ClinicalTrials.gg
RecruitingNCT03532737Updated Jan 23, 2024

Concomitant Immune Check Point Inhibitor With Radiochemotherapy in Head And Neck Cancer

A Phase 2 interventional study of Pembrolizumab in Locally Advanced Head and Neck Cancer, sponsored by Kuwait Cancer Control Center. Recruiting at 1 site in Kuwait. Open to participants aged 16 Years and older. Per ClinicalTrials.gov, last updated 2024-01-23.

Sponsored by Kuwait Cancer Control Center · Phase 2, Interventional, and Treatment

From the registry’s dates

  • Primary completion was expected by Sep 2025, 1 year 1 month ago, but the record still lists the study as recruiting.
  • Started Oct 2018; still recruiting 8 years 1 month later.
Phase
Phase 2
Study type
Interventional
Enrollment
50
Allocation
Not applicable
Ages
16 Years and older
Sex
All
01

Study summary

Background: Locally advanced head and neck cancer (HNC) is a challenge as, in spite of initial good control with chemoradiation, the majority of patients fails systemically. In the last 2 years, immune check points inhibitors (mainly Programmed Death (PD)-1 inhibitors) were approved for metastatic/recurrent HNC. The favorable toxicity profile and durable responses was the main benefit of these drugs along the scope of cancers they were approved for.

Aim of the study and methods: This will be a phase II non-randomized trial to define safety and efficacy of combining the PD-1 inhibitor pembrolizumab given concomitantly with the usual standard of care chemoradiation/bioradiation for locally advanced non-nasopharyngeal HNC. Primary end point will be assessment of toxicity and tolerability while the secondary end points will be response rates (RR) and progression free survival (PFS)

Read the detailed description

Among the Gulf Countries Collaboration Council (GCCC) states, HNC account for 11.5 per 100,000 population. The incidence of HNC in Kuwait is 3.8 per 100,000 population. This, as an example, accounts for about 12.7% of all cancer cases during the period from 1993 to 1999.

Rationale of Immunotherapy in Head and Neck Cancers Cancer immunotherapy principle is functional restoration of certain signaling pathways of the immune system. These pathways help to counteract different tumour evasion strategies. These may include reduced antigen processing and presentation, increased tumour-permissive cytokine profiles, creating an immunosuppressive microenvironment, cellular immune escape, and induction of non-functioning T-cells either by an increase of co-inhibitory receptors; e.g. cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) or PD-1 or decreased co-stimulatory receptors. , Immune checkpoints pathway is the most studied so far. It works by regulating the duration and extent of immune system activity through negative feedback signals. These include CTLA-4, PD-1 and PD-L1/PD-L2.

Head and neck cancers use different immune evasion mechanisms. Immune dysfunction has been implicated in carcinogenesis of human papillomavirus (HPV)-positive oropharyngeal cancer as well as cases linked to smoking.

PD-1 and PD-L1 interplay is extremely interesting. A French group from Sorbonne attempted to explain the better prognosis of HPV-positive tumours of the oropharynx. They examined PD-1 and PD-L1 expression in 64 cases, mostly of oropharyngeal origin. Infiltration of PD-1+ T-lymphocytes was a favourable prognostic factor in HPV-related disease. This also was confirmed by others, where expression of PD-L1 is common regardless of HPV status.

Safety Issues At the University of Pennsylvania, safety of ipilimumab with hypofractionated palliative radiotherapy (RT) was tested in a phase I study. There was no grade 4 or higher toxicities in the cohort of 21 patients. The most common grade 3 toxicity was anemia, that is unlikely to be related to the RT.

Anti-PD-1 agents have a better safety profile than anti-CTLA4 agents. The rate of grade 3 toxicity for pembrolizumab in NSCLC in KEYNOTE-001 was \<10%, including a 1.8% rate of grade 3 pneumonitis. And in modern stereotactic body radiotherapy (SBRT) series, the rate of grade 3 radiation pneumonitis is \<5%.

Interaction between Immunotherapy and Chemotherapy Classical speaking, chemotherapy (CTH) is very immune suppressive and therefore not an ideal partner for combining with vaccines (and of course other types of immunotherapy), that require an active response. Analysis of the potential interaction of CTH and immunotherapy reveals that there are many mechanisms of synergy. This suggests that the optimal treatment of cancer may include combination of immunotherapy-CTH in an optimal sequential manner.

