MRG003 (Becotatug Vedotin) Plus Toripalimab Versus Toripalimab as Neoadjuvant Therapy for PD-L1-Positive, Resectable, Locally Advanced Head and Neck Squamous Cell Carcinoma: A Multicenter, Prospective, Randomized, Controlled Phase II Trial
Trial Snapshot
- Phase
- Phase 2
- Status
- Not yet recruiting
- Sponsor
- Dongguan People's Hospital
- Enrollment
- 65
- Locations
- 1
- Primary Endpoint
- Major Pathological Response (MPR) rate
Study Overview
Brief Summary
This is a multicenter, prospective, randomized, controlled Phase II trial evaluating the safety and efficacy of MRG003 (Becotatug vedotin) combined with Toripalimab versus Toripalimab alone as neoadjuvant therapy for PD-L1-positive, resectable locally advanced head and neck squamous cell carcinoma. A total of 65 subjects are planned (43 experimental, 22 control). The experimental arm receives two cycles of MRG003 (Becotatug vedotin) 2.0 mg/kg intravenously on Day 1 followed by Toripalimab 240 mg intravenously on Day 1 every 3 weeks, while the control arm receives two cycles of Toripalimab 240 mg alone. After neoadjuvant therapy, both arms undergo radical surgery 3-4 weeks later, followed by risk-adapted adjuvant radiotherapy or chemoradiotherapy with concurrent Toripalimab (3 cycles) and then 12 cycles of adjuvant Toripalimab maintenance. The primary endpoint is the major pathological response rate.
Detailed Description
This study builds upon the limitations of neoadjuvant immunotherapy monotherapy (e.g., KEYNOTE-689), which showed a low MPR rate (9.8% overall, 13.7% in CPS>10) and a 25.6% progression rate, by exploring the synergistic combination of the EGFR-targeting antibody-drug conjugate MRG (Becotatug vedotin) with the PD-1 inhibitor Toripalimab. Eligible patients are treatment-naïve, PD-L1 positive (CPS ≥1), stage III-IVA resectable non-oropharyngeal, HPV-negative oropharyngeal, or specific HPV-positive oropharyngeal HNSCC, ECOG PS 0-1, aged 18-70. In the neoadjuvant phase, the experimental group receives MRG (Becotatug vedotin) 2.0 mg/kg (based on actual body weight) intravenously without prophylactic premedication, followed by Toripalimab 240 mg intravenously over 30-60 minutes on Day 1 of each 3-week cycle for 2 cycles; infusion reactions are monitored for at least 120 minutes after the first dose and 60 minutes thereafter. Dose reduction of MRG (Becotatug vedotin) to 1.5 mg/kg is permitted for toxicity, with permanent discontinuation if intolerance persists; Toripalimab dose modification is not allowed. The control group receives Toripalimab 240 mg alone on the same schedule. Three to four weeks after Cycle 2 Day 1, both arms undergo radical tumor resection; surgery is performed even if radiological progression occurs during neoadjuvant therapy, provided surgical criteria are met. Postoperatively, patients are stratified by pathology: those with extranodal extension or positive/inadequate margins receive adjuvant chemoradiotherapy (cisplatin 100 mg/m² every 3 weeks for 3 cycles plus radiotherapy at 60-70 Gy depending on risk), while those without receive adjuvant radiotherapy alone (same doses). During adjuvant radiotherapy, both arms concurrently receive 3 cycles of Toripalimab 240 mg every 3 weeks. After completing radiotherapy, all patients receive 12 cycles of adjuvant Toripalimab 240 mg every 3 weeks as maintenance. Secondary endpoints include event-free survival, pathologic complete response rate, objective response rate, R0 resection rate, surgical down-staging rate, safety (CTCAE v6.0), and quality of life; exploratory endpoints include overall survival and biomarker analysis. The MPR rate is compared using the exact test, assuming 45% in the experimental arm versus approximately 9.8% in the historical control, with a one-sided alpha of 0.025, 80% power, and 10% dropout, yielding the required sample size of 65. The full analysis set is the primary analysis population.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to 70 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Histologically or cytologically confirmed head and neck squamous cell carcinoma (HNSCC), PD-L1 positive (CPS ≥ 1)
