Lovastatin and Pembrolizumab for the Treatment of Patients With Recurrent or Metastatic Head and Neck Cancer, LAPP Trial

PRIMARY OBJECTIVE:

I. To evaluate anti-tumor activity of the combination of pembrolizumab and lovastatin by assessing the objective response rate (ORR) by Response Evaluation Criteria in Solid Tumors (RECIST 1.1).

SECONDARY OBJECTIVE:

I. To evaluate the anti-tumor activity of the combination of by assessing progression-free survival (PFS) and overall survival (OS).

TERTIARY/EXPLORATORY OBJECTIVES:

I. To assess the effects of the combination of lovastatin + pembrolizumab on immune cells in blood.

II. To assess the association between efficacy measures and expression in tumors.

III. To assess the association between anti-tumor activity and immune cells in the blood.

OUTLINE:

Patients receive lovastatin orally (PO) once daily (QD) and pembrolizumab intravenously (IV) over 60 minutes on day 1 of each cycle. Cycles repeat every 21 days for up to 12 months in the absence of disease progression or unacceptable toxicity. Patients also undergo blood sample collection, and computed tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography (PET)/CT throughout the study.

After completion of study treatment, patients are followed for up to 2 years.

• Biospecimen Collection (Procedure), also known as Biological Sample Collection, Biospecimen Collected, Specimen Collection: Undergo blood sample collection
• Computed Tomography (Procedure), also known as CAT, CAT Scan, Computed Axial Tomography, Computerized Axial Tomography, Computerized axial tomography (procedure), Computerized Tomography, Computerized Tomography (CT) scan, CT, CT Scan, tomography: Undergo CT or PET/CT
• Lovastatin (Drug), also known as Lovastatin Sodium, Mevacor, Mevinolin, Monacolin K: Given PO
• Magnetic Resonance Imaging (Procedure), also known as Magnetic Resonance, Magnetic Resonance Imaging (MRI), Magnetic resonance imaging (procedure), Magnetic Resonance Imaging Scan, Medical Imaging, Magnetic Resonance / Nuclear Magnetic Resonance, MR, MR Imaging, MRI, MRI Scan, MRIs, NMR Imaging, NMRI, Nuclear Magnetic Resonance Imaging, sMRI, Structural MRI: Undergo MRI
• Pembrolizumab (Biological), also known as BCD-201, GME 751, GME751, Keytruda, Lambrolizumab, MK 3475, MK-3475, MK3475, Pembrolizumab Biosimilar BCD-201, Pembrolizumab Biosimilar GME751, Pembrolizumab Biosimilar QL2107, QL2107, SCH 900475, SCH-900475, SCH900475: Given IV
• Positron Emission Tomography (Procedure), also known as Medical Imaging, Positron Emission Tomography, PET, PET Scan, Positron emission tomography (procedure), Positron Emission Tomography Scan, Positron-Emission Tomography, proton magnetic resonance spectroscopic imaging, PT: Undergo PET/CT

Primary outcomes

• Objective response rate (ORR) [Up to 1 year]: ORR will be defined as the proportion of subjects with partial response or complete response. ORR will be evaluated using Response Evaluation Criteria in Solid Tumors version (RECIST) (v)1.1 response criteria. ORR will be calculated with 95% confidence interval by binomial distribution.

Secondary outcomes

• Progression free survival (PFS) [From date of treatment start to the date of objectively documented progression or death due to any cause, whichever status is recorded first, assessed up to 1 year]: PFS will be defined as the duration from the date of treatment start to the date of objectively documented progression or death due to any cause, whichever status is recorded first. PFS will be assessed using RECIST v1.1 response criteria. Median PFS will be estimated by Kaplan-Meier method along with 95% confidence interval.
• Overall survival (OS) [Up to 1 year]: To evaluate the anti-tumor activity of the combination of by assessing overall survival (OS).
• Incidence of adverse events (AEs) and serious adverse events (SAEs) [Up to 30 days after last dose of study treatment]: AEs and SAEs will be assessed and graded according to Common Terminology Criteria for Adverse Events v5.0. Frequency of AEs and SAEs will be summarized accordingly.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Adult patients, male or female, aged ≥ 18, able to provide informed consent
* Subjects with pathologically proven, recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) involving the oral cavity, oropharynx, larynx, hypopharynx, nasopharynx, or paranasal sinuses; patients with unknown primary HNSCC involving the cervical lymph nodes can be included if human papillomavirus (HPV)-positive
* PD-L1 combined positive score (CPS) ≥ 1 (i.e., must be a candidate for treatment with pembrolizumab alone)
* Patients must not be under consideration for salvage surgery
* Measurable disease by RECIST 1.1 criteria
* Life expectancy of more than 3 months, as determined by the investigator
* Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
* Recovery to baseline or ≤ grade 1 Common Terminology Criteria for Adverse Events (CTCAE) version (v.)5.0 from toxicities related to any prior treatments, unless adverse events are clinically non-significant and/or stable on supportive therapy
* For men or women of reproductive potential: use of highly effective contraception for at least 1 month prior to enrollment and agreement to use such a method during study participation and for an additional 8 weeks after the end of lovastatin/pembrolizumab administration
* Absolute neutrophil count (ANC) ≥ 1000/mm\^3 without colony stimulating factor support
* Platelets ≥ 100,000/mm\^3
* Hemoglobin ≥ 9 g/dL
* Bilirubin ≤ 1.5 x the upper limit of normal (ULN). For subjects with known Gilbert's disease, bilirubin ≤ 3.0 mg/dL
* Serum albumin ≥ 2.8 g/dl
* Serum creatinine ≤ 1.5 x ULN or creatinine clearance (CrCl) ≥ 40 mL/min. For creatinine clearance estimation, the Cockcroft and Gault equation should be used
* Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.0 x ULN
* Serum phosphorus, calcium, magnesium and potassium ≥ lower limit of normal (LLN)

Exclusion Criteria:

* Patients already taking a statin drug
* Liver dysfunction precluding the use of statins
* Radiation to the head and neck or other sites within 4 weeks prior to enrollment
* Cytotoxic chemotherapy or any form of investigational therapy within 4 weeks prior to study treatment
* Prior treatment with immune checkpoint blocking therapy
* Current use of drugs that interact with lovastatin (cimetidine, spironolactone, ketoconazole, and others)
* Pregnancy, lactation, or plan to become pregnant
* Inability to swallow lovastatin tablets
* Known allergy or prior adverse reaction to lovastatin, other statin drugs, or pembrolizumab

• Nicole C Schmitt, D, FACS, Principal investigator, Emory University Hospital/Winship Cancer Institute

NIH grants: P30CA138292