These mechanism may include the synergistic effect of CTH in reducing tumor load and shedding antigens, as well as the inhibitory effect on regulatory cells and myeloid suppressive cells. On the other way around, immunotherapy can markedly enhance the response to CTH by activating the immune response prior to antigen release, as well as expanding activated T cells that have seen the tumor antigen.

In 2016, Langer et al published their work in the KEYNOTE-021 of combining carboplatin/pemetrexed with pembrolizumab. The combination of the chemotherapy with immunotherapy in advanced NSCLC showed tolerability as well as effectiveness. This lead to the approval of this combination in May 2017 by FDA.

Ongoing Concomitant Immunotherapy and Radiotherapy Trials in HNC Four ongoing studies are explore inhibition of the PD-1/PD-L1 in combination with definitive RT with or without cisplatin or cetuximab. These are trial: NCT02707588 assessing safety of pembrolizumab vs cetuximab in combination with radiation in non-platinum eligible patients. NCT03040999 (KEYNOTE-412) design added pembrolizumab to chemotherapy with post radiation consolidation as compared to platinum-radiation. NCT02999087 is comparing the combination of avelumab-cetuximab-radiation to cetuximab-radiation or cisplatin-radiation (REACH Trial). NCT02952586 (JAVELIN trail) is testing combination of avelumab with standard of care. RTOG 3504 examines the efficacy and safety of nivolumab in the definitive and adjuvant settings (NCT02764593). Finally, IRX-2 (citoplurikin), a primary human cell-derived biologic with multiple active cytokine components, is being tested in a randomized phase II trial of neoadjuvant and adjuvant therapy in patients with newly diagnosed curative resectable stages II, III, or IVA oral cavity cancer (NCT02609386).

Gaps in Design of ongoing Trials However, most of the studies testing the value of addition of immunotherapy to standard of care, are designed to continue immunotherapy for 4-12 months after finishing radical chemoradiation. This, in our opinion, will give mixed results and affect the conclusion of the survival benefit if found. Extrapolated from many adjuvant clinical trials, the disease control can be attributed to the length of the whole duration of treatment rather than the specific agent used. Moreover, there is no definite duration of this adjuvant immunotherapy in the ongoing trials i.e. they give a wide range of cycles and time. For example, the recruiting KEYNOTE-412 designed for 14 cycles of pembrolizumab while RTOG 3504 will try to give 7 adjuvant cycles (will be determined based on first 8 patients tolerance).

Another point in these trials design; although designed to be multicentric, most of recruiting centers are located in Europe and USA. This will limit the validity of the data and results when other countries (especially in Asia) try to adopt the treatment protocols. Based on many published data, the HNC in Eastern countries and among Asian showed different clinical and biological characteristics e.g. mostly HPV negative, related to tobacco chewing and poor nutritional status.

Lastly, the ongoing trial for nivolumab with RT in locally advanced head and neck cancer (LAHNC) is assessing the safety and efficacy. However, pembrolizumab has already published its phase Ib data extended from the large cohort of many solid tumors. In contrary, avelumab has no published supporting data (so far) regarding this indication from phase II trials. They depend largely upon their safety profiles from the pooled previous studies and/or the other subsites of diseases. As mentioned earlier, there is ongoing NCT02707588 Trial is assessing pembrolizumab safety with radiation vs cetuximab-radiation in cisplatin non-eligible patients.In the current trial, we are trying to fill this gap by testing the efficacy and safety of pembrolizumab with radical chemoradiation in all cases of LAHNC.

Post-Treatment Evaluations Post-treatment evaluations will start 4 weeks after completion of radiation therapy. The 4th week post-treatment evaluations will consist of a physical examination, hematology and biochemistry profiles, tumor assessments (by palpation) and an objective assessment of adverse events which may have occurred since completing treatment. Radiological assessment of response will be done 8-10 weeks post treatment. Responses will be reported according to irRECIST criteria.

Subsequent Follow-up evaluations will commence after the 8 week post-treatment, every four weeks (±1 week) for years one and every 8 weeks for year two, and then, every 4 months (± 2 weeks) for year three to five. The evaluations in the first year will consist of a physical examination, hematology and chemistry profiles, Quality of Life, imaging/diagnostic assessments, and tumor assessments. Evaluations in year 2-5 will consist of a physical examination, imaging/diagnostic, and tumor assessments.

