E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK (SCCHN) |
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E.1.1.1 | Medical condition in easily understood language |
Cancer of the head and neck |
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10060121 |
E.1.2 | Term | Squamous cell carcinoma of head and neck |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To demonstrate that treatment with avelumab in combination with SOC CRT is superior to SOC CRT alone in prolonging PFS in front-line patients with high risk (as defined in Inclusion Criterion 2 [Section 4.1] of the protocol), locally advanced SCCHN who are candidates for definitive CRT with cisplatin |
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E.2.2 | Secondary objectives of the trial |
- To compare the OS of avelumab in combination with SOC CRT vs SOC CRT alone. - To evaluate the anti-tumor activity of avelumab in combination with SOC CRT and SOC CRT alone. - To evaluate the overall safety and tolerability profile of avelumab in combination with SOC CRT and SOC CRT alone. - To evaluate the PK of avelumab. - To evaluate the PK of cisplatin (total and free). - To assess avelumab ADAs. - To evaluate the effect of avelumab in combination with SOC CRT and SOC CRT alone on patient-reported outcomes (PROs) of disease-related symptoms and healthrelated quality of life. - To evaluate candidate immune-related predictive biomarkers of sensitivity or insensitivity to treatment with avelumab in combination with SOC CRT in pre-treatment tumor samples (eg, PD-L1 expression).
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Histological diagnosis of squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx with tissue available. 2. High-risk disease as defined by American Joint Committee on Cancer [AJCC] Guidelines 7th Edition: - HPV-negative disease, Stage III, IVa, IVb per tumor/nodes/metastasis (TNM) guidelines for head and neck sites; or - Non-oropharyngeal HPV-positive disease, Stage III, IVa, IVb per TNM guidelines for head and neck sites; or - HPV-positive oropharyngeal disease T4 OR N2c OR N3 per TNM guidelines for head and neck sites. where HPV status will be determined per institutional standard using p16 immunohistochemistry (IHC). 3. No prior therapy for advanced stage SCCHN; eligible for definitive CRT with curative intent. 4. Available tumor samples for submission or willing to undergo further tumor biopsies: - Availability of a formalin-fixed paraffin-embedded (FFPE) tumor tissue block from primary tumor or nodal biopsy. If an FFPE tissue block cannot be provided, 15 unstained slides (10 minimum) will be acceptable. 5. Age ≥18 years (≥20 years in Japan). 6. Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) 0 or 1 7. Adequate bone marrow function, including: - Absolute Neutrophil Count (ANC) ≥1,800/μL or ≥1.8 x 109/L. - Platelets ≥100,000/μL or ≥100 x 109/L.- Hemoglobin ≥9 g/dL (may have been transfused). 8. Adequate renal function, including: - Estimated creatinine clearance ≥50 mL/min as calculated using the Cockcroft-Gault (CG) equation OR: - a creatinine clearance of at least 60 ml/min if this value is described in the contraindications for cisplatin as per country’s local labeling. 9. Adequate liver function, including: - Total serum bilirubin ≤1.5 x upper limit of normal (ULN). - Aspartate and alanine aminotransferase (AST and ALT) ≤2.5 x ULN. 10. Pregnancy test (for patients of childbearing potential) negative at screening. 11. Male patients able to father children and female patients of childbearing potential and at risk for pregnancy must agree to use two methods of contraception (at least one of which is considered to be highly effective as defined in section 4.3 of the protocol) throughout the study and for at least 6 months after the last dose of cisplatin and 30 days after the last dose of avelumab/placebo (whichever is later). Female patients who are not of childbearing potential (ie, meet at least one of the following criteria): - have undergone a documented hysterectomy and/or bilateral oophorectomy; - have medically confirmed ovarian failure; - have achieved postmenopausal status, defined as follows: cessation of regular menses for at least 12 consecutive months with no alternative pathological or physiological cause. Status may be confirmed by a serum follicle-stimulating hormone (FSH) level consistent with the post-menopausal state. 12. Evidence of a signed and dated informed consent document indicating that the patient (or a legally acceptable representative, as allowed by local guideline/practice) has been informed of all pertinent aspects of the study. 13. Patients who are willing and able to comply with scheduled visits, treatment plans, laboratory tests, and other study procedures |
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E.4 | Principal exclusion criteria |
