Overview
The purpose of this study is to explore the safety and feasibility of anti-programmed cell death protein 1(PD-1) immunotherapy, Camrelizumab, combined with cyclin-dependent kinase 4/6 blockade, Dalpiciclib, as a new neoadjuvant treatment regimen for patients with resectable esophageal squamous cell carcinoma (ESCC) or or head and neck squamous cell carcinoma(HNSCC).
Description
Esophageal cancer is the seventh leading cause of cancer related mortality worldwide and esophagus squamous cell carcinoma (ESCC) is the main histological type in China. Combination with operation and neoadjuvant therapy including chemotherapy with/without radiotherapy is considered the standard therapy for local advanced esophagus cancer. Nevertheless, in a phase 3 clinical trial，the 5-year overall survival rate and cumulative incidence of recurrence were 59.9% and 32.2%. It shows the limitations of current treatment modalities.
Immunotherapy such as PD-1/PD-L1 inhibitors have shown great improvement in first-line recurrent/metastatic and postoperative ESCC. It motivates recent phase I/II trials investigating the incorporation of ICB in the neoadjuvant treatment of ESCC.
However, a phase 1b trial of neoadjuvant adebrelimab in locally advanced resectable ESCC showed only 24% major pathologic response (MPR; tumor regression >90%). To improve the efficacy of ICB in neoadjuvant treatment of ESCC, a combined regimen should be explored.
Head and Neck Squamous Cell Carcinoma (HNSCC) is the most common malignancies of the head and neck, accounting for 90% of head and neck cancer. The 5-year survival rate under standard treatment is only 50%. 70%~80% of first diagnosed patients already developed into locally advanced status (stage II-Iva). In recent years, the use of neoadjuvant therapy (NAC) followed by surgery or radiotherapy has been advocated because of its higher probability of local/regional failure and distant metastasis after treatment. TPF (Docetaxel + Cisplatin + Fluorouracil) regimen is considered as the standard regimen of induced chemotherapy for head and neck squamous cell carcinoma (especially in laryngeal cancer), which can significantly reduce the patient's distant metastasis rate and prolong overall survival (OS). However, the therapeutic effect of neoadjuvant therapy on head and neck squamous cell carcinoma has reached a bottleneck. In recent years, PD-1 inhibitors have achieved significant effects in the field of tumor therapy and have been approved for the treatment of various tumors including recurrent metastatic head and neck tumors. There are also several prospective clinical research attempting to combine ICB with targeted therapeutic drugs for neoadjuvant therapy of HNSCC. The efficacy and safety results show potential synergy between these drugs.
Recent preclinical studies have shown that CDK4/6 inhibitors promote efficacy of PD-1/PD-L1 inhibitors through tumor antigen presentation enhancing, suppressed proliferation of regulatory T (Treg) cells, effector T- cell activation enhancing, and induction of T- cell memory. The previous study confirmed that CDK4/6 inhibitor combined with ICB can be administered safely in patients with recurrent or metastatic head and neck squamous cell carcinoma(HNSCC) and non-small cell lung carcinoma(NSCC).
In summary, the investigators designed this study to explore the safety and efficacy of anti-PD1 immunotherapy, Camrelizumab, combined with CDK4/6 inhibitor, dalpiciclib, as a new neoadjuvant treatment regimen for patients with resectable ESCC and HNSCC. It will also provide new ideas, strategies, and experimental evidence for the development of immunotherapy.
Eligibility
Inclusion Criteria:
- Patients diagnosed with esophageal squamous cell cancer by gastroscopic biopsies.
1.1. The primary tumor should be located in the thorax; the primary site is decided by the upper margin of the mass (upper thoracic esophagus: from the thoracic inlet to inferior margin of azygos arch, the endoscopic examination shows 20-25cm to the incisor; middle thoracic esophagus: from inferior margin of azygos arch to the inferior pulmonary vein level, the endoscopic examination shows 25-30cm to the incisor; lower thoracic esophagus: from the inferior pulmonary vein level to the stomach, the endoscopic examination shows 30-40cm to the incisor).
1.2. The patients should be evaluated to be able to have surgical resection before the surgery according to the examinations (use enhanced thoracic and abdominal CT, cervical lymph node ultrasound to evaluate whether the tumor has obvious invasion, whether there are enlarged mediastinal lymph nodes; use examinations including positron emission computed tomography (PET-CT), endoscopic ultrasonography (EUS) to make further clinical staging if considering the primary tumor as T4b, multiple mediastinal lymph nodes metastasis or distant metastasis).
1.3. The patients should be at the range of 18-75 years old, Eastern Cooperative Oncology Group (ECOG) 0-1.
1.4. The patients should be able to understand our research and be willing to accept surgical treatment and sign the informed consent.
- Patient diagnosed with locally advanced head and neck squamous cell carcinoma confirmed by histology or cytology.
2.1. Patients who are recommended to perform surgery
2.2. Patients between 18 and 70 years old
2.3. ECOG: 0～2 points
2.4. Estimated survival time ≥ 6 months
2.5. The patients should be able to understand our research and be willing to accept
surgical treatment and sign the informed consent.
Exclusion Criteria:
- 1.The stage of tumor is T4b (AJCC/International Union Against Cancer (UICC) 8th
Edition) which can not be resected according to imaging examinations like thoracic and
abdominal enhanced CT, cervical lymph nodes ultrasound, whole body PET-CT scan
(optional) or endobronchial ultrasonography (EBUS) (optional); several enlarged lymph
nodes existed (≥3 estimated lymph nodes metastasis); multiple station enlarged lymph
nodes existed (≥2 estimated stations of lymph nodes metastasis); distant metastasis
existed.
2.The patients have accepted or are on the process of other chemotherapy,
radiotherapy, targeted therapy or immunotherapy.
3.History of other malignancies (except for the history of malignant tumors that have
been cured and have not recurred within 5 years, such as skin basal cell carcinoma,
skin squamous cell carcinoma, superficial bladder cancer, in situ cervical cancer, and
gastrointestinal mucosal cancer, etc.） 4. Have an active autoimmune disease requiring
systemic treatment or a documented history of clinically severe autoimmune disease.
5. Any history of allergic disease, or a sever hypersensitivity reaction to drugs, or
allergy to the study drug components.
6.With serious medical diseases, such as grade II and above cardiac dysfunction (NYHA
criteria), ischemic heart disease, supraventricular or ventricular arrhythmia, poorly
controlled diabetes mellitus, poorly controlled hypertension, echocardiographic
ejection fraction < 50%, etc.
7.With interstitial pneumonitis, non-infectious pneumonitis, active pulmonary
tuberculosis, or history of pulmonary tuberculosis infection that were not controlled
by treatment.
8.The patients have severe systematic intercurrent disease, such as active infection
or poorly controlled diabetes; coagulation disorders; hemorrhagic tendency or under
treatment of thrombolysis or anticoagulant therapy.
9.The patients have active infection of HIV, hepatitis B virus (HBV), hepatitis C
virus (HCV) or be HIV serum positive; or HBV, HCV RNA positive.
10.Female who is positive for serum pregnancy test or during lactation period, or
people at child bearing stage who are reluctant to use contraception measures during
the research.
11.History of a clear neurological or psychiatric disorder.
12.History of a clear neurological or psychiatric disorder.
13.Received any investigational drug within 4 weeks prior to the first dose, or
concurrently enrolled in another clinical trial.
14.Any other factors that are not suitable for inclusion in this study judged by
investigators.