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NCT07195734PHASE2Recruiting

Testing the Addition of Chemotherapy or Chemo-Immunotherapy to the Usual Surgery for Advanced Head and Neck Cancer

National Cancer Institute (NCI)

Start Date

4/24/2026

Completion Date

2/1/2033

Summary

This phase II trial tests the addition of chemotherapy, with carboplatin and paclitaxel, or chemo-immunotherapy, with carboplatin, paclitaxel and cemiplimab to standard salvage surgery followed by post operative radiation therapy and cisplatin for high risk patients, for the treatment of patients with PD-L1 positive head and neck squamous cell carcinoma that has come back and spread to nearby tissue or lymph nodes after a period of improvement (locally recurrent) or is persistent. Carboplatin is 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. Paclitaxel is in a class of medications called antimicrotubule agents. It stops cancer cells from growing and dividing and may kill them. Immunotherapy with monoclonal antibodies, such as cemiplimab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Salvage surgery is surgery that takes place to remove tumor tissue after a failure of other treatment. High risk patients also receive radiation therapy uses high energy x-rays, particles, or radioactive seeds to kill cancer 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. Adding chemotherapy or chemo-immunotherapy to standard salvage surgery may kill more tumor cells than salvage surgery alone in patients with PD-L1 positive locally recurrent or persistent head and neck squamous cell carcinoma.

Detailed Description

PRIMARY OBJECTIVE: I. To assess and compare investigator-assessed event-free survival (EFS) of patients treated with chemotherapy (carboplatin + paclitaxel) or chemo-immunotherapy (carboplatin + paclitaxel + cemiplimab \[REGN2810\]) prior to salvage surgery (SS) versus patients undergoing standard of care SS. SECONDARY OBJECTIVES: I. To assess and compare disease-free survival (DFS). II. To assess and compare overall survival (OS). III. To assess and compare distant metastasis (DM). IV. To assess and compare acute and late toxicity (Common Terminology Criteria for Adverse Events \[CTCAE\] version \[v\] 5.0), and surgical complications. V. To assess radiographic response (Response Evaluation Criteria in Solid Tumors \[RECIST\] 1.1) to neoadjuvant therapy in the experimental arms. VI. To assess pathologic response in the experimental arms. EXPLORATORY OBJECTIVES: I. To assess and compare clinical outcomes (EFS, DFS, OS, DM, and response) within the PD-L1 subgroups (combined positive score \< 20 versus ≥ 20). II. To determine the impact of surgical quality benchmarks (margin assessment, cervical lymph node harvest collected per central surgery review) and oncologic outcomes. OUTLINE: Patients are randomized to 1 of 3 arms. ARM 1: Patients undergo standard of care salvage surgery. Starting within 8 weeks of surgery, patients with high risk features also undergo radiation therapy daily for 5 treatments per week for 6 weeks and receive cisplatin intravenously (IV) once per week for 6 weeks during radiation treatment, in the absence of disease progression or unacceptable toxicity. Patients undergo computed tomography (CT) scan, positron emission tomography (PET) scan and optionally undergo blood sample collection throughout the study. ARM 2: Patients receive paclitaxel IV and carboplatin IV on day 1 of each cycle. Cycles repeat every 21 days for 2 cycles in the absence of disease progression or unacceptable toxicity. 6-10 weeks after cycle 1 day 1 patients undergo standard of care salvage surgery. Starting within 8 weeks of surgery, patients with high risk features also undergo radiation therapy daily for 5 treatments per week for 6 weeks and receive cisplatin IV once per week for 6 weeks during radiation treatment, in the absence of disease progression or unacceptable toxicity. Patients undergo CT scan, PET scan and optionally undergo blood sample collection throughout the study. ARM 3: Patients receive paclitaxel IV, carboplatin IV and cemiplimab IV, over 30 minutes, on day 1 of each cycle. Cycles repeat every 21 days for 2 cycles in the absence of disease progression or unacceptable toxicity. 6-10 weeks after cycle 1 day 1 patients undergo standard of care salvage surgery. Starting within 8 weeks of surgery, patients with high risk features also undergo radiation therapy daily for 5 treatments per week for 6 weeks and receive cisplatin IV once per week for 6 weeks during radiation treatment, in the absence of disease progression or unacceptable toxicity. Patients undergo CT scan, PET scan and optionally undergo blood sample collection throughout the study. After completion of study treatment, patients are followed up at 12 weeks or at the end of post operative radiation, then every 3 months for 2 years, every 6 months for years 3 and 4 and annually thereafter.

