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Nivolumab and BMS986205 in Treating Patients With Stage II-IV Squamous Cell Cancer of the Head and Neck

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ClinicalTrials.gov Identifier: NCT03854032
Recruitment Status : Recruiting
First Posted : February 26, 2019
Last Update Posted : April 12, 2019
Sponsor:
Information provided by (Responsible Party):
Thomas Jefferson University

Brief Summary:
This phase II trial studies how well nivolumab works, with or without BMS986205, in treating patients with stage II-IV squamous cell cancer of the head and neck. Immunotherapy with monoclonal antibodies, such as nivolumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. BMS986205 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving nivolumab with BMS986205 may work better than nivolumab alone in treating patients with squamous cell cancer of the head and neck.

Condition or disease Intervention/treatment Phase
Lip Oral Cavity Squamous Cell Carcinoma Pharynx Larynx Squamous Cell Carcinoma Biological: Nivolumab Biological: IDO1 Inhibitor BMS-986205 Procedure: Therapeutic Conventional Surgery Other: Questionnaire Administration Phase 2

  Show Detailed Description

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 48 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Window-of-Opportunity Trial of Nivolumab and BMS986205 in Patients With Squamous Cell Carcinoma of the Head and Neck (CA017-087)
Actual Study Start Date : April 9, 2019
Estimated Primary Completion Date : December 2025
Estimated Study Completion Date : December 2025

Resource links provided by the National Library of Medicine

Drug Information available for: Nivolumab

Arm Intervention/treatment
Experimental: Arm I (BMS986205, nivolumab)
Patients receive IDO1 inhibitor BMS-986205 PO QD. Beginning week 2, patients also receive nivolumab IV over 30 minutes on day 1. Treatment repeats for up to 5 weeks in the absence of disease progression or unacceptable toxicity. Patients showing a treatment response receive IDO1 inhibitor BMS-986205 PO QD for 4 additional weeks and receive nivolumab IV over 30 minutes on day 1, then undergo surgery at week 10. Those without a treatment response after 5 weeks undergo surgery within 7 days.
Biological: Nivolumab
Given IV
Other Names:
  • 946414-94-4
  • BMS-936558
  • MDX-1106
  • NIVO
  • ONO-4538
  • Opdivo

Biological: IDO1 Inhibitor BMS-986205
Given PO
Other Names:
  • (R)-N-(4-chlorophenyl)-2-((1S,4S)-4-(6-fluoroquinolin-4-yl)cyclohexyl)propenamide
  • BMS 986205
  • BMS-986205
  • BMS986205
  • IDO-1 Inhibitor BMS-986205
  • Indoleamine-pyrrole 2,3-Dioxygenase Inhibitor BMS-986205
  • ONO-7701

Procedure: Therapeutic Conventional Surgery
Undergo Surgery

Other: Questionnaire Administration
Ancillary studies

Active Comparator: Arm II (nivolumab)
Patients receive nivolumab IV over 30 minutes on day 1 in the absence of disease progression or unacceptable toxicity. Patients showing treatment response after 4 weeks receive nivolumab IV over 30 minutes on day 1, then undergo surgery at week 9. Those without a treatment response after 4 weeks undergo surgery within 7 days.
Biological: Nivolumab
Given IV
Other Names:
  • 946414-94-4
  • BMS-936558
  • MDX-1106
  • NIVO
  • ONO-4538
  • Opdivo

Procedure: Therapeutic Conventional Surgery
Undergo Surgery

Other: Questionnaire Administration
Ancillary studies




Primary Outcome Measures :
  1. Objective Response [ Time Frame: At 5 weeks ]
    Will be assessed by computed tomography (CT) or magnetic resonance imaging (MRI) scans. The proportions of the primary endpoint in the two treatment groups will be compared at 25% significance level using a two-sided test in proportions. Will re-analyze the primary endpoints using a combined patients collection. Historical controls of patients who received nivolumab alone for 4 weeks in previous window of opportunity trial (CA209-9A7) will be included in the control group. Patients' demographic as well as pre-treatment clinical measurements will be compared between the combined control group versus the treatment group to ensure the homogeneity of the two groups. A multi-variable logistic regression model will be used in the statistical analysis, if any difference in the demographic and clinical predictors between treatment groups is detected. Otherwise, the proportions of the primary endpoint in the two treatment groups will be compared at 5% significance level using a two-sided test.


