Intensity-Modulated Radiation Therapy & Nivolumab for Recurrent or Second Primary Head & Neck Squamous Cell Cancer

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    Emory University
Updated on 11 March 2021


This phase II trial studies how well intensity-modulated radiotherapy and nivolumab work together in treating patients with head and neck squamous cell cancer that has come back. Intensity-modulation radiation therapy uses varying intensities of radiation beams to kill cancer cells and shrink tumors, thereby reducing the damage to nearby healthy tissue. Monoclonal antibodies, such as nivolumab, may interfere with the ability of tumor cells to grow and spread. Giving intensity-modulated radiation therapy and nivolumab may work better at treating head and neck squamous cell cancer.



I. To assess the 1-year progression-free survival (PFS) for patients with recurrent or second primary head and neck squamous cancer treated with intensity-modulated radiation therapy (IMRT) re-irradiation with concurrent and adjuvant nivolumab.


I. Evaluate the 1-year (yr) overall survival (OS) of patients treated with re-irradiation and nivolumab.

II. Evaluate patient quality of life (QOL).

III. Evaluate patterns of failure including local, regional and distant failure rates at 1 yr.

IV. Identify and estimate the incidence rate of acute and late toxicities associated with combined re-irradiation and concurrent and adjuvant nivolumab.


I. To identify potential biomarkers related to clinical benefit to concurrent and adjuvant nivolumab and re-irradiation in patients with recurrent or second primary (RSP) head and neck squamous cell carcinoma (HNSCC).


Patients receive nivolumab intravenously (IV) over 30 minutes on weeks -2, 0, 2, 4, and 6 and undergo IMRT once daily beginning on week 0 for up to 6-6.5 weeks. Beginning week 10, patients receive nivolumab IV over 30 minutes every 4 weeks for up to 10 courses in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up for 2 years from the beginning of radiation therapy.

Condition Recurrent Head and Neck Squamous Cell Carcinoma
Treatment IMRT, Nivolumab
Clinical Study IdentifierNCT03521570
SponsorEmory University
Last Modified on11 March 2021


Yes No Not Sure

Inclusion Criteria

Patients with recurrent squamous cell carcinoma or a second primary arising in a previously irradiated field
Life expectancy of greater than 6 months
Patients cannot have distant metastases and have to be candidates for curative re-irradiation
Patients with salivary gland tumors are excluded (patients with nasopharynx or sinonasal cancers can participate)
Patients with unresectable disease are eligible
Patients who undergo surgical resection will be allowed regardless of human papilloma virus (HPV) status provided they have one of the following criteria
Positive margins on pathology
Evidence of extracapsular spread on nodal pathology
Gross residual disease on postoperative or simulation imaging
N2/3 disease
T3/4 disease
Multifocal perineural invasion and/or lymphovascular space invasion
The majority of the anticipated target volume (> 50%) must have been previously treated to 40 Gy; prior radiation therapy (RT) must have been completed > 6 months prior to initiation of IMRT reirradiation; if previous RT records are unavailable, investigators can estimate the dose to previously treated tissues based on completion notes or other treatment history
An Eastern Cooperative Oncology Group (ECOG) performance score 0-2
Granulocytes > 1500/mm
Platelets > 100,000/mm
Bilirubin < 1.5 mg/dl
Creatinine < 1.5 mg/dl
No other concurrent invasive malignancies treated for the past year (localized prostate cancer or early stage skin cancer are not exclusion criteria)
Patients with carotid artery involvement or encasement will be allowed provided they have no symptoms related to carotid involvement
No prior exposure to immunotherapy agents
Ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria

Any known factors that would pose a contraindication to receiving nivolumab
Recursive partitioning analysis (RPA) class III patients defined as those expected to begin reirradiation within 2 years of first course of radiation therapy AND are percutaneous endoscopic gastrostomy (PEG) dependent or have a tracheostomy (patients who have undergone total laryngectomy are not excluded)
Patients with metastases
Prior treatment with a programmed cell death protein-1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitor
Female patients of childbearing potential must have a negative serum pregnancy test within 7 days prior to enrollment
Patients with primary salivary gland cancers are excluded
Patients who have had chemotherapy or biological therapy within 4 weeks of registration
Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, autoimmune disease requiring systemic steroids, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
Patients who are pregnant or breast-feeding
Patients with known active human immunodeficiency virus (HIV), hepatitis (hep) B, or hep C infection
Subjects with a condition requiring systemic treatment with either corticosteroids (> 10 mg daily prednisone equivalents) or other immunosuppressive medications within 14 days of study drug administration; inhaled or topical steroids and adrenal replacement doses > 10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease
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