- •Treatment-naïve, pathologically confirmed stage III-IVA resectable non-oropharyngeal HNSCC (oral cavity, larynx, hypopharynx) OR HPV-negative oropharyngeal SCC, OR HPV-positive stage III T4N0-2 resectable oropharyngeal cancer (AJCC 8th edition)
- •No prior antitumor treatment (radiotherapy, chemotherapy, targeted therapy, or immunotherapy)
- •Age 18 to 70 years
- •ECOG performance status 0 or 1
- •Adequate organ function within 14 days before first dose (no blood products or growth factors within 14 days):
- •ANC ≥ 1.0 × 10⁹/L, Hb ≥ 90 g/L, PLT ≥ 75 × 10⁹/L
- •ALT/AST ≤ 1.5 × ULN, total bilirubin ≤ 1.5 × ULN, ALP < 2.5 × ULN
- •CrCl ≥ 50 mL/min (Cockcroft-Gault)
- •APTT and INR ≤ 1.5 × ULN
- •At least one measurable lesion per RECIST 1.1
- •Life expectancy ≥ 12 weeks
- •Female subjects of childbearing potential and male subjects with reproductive potential must use medically accepted contraception during treatment and for 3 months after last dose
- •Voluntary signed informed consent, good compliance, willing to undergo follow-up
Exclusion Criteria
- Not provided
Arms & Interventions
Toripalimab Monotherapy
Participants receive 2 cycles of neoadjuvant toripalimab monotherapy. After the neoadjuvant phase, radical surgery is performed. Postoperative management is determined by pathology: participants with extranodal extension (ENE) or positive/inadequate margins receive adjuvant chemoradiotherapy (cisplatin 100 mg/m² every 3 weeks for 3 cycles plus radiotherapy at 60-70 Gy depending on risk), while those without receive adjuvant radiotherapy alone. During adjuvant radiotherapy, participants receive 3 cycles of concurrent toripalimab. After radiotherapy, all participants receive 12 cycles of adjuvant toripalimab maintenance therapy.
Intervention: Toripalimab (Drug)
MRG003 + Toripalimab
Participants receive 2 cycles of neoadjuvant combination therapy with toripalimab plus MRG003 (Becotatug vedotin). After the neoadjuvant phase, radical surgery is performed. Postoperative management follows the same risk-adapted criteria as the control arm: participants with ENE or positive/inadequate margins receive adjuvant chemoradiotherapy, while those without receive adjuvant radiotherapy alone. During adjuvant radiotherapy, participants receive 3 cycles of concurrent toripalimab. After radiotherapy, all participants receive 12 cycles of adjuvant toripalimab maintenance therapy.
Intervention: MRG003 (Becotatug vedotin) and Toripalimab (Drug)
MRG003 + Toripalimab
Participants receive 2 cycles of neoadjuvant combination therapy with toripalimab plus MRG003 (Becotatug vedotin). After the neoadjuvant phase, radical surgery is performed. Postoperative management follows the same risk-adapted criteria as the control arm: participants with ENE or positive/inadequate margins receive adjuvant chemoradiotherapy, while those without receive adjuvant radiotherapy alone. During adjuvant radiotherapy, participants receive 3 cycles of concurrent toripalimab. After radiotherapy, all participants receive 12 cycles of adjuvant toripalimab maintenance therapy.
Intervention: Toripalimab (Drug)
Outcomes
Primary Outcomes
Major Pathological Response (MPR) rate
Time Frame: At the time of surgical specimen evaluation (approximately 6-8 weeks after initiation of neoadjuvant therapy)
Proportion of patients with major pathological response, defined as ≤ 10% residual viable tumor in the primary tumor and all sampled lymph nodes after completion of neoadjuvant therapy.
Secondary Outcomes
- Event-Free Survival (EFS)(From randomization up to approximately 36 months)
- Pathologic Complete Response (pCR) Rate(At definitive surgery (approximately Week 6-8 after randomization))
- Objective Response Rate (ORR) per RECIST 1.1(After completion of 2 cycles of neoadjuvant therapy (approximately Week 6))
- Safety: Incidence of Adverse Events and Serious Adverse Events(From first dose of study drug through 90 days after last dose or 30 days after surgery, whichever occurs later)
- On-Time Surgery Rate(Within 49 days after Cycle 2 Day 1（ (each cycle is 21 days)）)
- R0 Resection Rate(At definitive surgery (approximately Week 6-8 after randomization))