Eligibility Criteria

Age Range: 18 years to No maximum

Inclusion Criteria: * Pathologically (histologically or cytologically) proven diagnosis of locally recurrent or persistent squamous cell carcinoma of head and neck (SCCHN) arising within the oral cavity, oropharynx, larynx, or hypopharynx * PD-L1 combined positive score (CPS) ≥ 1 using a Clinical Laboratory Improvement Amendments (CLIA) certified laboratory * Verify insurance (or other payment) coverage for neoadjuvant chemotherapy * Measurable disease as defined by RECIST 1.1 * Patients must have locally recurrent or persistent SCCHN arising within the oral cavity, oropharynx, larynx, or hypopharynx (American Joint Committee on Cancer \[AJCC\] Cancer Staging Manual, 8th Edition) AND are deemed candidates for salvage surgery: * P16 positive oropharynx patients with T2, T3, T4, N0, N1, N2 and all other patients with T2, T3, T4a, N0, N1, N2a, N2b, N2c, N3a are eligible. * Patients must be deemed surgically resectable without gross residual disease. * For patients with oral cavity SCCHN, only those with recurrent or persistent disease after prior surgery are eligible. * Patients who are candidates for salvage laryngectomy to treat recurrent laryngeal cancer and who are having salvage surgery for curative intent are eligible. * Patients with resectable lymph node-only recurrence are eligible. * No major vascular involvement (\> 180° involvement of the common carotid or internal carotid artery), jugular foramen involvement, or prevertebral, paraspinous muscle involvement precluding a curative resection * No evidence of distant metastatic disease * The following minimum diagnostic workup is required: * General history and physical examination. * Diagnostic-quality neck CT and PET/CT of neck (PET with attenuation-correction CT of neck, chest, and abdomen) * Age ≥ 18 * Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 * Negative urine or serum pregnancy test (in persons of childbearing potential) within 30 days prior to registration. Childbearing potential is defined as any person who has experienced menarche and who has not undergone surgical sterilization (hysterectomy or bilateral oophorectomy) or who is not postmenopausal * Absolute neutrophil count (ANC) ≥ 1,500 cells/mm\^3 * Platelets ≥ 100,000 cells/mm\^3 * Hemoglobin ≥ 8.0 g/dL (Note: The use of transfusion or other intervention to achieve hemoglobin \[Hgb\] ≥ 8.0 g/dL is acceptable) * Adequate renal function defined as creatinine clearance (CrCL) \> 50 mL/min by the Cockcroft-Gault formula * Total bilirubin ≤ 1.5 x institutional upper limit of normal (ULN) (Not applicable to patients with known Gilbert's syndrome) * Aspartate aminotransferase (AST)(serum glutamic oxaloacetic transaminase \[SGOT\]) and alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase \[SGPT\]) ≤ 3 x institutional ULN * Only patients who received prior radiation therapy in the definitive or post-operative setting (limited to one course) are eligible. * Prior radiation therapy must have been completed at least 6 months prior to registration with the majority of the index persistent/recurrent cancer volume (\> 50%) irradiated to ≥ 40 Gy at the time * Prior systemic therapy including immunotherapy with anti-PD1 or anti-PDL1 within the definitive setting (neo-adjuvant, or adjuvant) is permitted and must have been completed at least 4 months prior to registration * Prior systemic therapy including immunotherapy for treatment of recurrent or metastatic SCCHN is not permitted * No investigational anti-cancer agents received within 4 weeks prior to registration * No New York Heart Association Functional Classification III or IV (Note: Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification) * No active infection requiring IV antibiotics, IV antiviral, or IV antifungal treatments * No peripheral neuropathy grade 3 or 4 * No history of interstitial lung disease * No active, noninfectious pneumonitis requiring immunosuppressive therapy * No history of a solid organ transplant (other than corneal transplant) * No active autoimmune disease that has required systemic treatment in the past 2 years (i.e., use of disease-modifying agents, corticosteroids \[\> 10 mg prednisone/day or equivalent\] or immunosuppressive drugs) * NOTE: Patients meeting the following criteria are not considered immunosuppressed and are eligible to enroll: * Patients who require a brief course of steroids (e.g., prophylaxis for imaging assessments due to hypersensitivity to contrast agents) are not excluded * Patients with type I diabetes mellitus, and endocrinopathies (including hypothyroidism due to autoimmune thyroiditis) only requiring hormone replacement, or skin disorders (such as vitiligo, psoriasis, or alopecia) not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger are permitted to enroll * Physiologic replacement doses ≤ 10 mg prednisone/day or equivalent are allowed. Inhaled or topical steroids are permitted * No history of allergic reaction to the study agent, compounds of similar chemical or biologic composition to the study agent, and immune checkpoint inhibitors (or any of its excipients)

