TMV Vaccine Therapy alone and with Pembrolizumab for the Treatment of Recurrent and/or Metastatic Head and Neck Squamous Cell Cancer
Head and Neck Cancer
Skin Cancer (Non-Melanoma)
Unknown Primary
18 Years and older, Male and Female
Winship6045-23 (primary)
NCI-2024-08422
STUDY00006705
Summary
This phase Ib trial tests the safety, side effects and best dose of tumor membrane vesicle (TMV) vaccine therapy alone and in combination with pembrolizumab and evaluates how well it works in treating patients with head and neck squamous cell cancer that has come back after a period of improvement (recurrent) or that has spread from where it first started (primary site) to other places in the body (metastatic). Vaccines made from a person's tumor cells, such as TMV vaccines, may help the body build an effective immune response to kill tumor cells. Immunotherapy with monoclonal antibodies, such as pembrolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Giving TMV vaccine therapy alone or with pembrolizumab may be safe, tolerable and/or effective in treating patients with recurrent and/or metastatic head and neck squamous cell cancer.
Objectives
PRIMARY OBJECTIVE:
I. To determine the safety, tolerability, and recommended dose and schedule of TMV vaccine alone or TMV vaccine plus pembrolizumab in patients with surgically resected, recurrent and/or metastatic head and neck squamous cell carcinoma (HNSCC).
SECONDARY OBJECTIVE:
I. To assess vaccine-induce immune activity, antitumor response, progression-free survival (PFS) and overall survival (OS) in adult patients with recurrent and/or metastatic HNSCC administered TMV vaccine alone and TMV vaccine plus pembrolizumab.
TERTIARY/EXPLORATORY OBJECTIVES:
I. Determine whether TMV vaccine induces immune response and the magnitude of the response.
II. Next-generation sequencing (NGS) will be performed using patients’ tumor samples and peripheral blood mononuclear cells to assess tumor mutational burden and identify potential neoantigens.
OUTLINE: This is a dose-escalation study of TMV vaccine alone and in combination with (fixed-dose) pembrolizumab. Patients are assigned to 1 of 2 cohorts.
COHORT 1: Patients provide tissue from standard of care surgery to generate vaccine. Patients receive TMV vaccine intradermally once every 2 weeks for up to 3 doses. Patients undergo echocardiography at baseline and at end of treatment and blood sample collection throughout the study. Patients may also undergo additional computed tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography (PET) on study.
COHORT 2: Patients provide tissue from standard of care surgery to generate vaccine. Patients receive TMV vaccine intradermally once every 2 weeks for up to 3 doses. Patients also receive pembrolizumab intravenously (IV) on day 1 of each cycle. Cycles repeat every 3 weeks for up to 1 year in the absence of disease progression or unacceptable toxicity. Patients undergo echocardiography at baseline and at end of treatment and blood sample collection throughout the study. Patients may also undergo additional CT, MRI or PET on study.
After completion of study treatment, patients are followed up on day 90 then every 3 weeks for up to 12 months.
Eligibility
- Must be at least = 18 years of age
- Histologically proven squamous cell carcinoma of the head and neck (HNSCC), amenable to curative salvage surgery. p16 positive and negative allowed. Squamous cell carcinoma of the oral cavity, larynx, hypopharynx, oropharynx, nasopharynx, sinonasal carcinoma and cancer of unknown primary (squamous cell carcinoma only) are all allowed. They will be allowed to have up to 3 different regimens after diagnosed of recurrent or metastatic HNSCC
- Oropharyngeal tumors must have p16 or human papillomavirus (HPV) testing done
- The tumor tissues must be available and banked (- 80°C) at the time of salvage surgery (1st informed consent form [ICF] must be signed)
- Recurrent and/or metastatic HNSCC that has failed standard chemotherapy and immunotherapy. Eligible subjects must have progressed on = 2 lines of standard of care prior to starting trial therapy. For patients who have relapsed within 6 months of systemic therapy given with curative intent, that therapy will count as a line of metastatic therapy. Eligible subjects will have no restriction on prior lines of therapy in the metastatic/advanced disease setting
- The tumors should be measurable by Response Evaluation Criteria in Solid Tumors (RECIST) criteria
- Must have enough tissue collected after salvage surgery to make at least 3 doses of vaccine (minimum weight of the resectable tumor tissue is = .5 grams) and adequate cellularity (> 40% cellularity) assessed by the head and neck pathologists
- Eastern Cooperative Oncology Group (ECOG) performance status 0, 1 or 2
- Absolute neutrophil count = 1,500 cells/uL
- Platelets = 100,000/uL
- Hemoglobin = 9.0g/dL (may receive packed red blood cell [prbc] transfusion)
- Total bilirubin = 1.5 x the upper limit of normal (ULN)
- Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) = 2.5 x ULN
- Albumin = 3.0 g/dL
- Serum creatinine = 1.5 x ULN
- Calculated creatinine clearance of = 50 mL/min
- International normalized ratio (INR) = 1.5. Anticoagulation is allowed only with low molecular weight heparin (LMWH). Patient receiving low molecular weight (LMW) heparin on stable therapeutic dose for more than 2 weeks or with factor Xa level < 1.1U/mL are allowed on the trial
- Willingness and ability to comply with scheduled visits, treatment plans, laboratory tests, and other study procedures
- Ability to understand and willingness to sign written informed consent documents
- Female subjects of childbearing potential must agree to use adequate contraception (e.g., hormonal or barrier method of birth control; abstinence) for the duration of study treatment and 3 months after completion
- Male subjects must agree to use adequate contraception (e.g., condoms; abstinence) for the duration of study treatment and 3 months after completion
- Female subjects of childbearing age must have a negative serum pregnancy test at study entry
- Patients who have received prior pembrolizumab are eligible
Treatment Sites in Georgia
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