1. Prior immunotherapy with an anti PD 1, anti PD L1, anti PD L2, anti CD137, or anti CTLA 4 antibody (including ipilimumab), or any other antibody or drug specifically targeting T cell co stimulation or immune checkpoint pathways. 2. Major surgery ≤4 weeks prior to randomization. 3. Prior malignancy (other than the current Head and Neck cancer or in situ disease) requiring tumor-directed therapy within the last 2 years prior to enrollment, or concurrent malignancy associated with clinical instability. Exceptions for disease within the 2 years are superficial esophageal cancer (TIS or T1a) fully resected by endoscopy, prostate cancer (Gleason score ≤6) either curatively treated or deemed to not require treatment, ductal in situ carcinoma of the breast that has completed curative treatment, adequately treated basal cell or squamous cell skin cancer. 4. Active autoimmune disease that might deteriorate when receiving an immunostimulatory agent. Patients with diabetes type I, vitiligo, psoriasis, or hypo- or hyperthyroid disease not requiring immunosuppressive treatment are eligible. 5. Any of the following in the 6 months prior to randomization: myocardial infarction, severe/unstable angina, coronary/peripheral artery bypass graft, symptomatic congestive heart failure, cerebrovascular accident, transient ischemic attack, or symptomatic pulmonary embolism. 6. Active infection requiring systemic therapy. 7. Known prior severe hypersensitivity to investigational products or any component in the formulations, including known severe hypersensitivity reactions to mAbs, cisplatin, or platinum-related compounds (NCI CTCAE v4.03 Grade ≥ 3). 8. Use of immunosuppressive medication at time of randomization, except the following: a. Intranasal, inhaled, topical steroids, or local steroid injections (eg, intra-articular injection); b. Systemic corticosteroids at physiologic doses ≤10 mg/day of prednisone or equivalent; c. Steroids as premedication for hypersensitivity reactions (eg, CT scan premedication). 9. Prior organ transplantation including allogenic stem-cell transplantation. 10. Diagnosis of prior immunodeficiency or known human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) related illness. 11. Hepatitis B virus (HBV) or hepatitis C virus (HCV) infection at screening (positive HBV surface antigen or HCV RNA [ribonucleic acid] if anti-HCV antibody screening test positive). 12. Vaccination within 4 weeks prior to randomization except for administration of inactivated vaccines. 13. Current use of or anticipated need for treatment with other anti-cancer drugs. 14. Pregnant female patients, breastfeeding female patients, and male patients able to father children and female patients of childbearing potential who are unwilling or unable to use 2 methods of contraception (at least one of which is considered to be highly effective) as outlined in the protocol for the duration of the study and for at least 6 months after the last dose of cisplatin and 30 days after the last dose of avelumab/placebo (whichever is later). 15. Other severe acute or chronic medical conditions including: immune colitis, inflammatory bowel disease, pneumonitis, pulmonary fibrosis, or psychiatric condition including recent (within the past year) or active suicidal ideation or behavior; or laboratory abnormality 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. Patients who are investigational site staff members directly involved in the conduct of the study and their family members, site staff members otherwise supervised by the investigator, or patients who are Pfizer employees directly involved in the conduct of the study. 17. Participation in other interventional studies involving investigational drug(s) within 4 weeks prior to randomization.
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E.5 End points |
E.5.1 | Primary end point(s) |
PFS per modified RECIST v1.1 (see Appendix 3 of the protocol for specific modifications, including pathologic confirmation) by investigator assessment. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
- OS. - Antitumor activity: Pathologic complete response in any resected specimens, neck dissection. - Antitumor activity: Locoregional failure, objective response, distant metastatic failure, and duration of response, per modified RECIST v1.1 by investigator assessment. - Safety: Adverse events and laboratory abnormalities as graded by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v4.03; vital signs (blood pressure, pulse rate). - Pharmacokinetics: - Cmax and Ctrough for avelumab; - Area under the concentration-time curve extrapolated to infinity (AUCinf),Cmax, clearance (CL), time to maximum plasma concentration (Tmax), elimination half-life (t1/2), and volume of distribution (Vz) for cisplatin (total and free), as data permit. - Immunogenicity: ADA (neutralizing antibody) against avelumab. - Patient-Reported Outcomes: Disease-related symptoms and Health-Related Quality of Life as measured by the National Cancer Comprehensive Network (NCCN) Head and Neck Symptom Index-22 items (FHNSI-22), and the EuroQoL Group 5- Dimension 5- Level Self-Report Questionnaire (EQ-5D-5L). - Biomarkers: Tumor tissue biomarkers includi |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | Yes |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 10 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 115 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Australia |
Austria |
Belgium |
Canada |
China |
France |
Germany |
Greece |
Hungary |
Ireland |
Israel |
Italy |
Japan |
Korea, Republic of |
Netherlands |
Poland |
Portugal |
Russian Federation |
Spain |
Switzerland |
Taiwan |
United Kingdom |
United States |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 5 |
E.8.9.1 | In the Member State concerned months | 9 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 5 |
E.8.9.2 | In all countries concerned by the trial months | 10 |
E.8.9.2 | In all countries concerned by the trial days | 14 |