Interventions

PROCEDURE

Biospecimen Collection

DRUG

Carboplatin

BIOLOGICAL

Cemiplimab

DRUG

Cisplatin

PROCEDURE

Computed Tomography

DRUG

Paclitaxel

PROCEDURE

Positron Emission Tomography

RADIATION

Radiation Therapy

PROCEDURE

Salvage Surgery

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Conditions

Clinical Stage II HPV-Mediated (p16-Positive) Oropharyngeal Carcinoma AJCC v8Clinical Stage III HPV-Mediated (p16-Positive) Oropharyngeal Carcinoma AJCC v8Locally Recurrent Head and Neck Squamous Cell CarcinomaLocally Recurrent Hypopharyngeal Squamous Cell CarcinomaLocally Recurrent Laryngeal Squamous Cell CarcinomaLocally Recurrent Oral Cavity Squamous Cell CarcinomaLocally Recurrent Oropharyngeal Squamous Cell CarcinomaStage II Laryngeal Cancer AJCC v8Stage II Lip and Oral Cavity Cancer AJCC v8Stage II Oropharyngeal (p16-Negative) Carcinoma AJCC v8Stage III Laryngeal Cancer AJCC v8Stage III Lip and Oral Cavity Cancer AJCC v8Stage III Oropharyngeal (p16-Negative) Carcinoma AJCC v8Stage IVA Laryngeal Cancer AJCC v8Stage IVA Lip and Oral Cavity Cancer AJCC v8Stage IVA Oropharyngeal (p16-Negative) Carcinoma AJCC v8Stage IVB Laryngeal Cancer AJCC v8Stage IVB Oropharyngeal (p16-Negative) Carcinoma AJCC v8