Statistical methods and consideration.

  • Statistical package for social sciences (SPSS) version 16. Quantitative variables will be summarized using mean and standard deviation (SD), median minimum and maximum values. Qualitative data will be summarized using frequencies and percentage.
  • Overall survival will be calculated from the date of histological diagnosis.
  • Progression free survival (PFS) will be calculated from the date of starting of treatment till disease progression and death whichever comes first.
  • Survival analysis will be done using Kaplan- Meier, comparisons will be done using Log-rank test.
  • Differences will be considered significant when p was 0.05 and highly significant when p 0.01.
  • Patients lost for follow up with disease will be considered as dead.
  • At the time of data analysis stratification of the patients according to sub sites, prognostic and risk factors including HPV status will be done.
02

Conditions studied

  • Locally Advanced Head and Neck Cancer

Keywords

  • head and neck cancer
  • check point inhibitor
  • Pembrolizumab
  • Chemoradiation
03

In context

Head and Neck Neoplasms

2,710 studies on the registry are indexed under Head and Neck Neoplasms; 594 are open to participants now.

This study's planned enrollment of 50 is close to the median of 46 across 2,032 interventional studies indexed under Head and Neck Neoplasms.

Browse Head and Neck Neoplasms studies →

Lead sponsor

Kuwait Cancer Control Center is the lead sponsor of 3 studies on the registry; 2 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
16 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • The patient has proven squamous cell carcinoma arising in the oropharynx, hypopharynx, oral cavity, or larynx
  • The patient has stage III or IVA disease with an expected survival of 12 months.
  • The patient is medically suitable to withstand a course of definitive radiation therapy \& chemotherapy.
  • performance status is > 60.
  • The patient must have achieved lawful age to provide according to local or national law .
  • Laboratory values performed within 14 days prior to concurrent chemotherapy should be as follows:

    i) (ANC) ≥ 2000/mm ii) count ≥ 100.000/mm iii) ≥ 10g/dl or 100g/L iv) Urea and serum creatinine ≤ 1.5 mg/dl. (for cisplatin) v) ≥ 50 ml/min. (for cisplatin) vi) serum glutamic-oxaloacetic transaminase () and serum glutamic-pyruvic transaminase (SGPT) ≤ 2 × upper limit of laboratory normal vii) Serum calcium within normal limits.

  • Has provided tissue for Programmed Cell Death Receptor Ligand 1 () biomarker analysis from a core or excisional
  • Has evaluable tumor burden (measurable and/or non-measurable tumor lesions) assessed by computed tomography scan or magnetic resonance imaging, based on version 1.1
  • Is eligible for definitive chemoradiation (CRT) and not considered for primary surgery based on investigator decision
  • Female participants of must have a negative urine or serum pregnancy test within 72 hours prior to receiving the first dose of study therapy
  • Female and male participants of must agree to use adequate throughout the study period and for up to 180 days after the last dose of study therapy

Exclusion criteria

Exclusion Criteria:

  • The patient has evidence of distant disease.
  • The patient has received prior systemic chemotherapy within the last three years.
  • The patient has undergone previous surgery for the tumor, other than .
  • The patient has received prior radiation therapy to the H\&N.
  • The patient's radiation therapy is considered to be a part of a postoperative regimen following primary surgical resection.
  • The patient is pregnant or breast feeding.
  • The patient has a medical (e.g. renal impairment) or psychological condition that would not permit the patient to complete the trial or sign .
  • Has received prior therapy with an anti-Programmed Cell Death Receptor 1 (), anti-PD-L1, anti-Programmed Cell Death Receptor Ligand 2 (PD-L2) agent or with an agent directed to another co-inhibitory T-cell receptor or has previously participated in clinical studies with immunotherapy
  • Has received a within 30 days prior to the first dose of study therapy
  • Has not recovered from major surgery prior to starting study therapy
  • Has known active or C
  • Has known history of (HIV)
  • Has a diagnosis of immunodeficiency or is receiving systemic therapy or any other form of therapy within 7 days prior to the first dose of study therapy
  • Has a history of (non-infectious) pneumonitis that required steroids or current pneumonitis
  • Has an active disease that has required systemic treatment in the past 2 years. Replacement therapy is not considered a form of systemic treatment.
  • Has history of a diagnosed and/or treated hematologic or primary solid tumor , unless in remission for at least 5 years prior to randomization
  • Has had previous allogeneic tissue/solid organ transplant
  • Has active infection requiring systemic therapy
  • Has a history of severe reaction to Pembrolizumab, Cisplatin, cetuximab or radiotherapy or their analogs
Terms in these criteria, in plain language(23)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Histologically or cytologically confirmed

