Phase III Open Label Study of MEDI 4736 With/Without Tremelimumab Versus Standard of Care (SOC) in Recurrent/Metastatic Head and Neck Cancer (KESTREL)
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The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. |
ClinicalTrials.gov Identifier: NCT02551159 |
Recruitment Status :
Active, not recruiting
First Posted : September 16, 2015
Last Update Posted : December 10, 2020
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Condition or disease | Intervention/treatment | Phase |
---|---|---|
Squamous Cell Carcinoma of the Head and Neck | Biological: MEDI4736 Biological: Tremelimumab Biological: MEDI4736+Tremelimumab Biological: Cetuximab Drug: 5-fluorouracil (5FU) Drug: Cisplatin Drug: Carboplatin | Phase 3 |
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 823 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | A Phase III Randomized, Open-label, Multi-center, Global Study of MEDI4736 Alone or in Combination With Tremelimumab Versus Standard of Care in the Treatment of First-line Recurrent or Metastatic Squamous Cell Head and Neck Cancer Patients |
Actual Study Start Date : | October 15, 2015 |
Actual Primary Completion Date : | July 6, 2020 |
Estimated Study Completion Date : | March 1, 2021 |

Arm | Intervention/treatment |
---|---|
Experimental: Monotherapy
MEDI4736 monotherapy.
|
Biological: MEDI4736
Anti-PD-L1 antibody |
Experimental: Combination Therapy
MEDI4736+Tremelimumab combination therapy
|
Biological: Tremelimumab
Anti-CTLA-4 Antibody Biological: MEDI4736+Tremelimumab |
Active Comparator: Standard of Care
Standard of Care treatment
|
Biological: Cetuximab
Monoclonal Antibody Drug: 5-fluorouracil (5FU) Chemotherapy Agent Drug: Cisplatin Chemotherapy agent Drug: Carboplatin Chemotherapy Agent |
- To assess the efficacy of MEDI4736 monotherapy compared to Standard of Care (SoC, EXTREME) in terms of overall survival (OS) [ Time Frame: Estimated up to 2 years ]PD-L1 TC/IC high subgroup
- The efficacy of MEDI4736 + tremelimumab combination therapy compared to SoC in terms of Overall Survival (OS) [ Time Frame: Estimated up to 2 years ]OS in low risk of early mortality (EM) subgroup, ctDNA TMB high subgroup, all-comers and in the PD-L1 TC/IC high subgroup
- The efficacy of MEDI4736 + tremelimumab combination therapy compared to SoC in terms of Objective Response Rate (ORR) [ Time Frame: Estimated up to 2 years ]ORR in the PD-L1 TC/IC high subgroup, low risk of EM subgroup, ctDNA TMB high subgroup and all-comers using investigator assessments according to RECIST 1.1
- The efficacy of MEDI4736 + tremelimumab combination therapy compared to SoC in terms of Progression Free Survival (PFS) [ Time Frame: Estimated up to 2 years ]PFS in the PD-L1 TC/IC high subgroup, low risk of EM subgroup, ctDNA TMB high subgroup and all-comers using investigator assessments according to RECIST 1.1
- The efficacy of MEDI4736 + tremelimumab combination therapy compared to SoC in terms of Second Progression (PFS2) [ Time Frame: Estimated up to 2 years ]PFS2 using local standard clinical practice in the PD-L1 TC/IC high subgroup, and all-comers
- The efficacy of MEDI4736 + tremelimumab combination therapy compared to SoC in terms of Duration of Response (DoR) [ Time Frame: Estimated up to 2 years ]DOR using site investigator assessments according to RECIST 1.1 in the PD-L1 TC/IC high subgroup and all-comers
- The efficacy of MEDI4736 + tremelimumab combination therapy compared to SoC in terms of Best Objective Response (BoR) [ Time Frame: Estimated up to 2 years ]BoR using site investigator assessments according to RECIST 1.1 in the PD-L1 TC/IC high subgroup and all-comers.
- The efficacy of MEDI4736 + tremelimumab combination therapy compared to SoC in terms of Time to Response (TTR) [ Time Frame: Estimated up to 2 years ]TTR using site investigator assessments according to RECIST 1.1 in the PD-L1 TC/IC high subgroup and all-comers.
