A Study of Chemoradiation Plus Pembrolizumab for Locally Advanced Laryngeal Squamous Cell Carcinoma

Phase 1

Completed

Interventions: Drug: Pembrolizumab
Radiation: Radiation Therapy
Drug: Cisplatin

Brief Summary: The purpose of this research study is to test the safety and the benefit of adding pembrolizumab (a therapy that activates the immune system to fight cancer) to standard of care treatment for larynx cancer. The standard of care treatment will include chemotherapy and radiation for 7 weeks.

Detailed Description: This study is an open label, single arm study which will enroll patients with locally advanced squamous cell carcinomas of the larynx. Positive tumor PDL1 expression by IHC will not be required for enrollment.

All patients with receive Pembrolizumab and cisplatin in combination with radiation. Pembrolizumab 200 mg flat dose given Q21 days will begin 3 weeks prior to initiation of chemoradiation and continued through the 21-day cycle until completion of chemoradiation. Cisplatin will be given 100 mg/m2 every 21 days during radiation as per standard of care.

Pembrolizumab has well defined toxicities as single agent and has non-overlapping mechanisms of action with cisplatin and radiation. The safety of these agents used in combination has not been previously described, therefore the study will begin with a safety run-in phase 1 followed by the phase II design. See statistical section for details.

Recruitment & Eligibility

Inclusion Criteria

Biopsy-proven, previously untreated stage III or IV squamous cell carcinoma of the larynx, Primary tumor stage (T2, T3) and nodal stage (N0, N1, N2, N3).
Measurable disease based on RECIST 1.1.
Performance status 0 or 1 on Eastern Cooperative Oncology Group Performance Scale.
Anticipated survival minimum of 12 months.
Adequate labs

Exclusion Criteria

Patients with T1 primary tumor or T4 large volume tumor that has resulted in larynx dysfunction at baseline (for example tumor largely penetrating into base of tongue and resulting in inability to swallow at baseline)
Prior radiation therapy to the larynx area or involved neck.
Distant metastasis
Known history of active tuberculosis (TB), autoimmune disease, pneumonitis, infection, HIV, Hepatitis B, or Hepatitis C

Arm && Interventions

Group	Intervention	Description
Pembrolizumab	Radiation Therapy	Pembrolizumab every 3 weeks in combination with 7 weeks of radiation therapy and every 3 week cisplatin
Pembrolizumab	Cisplatin	Pembrolizumab every 3 weeks in combination with 7 weeks of radiation therapy and every 3 week cisplatin
Pembrolizumab	Pembrolizumab	Pembrolizumab every 3 weeks in combination with 7 weeks of radiation therapy and every 3 week cisplatin

Primary Outcome Measures

Name	Time	Method
Number of Participants With Treatment-Related Grade 3 or 4 Adverse Events as Assessed by CTCAE V4.0	30 days following completion of treatment for the first 6 participants	Greater than 2 grade 3 or 4 adverse events that are definitely, probably or possibly related to the pembrolizumab in the first cohort of 6 participants
Laryngectomy-free Survival in Locally Advanced Laryngeal Squamous Cell Carcinoma	18 months	This is the number of subjects that are laryngectomy-free at 18 months.

Secondary Outcome Measures

Name	Time	Method
Laryngectomy-free Survival in Locally Advanced Laryngeal Squamous Cell Carcinoma	12 months	This is the number of subjects that are laryngectomy-free at 12 months.