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Combining radiotherapy and immunotherapy in definitive treatment of head and neck squamous cell carcinoma: review of current clinical trials


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Neoadjuvant immunoradiotherapy trials

Trial, start yearPhaseNSubsite and subtypeBasic schemeImmunotherapy detailsRT detailsMain results
NIRT-HNC, NCT03247712,89 2018I10HPV+ resectable HNSCC stage I-III or CUP with clinical indications for adj. RT or TORS ineligibleNIVO+SBRT 5 weeks before surgery, followed by NIVO3x NIVO neoadj. and 3x adj. NIVO starting 4 weeks postop.SBRT to GTV+3mm; 5pts: 5x8Gy daily (A), and 5 pts: 3x8Gy (B) every other day; delivered between 1st and 2nd NIVO cycleno surgical delays; G3 postop. toxicity higher in cohort A; pCR: 100% in cohort A, and 80% in cohort B.
II11, ongoingcohort C: same as phase I, cohort D: stage III-IV HPV- resectable HNSCCcohort C: SBRT alone 5 weeks before surgery, followed by NIVO, cohort D: same as phase Icohort C: only adj. NIVO, same as in phase I cohort D: same as phase Icohort C (6pts): SBRT 3 x 8 Gy cohort D (5 pts): SBRT 3 x 8 Gyno G3-4 toxicity; major pathologic response in majority of pts
NCT03635164,91 2018I18HPV- resectable LAHNSCCDURVA+SBRT 3–6 weeks before surgery, followed by DURVADURVA neoadj. with the first SBRT fraction and up to 6x DURVA postop.SBRT to gross disease only, starting dose of 2x6Gy (planned increase to 3x6Gy, cohort size of 3 patients) every other day, starting concurrently with DURVANA
NCT03618134,92 2018I/II82TORS eligible HPV+ oropharyngeal HNSCCDURVA+SBRT+/- tremelimumab 5–7 weeks before TORS, followed by DURVADURVA+/- tremelimumab neoadj. with the first SBRT fraction and on day 27, followed by up to 4x adj. DURVASBRT in 5fx, starting concurrently with DURVA+/-tremelimumabNA