The diagnosis was confirmed by looking at a sample under a microscope: tissue from a biopsy or surgery (histology), or cells from a fluid or needle sample (cytology).

Your pathology report is the document that shows this.

Karnofsky performance status (KPS)

A 0–100 scale of how well someone can carry out everyday activities. 100 is no complaints and no signs of illness; 70 is able to look after yourself but not to work or keep up normal activity; 50 is needing considerable help and frequent medical care.

Studies often ask for 60 or 70 and above. Your doctor gives the score.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Absolute neutrophil count (ANC)

The number of neutrophils, white blood cells that help fight infection, in a given amount of blood. Too few raises the risk of infection.

It is a count, not a percentage of the white cells. Limits are written in units that mean the same: ≥ 1.5 × 10⁹/L is ≥ 1,500 per mm³ (µL). Each lab has its own reference range.

Platelets

Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.

Hemoglobin (Hb)

The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).

Creatinine clearance (CrCl)

How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

PD-1, PD-L1 and checkpoint inhibitors

PD-1, PD-L1 and CTLA-4 are proteins that act as brakes on the immune system. Checkpoint inhibitors, such as pembrolizumab or nivolumab, block them so the immune system can attack a cancer.

PD-L1 can also be measured in a tumour sample. Some scores count stained tumour cells only (TPS); others also count certain immune cells (CPS). The study names the score and the minimum it uses.

Biopsy and archival tissue

A biopsy takes a small piece of tissue to examine. “Archival tissue” is a sample already taken, for example at diagnosis, and kept by the hospital.

Whether a stored sample will do depends on when it was taken, how much there is and what the study needs. Ask whether the study accepts your stored sample or needs a new biopsy.

RECIST

The standard rules for measuring tumours on CT or MRI scans, to tell whether a cancer is shrinking, stable or growing during treatment.

“Measurable disease per RECIST 1.1” usually means at least one tumour 10 mm or more at its longest on a CT scan, or a lymph node 15 mm or more across its short axis.

Childbearing potential

Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).

Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.

Reproductive potential

Able to have children. For women this usually means from the first period until menopause, unless permanently unable to through surgery; for men, unless permanently sterile. Read who the line is about — participants, women, men, or their partners.

Criteria about it usually ask for contraception during the study and for a time after it.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Metastases

Cancer that has spread from where it began to other parts of the body. “Metastatic” cancer is cancer that has spread this way.

Live vaccines

Vaccines made with a weakened form of the germ, such as measles–mumps–rubella (MMR), chickenpox and yellow fever. They can be risky when the immune system is weakened. Flu injections are not live; the nasal flu spray is.

Hepatitis B tests

Hepatitis B is a virus that infects the liver. These are separate tests: HBsAg positive usually means a current infection (a recent vaccination can briefly cause it too); total anti-HBc (HBcAb) positive means an infection now or in the past; HBV DNA measures how much virus is in the blood.

Some studies accept a past infection if HBV DNA is undetectable, sometimes with antiviral medicine during the study. Check what this study allows.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

Immunosuppression

A weakened immune system. It can come from an illness, such as HIV or some blood cancers, or from medicines that turn the immune system down, for example after an organ transplant or for an autoimmune disease; steroids at higher doses count.

Read whether the line is about a condition or about medicines, and which medicines and doses it means.

Autoimmune disease

A condition in which the immune system attacks the body’s own tissues, such as rheumatoid arthritis, lupus, psoriasis, type 1 diabetes or inflammatory bowel disease.

Immunotherapy studies often leave out active autoimmune disease, and some name exceptions, such as thyroid disease on replacement hormone. Check the exceptions this study lists.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

Hypersensitivity

An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.

