Patient case: 64-year-old male with head and neck squamous cell carcinoma; genetic feature: CDKN2A

Clinical trial: Randomized Trial of Avelumab-cetuximab-radiotherapy Versus SOCs in LA SCCHN (REACH)

Summary: The purpose of this study is to demonstrate that treatment with avelumab in combination with RT-cetuximab is superior to standard of care (SOC) cisplatin-RT and/or to SOC RT-cetuximab alone in terms of progression-free survival (PFS) in front-line patients with locally advanced SCCHN.

Detailed description: This open-label, randomized, controlled, multicenter phase III study will include 688 patients with LA SCCHN (420 fit for HD cisplatin and 268 unfit for HD cisplatin), histologically confirmed who had not received previous treatment for this setting. The study is designed with the primary objective of demonstrating that treatment with avelumab in combination with cetuximab-RT is superior to SOC Cisplatin-RT or cetuximab-RT alone in terms of PFS. Randomization will assign the 2 treatment arms of each cohort with a 1:1 ratio. In each cohort (fit for cisplatin and unfit for cisplatin), the randomization will be stratified for the 2 most established prognostic factors N stage (N0-N1 vs N2-3) and p16 expression (OPC p16+ versus OPC p16- or non OPC). All patients will be followed until death or at least 60 months.

Eligibility: Inclusion Criteria:
  1. Age ≤ 80 years
  2. Performance Status ECOG 0-1
  3. Squamous cell carcinoma, previously untreated
  4. Stage III, stage IVa (i.e. operable, but not operated) or IVb (non resectable)
  5. Oral cavity, oropharynx, hypopharynx or larynx
  6. Availability of pre-treatment tumour tissue sample (for p16 & PD -L1 expression, TILs and immune landscape)
  7. Recording of alcohol consumption and smoking history
  8. Determination of the patient's ability to receive cisplatin 100 mg /m2 for 3 cycles (fit / unfit)*
  9. Written informed consent
  -  Criteria for determining if a patient is fit for receiving high dose cisplatin:
  -  Calculated creatinin clearance ≥ 60 mL/min as determined by the modified. method of Cockcroft and Gault or by the EDTA method
  -  Absolute neutrophil count ≥1 500/μL, platelets ≥100 000/μL, hemoglobin ≥ 10 g/dL, aspartate (AST) and alanine transaminase (ALT) less than 2 times the upper limit of the normal range (ULN), total bilirubin ≤ 1.5 mg/dL, serum albumin > 35 g/L
  -  Peripheral neuropathy < grade 2
  -  No clinical hearing loss (confirmed by audiogram)
  -  Cardiac function compatible with hyperhydration; Left ventricular ejection fraction within the institutional normal ranges as measured by echocardiogram
  Exclusion Criteria:
  1. Nasopharyngeal, paranasal sinuses, nasal cavity tumors or thyroid cancers
  2. Squamous cell carcinoma involving cervical neck nodes with unknown primary site
  3. Metastatic disease (stage IVc)
  4. Viral infection (HIV, Hepatitis B/C)
  5. Autoimmune disease
  6. Immunodeficiency or immunosuppressive therapy
  7. Active CNS disease
  8. Interstitial lung disease
  9. Active infection
  10. Any prior or current treatment for invasive head and neck cancer. This will include but is not limited to: prior tyrosine kinase inhibitors, any monoclonal antibody, induction chemotherapy, prior surgical resection or RT, or use of any investigational agent
  11. Weight loss of > 10% during the last 4 weeks (except if renutrition with a feeding tube is planned before the onset of treatment or is ongoing)
  12. Concurrent treatment with any other systemic anti-cancer therapy that is not specified in the protocol
  13. Concomitant treatment with any drug on the prohibited medication list such as live vaccines
  14. History of other malignancy within the last 3 years (exception of in situ carcinoma and skin carcinomas)
  15. Significant disease which, in the judgment of the investigator, as a result of the medical interview, physical examinations, or screening investigations would make the patient inappropriate for entry into the trial
  16. Known hypersensitivity reaction to study drugs
  17. Any social, personal, medical and/or psychological factor(s) that could interfere with the observance of the patient to the protocol and/or the follow-up and/or the signature of the informed consent.

Relevance to patient case: not relevant