Definitive immunoradiotherapy trials

Trial, start yearPhaseNSubsite and subtypeBasic schemeImmunotherapy detailsRT detailsMain results
NCT02586207,117 2015I59LAHNSCC eligible for CRT (34 pts HPV + and 23 pts HPV-)PEMBRO + CRT, followed by PEMBROPEMBRO on days -7 (before CRT), 15 and 36 (conc. with CRT), and adj. for 5 cyclesstarting on day 1: CRT with IMRT 70 Gy (2Gy/fx) and LD-CDDP for 6 cyclesHPV + : 85% CR 12 weeks after CRT; HPV-: 78% CR 12 weeks after CRT; HPV + : 2-year OS 97% and PFS 93%; HPV-: 1-year OS 87% and PFS 73%
GORTEC 2015-01 “PembroRad” (NCT02707588),114 2016II, rand.133LAHNSCC ineligible for CDDParm A: CETUX + RT; arm B: PEMBRO + RTarm A: CETUX during RT; arm B: PEMBRO during RTIMRT (69.99Gy/33fx)arm A: 94% grade 3 toxicity, 57% grade 3 mucositis, 86% received full RT; arm B: 78% grade 3 toxicity, 24% grade 3 mucositis, 88% received full RT
KEYNOTE-412 (NCT03040999),124 2017III, rand.780LAHNSCC eligible for CRTarm A: PEMBRO + CRT, followed by PEMBRO; arm B: placebo + CRT, followed by placeboarm A: priming dose of PEMBRO followed by 2x PEMBRO + CRT, followed by 14x maint. PEMBRO; arm B: placebo instead of PEMBROCRT (70Gy/35fx) and HD-CDDPNA
NCT02759575,131 2016I/II47LAHNSCC of larynxPEMBRO + CRTPEMBRO starting 3 weeks before CRT, maximum 4xCRT (70Gy/35fx) and HD-CDDPNA
NCT02609503,116 2016II29LAHNSCC ineligible for CDDPPEMBRO + RT, followed by PEMBROPEMBRO conc. with RT and 3 adj. cyclesIMRT (70Gy/35fx)2-year OS 75% and PFS 71%; 59% grade 3–4 lymphopenia
NCT02777385,130 2016II, rand.90LAHNSCCarm A: PEMBRO + CRT; arm B: CRT followed by PEMBROarm A: 8x PEMBRO 1 week prior to RT; arm B: 8x PEMBRO beginning in week 10CRT with IMRT (70Gy/35fx) and LD-CDDPNA
NCT03532737,132 2018II50LAHNSCCPEMBRO + CRT or PEMBRO + CETUX + RTPEMBRO starting 3 weeks before (C)RT and during CRT or during RT + CETUXCRT with IMRT (66–70Gy/30–35fx) and HD-CDDP or conc. CETUXNA
KEYCHAIN (NCT03383094),133 2018II, rand.114HPV + LAHNSCCarm A: PEMBRO + RT; arm B: CRTarm A: conc. and adj. PEMBRO for 20 cycles; arm B: CDDP-based CRTIMRT (70Gy/33– 35fx) (arm A) and HD-CDDP in arm BNA
PEACH (NCT02819752),134 2017I36LAHNSCCPEMBRO + CRT, followed by PEMBROpre-loading dose of PEMBRO (dose-escalation trial, 100–200mg) and conc. CRT and PEMBRO and 4x adj. PEMBROstandard CRTNA
NCT04369937,127 2020II50IR HPV + HNSCCHPV-16 vaccination (ISA101b) + PEMBRO + CRT3x ISA101b starting 1 week prior to PEMBRO and two weeks prior to CRTCRT with IMRT (70Gy/35fx) and HD-CDDPNA
RTOG 3504 (NCT02764593),120 2016I40IR-HR LAHNSCCconc. and adj. NIVO added to each of 4 (C)RT cohortsconc. NIVO starting 2 weeks before (C)RT and adj. NIVO starting 3 months after CRTall cohorts: IMRT (70Gy/35fx); cohort 1: CRT with LD-CDDP; cohort 2: CRT with HD- CDDP; cohort 3: RT + CETUX; cohort 4: RTadj. NIVO infeasible after HD-CDDP or in CDDP-ineligible pts; low rates of NIVO DLT
NCT03349710,125 2017III, rand.1046LAHNSCCNIVO + RT vs. CETUX + RT vs. NIVO + CRT vs. CRTClosed due to slowaccrual
NCT03162731,121 2017I24HR LAHNSCCNIVO + ipilimumab + RT17x NIVO and 6x ipilimumab, both starting 2 weeks before RTIMRT (70Gy/35fx)first 12 pts: grade 3 in-RT-field toxicity in 50% of pts, 3 pts discontinued therapy >3 months post-RT, 1 grade 3 colitis, 1 grade 5 bleeding, irAE in 50% of pts
NCT03894891,135 2019II70LAHNSCC of larynx and hypopharynxinduction docetaxel + CDDP + NIVO, followed by NIVO + RTstandard institutional dosingstandard institutional dosingNA
NCT03829722,136 2019II40HR HPV + OP cancerNIVO + CRT, followed by adj. NIVO4x NIVO before and conc. with CRT, followed by 4x NIVOCRT (70Gy/35fx) and carboplatin + paclitaxel combination once per weekNA (temporarily suspended due to COVID-19)
NRG-HN005 (NCT03952585),126 2019II/III, rand.711early-stage HPV + OP cancerarm A: NIVO + deescalated RT; arm B: CRT arm C: deescalated CRT6x NIVO, starting 1 week prior to RTIMRT, CRT with HD- CDDPNA
NCT03799445,137 2019II180low- intermediate volume HPV + OP cancerNIVO + ipilimumab + RTNIVO on days 1, 15, 29, and ipilimumab on day 1; for 2 cyclesIMRT 50–66Gy starting on day 1 of 2. cycle of NIVO + ipilimumabNA
GORTEC 2017- 01 “REACH” (NCT02999087),138 2017III, rand.688LAHNSCCCohort 1 (fit for CDDP): CRT with CDDP (arm 1A), RT + AVEL + CETUX (arm 1B); Cohort 2 (unfit for CDDP); RT + CETUX (arm 2A), RT + AVEL + CETUX (arm 2B)AVEL and CETUX starting 1 week prior to RT, followed by AVEL maint. for 12 monthsIMRT 69.96Gy with either HD-CDDP or CETUXfirst 82 pts: thresholds of the safety monitoring rule not crossed; trial continues
JAVELIN HEAD AND NECK 100 (NCT02952586),110 2016III, rand.697LAHNSCCarm A: AVEL + CRT; arm B: placebo + CRTAVEL starting 1 week prior to CRT, followed by maint. AVEL for 12 monthsCRT with IMRT (70Gy/35fx) and HD-CDDPpreplanned interim analysis: unlikely to show improvement, terminated
NCT02938273,122 2017I10LAHNSCC ineligible for CDDPAVEL + CETUX + RTAVEL starting 1 week prior to RT, followed by maint. AVEL for 4 months; CETUX conc.VMAT (70Gy/35fx)tumour recurrence in 50% after a median follow up of 12months; transient and manageable irAE
DUCRO-HN (NCT03051906),139 2018I/II69LAHNSCCDURVA + CETUX + RTDURVA and CETUX, both conc. with RT, followed by adj. DURVA for 6 monthsIMRT (69.9Gy/33fx)NA
DURTRE-RAD (NCT03624231),115 2018II, rand.120HPV- LAHNSCCarm A: DURVA + TREM + RT; arm B: DURVA + RTDURVA started 2 weeks prior to RT and TREM started with RT, followed by DURVA for up to 9 cyclesRT (70Gy/35fx)first 16 patients: in arm A 5/6 stopped treatment due to toxicity -> terminated; in arm B 1/10 patients stopped treatment
CheckRad-CD8 (NCT03426657),123 2018II120LAHNSCCinduction DURVA + TREM + CDDP + docetaxel and in case of increased CD8 + TILs compared to pre-treatment Bx -> DURVA + TREM + RTafter induction: DURVA with RT and TREM with RT, followed by DURVA for up to 12 cyclesRT (70Gy/35fx)first 10pts after induction (re-biopsies): pCR in 8/10pts, 2 grade 3 + toxicities
NRG-HN004 (NCT03258554),113 2017II/III, rand.523LAHNSCC ineligible for CDDParm A: DURVA + RT; arm B: CETUX + RTDURVA started 2 weeks prior to RT for 7 cycles; CETUX conc.RT (70Gy/35fx)lead-in trial, 10 pts: all received arm A treatment, all completed RT, 8/10 received all doses of DURVA
CITHARE (NCT03623646),140 2019II, rand.66early-stage HPV + OP cancerarm A: DURVA + RT; arm B: CRTDURVA conc. with RTRT 70Gy with CDDP in arm BNA
REWRITe (NCT03726775),129 2018II73HNSCC T1-2 or HNSCC T3-4 and not eligible for CRT/CETUX + RTDURVA + RT, followed by additional 6 months of DURVADURVA conc. with RT, followed by 6 months of DURVART to only primary tumour and immediately adjacent nodal level without extended neck irradiationNA
NCT04405154,141 2020II32LAHNSCCCRT + camrelizumabcamrelizumab conc. with CRT and after for total of 8 cyclesCRT with IMRT/VMAT (66–70Gy/33–35fx) and HD-CDDPNA