05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
50 participants (estimated)

Study arms

  • Experimental
    Investigational Arm

    All patients will receive radical chemoradiation in addition to the investigational concomitant check point inhibitor CHEMOTHERAPY: Cisplatin: 100 mg/m2 Q21d D1, D22, D43. OR Cetuximab Loading dose 400 mg/m², one week before radiation then maintenance dose 250 mg/m² weekly, D8, D15, D22, D29, D36, D43. PD-1 inhibitor: Pembrolizumab 200 mg administered as an intravenous infusion over 30 minutes every 3 weeks 21 days prior to radiation, then Day 1 of radiation and then every 21 days for total 6 doses Intensity modulated radiotherapy (IMRT) techniques will be used. A total dose of 66-70 Gy/ 30-35 Fr over 6-7 weeks will be delivered to the primary site and draining lymphatics using simultaneous Integrated Boost (SIB).

    Drug: Pembrolizumab

Interventions

  • Adding PD-1 inhibitor to the standard of care

    Also known as: Keytruda

06

What researchers measure

Primary outcomes

  1. Dose Limiting Toxicity (DLT)

    A pembrolizumab attributable, dose-limiting toxicity (DLT) will be defined as follows: 1) Any ≥ grade 3 adverse event (CTCAE, v. 4) that is related to pembrolizumab that does not resolve to grade 1 or less within 28 days; 2) A delay in radiotherapy of \> 2 weeks due to toxicity related to pembrolizumab; 3) Inability to complete radiotherapy due to toxicity related to pembrolizumab; 4) Inability to receive an adequate dose (≥ 70%) of cisplatin or cetuximab due to toxicity definitely related to pembrolizumab.

    Time frame: From the first dose of pembrolizumab to 28 days after the completion of radiation therapy

  2. Response Rate

    Response rates according to irRECIST criteria

    Time frame: 3 years

Secondary outcomes

  1. Locoregional control rates

    Number of local disease progression events

    Time frame: 5 years

  2. Progression free survival

    Number of local or distant disease progression events

    Time frame: 5 years

  3. Overall survival

    Number of cancer-related deaths

    Time frame: 5 years initially (longer follow up will be done)

