Danvatirsen + Pembrolizumab for Head and Neck Cancer

(PEMDA-HN Trial)

Recruiting at31 trial locations

Overseen by Ezra Cohen, MD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 2

Recruiting

Sponsor: Flamingo Therapeutics NV

Must not be taking: Steroids, Antivirals, Antimicrobials, others

Disqualifiers: Autoimmune, Cardiovascular, Pneumonitis, others

No Placebo Group

Prior Safety Data

Breakthrough Therapy

Trial Summary

What is the purpose of this trial?

This trial is testing danvatirsen with pembrolizumab in patients with head and neck cancer that has returned or spread. Danvatirsen aims to stop cancer growth, and pembrolizumab helps the immune system attack the cancer.

Will I have to stop taking my current medications?

The trial information does not specify if you need to stop taking your current medications. However, if you are on systemic steroid therapy or have received a live vaccine recently, you may not be eligible to participate.

What data supports the effectiveness of the drug Danvatirsen + Pembrolizumab for head and neck cancer?

Research shows that pembrolizumab, a part of the treatment, is effective for recurrent or metastatic head and neck cancer, as it helps the immune system fight cancer cells. It is approved for use after other treatments have failed, indicating its potential benefit in challenging cases. ^{1 2 3 4 5}

What makes the drug Danvatirsen + Pembrolizumab unique for head and neck cancer?

The combination of Danvatirsen and Pembrolizumab is unique because it pairs an immune checkpoint inhibitor (Pembrolizumab) with another agent (Danvatirsen) to potentially enhance the immune response against head and neck cancer, offering a novel approach compared to traditional chemotherapy or single-agent immunotherapy. ^{1 2 3 4 6}

Research Team

Ezra Cohen, MD

Principal Investigator

Moores Cancer Center at UC San Diego Health

Eligibility Criteria

This trial is for adults with recurrent or metastatic head and neck squamous cell carcinoma that can't be cured by surgery. They must have a life expectancy of at least 3 months, measurable tumor growth, PD-L1 expression in the tumor, good organ function, and agree to birth control if necessary. Excluded are those with curable disease by local therapy, prior metastatic treatment, certain heart diseases, previous immunotherapy drugs like anti-PD-1/L1/L2 agents.

Inclusion Criteria

I am a man who is either surgically sterile or I agree to use birth control.

My tumor shows high PD-L1 levels according to an FDA-approved test.

Oxygen saturation on room air ≥92% by pulse oximetry

Exclusion Criteria

I have received treatment for advanced head and neck cancer before.

I have been treated with drugs targeting PD-1, PD-L1, or PD-L2.

My condition can be treated with the goal of curing it.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

1 visit (in-person)

Treatment

Participants receive danvatirsen plus pembrolizumab or pembrolizumab alone in 21-day cycles

Up to 24 months

Every 3 weeks (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, with radiologic tumor assessments every 6 weeks and survival follow-up every 12 weeks

Up to 18 months

Every 6 weeks (in-person) for tumor assessments, every 12 weeks (virtual) for survival follow-up

Treatment Details

Interventions

• Danvatirsen (Antisense Oligonucleotide)
• Pembrolizumab (Monoclonal Antibodies)

Trial Overview The study compares two treatments: Danvatirsen combined with Pembrolizumab versus Pembrolizumab alone for first-line treatment of advanced head and neck cancer. Patients will be randomly assigned to either receive both drugs or just Pembrolizumab in an open-label Phase II trial.

Participant Groups

Group I: Danvatirsen plus pembrolizumab Experimental Treatment 2 Interventions

Danvatirsen dosing: Week 1: Danvatirsen intravenously (IV) on Days 1, 3, and 5 Week 2 and subsequent weeks: Danvatirsen IV weekly Pembrolizumab dosing: Pembrolizumab every 3 weeks after the Danvatirsen dose.

Group II: Pembrolizumab Active Control 1 Intervention

Pembrolizumab IV every 3 weeks after the Danvatirsen dose.

Who Is Running the Clinical Trial?