- The efficacy of MEDI4736 + tremelimumab combination therapy compared to SoC in terms of Time to First Subsequent Therapy (TFST) [ Time Frame: Estimated up to 2 years ]TFST in the PD-L1 TC/IC high subgroup and all-comers
- The efficacy of MEDI4736 + tremelimumab combination therapy compared to SoC in terms of Time to Second Subsequent Therapy (TSST) [ Time Frame: Estimated up to 2 years ]TSST in the PD-L1 TC/IC high subgroup and all-comers
- The efficacy of MEDI4736 + tremelimumab combination therapy compared to SoC in terms of Overall Survival at 12, 18 and 24 Months (OS12, OS18, OS24) over a period of 2 years [ Time Frame: Estimated up to 2 Years ]OS12, OS18 and OS24 in the low risk of EM subgroup, ctDNA TMB high subgroup, all-comers and in the PD-L1 TC/IC high subgroup
- The efficacy of MEDI4736 + tremelimumab combination therapy compared to SoC in terms of Alive and Progression Free at 6 and 12 Months (APF6, APF12) over a period of 1 year [ Time Frame: Estimated up to 1 Year ]APF6 and APF12 in the PD-L1 TC/IC subgroup, low risk of EM subgroup, ctDNA TMB high subgroup and all-comers using site investigator assessments according to RECIST 1.1
- The efficacy of MEDI4736 monotherapy vs SoC in terms of Duration of Response(DoR) [ Time Frame: Estimated up to 2 years ]DoR using site investigator assessments according to RECIST 1.1 in the PD-L1 TC/IC high subgroup and all-comers
- The efficacy of MEDI4736 monotherapy vs SoC in terms of Time to Response (TTR) [ Time Frame: Estimated up to 2 years ]TTR using site investigator assessments according to RECIST 1.1 in the PD-L1 TC/IC high subgroup and all-comers
- The efficacy of MEDI4736 monotherapy vs SoC in terms of Time to First Subsequent Therapy(TFST) [ Time Frame: Estimated up to 2 years ]TFST in the PD-L1 TC/IC high subgroup and all-comers
- The efficacy of MEDI4736 monotherapy vs SoC in terms of Time to Second Subsequent Therapy(TSST) [ Time Frame: Estimated up to 2 years ]TSST in the PD-L1 TC/IC high subgroup and all-comers
- The efficacy of MEDI4736 monotherapy vs SoC in terms of Best Objective Response (BoR) [ Time Frame: Estimated up to 2 Years ]BoR using site investigator assessments according to RECIST 1.1 in the PD-L1 TC/IC high subgroup and all-comers
- The efficacy of MEDI4736 monotherapy vs SoC in terms of proportion of patients Alive and Progression Free at 6 and 12 Months (APF6, APF12) over a period of 1 year [ Time Frame: Estimated up to 1 year ]APF6 and APF12 using site investigator assessments according to RECIST 1.1 in the PD-L1 TC/IC high subgroup, low risk of EM subgroup, ctDNA TMB high subgroup and all-comers
- The efficacy of MEDI4736 monotherapy compared to SoC in terms of Progression Free Survival (PFS) and Second Progression (PFS2) [ Time Frame: Estimated up to 2 years ]
PFS using site investigator assessments according to RECIST 1.1 in the PD-L1 TC/IC high subgroup, low risk of EM subgroup, ctDNA TMB high subgroup and all-comers
PFS2 using local standard clinical practice in the PD-L1 TC/IC high subgroup and all-comers
- The efficacy of MEDI4736 monotherapy compared to SoC in terms of Overall Survival (OS) and Overall Survival at 12, 18 and 24 months (OS12, OS18, OS24) [ Time Frame: Estimated up to 2 Years ]
OS in low risk of EM subgroup, ctDNA TMB high subgroup and all-comers
OS12, OS18 and OS24 in the low risk of EM subgroup, ctDNA TMB high subgroup all-comers and PD-L1 TC/IC high subgroup
- The efficacy of MEDI4736 monotherapy compared to SoC in terms of Objective Response Rate (ORR) [ Time Frame: Estimated up to 2 years ]ORR using site investigator assessments according to RECIST 1.1 in the PD-L1 TC/IC high subgroup, low risk of EM subgroup, ctDNA TMB high subgroup and all-comers
- The efficacy of MEDI4736 + tremelimumab combination therapy compared to MEDI4736 monotherapy in terms of Progression Free Survival (PFS) [ Time Frame: Estimated up to 2 years ]PFS using site investigator assessments according to RECIST 1.1 in the low risk of EM subgroup, ctDNA TMB high subgroup, PD-L1 TC/IC high subgroup and all-comers
- The efficacy of MEDI4736 + tremelimumab combination therapy compared to MEDI4736 monotherapy in terms of Objective Response Rate (ORR) [ Time Frame: Estimated up to 2 years ]ORR using site investigator assessments according to RECIST 1.1 in the low risk of EM subgroup, ctDNA TMB high subgroup, PD-L1 TC/IC high subgroup and all-comers
- The efficacy of MEDI4736 + tremelimumab combination therapy compared to MEDI4736 monotherapy in terms of Overall Survival (OS) [ Time Frame: Estimated up to 2 years ]OS in the low risk of EM subgroup, ctDNA TMB high subgroup, PD-L1 TC/IC high subgroup and all-comers
- The pharmacokinetics (PK) analysis of MEDI4736 and Tremelimumab using Area Under the Curve (AUC) [ Time Frame: Estimated up to 6 months ]After the first and steady-state doses: peak and trough concentrations of MEDI4736 and Tremelimumab will be determined.