Other outcomes

  1. Patients' Quality of life (QoL)

    QoL assessment by the patients

    Time frame: 5 years initially

07

Study locations

1 of 1 sites recruiting
08

References and documents

Publications

  • Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin. 2017 Jan;67(1):7-30. doi: 10.3322/caac.21387. Epub 2017 Jan 5. PubMed 28055103 ↗
  • Kuwait Cancer Registry: Annual Report 2013. Ministry of Health Publications
  • Thompson LDR. Squamous cell carcinoma variants of the head and neck. Current Diagnostic Pathology (2003) 9, 384 -396
  • Vokes EE, Weichselbaum RR, Lippman SM, Hong WK. Head and neck cancer. N Engl J Med. 1993 Jan 21;328(3):184-94. doi: 10.1056/NEJM199301213280306. No abstract available. PubMed 8417385 ↗
  • Carvalho AL, Nishimoto IN, Califano JA, Kowalski LP. Trends in incidence and prognosis for head and neck cancer in the United States: a site-specific analysis of the SEER database. Int J Cancer. 2005 May 1;114(5):806-16. doi: 10.1002/ijc.20740. PubMed 15609302 ↗
  • Pignon JP, le Maitre A, Maillard E, Bourhis J; MACH-NC Collaborative Group. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol. 2009 Jul;92(1):4-14. doi: 10.1016/j.radonc.2009.04.014. Epub 2009 May 14. PubMed 19446902 ↗
  • Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A, Ozsahin EM, Jacobs JR, Jassem J, Ang KK, Lefebvre JL. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck. 2005 Oct;27(10):843-50. doi: 10.1002/hed.20279. PubMed 16161069 ↗
  • Bonner JA, Harari PM, Giralt J, Azarnia N, Shin DM, Cohen RB, Jones CU, Sur R, Raben D, Jassem J, Ove R, Kies MS, Baselga J, Youssoufian H, Amellal N, Rowinsky EK, Ang KK. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med. 2006 Feb 9;354(6):567-78. doi: 10.1056/NEJMoa053422. PubMed 16467544 ↗
  • Vermorken JB, Remenar E, van Herpen C, Gorlia T, Mesia R, Degardin M, Stewart JS, Jelic S, Betka J, Preiss JH, van den Weyngaert D, Awada A, Cupissol D, Kienzer HR, Rey A, Desaunois I, Bernier J, Lefebvre JL; EORTC 24971/TAX 323 Study Group. Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer. N Engl J Med. 2007 Oct 25;357(17):1695-704. doi: 10.1056/NEJMoa071028. PubMed 17960012 ↗
  • Kimura H, Sakai K, Arao T, Shimoyama T, Tamura T, Nishio K. Antibody-dependent cellular cytotoxicity of cetuximab against tumor cells with wild-type or mutant epidermal growth factor receptor. Cancer Sci. 2007 Aug;98(8):1275-80. doi: 10.1111/j.1349-7006.2007.00510.x. Epub 2007 May 13. PubMed 17498200 ↗
  • Yang X, Zhang X, Mortenson ED, Radkevich-Brown O, Wang Y, Fu YX. Cetuximab-mediated tumor regression depends on innate and adaptive immune responses. Mol Ther. 2013 Jan;21(1):91-100. doi: 10.1038/mt.2012.184. Epub 2012 Sep 18. PubMed 22990672 ↗
  • Lattanzio L, Denaro N, Vivenza D, Varamo C, Strola G, Fortunato M, Chamorey E, Comino A, Monteverde M, Lo Nigro C, Milano G, Merlano M. Elevated basal antibody-dependent cell-mediated cytotoxicity (ADCC) and high epidermal growth factor receptor (EGFR) expression predict favourable outcome in patients with locally advanced head and neck cancer treated with cetuximab and radiotherapy. Cancer Immunol Immunother. 2017 May;66(5):573-579. doi: 10.1007/s00262-017-1960-8. Epub 2017 Feb 14. PubMed 28197666 ↗
  • Allen CT, Clavijo PE, Van Waes C, Chen Z. Anti-Tumor Immunity in Head and Neck Cancer: Understanding the Evidence, How Tumors Escape and Immunotherapeutic Approaches. Cancers (Basel). 2015 Dec 9;7(4):2397-414. doi: 10.3390/cancers7040900. PubMed 26690220 ↗
  • Ferris RL. Immunology and Immunotherapy of Head and Neck Cancer. J Clin Oncol. 2015 Oct 10;33(29):3293-304. doi: 10.1200/JCO.2015.61.1509. Epub 2015 Sep 8. PubMed 26351330 ↗
  • Tommasino M. The human papillomavirus family and its role in carcinogenesis. Semin Cancer Biol. 2014 Jun;26:13-21. doi: 10.1016/j.semcancer.2013.11.002. Epub 2013 Dec 4. PubMed 24316445 ↗
  • Badoual C, Hans S, Merillon N, Van Ryswick C, Ravel P, Benhamouda N, Levionnois E, Nizard M, Si-Mohamed A, Besnier N, Gey A, Rotem-Yehudar R, Pere H, Tran T, Guerin CL, Chauvat A, Dransart E, Alanio C, Albert S, Barry B, Sandoval F, Quintin-Colonna F, Bruneval P, Fridman WH, Lemoine FM, Oudard S, Johannes L, Olive D, Brasnu D, Tartour E. PD-1-expressing tumor-infiltrating T cells are a favorable prognostic biomarker in HPV-associated head and neck cancer. Cancer Res. 2013 Jan 1;73(1):128-38. doi: 10.1158/0008-5472.CAN-12-2606. Epub 2012 Nov 7. PubMed 23135914 ↗
  • Lin Z, Xu Y, Zhang Y, He Q, Zhang J, He J, Liang W. The prevalence and clinicopathological features of programmed death-ligand 1 (PD-L1) expression: a pooled analysis of literatures. Oncotarget. 2016 Mar 22;7(12):15033-46. doi: 10.18632/oncotarget.7590. PubMed 26930715 ↗
  • Seiwert TY, Burtness B, Mehra R, Weiss J, Berger R, Eder JP, Heath K, McClanahan T, Lunceford J, Gause C, Cheng JD, Chow LQ. Safety and clinical activity of pembrolizumab for treatment of recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-012): an open-label, multicentre, phase 1b trial. Lancet Oncol. 2016 Jul;17(7):956-965. doi: 10.1016/S1470-2045(16)30066-3. Epub 2016 May 27. PubMed 27247226 ↗
  • Chow LQM, Haddad R, Gupta S, Mahipal A, Mehra R, Tahara M, Berger R, Eder JP, Burtness B, Lee SH, Keam B, Kang H, Muro K, Weiss J, Geva R, Lin CC, Chung HC, Meister A, Dolled-Filhart M, Pathiraja K, Cheng JD, Seiwert TY. Antitumor Activity of Pembrolizumab in Biomarker-Unselected Patients With Recurrent and/or Metastatic Head and Neck Squamous Cell Carcinoma: Results From the Phase Ib KEYNOTE-012 Expansion Cohort. J Clin Oncol. 2016 Nov 10;34(32):3838-3845. doi: 10.1200/JCO.2016.68.1478. Epub 2016 Sep 30. PubMed 27646946 ↗
  • Ferris RL, Blumenschein G Jr, Fayette J, Guigay J, Colevas AD, Licitra L, Harrington K, Kasper S, Vokes EE, Even C, Worden F, Saba NF, Iglesias Docampo LC, Haddad R, Rordorf T, Kiyota N, Tahara M, Monga M, Lynch M, Geese WJ, Kopit J, Shaw JW, Gillison ML. Nivolumab for Recurrent Squamous-Cell Carcinoma of the Head and Neck. N Engl J Med. 2016 Nov 10;375(19):1856-1867. doi: 10.1056/NEJMoa1602252. Epub 2016 Oct 8. PubMed 27718784 ↗
  • Ehlers G, Fridman M. Abscopal effect of radiation in papillary adenocarcinoma. Br J Radiol. 1973 Mar;46(543):220-2. doi: 10.1259/0007-1285-46-543-220. No abstract available. PubMed 4706791 ↗
  • Postow MA, Callahan MK, Barker CA, Yamada Y, Yuan J, Kitano S, Mu Z, Rasalan T, Adamow M, Ritter E, Sedrak C, Jungbluth AA, Chua R, Yang AS, Roman RA, Rosner S, Benson B, Allison JP, Lesokhin AM, Gnjatic S, Wolchok JD. Immunologic correlates of the abscopal effect in a patient with melanoma. N Engl J Med. 2012 Mar 8;366(10):925-31. doi: 10.1056/NEJMoa1112824. PubMed 22397654 ↗
  • Kalbasi A, June CH, Haas N, Vapiwala N. Radiation and immunotherapy: a synergistic combination. J Clin Invest. 2013 Jul;123(7):2756-63. doi: 10.1172/JCI69219. Epub 2013 Jul 1. PubMed 23863633 ↗
  • Demaria S, Golden EB, Formenti SC. Role of Local Radiation Therapy in Cancer Immunotherapy. JAMA Oncol. 2015 Dec;1(9):1325-32. doi: 10.1001/jamaoncol.2015.2756. PubMed 26270858 ↗
  • Schaue D, McBride WH. Opportunities and challenges of radiotherapy for treating cancer. Nat Rev Clin Oncol. 2015 Sep;12(9):527-40. doi: 10.1038/nrclinonc.2015.120. Epub 2015 Jun 30. PubMed 26122185 ↗
  • Szturz P, Vermorken JB. Immunotherapy in head and neck cancer: aiming at EXTREME precision. BMC Med. 2017 Jun 2;15(1):110. doi: 10.1186/s12916-017-0879-4. PubMed 28571578 ↗
  • Theurich S, Rothschild SI, Hoffmann M, Fabri M, Sommer A, Garcia-Marquez M, Thelen M, Schill C, Merki R, Schmid T, Koeberle D, Zippelius A, Baues C, Mauch C, Tigges C, Kreuter A, Borggrefe J, von Bergwelt-Baildon M, Schlaak M. Local Tumor Treatment in Combination with Systemic Ipilimumab Immunotherapy Prolongs Overall Survival in Patients with Advanced Malignant Melanoma. Cancer Immunol Res. 2016 Sep 2;4(9):744-54. doi: 10.1158/2326-6066.CIR-15-0156. Epub 2016 Jul 27. PubMed 27466265 ↗
  • Tang C, Welsh JW, de Groot P, Massarelli E, Chang JY, Hess KR, Basu S, Curran MA, Cabanillas ME, Subbiah V, Fu S, Tsimberidou AM, Karp D, Gomez DR, Diab A, Komaki R, Heymach JV, Sharma P, Naing A, Hong DS. Ipilimumab with Stereotactic Ablative Radiation Therapy: Phase I Results and Immunologic Correlates from Peripheral T Cells. Clin Cancer Res. 2017 Mar 15;23(6):1388-1396. doi: 10.1158/1078-0432.CCR-16-1432. Epub 2016 Sep 20. PubMed 27649551 ↗
  • Zhao J, Yorke ED, Li L, Kavanagh BD, Li XA, Das S, Miften M, Rimner A, Campbell J, Xue J, Jackson A, Grimm J, Milano MT, Spring Kong FM. Simple Factors Associated With Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy of the Thorax: A Pooled Analysis of 88 Studies. Int J Radiat Oncol Biol Phys. 2016 Aug 1;95(5):1357-1366. doi: 10.1016/j.ijrobp.2016.03.024. Epub 2016 Mar 25. PubMed 27325482 ↗
  • Lake RA, Robinson BW. Immunotherapy and chemotherapy--a practical partnership. Nat Rev Cancer. 2005 May;5(5):397-405. doi: 10.1038/nrc1613. PubMed 15864281 ↗
  • Langer CJ, Gadgeel SM, Borghaei H, Papadimitrakopoulou VA, Patnaik A, Powell SF, Gentzler RD, Martins RG, Stevenson JP, Jalal SI, Panwalkar A, Yang JC, Gubens M, Sequist LV, Awad MM, Fiore J, Ge Y, Raftopoulos H, Gandhi L; KEYNOTE-021 investigators. Carboplatin and pemetrexed with or without pembrolizumab for advanced, non-squamous non-small-cell lung cancer: a randomised, phase 2 cohort of the open-label KEYNOTE-021 study. Lancet Oncol. 2016 Nov;17(11):1497-1508. doi: 10.1016/S1470-2045(16)30498-3. Epub 2016 Oct 10. PubMed 27745820 ↗
  • Mehanna H, Franklin N, Compton N, Robinson M, Powell N, Biswas-Baldwin N, Paleri V, Hartley A, Fresco L, Al-Booz H, Junor E, El-Hariry I, Roberts S, Harrington K, Ang KK, Dunn J, Woodman C. Geographic variation in human papillomavirus-related oropharyngeal cancer: Data from 4 multinational randomized trials. Head Neck. 2016 Apr;38 Suppl 1(Suppl 1):E1863-9. doi: 10.1002/hed.24336. Epub 2016 Jan 8. PubMed 26749143 ↗