Flamingo Therapeutics NV

Lead Sponsor

Trials

2

Recruited

110+

Findings from Research

Pembrolizumab, an immune checkpoint inhibitor, has been approved by the FDA for treating platinum-refractory recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC), offering a new option with potentially improved efficacy compared to traditional chemotherapy and EGFR inhibitors.

This review discusses the pharmacology and tolerability of pembrolizumab, emphasizing its mechanism of action by blocking the PD-1 receptor, which may enhance the immune response against HNSCC tumors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pembrolizumab and its use in the treatment of recurrent or metastatic head and neck cancer. Sheth, S., Weiss, J.[2019]

In a study of 14 heavily pretreated patients with recurrent and metastatic head and neck squamous cell carcinoma (R/M HNSCC), the combination of pembrolizumab and lenvatinib showed an objective response rate of 28.6%, indicating potential efficacy even in patients who had previously failed anti-PD-1 therapy.

The disease control rate was 42.9%, with an overall survival of 6.2 months and progression-free survival of 4.6 months, suggesting that this combination therapy may provide meaningful benefits for patients who have limited treatment options.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Combination of pembrolizumab and lenvatinib is a potential treatment option for heavily pretreated recurrent and metastatic head and neck cancer. Chen, TH., Chang, PM., Yang, MH.[2021]

In a phase IB study involving 59 patients with locally advanced head and neck squamous cell carcinoma, the combination of pembrolizumab with cisplatin-based chemoradiotherapy was found to be safe, with a high completion rate of treatment and only 8.8% of patients experiencing immune-related adverse events.

The treatment showed promising efficacy, with complete response rates of 85.3% for HPV-positive and 78.3% for HPV-negative patients, suggesting that this combination warrants further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety and Efficacy of Pembrolizumab With Chemoradiotherapy in Locally Advanced Head and Neck Squamous Cell Carcinoma: A Phase IB Study. Powell, SF., Gold, KA., Gitau, MM., et al.[2022]

In a study of 66 patients with recurrent and metastatic head and neck squamous cell carcinoma treated with pembrolizumab, the one-year overall survival rate was 69.4%, indicating the regimen's effectiveness as a first-line therapy.

The depth of response (DpR) was found to be a significant predictor of survival outcomes, with a greater tumor reduction (≥-45%) correlating with improved overall survival and progression-free survival rates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Depth of response may predict clinical outcome in patients with recurrent/metastatic head and neck cancer treated with pembrolizumab-containing regimens. Saijo, K., Imai, H., Ouchi, K., et al.[2023]

A 69-year-old patient with relapsed squamous cell carcinoma showed significant improvement after 14 cycles of pembrolizumab, indicating its efficacy as a second-line treatment for metastatic head and neck cancer.

The patient developed severe immune-related adverse effects, specifically grade 4 mucositis and esophagitis, highlighting the importance of monitoring for such complications in patients receiving PD-1 inhibitors like pembrolizumab.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Severe immune mucositis and esophagitis in metastatic squamous carcinoma of the larynx associated with pembrolizumab. Acero Brand, FZ., Suter, N., Adam, JP., et al.[2019]

References

1. England pubmed.ncbi.nlm.nih.gov

Pembrolizumab and its use in the treatment of recurrent or metastatic head and neck cancer. [2019]

2. Netherlands pubmed.ncbi.nlm.nih.gov

Combination of pembrolizumab and lenvatinib is a potential treatment option for heavily pretreated recurrent and metastatic head and neck cancer. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

Safety and Efficacy of Pembrolizumab With Chemoradiotherapy in Locally Advanced Head and Neck Squamous Cell Carcinoma: A Phase IB Study. [2022]

4. Switzerland pubmed.ncbi.nlm.nih.gov

Depth of response may predict clinical outcome in patients with recurrent/metastatic head and neck cancer treated with pembrolizumab-containing regimens. [2023]

5. Greece pubmed.ncbi.nlm.nih.gov

Effects of Pembrolizumab in Recurrent/Metastatic Squamous Cell Head and Neck Carcinoma: A Multicenter Retrospective Study. [2023]

6. England pubmed.ncbi.nlm.nih.gov

Severe immune mucositis and esophagitis in metastatic squamous carcinoma of the larynx associated with pembrolizumab. [2019]