Locations

Banner University Medical Center - Tucson

Tucson, Arizona 85719

United States

University of Arizona Cancer Center-North Campus

Tucson, Arizona 85719

United States

USC / Norris Comprehensive Cancer Center

Los Angeles, California 90033

United States

Sutter Medical Center Sacramento

Sacramento, California 95816

United States

University of California Davis Comprehensive Cancer Center

Sacramento, California 95817

United States

Emory Proton Therapy Center

Atlanta, Georgia 30308

United States

Emory University Hospital Midtown

Atlanta, Georgia 30308

United States

Northwestern University

Chicago, Illinois 60611

United States

Rush MD Anderson Cancer Center

Chicago, Illinois 60612

United States

Northwestern Medicine Cancer Center Kishwaukee

DeKalb, Illinois 60115

United States

Northwestern Medicine Cancer Center Delnor

Geneva, Illinois 60134

United States

Northwestern Medicine Glenview Outpatient Center

Glenview, Illinois 60026

United States

Northwestern Medicine Grayslake Outpatient Center

Grayslake, Illinois 60030

United States

Northwestern Medicine Lake Forest Hospital

Lake Forest, Illinois 60045

United States

Rush MD Anderson Cancer Center at Rush Lisle

Lisle, Illinois 60532

United States

Northwestern Medicine Oak Brook

Oak Brook, Illinois 60523

United States

Northwestern Medicine Orland Park

Orland Park, Illinois 60462

United States

Memorial Hospital East

Shiloh, Illinois 62269

United States

Northwestern Medicine Cancer Center Warrenville

Warrenville, Illinois 60555

United States

UI Health Care Mission Cancer and Blood - Ankeny Clinic

Ankeny, Iowa 50023

United States

UI Health Care Mission Cancer and Blood - West Des Moines Clinic

Clive, Iowa 50325

United States

Methodist Jennie Edmundson Hospital

Council Bluffs, Iowa 51503

United States

Iowa Methodist Medical Center

Des Moines, Iowa 50309

United States

UI Health Care Mission Cancer and Blood - Des Moines Clinic

Des Moines, Iowa 50309

United States

Broadlawns Medical Center

Des Moines, Iowa 50314

United States

Mercy Medical Center - Des Moines

Des Moines, Iowa 50314

United States

UI Health Care Mission Cancer and Blood - Laurel Clinic

Des Moines, Iowa 50314

United States

UI Health Care Mission Cancer and Blood - Waukee Clinic

Waukee, Iowa 50263

United States

University of Kansas Cancer Center

Kansas City, Kansas 66160

United States

University of Kansas Cancer Center-Overland Park

Overland Park, Kansas 66210

United States

University of Kansas Hospital-Westwood Cancer Center

Westwood, Kansas 66205

United States

LSU Health Baton Rouge-North Clinic

Baton Rouge, Louisiana 70805

United States

Our Lady of the Lake Physician Group

Baton Rouge, Louisiana 70808

United States

Lafayette Family Cancer Center-EMMC

Brewer, Maine 04412

United States

University of Michigan Rogel Cancer Center

Ann Arbor, Michigan 48109

United States

University of Michigan - Brighton Center for Specialty Care

Brighton, Michigan 48116

United States

Wayne State University/Karmanos Cancer Institute

Detroit, Michigan 48201

United States

Henry Ford Hospital

Detroit, Michigan 48202

United States

Weisberg Cancer Treatment Center

Farmington Hills, Michigan 48334

United States

Siteman Cancer Center at Saint Peters Hospital

City of Saint Peters, Missouri 63376

United States

Siteman Cancer Center at West County Hospital

Creve Coeur, Missouri 63141

United States

University of Kansas Cancer Center - Briarcliff

Kansas City, Missouri 64116

United States

University of Kansas Cancer Center - North

Kansas City, Missouri 64154

United States

University of Kansas Cancer Center - Lee's Summit

Lee's Summit, Missouri 64064

United States

Washington University School of Medicine

St Louis, Missouri 63110

United States

Siteman Cancer Center-South County

St Louis, Missouri 63129

United States

Siteman Cancer Center at Christian Hospital

St Louis, Missouri 63136

United States

Nebraska Cancer Specialists/Oncology Hematology West PC - MECC

Omaha, Nebraska 68114

United States

Nebraska Methodist Hospital

Omaha, Nebraska 68114

United States

Cooper Hospital University Medical Center

Camden, New Jersey 08103

United States

Jersey City Medical Center