Individual participant data

Plan to share: Undecided

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Started Oct 2018 (actual). Primary completion is estimated for Sep 2025, 83 months after the start.

Of 215 non-industry phase 2 interventional studies under Head and Neck Neoplasms, half reached primary completion within 57 months of starting (the median), counting those still running; a quarter within 37 and three quarters within 84. This study's planned 83 months is above that.

Counting every sponsor, half of 259 studies reached it within 51 months; a quarter within 30 and three quarters within 76.

How these figures are worked out, and which studies are left out of them.

Registered
May 6, 2018
First posted
May 22, 2018
StartActual
Oct 7, 2018
Primary completionEst.
Sep 30, 2025
CompletionEst.
Oct 31, 2025
Last update
Jan 23, 2024
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Jan 23, 2024, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT03532737
Lead sponsor
Kuwait Cancer Control Center
Responsible party
Sponsor
First posted
May 22, 2018
Start date
Oct 7, 2018
Primary completion
Sep 30, 2025 (estimated)
Completion
Oct 31, 2025 (estimated)
Last update
Jan 23, 2024

Study contacts

Mustafa S El-Sherify, MD
Contact
mustafashawki@yahoo.com
+965 554 66285
Mustafa S El-Sherify, MD
principal investigator · Kuwait Cancer Control Center

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Interested in this study?

Eligibility is decided by the study team. Share this record with your doctor or contact the team directly.

Contact study team

Follow this study

Get an email when the registry record changes — status, dates, results — or when someone posts here.

Sign in to follow

Discussion

Questions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.

Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.

Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.

Studies of the drug tested here: Pembrolizumab

Start the discussion