Trials utilizing adjuvant immunoradiotherapy

Trial, start yearPhaseNSubsite and subtypeBasic schemeImmunotherapy detailsRT detailsMain results
NCT02641093,142 2016II80LAHNSCCneoadj. PEMBRO followed by resection, followed by PEMBRO + (C)RTPEMBRO 1 week prior to surgery and conc. with RT for total of 7 dosesIMRT (60–66Gy/30fx) + /- LD-CDDP (if ECE + /R1)first 23 pts (lead-in phase): 47% pathological response, no DLT, 2 pts recurred
NRG-HN003 (NCT02775812),143 2016I34resected R1/ECE + HPV- HNSCCadj. PEMBRO + CRT3 different schedules aimed to determine phase II scheduleCRT with IMRT (60Gy/30fx) and LD-CDDPNo irAE unacceptably delayed RT, 50% got all 8 doses of PEMBRO
KEYNOTE-689 (NCT03765918),144,145 2018III, rand.600resected LAHNSCCarm A: neoadj. PEMBRO followed by resection then PEMBRO + (C)RT; arm B: resection then (C)RTarm A: 2x neoadj. PEMBRO and PEMBRO conc. with adj. (C) RT, followed by PEMBRO for up to 15 cycles(C)RT 60–70Gy/30–35fx + /- HD-CDDP depending on risk factorsNA
GORTEC 2018-01 “NIVOPOSTOP” (NCT03576417),146 2018III, rand.680resected R1/ECE + LAHNSCCarm A: adj. NIVO + CRT; arm B: adj. CRTNIVO starting 3 weeks before CRT for total of 4 dosesCRT with IMRT (66Gy/33fx) and HD-CDDPNA
ADHERE (NCT03673735),147 2019III, rand.650resected HR HPV- HNSCCarm A: adj. DURVA + CRT; arm B: adj. CRT1 dose of DURVA 1 week prior to CRT and maint. DURVA for 6 dosesCRT 66Gy/33fx and HD-CDDPNA
ADRISK (NCT03480672),149 2018II, rand.240resected LAHNSCC with >1LN/ECE + /R1arm A: adj. PEMBRO + CRT; arm B: adj. CRTPEMBRO conc. with RT and for up to 12 monthsCRT with CDDPNA
NCT03715946,150 2018II135resected IR- HR HPV + oropharyngeal canceradj. NIVO + deescalated RTNIVO conc. with RT and for additional 6 doses after RTRT (45–50Gy/25fx)NA
NCT03529422,151 2019II33resected IR HNSCCadj. DURVA + RTDURVA starting conc. with RT for total of 6 cyclesIMRT (60Gy/30fx)NA
eISSN:
1581-3207
Language:
English
Publication timeframe:
4 times per year
Journal Subjects:
Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology