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The UNSCARRed Study: UNresctable Squamous Cell Carcinoma Treated With Avelumab and Radical Radiotherapy (UNSCARRed)

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ClinicalTrials.gov Identifier: NCT03737721
Recruitment Status : Recruiting
First Posted : November 9, 2018
Last Update Posted : April 16, 2019
Sponsor:
Collaborators:
EMD Serono
Alberta Cancer Foundation
Information provided by (Responsible Party):
AHS Cancer Control Alberta

Brief Summary:

The purpose of this study is to find out what effects the combination of radiation therapy and Avelumab have on you and your cancer. The effectiveness of this treatment as well as what side effects occur will both be studied.

Squamous cell carcinoma of the skin is the most commonly diagnosed cancer. Risk factors for the development of squamous cell cancer include ultraviolet (sun) exposure, as well as increasing age. In the majority of instances, a minor surgical procedure is curative. Less commonly, squamous cell carcinoma cannot be removed surgically, due to the location and/or extent of the cancer, or due to patient-specific factors which would make surgery unsafe (for instance, the presence of unrelated medical illnesses such as heart disease or stroke).

When squamous cell carcinoma cannot be removed surgically, radiation therapy may serve as an effective alternative treatment. Squamous cell carcinomas are typically very sensitive to radiation, and in some instances radiation therapy may also cure a person of their cancer.

While some people may be cured by radiation therapy, not all people are. This study is investigating the combination of radiation therapy and immune therapy. When given together, more patients may be cured of their cancer.

Immune therapy is effective for the treatment of squamous cell carcinoma. In clinical trials, more than half of patients benefit from immune therapy. Immune therapy is not chemotherapy. Instead, immune therapy involves the infusion of antibodies which target a person's own immune system. Immune therapy "re-activates" a person's own immune system against their cancer.

The treatment offered within this clinical trial includes daily radiation treatments as well as immunotherapy treatments administered once every two weeks. The immunotherapy in use is a drug called Avelumab, which is an antibody that helps your body's immune system fight cancer.

Health Canada, the regulatory body that oversees the use of natural health products, drugs and devices in Canada, has not approved the sale or use of this product to treat this kind of cancer, although they have allowed its use in this study


Condition or disease Intervention/treatment Phase
Squamous Cell Carcinoma of the Skin Combination Product: Avelumab and Radical radiotherapy Phase 2

  Show Detailed Description

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 20 participants
Intervention Model: Single Group Assignment
Intervention Model Description: This study has been designed as an open-label, non-randomized, single-arm phase II study to investigate the feasibility and efficacy of Avelumab in combination with radiation therapy in patients with unresectable cuSCC.
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: UNresectable Squamous Cell Carcinoma Treated With Avelumab and Radical Radiotherapy. A Study to Evaluate the Efficacy and Safety of the Combined Use of Avelumab With Radiation Therapy for the Treatment of Unresectable Cutaneous Squamous Cell Carcinoma
Actual Study Start Date : April 12, 2019
Estimated Primary Completion Date : June 30, 2023
Estimated Study Completion Date : June 30, 2023

Resource links provided by the National Library of Medicine

Drug Information available for: Avelumab

Arm Intervention/treatment
Experimental: Avelumab and Radical radiotherapy
Single-arm combining Avelumab with radical radiotherapy.
Combination Product: Avelumab and Radical radiotherapy
A single-arm, interventional study combining Avelumab with radical radiotherapy. Avelumab will be delivered on a 14-day cycle, with the first cycle administered 14 days in advance of the radiation therapy start date; 63-66 Gy radiation will be delivered over 30 daily fractions concurrent with an additional 4 cycles of Avelumab




Primary Outcome Measures :
  1. Objective response rate (assessing change in tumour response before treatment vs after) [ Time Frame: Primary analysis to occur approximately 36 weeks after LPFV. Baseline staging at screening,repeated at 90 day fup and confirmatory scan ]
    Associated with combination Avelumab/radiation therapy (defined as the proportion of patients achieving either a partial response or a complete response as best-overall response per RECIST criteria 1.1)


Secondary Outcome Measures :
  1. Progression-free survival [ Time Frame: PFS will be based on the disease assessment or date of death provided by the investigator. The analysis of PFS will be scheduled to occur approximately 90 days following completion of the 24 month follow-up period for the final patient enrolled to study ]
    PFS is defined as the time between the date of treatment initiation and the date of disease progression (determined utilizing RECIST 1.1 criteria) or death (whatever the cause), whichever occurs first. For patients who remain alive and whose disease has not progressed, PFS data will be censored on the date of the last tumour assessment on study for patients who do not have objective tumour progression and who do not die while on study

  2. Clinical and pathological response rate [ Time Frame: The analysis of clinical and pathological response will be conducted within 90 days of enrollment of the last patient to study ]
    associated with Avelumab monotherapy (clinical response rate per RECIST 1.1; pathological response rate defined as the proportion of patients who, upon post-Avelumab monotherapy re-biopsy, demonstrate ≥ 10% increase tumor necrosis versus pre-treatment biopsy)

  3. Safety analysis: CTCAE v.4.03 [ Time Frame: Delegated study personnel will assess the patients for adverse events at baseline through to study completion per protocol (Baseline, cycles 1-5 (each cycle is 14 days), and in follow up at 30 days, 90 days and every 12 weeks up to 2 years). ]
    (treatment-related and non-related adverse events per CTCAE v.4.03)


Other Outcome Measures:
  1. Utility of tumoral PD-L1 expression as a predictive and prognostic biomarker [ Time Frame: Tumor biopsies will be obtained prior to treatment (baseline), following Avelumab monotherapy (post-cycle 1 treatment) and following completion of Avelumab concurrent with radiation therapy (end of cycle 4). Each cycle is 14 days. ]
    Quantitative immunohistochemical analysis of PD-L1 expression will be performed and correlated with treatment response. PD-L1 expression may be constitutive or inducible; radiation therapy has been demonstrated to induce the expression of PD-L1 on tumor cells(22). Tumor biopsy will be repeated during concurrent Avelumab/radiation treatment, and tumoral expression of PD-L1 analyzed.

  2. Quantification/characterization of tumor-infiltrating lymphocytes/PBMCs [ Time Frame: Blood samples will be obtained prior to treatment (baseline), after Avelumab monotherapy (post-cycle 1 treatment) following completion of Avelumab concurrent with radiation therapy (end of cycle 4). Each cycle is 14 days. ]
    To isolate TILs and collect PBMCs from this patient cohort according to the schedule in section 3.5.2 table 1.

  3. Characterization of tumoral MHC-I/II expression/ Analysis of MHC immunopeptidomes [ Time Frame: Tumor biopsies will be obtained prior to treatment (baseline), following Avelumab monotherapy (post-cycle 1 treatment) and following completion of Avelumab concurrent with radiation therapy. Each cycle is 14 days. ]
    The design of this study is such that pre- and post/during treatment biopsies can be compared for MHC antigen expression, hypothesizing that expression levels may have predictive value in the setting of checkpoint inhibition. Expression of MHC molecules (class I and class II) will be analyzed on pre- and post/during treatment biopsies by immunohistochemistry. In addition to quantifying tumoral expression of MHC I/II molecules at baseline, following treatment with Avelumab, and following treatment with Avelumab/RT, investigators propose small scale MHC class I immuno-isolation and peptide extraction(30) to determine the repertoire of antigenic peptides expressed at each of the three time-points. The investigators hypothesize that antigen quantity and diversity may have predictive value for response to Avelumab, and that treatment at each of the three time-points will alter the presentation of immunogenic antigens.

  4. Patient-reported quality of life: Brief Older People's Quality of Life questionnaire (OPQOL-brief) [ Time Frame: Assess patient-reported QoL at baseline and 30 days after last avelumab administration (cycle 5) ]

    Brief Older People's Quality of Life questionnaire (OPQOL-brief) will be used to assess patient-reported QoL.

    The OPQOL-BRIEF questionnaire has 13 items, with a preliminary single item on global QoL, shown below. This single item is not scored with the OPQOL; it is coded as Very good (1) to Very bad (5).

    Each of the 13 items is scored Strongly agree=1, Agree=2, Neither=3, Disagree=4, Strongly disagree=5. The items are summed for a total OPQOL-Brief score, then positive items are reverse coded, so that higher scores represented higher QoL.




Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Patients must be 18 years of age or older.
  2. Patients with histologically confirmed, unresectable cuSCC, stage I-IV (M0).
  3. Patients must be capable of providing consent to enrolment and treatment.
  4. Patients with a performance status of ECOG 0-2 will be eligible for enrolment
  5. Measurable disease must be present according to RECIST 1.1 criteria.
  6. Women of child bearing potential (WOCBP) must have a negative serum (or urine) pregnancy test at the time of screening. WOCBP is defined as any female who has experienced menarche and who has not undergone surgical sterilization (hysterectomy or bilateral oophorectomy or bilateral salpingectomy) and is not postmenopausal. Menopause is defined as 12 months of amenorrhea in a woman over age 45 years in the absence of other biological or physiological causes. In addition, females under the age of 55 years must have a serum follicle stimulating hormone, (FSH) level > 40 mIU/mL to confirm menopause.
  7. Patients of childbearing / reproductive potential should use highly effective birth control methods, as defined by the investigator, during the study treatment period and for a period of 30 days after the last dose of study drug. A highly effective method of birth control is defined as those that result in low failure rate (i.e. less than 1% per year) when used consistently and correctly.

    Note: abstinence is acceptable if this is established and preferred contraception for the patient and is accepted as a local standard.

