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

Groupe Oncologie Radiotherapie Tete et Cou

Status and phase: Active, not recruiting; Phase 3

Conditions: HNSCC

Treatments: Drug: Cetuximab; Radiation: IMRT; Drug: avelumab; Drug: Cisplatin

Study type: Interventional

Funder types: Other

Identifiers

NCT02999087

GORTEC 2017-01

Details and patient eligibility

About

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

Full description

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

Enrollment: 707 patients

Sex: All

Ages: 18 to 80 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Age ≤ 80 years

2. Performance Status ECOG 0-1

3. Squamous cell carcinoma, previously untreated

4. Stage III, stage IVa (i.e. operable, but not operated) or IVb (non resectable)

5. Oral cavity, oropharynx, hypopharynx or larynx

6. Availability of pre-treatment tumour tissue sample (for p16 & PD -L1 expression, TILs and immune landscape)

7. Recording of alcohol consumption and smoking history

8. Determination of the patient's ability to receive cisplatin 100 mg /m2 for 3 cycles (fit / unfit)*

9. Written informed consent

   • Criteria for determining if a patient is fit for receiving high dose cisplatin:

     • Calculated creatinin clearance ≥ 60 mL/min as determined by the modified. method of Cockcroft and Gault or by the EDTA method
     • Absolute neutrophil count ≥1 500/μL, platelets ≥100 000/μL, hemoglobin ≥ 10 g/dL, aspartate (AST) and alanine transaminase (ALT) less than 2 times the upper limit of the normal range (ULN), total bilirubin ≤ 1.5 mg/dL, serum albumin > 35 g/L
     • Peripheral neuropathy < grade 2
     • No clinical hearing loss (confirmed by audiogram)
     • Cardiac function compatible with hyperhydration; Left ventricular ejection fraction within the institutional normal ranges as measured by echocardiogram

Exclusion criteria

1. Nasopharyngeal, paranasal sinuses, nasal cavity tumors or thyroid cancers
2. Squamous cell carcinoma involving cervical neck nodes with unknown primary site
3. Metastatic disease (stage IVc)
4. Viral infection (HIV, Hepatitis B/C)
5. Autoimmune disease
6. Immunodeficiency or immunosuppressive therapy
7. Active CNS disease
8. Interstitial lung disease
9. Active infection
10. Any prior or current treatment for invasive head and neck cancer. This will include but is not limited to: prior tyrosine kinase inhibitors, any monoclonal antibody, induction chemotherapy, prior surgical resection or RT, or use of any investigational agent
11. Weight loss of > 10% during the last 4 weeks (except if renutrition with a feeding tube is planned before the onset of treatment or is ongoing)
12. Concurrent treatment with any other systemic anti-cancer therapy that is not specified in the protocol
13. Concomitant treatment with any drug on the prohibited medication list such as live vaccines
14. History of other malignancy within the last 3 years (exception of in situ carcinoma and skin carcinomas)
15. Significant disease which, in the judgment of the investigator, as a result of the medical interview, physical examinations, or screening investigations would make the patient inappropriate for entry into the trial
16. Known hypersensitivity reaction to study drugs
17. Any social, personal, medical and/or psychological factor(s) that could interfere with the observance of the patient to the protocol and/or the follow-up and/or the signature of the informed consent.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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707 participants in 4 patient groups

Arm A Patient FIT

Active Comparator group

Description:

Lead-in phase (Day-8) : no treatment Concomitant radiotherapy phase : Radiotherapy by IMRT + cisplatin 100mg/m2 Maintenance phase : no treatment until follow-up phase

Treatment:

Drug: Cisplatin

Radiation: IMRT

Arm B Patient FIT

Experimental group

Description:

Lead-in phase (Day-8) : Cetuximab 400mg/m2 and avelumab 10mg/kg Concomitant radiotherapy phase : Radiotherapy by IMRT + cetuximab 250mg/m2 and avelumab 10mg/kg Maintenance phase : avelumab 10mg/kg every 2 weeks during 12 months

Treatment:

Drug: avelumab

Radiation: IMRT

Drug: Cetuximab

Arm C Patient UNFIT

Experimental group

Description:

Lead-in phase (Day-8) : Cetuximab 400mg/m2 and avelumab 10mg/kg Concomitant radiotherapy phase: Radiotherapy by IMRT + cetuximab 250mg/m2 and avelumab 10mg/kg Maintenance phase : avelumab 10mg/kg every 2 weeks during 12 months

Treatment:

Drug: avelumab

Radiation: IMRT

Drug: Cetuximab

Arm D Patient UNFIT

Active Comparator group

Description:

Lead-in phase (Day-8): Cetuximab 400mg/m2 Concomitant radiotherapy phase: Radiotherapy by IMRT + cetuximab 250mg/m2 Maintenance phase : no treatment until follow-up phase

Treatment:

Radiation: IMRT

Drug: Cetuximab