- The immunogenicity of MEDI4736 and tremelimumab [ Time Frame: Estimated up to 2 years ]Serum will be tested for the presence of anti-drug antibodies.
- HRQoL in patients treated with MEDI4736 + tremelimumab or MEDI4736 compared to SoC using the European Organization for Research and Treatment of Cancer Core Quality of Life (EORTC QLQ-C30) module [ Time Frame: Estimated up to 2 years ]EORTC QLQ-C30: global health QoL, functioning (physical) and symptoms (fatigue) in the PD-L1 TC/IC high subgroup and all-comers
- HRQoL in patients treated with MEDI4736 + tremelimumab or MEDI4736 compared to SoC using the European Organization for Research and Treatment of Cancer Head and Neck Quality of Life (EORTC QLQ-H&N35) module [ Time Frame: Estimated up to 2 years ]EORTC QLQ-H&N35: symptoms (pain, swallowing) in the primary analysis population, and all-comers Changes in WHO/ECOG performance status in the PD-L1 TC/IC high subgroup and all-comers
- The pharmacokinetics (PK) analysis of MEDI4736 and Tremelimumab using Maximum Plasma Concentration (Cmax) [ Time Frame: Estimated up to 6 months ]After the first and steady-state doses: peak and trough concentrations of MEDI4736 and Tremelimumab will be determined.
- Safety and tolerability profile of MEDI4736 + tremelimumab combination therapy and MEDI4736 monotherapy compared to SoC (EXTREME) in the first-line setting for treatment of SCCHN-Adverse Events [ Time Frame: Estimated up to 2 years ]Adverse Events in PD-L1 TC/IC high subgroup, low risk of EM subgroup and all-comers
- Safety and tolerability profile of MEDI4736 + tremelimumab combination therapy and MEDI4736 monotherapy compared to SoC (EXTREME) in the first-line setting for treatment of SCCHN-Physical Examination [ Time Frame: Estimated up to 2 years ]Incidence of abnormal physical examination findings in PD-L1 TC/IC high subgroup, low risk of EM subgroup and all-comers
- Safety and tolerability profile of MEDI4736 + tremelimumab combination therapy and MEDI4736 monotherapy compared to SoC (EXTREME) in the first-line setting for treatment of SCCHN-Clinical Chemistry [ Time Frame: Estimated up to 2 years ]Incidence of abnormal clinical chemistry test results in PD-L1 TC/IC high subgroup, low risk of EM subgroup and all-comers
- Safety and tolerability profile of MEDI4736 + tremelimumab combination therapy and MEDI4736 monotherapy compared to SoC (EXTREME) in the first-line setting for treatment of SCCHN-Hematology [ Time Frame: Estimated up to 2 years ]Incidence of abnormal hematology test results in PD-L1 TC/IC high subgroup, low risk of EM subgroup and all-comers
- Safety and tolerability profile of MEDI4736 + tremelimumab combination therapy and MEDI4736 monotherapy compared to SoC (EXTREME) in the first-line setting for treatment of SCCHN-Urinalysis [ Time Frame: Estimated up to 2 years ]Incidence of abnormal urinalysis test results in PD-L1 TC/IC high subgroup, low risk of EM subgroup and all-comers
- Safety and tolerability profile of MEDI4736 + tremelimumab combination therapy and MEDI4736 monotherapy compared to SoC (EXTREME) in the first-line setting for treatment of SCCHN-Blood Pressure [ Time Frame: Estimated up to 2 years ]Incidence of abnormal vital signs (systolic and diastolic blood pressure) in PD-L1 TC/IC high subgroup, low risk of EM subgroup and all-comers
- Safety and tolerability profile of MEDI4736 + tremelimumab combination therapy and MEDI4736 monotherapy compared to SoC (EXTREME) in the first-line setting for treatment of SCCHN-Pulse [ Time Frame: Estimated up to 2 years ]Vital signs (pulse) in PD-L1 TC/IC high subgroup, low risk of EM subgroup and all-comers
- Safety and tolerability profile of MEDI4736 + tremelimumab combination therapy and MEDI4736 monotherapy compared to SoC (EXTREME) in the first-line setting for treatment of SCCHN-ECG [ Time Frame: Estimated up to 2 years ]Incidence of abnormal ECG (QTcF) findings in PD-L1 TC/IC high subgroup, low risk of EM subgroup and all-comers

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.