Secondary Outcome Measures :
  1. Objective pathologic response at time of surgery [ Time Frame: At time of surgery ]
    If there is at least one significant difference between groups among the primary outcomes, the two randomization arms will be compared with respect to each secondary outcome using two-sample t-tests. P-values for comparisons of changes in secondary outcomes will be adjusted using the method of Benjamini and Hochberg to control the false discovery rate (FDR) among the secondary outcomes at 5%.

  2. Change in immune cell polarization (Th1/Th2; M1/M2) in peripheral blood and tumor specimens [ Time Frame: Baseline up to 12 months ]
    Will be analyzed and compared using multiplex cytokine analysis collected before and after exposure to nivolumab +/- IDO1 inhibitor BMS-986205 (BMS986205). If there is at least one significant difference between groups among the primary outcomes, the two randomization arms will be compared with respect to each secondary outcome using two-sample t-tests. P-values for comparisons of changes in secondary outcomes will be adjusted using the method of Benjamini and Hochberg to control the FDR among the secondary outcomes at 5%.

  3. Change in inflammatory markers [ Time Frame: Baseline up to 12 months ]
    These include soluble (s)CD40 ligand (L), EGF, eotaxin, FGF-2, Flt-3 ligand, fractalkine, granulocyte colony-stimulating factor (G-CSF), granulocyte colony-macrophage (GM)-CSF, GRO, IFN-alpha2, IL-1alpha, IL-1beta, IL-1ra, IL-3, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-12 (p40), IL-13, IL-15, IL-17A, IP-10, MCP-1, MCP-3, MDC (CCL22), MIP-1alpha, MIP-1beta, PDGF-AA, PDGF-AB/BB, RANTES, TGF-alpha, TNF-alpha, VEGF. If there is at least one significant difference between groups among the primary outcomes, the two randomization arms will be compared with respect to each secondary outcome using two-sample t-tests. P-values for comparisons of changes in secondary outcomes will be adjusted using the method of Benjamini and Hochberg to control the FDR among the secondary outcomes at 5%

  4. Change in prevalence of intratumoral immune cell populations (effector T cells [Teff], regulatory T cells [Treg], and tumor-associated macrophages [TAM] in patients treated with Nivolumab and BMS986205 as compared to patients treated with Nivolumab alone [ Time Frame: Baseline up to 12 months ]
    Assessed by immunohistochemistry (IHC). If there is at least one significant difference between groups among the primary outcomes, the two randomization arms will be compared with respect to each secondary outcome using two-sample t-tests. P-values for comparisons of changes in secondary outcomes will be adjusted using the method of Benjamini and Hochberg to control the FDR among the secondary outcomes at 5%.

  5. Localization of immune cells within the tumor [ Time Frame: Up to 12 months ]
    Will be analyzed using confocal microscopy.

  6. Multiplex colocalization of resident immune cells [ Time Frame: Up to 12 months ]
    Will utilize 5-6 markers per section.

  7. Kynurenine levels (blood and tumor) [ Time Frame: Up to 12 months ]
    Measured with commercial quantitative enzyme-linked immunosorbent assay (ELISA) kits. If there is at least one significant difference between groups among the primary outcomes, the two randomization arms will be compared with respect to each secondary outcome using two-sample t-tests. P-values for comparisons of changes in secondary outcomes will be adjusted using the method of Benjamini and Hochberg to control the FDR among the secondary outcomes at 5%.

  8. Intratumoral immune cell populations, immune polarization data, exosome composition, and exosome function in human papilloma virus (HPV) + and HPV- tumors [ Time Frame: Up to 12 months ]
    Baseline IHC staining for P16 will be performed as a surrogate for HPV status. If there is at least one significant difference between groups among the primary outcomes, the two randomization arms will be compared with respect to each secondary outcome using two-sample t-tests. P-values for comparisons of changes in secondary outcomes will be adjusted using the method of Benjamini and Hochberg to control the FDR among the secondary outcomes at 5%.

  9. Intratumoral immune cell populations, immune polarization data, exosome composition, and exosome function relative to PD-L1 expression levels [ Time Frame: Up to 12 months ]
    Assessed by IHC. If there is at least one significant difference between groups among the primary outcomes, the two randomization arms will be compared with respect to each secondary outcome using two-sample t-tests. P-values for comparisons of changes in secondary outcomes will be adjusted using the method of Benjamini and Hochberg to control the FDR among the secondary outcomes at 5%.