Jersey City, New Jersey 07302

United States

Cooperman Barnabas Medical Center

Livingston, New Jersey 07039

United States

Monmouth Medical Center

Long Branch, New Jersey 07740

United States

Rutgers Cancer Institute of New Jersey

New Brunswick, New Jersey 08903

United States

Rutgers New Jersey Medical School

Newark, New Jersey 07101

United States

Community Medical Center

Toms River, New Jersey 08755

United States

Stony Brook University Medical Center

Stony Brook, New York 11794

United States

UNC Lineberger Comprehensive Cancer Center

Chapel Hill, North Carolina 27599

United States

Carolinas Medical Center/Levine Cancer Institute

Charlotte, North Carolina 28203

United States

Atrium Health Cabarrus/LCI-Concord

Concord, North Carolina 28025

United States

ProMedica Flower Hospital

Sylvania, Ohio 43560

United States

University of Oklahoma Health Sciences Center

Oklahoma City, Oklahoma 73104

United States

Clackamas Radiation Oncology Center

Clackamas, Oregon 97015

United States

Legacy Mount Hood Medical Center

Gresham, Oregon 97030

United States

Providence Newberg Medical Center

Newberg, Oregon 97132

United States

Providence Willamette Falls Medical Center

Oregon City, Oregon 97045

United States

Legacy Good Samaritan Hospital and Medical Center

Portland, Oregon 97210

United States

Providence Portland Medical Center

Portland, Oregon 97213

United States

Providence Saint Vincent Medical Center

Portland, Oregon 97225

United States

Legacy Meridian Park Hospital

Tualatin, Oregon 97062

United States

UPMC Hillman Cancer Center Erie

Erie, Pennsylvania 16505

United States

Saint Vincent Hospital

Erie, Pennsylvania 16544

United States

UPMC Cancer Center at UPMC Horizon

Farrell, Pennsylvania 16121

United States

IRMC Cancer Center

Indiana, Pennsylvania 15701

United States

Jefferson Hospital

Jefferson Hills, Pennsylvania 15025

United States

UPMC-Johnstown/John P. Murtha Regional Cancer Center

Johnstown, Pennsylvania 15901

United States

Forbes Hospital

Monroeville, Pennsylvania 15146

United States

UPMC Cancer Center - Monroeville

Monroeville, Pennsylvania 15146

United States

UPMC Hillman Cancer Center - Monroeville

Monroeville, Pennsylvania 15146

United States

Thomas Jefferson University Hospital

Philadelphia, Pennsylvania 19107

United States

Allegheny General Hospital

Pittsburgh, Pennsylvania 15212

United States

UPMC-Saint Margaret

Pittsburgh, Pennsylvania 15215

United States

UPMC Hillman Cancer Center

Pittsburgh, Pennsylvania 15232

United States

UPMC-Shadyside Hospital

Pittsburgh, Pennsylvania 15232

United States

UPMC-Saint Clair Hospital Cancer Center

Pittsburgh, Pennsylvania 15243

United States

UPMC Cancer Center at UPMC Northwest

Seneca, Pennsylvania 16346

United States

UPMC Cancer Center-Washington

Washington, Pennsylvania 15301

United States

UPMC Washington Hospital Radiation Oncology

Washington, Pennsylvania 15301

United States

Wexford Health and Wellness Pavilion

Wexford, Pennsylvania 15090

United States

Asplundh Cancer Pavilion

Willow Grove, Pennsylvania 19090

United States

Medical University of South Carolina

Charleston, South Carolina 29425

United States

Vanderbilt University/Ingram Cancer Center

Nashville, Tennessee 37232

United States

Legacy Cancer Institute Medical Oncology and Day Treatment

Vancouver, Washington 98684

United States

Legacy Salmon Creek Hospital

Vancouver, Washington 98686

United States

University of Wisconsin Carbone Cancer Center - Johnson Creek

Johnson Creek, Wisconsin 53038

United States

University of Wisconsin Carbone Cancer Center - Eastpark Medical Center

Madison, Wisconsin 53718

United States

University of Wisconsin Carbone Cancer Center - University Hospital

Madison, Wisconsin 53792

United States

Froedtert Menomonee Falls Hospital

Menomonee Falls, Wisconsin 53051

United States

Medical College of Wisconsin

Milwaukee, Wisconsin 53226

United States

Froedtert and MCW Moorland Reserve Health Center

New Berlin, Wisconsin 53151

United States

Drexel Town Square Health Center

Oak Creek, Wisconsin 53154

United States

Froedtert West Bend Hospital/Kraemer Cancer Center

West Bend, Wisconsin 53095

United States