upper limit of normal * creatinine within normal institutional limits OR * creatinine clearance ≥50 mL/min/1.73 m2 for participants with creatinine levels above institutional normal * Serum calcium (corrected for albumin value), magnesium, and potassium levels within normal limits per institutional standards. * Assessment of cardiac function either by an echocardiogram or a multi-gated acquisition (MUGA) scan prior to the therapy initiation, with a baseline left systolic ventricular ejection fraction (LVEF) ≥ 50% within 1 month prior to study registration. * Ability to understand and the willingness to sign a written informed consent document. * Women of childbearing potential must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG) within 72 hours prior to the start of T-DM1. "Women of childbearing potential (WOCBP)" is defined as any female who has experienced menarche and who has not undergone surgical sterilization (hysterectomy or bilateral oophorectomy) or who is not postmenopausal. Menopause is defined clinically as 12 months of amenorrhea in a woman over 45 in the absence of other biological or physiological causes. In addition, women under the age of 55 must have a documented serum follicle stimulating hormone (FSH) level less than 40 mIU/mL. * Men who are sexually active with WOCBP must agree to use any contraceptive method with a failure rate of less than 1% per year. Men who are sexually active with WOCBP will be instructed to adhere to contraception for a period of 6 months after the last dose of investigational product. Women who are not of childbearing potential (ie, who are postmenopausal or surgically sterile as well as azoospermic men) do not require contraception. See Appendix B for further guidance on contraception. Exclusion Criteria: * Patient with AJCC 2017 8th edition stage I or stage IVC (metastatic) disease, or unresectable disease. * Subject who has had prior radiation and/or chemotherapy for head and neck cancer. * Any history of prior HER2 directed therapy. * Active or uncontrolled infection. * Pregnant or lactating women. * Uncontrolled intercurrent illness including, but not limited to, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements. * 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, and low risk prostate adenocarcinoma being managed with active surveillance. A history of another separate malignancy in remission without evidence of active disease in the last 2 years is permitted.
Where this trial is running
Atlanta, Georgia and 12 other locations
- Winship Cancer Institute, Emory University — Atlanta, Georgia, United States (Recruiting)
- University of Chicago — Chicago, Illinois, United States (Recruiting)
- Brigham and Women's Hospital — Boston, Massachusetts, United States (Recruiting)
- Dana Farber Cancer Institute — Boston, Massachusetts, United States (Recruiting)
- Memorial Sloan Kettering Basking Ridge — Basking Ridge, New Jersey, United States (Recruiting)
- Memorial Sloan Kettering Monmouth — Middletown, New Jersey, United States (Recruiting)
- Memorial Sloan Kettering Bergen — Montvale, New Jersey, United States (Recruiting)
- Memorial Sloan Kettering Commack — Commack, New York, United States (Recruiting)
- Memorial Sloan Kettering Westchester — Harrison, New York, United States (Recruiting)
- David H. Koch Center for Cancer Care at Memorial Sloan Kettering Cancer Center — New York, New York, United States (Recruiting)
- Memorial Sloan Kettering Cancer Center — New York, New York, United States (Recruiting)
- Memorial Sloan Kettering Nassau — Uniondale, New York, United States (Recruiting)
- University of Washington Medical Center — Seattle, Washington, United States (Recruiting)
Study contacts
- Principal investigator: Glenn J Hanna, MD — Dana-Farber Cancer Institute
- Study coordinator: Glenn J Hanna, MD
- Email: glenn_hanna@dfci.harvard.edu
- Phone: 617-632-3090
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.