NCT06494189

Low-dose Radiotherapy Plus Tislelizumab in Combination With Afatinib for Neoadjuvant Treatment of Surgically Resectable Head and Neck Squamous Carcinoma

A Prospective, Single-arm Clinical Study of Low-dose Radiotherapy Plus Tislelizumab in Combination With Afatinib for Neoadjuvant Treatment of Surgically Resectable Head and Neck Squamous Carcinoma

• Status: Completed
• Phase: Phase 1
• Study type: Interventional
• Enrollment: 9 (actual)
• Sponsor: West China Hospital · Academic / Other
• Sex: All
• Age: 18 Years
• Healthy volunteers: Not accepted

Summary

The purpose of this study was to evaluate the safety and tolerability of low-dose radiotherapy plus tislelizumab in combination with afatinib neoadjuvant therapy for patients with surgically resectable squamous carcinoma of the head and neck.

Detailed description

Head and neck squamous cell carcinoma (HNSCC) is the most common malignancy of the head and neck. More than 60% of patients with HNSCC have locally advanced or metastatic disease at the time of diagnosis, with a 5-year overall survival rate of less than 60%. The clinical outcomes of those patients still need to be improved. Neoadjuvant therapy theoretically can reduce tumor volume, increase organ retention rate, and reduce distant metastasis rate. However, in addition to nasopharyngeal carcinoma, results from several phase III clinical trials have not proved a significant survival benefit of neoadjuvant chemotherapy for patients with resectable HNSCC. It is urgent to explore new neoadjuvant treatment options to improve the prognosis of patients with HNSCC. Immunotherapy such as PD-1/PD-L1 inhibitors have shown excellent efficiency in the treatment of malignancies. Anti-PD-1 therapy is approved as the first-line treatment of recurrent/metastatic HNSCC. Neoadjuvant immunotherapy for the treatment of locally advanced and resectable HNSCC has been demonstrated to be feasible in some trials. Afatinib, as an irreversible ErbB tyrosine kinase inhibitor (TKI), has been used as the second-line treatment for recurrent and/or metastatic HNSCC. However, there is a lack of high-level evidence-based medical evidence for the use of afatinib in preoperative therapy for HNSCC. A previous study published in 2018 confirmed that afatinib can be administered safely before surgery. Radiotherapy is the standard or adjuvant treatment for most patients with head and neck cancer. In HNSCC, combining radiotherapy with immunotherapy has been shown to induce effective anti-tumor immune responses. The mechanism may be that, in addition to direct cytotoxic effects on cancer cells, radiotherapy remodels the tumor microenvironment and affects the number and composition of tumor-infiltrating immune cells, thereby altering the response to immune checkpoint inhibitor therapy. However, conventional radiation therapy is often associated with adverse effects, such as dry mouth, dysphagia, oral mucositis, and pain, which will lead to a reduction in the quality of life of the patient, and severe adverse effects can even lead to interruption of treatment. Low-dose radiotherapy (LDRT) is usually defined as radiotherapy with ≤2 Gray (Gy) per fraction and a total dose of up to 10 Gy, and is considered to be a non-ablative treatment.LDRT has less impact on the patient compared to conventional radiation therapy, and its low toxicity makes it suitable for tumor lesions that are not amenable to stereotactic radiation therapy.In addition to its low radiotherapy toxicity, LDRT has been shown to cause tumor regression by reprogramming the tumor immune microenvironment. In conclusion, the researchers designed this study to investigate the efficacy and safety of low-dose radiotherapy plus the anti-PD1 immunotherapy teslizumab in combination with an epidermal growth factor receptor-TKI (afatinib) as a neoadjuvant treatment option for patients with resectable HNSCC, with the aim of providing a new therapeutic option for these patients.

Conditions

• Head and Neck Cancer

Interventions

Type	Name	Description
BIOLOGICAL	Tislelizumab	200mg ivgtt q3w
DRUG	Afatinib	30mg po qd
RADIATION	Low dose radiotherapy	The phase Ia clinical trial took low dose radiotherapy doses of 2Gy/1f (on day 1) for group 1, 4Gy/2f (from days 1 to 2) for group 2, and 10Gy/5f (from days 1 to 5) for group 3. The radiotherapy doses in phase Ib were judged according to the efficacy and toxicity of phase Ia.

Timeline

• Start date: 2024-07-31
• Primary completion: 2025-04-10
• Completion: 2025-04-10
• First posted: 2024-07-10
• Last updated: 2025-12-29

Locations

1 site across 1 country: China