Testing the Addition of Chemotherapy or Chemo-Immunotherapy to the Usual Surgery for Advanced Head and Neck Cancer
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
Interventions
Biospecimen Collection
Carboplatin
Cemiplimab
Cisplatin
Computed Tomography
Paclitaxel
Positron Emission Tomography
Radiation Therapy
Salvage Surgery
Conditions
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