Ages Eligible for Study: | 18 Years to 130 Years (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Age ≥18 years at the time of screening
- Documented evidence of recurrent or metastatic SCCHN (oral cavity, oropharynx, hypopharynx, or larynx).
- A fresh tumor biopsy for the purpose of screening or an available archival tumor sample. Tumor lesions used for fresh biopsies should not be the same lesions used as RECIST target lesions, unless there are no other lesions suitable for biopsy.
- No prior systemic chemotherapy for recurrent or metastatic disease
- World Health Organization (WHO)/Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 at enrollment
- No prior exposure to immune-mediated therapy,
Exclusion Criteria:
- Histologically or cytologically confirmed head and neck cancer of any other primary anatomic location in the head and neck not specified in the inclusion criteria including patients with SCCHN of unknown primary or non-squamous histologies (eg, nasopharynx or salivary gland)
- Tumor progression or recurrence within 6 months of last dose of platinum therapy in the primary treatment setting
- Receipt of any radiotherapy or hormonal therapy for cancer treatment within 30 days prior to first dose of study treatment
- Active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease [eg, colitis, Crohn's disease], diverticulitis

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): NCT02551159

Study Director: | Richard Olsson | ||
Principal Investigator: | Tanguy Seiwert | The University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637 |
Responsible Party: | AstraZeneca |
ClinicalTrials.gov Identifier: | NCT02551159 |
Other Study ID Numbers: |
D419LC00001 |
First Posted: | September 16, 2015 Key Record Dates |
Last Update Posted: | December 10, 2020 |
Last Verified: | December 2020 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | Yes |
Plan Description: | Qualified researchers can request access to anonymized individual patient-level data from AstraZeneca group of companies sponsored clinical trials via the request portal. All request will be evaluated as per the AZ disclosure commitment: https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure. Yes, indicates that AZ are accepting requests for IPD, but this does not mean all requests will be shared. |
Supporting Materials: |
Study Protocol Statistical Analysis Plan (SAP) |
Time Frame: | AstraZeneca will meet or exceed data availability as per the commitments made to the EFPIA Pharma Data Sharing Principles. For details of our timelines, please rerefer to our disclosure commitment at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure. |
Access Criteria: | When a request has been approved AstraZeneca will provide access to the deidentified individual patient-level data in an approved sponsored tool . Signed Data Sharing Agreement (non-negotiable contract for data accessors) must be in place before accessing requested information. Additionally, all users will need to accept the terms and conditions of the SAS MSE to gain access. For additional details, please review the Disclosure Statements at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure. |
URL: | https://astrazenecagroup-dt.pharmacm.com/DT/Home |
Studies a U.S. FDA-regulated Drug Product: | Yes |
Studies a U.S. FDA-regulated Device Product: | No |
programmed cell death ligand 1 (PD-L1), MEDI4736, Cytotoxic T-lymphocyte-associated antigen 4 {CTLA-4}, PFS, SCCHN |
Head and Neck Neoplasms Squamous Cell Carcinoma of Head and Neck Carcinoma, Squamous Cell Carcinoma Neoplasms, Glandular and Epithelial Neoplasms by Histologic Type Neoplasms Neoplasms by Site Cisplatin Carboplatin Fluorouracil Cetuximab |
Durvalumab Tremelimumab Antibodies, Monoclonal Antineoplastic Agents Antimetabolites Molecular Mechanisms of Pharmacological Action Antimetabolites, Antineoplastic Immunosuppressive Agents Immunologic Factors Physiological Effects of Drugs Antineoplastic Agents, Immunological |