  10. Incidence of adverse events [ Time Frame: Up to 100 days ]
    Will be graded by Common Terminology Criteria for Adverse Events version 5.0. Safety outcomes will be summarized overall and by treatment arm.


Other Outcome Measures:
  1. Intratumoral T-cell receptor (TCR) repertoire and diversity [ Time Frame: Up to 12 months ]
    Assesses with next generation sequencing.

  2. Change in exosome abundance and composition in the peripheral blood of patients both before and after exposure to both nivolumab and BMS986205 and nivolumab alone [ Time Frame: Baseline up to 12 months ]
    Will be compared between treatment arms using two-sample t-tests.

  3. Rates of wound dehiscence, postop wound infection (requiring antibiotics), and fistula formation [ Time Frame: Up to 12 months ]
    Will be summarized by treatment arm and compared using Fisher's exact test.

  4. Changes in tumor volume and rates of radiographic response [ Time Frame: Baseline up to 12 months ]
    Will be summarized by treatment arm and compared using two-sample t-tests or Fisher's exact test, as appropriate.

  5. Patient-reported outcomes [ Time Frame: Up to 12 months ]
    Data will be collected and correlated to both immune cell composition and polarization and tumor radiographic response using scores from Patient Health Questionnaire (PHQ)2/9, Functional Assessment of Cancer Therapy- General (FACT-G), and FACT-head and neck (HN). Will conduct descriptive statistics and will summarize variable of interest using standard statistics such as frequency tables, means, and standard deviations. All measures will be evaluated for reliability and factor analyses will be conducted.



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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:

  • Pathologically confirmed head and neck squamous cell carcinoma (HNSC).
  • Any stage 2 or greater HNSCC (American Joint Committee on Cancer [AJCC] 8th edition) of the 1) oral cavity, 2) larynx, 3) hypopharynx, 4) nasal cavity/paranasal sinuses or 5) stage 1 oropharyngeal with lymphadenopathy. Patients with resectable disease that is amenable to surgery are eligible.
  • Eastern Cooperative Oncology Group (ECOG) performance status 0-2.
  • White blood cells 2000/ul or more.
  • Absolute neutrophil count 1500/ul or more.
  • Platelets 100,000/ul or more.
  • Hemoglobin 9 g/dl or more.
  • Bilirubin less than or equal to 1.5 x the upper limit of normal (except subjects with Gilbert syndrome, who can have total bilirubin < 3 mg/dl).
  • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) less than or equal to 3 x the upper limit of normal.
  • Glomerular filtration rate (GFR) greater than or equal to 40 ml/min using the Cockcroft-Gault formula or serum creatinine less than or equal to 1.5 x ULN.
  • Women of child bearing potential (WOCBP) should have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of human chorionic gonadotropin [HCG]) within 21 days of study enrollment.
  • WOCBP must agree to follow instructions for method(s) of contraception for the duration of treatment with study treatment(s) plus 5 months post-treatment completion.
  • Males who are sexually active with WOCBP must agree to follow instructions for method(s) of contraception for the duration of treatment with study treatment(s) plus 7 months post-treatment completion. In addition, male participants must be willing to refrain from sperm donation during this time.
  • Males who are sexually active with WOCBP must agree to use a condom during any sexual activity for the duration of treatment with study treatment plus 7 months after the last dose of the study treatment (i.e., 90 days [duration of sperm turnover] plus the time required for nivolumab to undergo approximately 5 half-lives). This criterion applies to azoospermic males as well. In addition, male participants must be willing to refrain from sperm donation during this time.

    • Male mandatory condom use is regardless of whether the participant has undergone a successful vasectomy or if the female partner is pregnant.
    • Investigators shall counsel WOCBP, and male participants who are sexually active with WOCBP, on the importance of pregnancy prevention and the implications of an unexpected pregnancy. Investigators shall advise on the use of highly effective methods of contraception, which have a failure rate of < 1% when used consistently and correctly. Hormonal contraceptives are prohibited methods of contraception for participants receiving BMS-986205 this study who are WOCBP.
  • All subjects must be able to comprehend and sign a written informed consent document.