  8. Female patients who are breast-feeding should discontinue nursing prior to the first dose of study treatment and until 30 days after the last dose of study drug.
  9. Male patients should agree to not donate sperm during the study and for a period of at least 30 days after last dose of study drug.
  10. Absence of any condition hampering compliance with the study protocol and follow- up schedule; those conditions should be discussed with the patient before registration in the trial.
  11. The following adequate organ function laboratory values must be met:

Hematological:

  • Absolute neutrophil count (ANC) >1.5 x109/L
  • Platelet count >100 x109/L
  • Hemoglobin >9 g/dL (may have been transfused)

Renal:

o Estimated creatinine clearance ≥ 30 mL/min according to the Cockcroft-Gault formula (or local institutional standard method)

Hepatic:

  • Total serum bilirubin <1.5x ULN
  • AST and ALT <2.5x ULN

Coagulation:

  • International Normalized Ratio (INR) <1.5x ULN (unless patient is receiving anticoagulant therapy as long as prothromin time (PT) or activated partial thromboplastin time (PTT) is within therapeutic range of intended use of anticoagulants)
  • PTT <1.5x ULN (unless patient is receiving anticoagulant therapy as long as PT or PTT is within therapeutic range of intended use of anticoagulants)

Exclusion Criteria:

  1. History of pneumonitis requiring treatment with steroids.
  2. History of active interstitial lung disease.
  3. Clinically significant (i.e., active) cardiovascular disease: cerebral vascular accident/stroke (< 6 months prior to enrollment), myocardial infarction (< 6 months prior to enrollment), unstable angina, congestive heart failure (≥ New York Heart Association Classification Class II), or serious cardiac arrhythmia requiring medication.
  4. History of another malignancy or a concurrent malignancy; Exceptions include patients who have been disease-free for 3 years, or patients with a history of completely resected non-melanoma skin cancer or successfully treated in situ carcinoma are eligible, for example cervical cancer in situ.
  5. Diagnosis of immunodeficiency.
  6. Current use of immunosuppressive medication, EXCEPT for the following: a. intranasal, inhaled, topical steroids, or local steroid injection (e.g., intra-articular injection); b. Systemic corticosteroids at physiologic doses ≤ 10 mg/day of prednisone or equivalent; c. Steroids as premedication for hypersensitivity reactions (e.g., CT scan premedication).
  7. Prior organ transplantation including allogeneic stem-cell transplantation.
  8. Known history of human immunodeficiency virus (HIV).
  9. Hepatitis B virus (HBV) or hepatitis C virus (HCV) infection at screening (positive HBV surface antigen or HCV ribonucleic acid (RNA) if anti-HCV antibody screening test positive).
  10. Active autoimmune disease that might deteriorate when receiving an immuno-stimulatory agent. Patients with diabetes type I, vitiligo, psoriasis, or hypo- or hyperthyroid diseases not requiring immunosuppressive treatment are eligible.
  11. Active infection requiring systemic therapy.
  12. Vaccination within 4 weeks of the first dose of Avelumab and while on trials is prohibited except for administration of inactivated vaccines.
  13. Patient will not be eligible if the patient is or has an immediate family member (e.g., spouse, parent/legal guardian, sibling or child) who is investigational site or sponsor staff directly involved with this trial, unless prospective independent ethics committee (IEC) approval (by chair or designee) is given allowing exception to this criterion for a specific subject.
  14. Known prior severe hypersensitivity to investigational product or any component in its formulations, including known severe hypersensitivity reactions to monoclonal antibodies (CTCAE v4.03 Grade ≥ 3).
  15. Other severe acute or chronic medical conditions including inflammatory bowel disease, immune pneumonitis, pulmonary fibrosis or psychiatric conditions including recent (within the past year) or active suicidal ideation or behavior; or laboratory abnormalities that may increase the risk associated with study participation or study treatment administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the patient inappropriate for entry into this study.
  16. Persisting toxicity related to prior therapy (NCI CTCAE v. 4.03 grade > 1); however, alopecia, sensory neuropathy ≤ grade 2, or other toxicities ≤ grade 2 not constituting a safety risk based on investigator's judgment are acceptable.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03737721


Contacts
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Contact: John Walker, MD PhD FRCPC 780-432-8340 John.Walker2@ahs.ca
Contact: Alison Schmidt 780-577-8149 alison.schmidt@ahs.ca

Locations
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Canada, Alberta
Cross Cancer Institute Recruiting
Edmonton, Alberta, Canada, T6G1Z2
Contact: John Walker, MD    780-432-8340      
Sponsors and Collaborators
AHS Cancer Control Alberta
EMD Serono
Alberta Cancer Foundation
Investigators
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Principal Investigator: John Walker, Walker Alberta Health Services - Cross Cancer Institute

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Responsible Party: AHS Cancer Control Alberta
ClinicalTrials.gov Identifier: NCT03737721     History of Changes
Other Study ID Numbers: UNSCARRed: IIT-0004
First Posted: November 9, 2018    Key Record Dates
Last Update Posted: April 16, 2019
Last Verified: April 2019

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: Yes

Additional relevant MeSH terms:
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Carcinoma
Carcinoma, Squamous Cell
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Squamous Cell
Antibodies, Monoclonal
Immunologic Factors
Physiological Effects of Drugs