Exclusion Criteria:

  • Patients with nasopharyngeal carcinoma, salivary gland or skin primaries.
  • Patients with recurrent head and neck cancer treated previously with chemotherapy, radiation or immunotherapy.
  • Any history of a severe hypersensitivity reaction to any monoclonal antibody.
  • Any history of allergy to the study drug components.
  • Participants with a personal or family (i.e., in a first-degree relative) history or presence of cytochrome b5 reductase deficiency (previously called methemoglobin reductase deficiency) or other diseases that puts them at risk of methemoglobinemia. All participants will be screened for methemoglobin levels prior to randomization.
  • Participants with a history of G6PD deficiency or other congenital or autoimmune hemolytic disorders. All participants will be screened for G6PD deficiency prior to randomization.
  • Participants with history of serotonin syndrome.
  • Participants with active interstitial lung disease (ILD)/pneumonitis or history of ILD/ pneumonitis requiring steroids.
  • Prior treatment with BMS-986205 or any other IDO1 inhibitors.
  • Quantitative or qualitative G6PD assay results suggesting underlying G6PD deficiency.
  • Blood methemoglobin > upper limit of normal (ULN), assessed in an arterial or venous blood sample or by co-oximetry.
  • History or presence of hypersensitivity or idiosyncratic reaction to methylene blue.
  • History of allergy or hypersensitivity to any study treatment components, specifically to that of BMS-986205.
  • Any concurrent malignancies; exceptions include- basal cell carcinoma of the skin, squamous cell carcinoma of the skin, superficial bladder cancer or in situ cervical cancer that has undergone potentially curative therapy. Patients with a history of other prior malignancy must have been treated with curative intent and must have remained disease-free for 2 years post-diagnosis.
  • Any diagnosis of immunodeficiency or receiving systemic steroid therapy (> 10 mg daily prednisone equivalents) or any other form of immunosuppressive therapy within 14 days of initiation of therapy.
  • Patients that have an active autoimmune disease requiring systemic treatment within the past 3 months or a documented history of clinically severe autoimmune disease, or a syndrome that requires systemic steroids (> 10 mg daily prednisone equivalents) or immunosuppressive agents. Subjects with vitiligo, type I diabetes mellitus, or resolved childhood asthma/atopy would be an exception to this rule. Subjects that require intermittent use of bronchodilators or local steroid injections would not be excluded from the study. Subjects with hypothyroidism stable on hormone replacement or Sjogren's syndrome will not be excluded from the study.
  • Patients must not be receiving any other investigational agents.
  • Patients with uncontrolled intercurrent illnesses including, but not limited to an active infection requiring systemic therapy or a known psychiatric or substance abuse disorder(s) that would interfere with cooperation with the requirements of the trial.
  • Patients must not be pregnant or breastfeeding.
  • Patients with a known human immunodeficiency virus infection (HIV 1/2 antibodies) or acquired immunodeficiency syndrome (HIV/AIDS), active hepatitis B (e.g., hepatitis B surface antigen [HBsAg] reactive) or hepatitis C (e.g., hepatitis C virus [HCV] ribonucleic acid [RNA] [qualitative] is detected).
  • Patients with any evidence of current interstitial lung disease (ILD) or pneumonitis.
  • Patients with prior history of ILD or non-infectious pneumonitis that required steroids.
  • Patients who have received a live vaccine within 30 days of the planned start of study therapy.

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): NCT03854032


Contacts
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Contact: Adam Luginbuhl, MD 215-955-6760 adam.luginbuhl@jefferson.edu

Locations
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United States, Pennsylvania
Sidney Kimmel Cancer Center at Thomas Jefferson University Recruiting
Philadelphia, Pennsylvania, United States, 19107
Contact: Adam Luginbuhl, MD       adam.luginbuhl@jefferson.edu   
Sponsors and Collaborators
Thomas Jefferson University
Investigators
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Principal Investigator: Adam Luginbuhl, MD Sidney Kimmel Cancer Center at Thomas Jefferson University

Additional Information:
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Responsible Party: Thomas Jefferson University
ClinicalTrials.gov Identifier: NCT03854032     History of Changes
Other Study ID Numbers: 18P.771
First Posted: February 26, 2019    Key Record Dates
Last Update Posted: April 12, 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

Additional relevant MeSH terms:
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Carcinoma
Carcinoma, Squamous Cell
Squamous Cell Carcinoma of Head and Neck
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Squamous Cell
Head and Neck Neoplasms
Neoplasms by Site
Nivolumab
Antineoplastic Agents, Immunological
Antineoplastic Agents