Testing what Happens when an Immunotherapy Drug (Avelumab) Is Added to a Usual Drug Treatment (Cetuximab) Compared to Avelumab by Itself in the Treatment of Advanced Squamous Cell Carcinoma of the Skin (cSCC)
This phase II trial studies how well avelumab with or without cetuximab work in treating patients with skin squamous cell cancer that has spread to other places in the body (advanced). Immunotherapy with monoclonal antibodies, such as avelumab and cetuximab, may help the body’s immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread.
Eligibility
Inclusion Criterea
- PRE-REGISTRATION ELIGIBILITY CRITERIA
- Provide adequate tissue for PD-L1 testing
* Fresh tissue or archival tissue can be used. Sample must be at least core needle biopsy. Fine needle aspiration is not adequate. This specimen submission is mandatory prior to registration as results will be used for stratification
- REGISTRATION ELIGIBILITY CRITERIA
- Biopsy-proven advanced cutaneous squamous cell carcinoma. Advanced disease is defined as either metastatic cutaneous squamous cell carcinoma or locally advanced cutaneous squamous cell carcinoma not amenable to curative surgical resection, or the patient declines surgical resection
- The patient must have at least one lesion that is measurable disease based on Response Evaluation Criteria in Solid Tumors (RECIST) 1.1
- If patient received major surgery, they must have recovered adequately from the toxicity and/or complications from the intervention prior to starting therapy
- This study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown. Therefore, for women of childbearing potential only, a negative urine or serum pregnancy test done =< 7 days prior to registration is required
- Age >= 18 years
- Eastern Cooperative Oncology Group (ECOG) performance status 0-2
- If human immunodeficiency virus (HIV) positive the HIV viral load must be 200. If an HIV positive patient is on highly active antiretroviral therapy (HAART) the patient must have been so for > 4 weeks
- Absolute neutrophil count (ANC) >= 1,500/mm^3
- Platelet count >= 100,000/mm^3
- Calculated creatinine clearance >= 30 mL/min
- Total bilirubin =< 1.5 x upper limit of normal (ULN)
- Aspartate aminotransferases (AST) / alanine aminotransferase (ALT) =< 2.5 x upper limit of normal (ULN)
- Patients who received prior treatment with cetuximab as palliative treatment for advanced cutaneous squamous cell carcinoma (cSCC) are excluded. Patients that received cetuximab based chemoradiation (either definitive or adjuvant) as prior treatment for locally advanced disease are eligible as long as the last dosage was given >= 6 months prior to registration
- Patients who received prior cetuximab and had a severe infusion reaction requiring discontinuation of cetuximab are excluded
- Patients treated with prior anti-PD-1 or anti-PD-L1 monoclonal antibodies (mAbs) are excluded
- Patients cannot have received treatment with radiation or chemotherapy including another investigational agent within 2 weeks of registration. Other than as stated above for cetuximab there are no limits on the number of lines of other therapies given for advanced cSCC
- Patients with a “currently active” second malignancy will be excluded with the exception of other non-melanoma skin cancers or cervical carcinoma in situ. Patients are not considered to have a “currently active” malignancy if they have completed therapy and are free of disease for 3 years
- No history of the following:
* Autoimmune disease (including inflammatory bowel disease) with the exception of patients with diabetes type I, vitiligo, psoriasis, or hypo- or hyperthyroid diseases not requiring immunosuppressive treatment
* Non-infectious pneumonitis that required steroids within 5 years
* Organ transplant including prior stem cell transplant
* Receipt of a live vaccine =< 4 weeks
- Comorbid conditions (excluded):
* Active infection requiring systemic treatment
* Use of immunosuppressive medication =< 7 days of registration, EXCEPT for the following: a. intranasal, inhaled, topical steroids, or local steroid injection (e.g., intra-articular injection); b. Systemic corticosteroids at physiologic doses =< 10 mg/day of prednisone or equivalent; c. Steroids as premedication for hypersensitivity reactions (e.g., CT scan premedication).
- Chronic concomitant treatment that are strong inhibitors of CYP3A4 are not allowed on this study. Patients on strong CYP3A4 inhibitors must discontinue the drug for 14 days prior to registration on the study
Participating Clinics
Sunrise Hospital and Medical Center
Renown Regional Medical Center
Saint Mary's Regional Medical Center
University Medical Center of Southern Nevada
Radiation Oncology Centers of Nevada Southeast
GenesisCare USA - Fort Apache
GenesisCare USA - Vegas Tenaya
Cancer and Blood Specialists-Shadow
OptumCare Cancer Care at Fort Apache
HealthCare Partners Medical Group Oncology/Hematology-San Martin
HealthCare Partners Medical Group Oncology/Hematology-Centennial Hills
Comprehensive Cancer Centers of Nevada-Summerlin
HealthCare Partners Medical Group Oncology/Hematology-Maryland Parkway
Comprehensive Cancer Centers of Nevada - Central Valley
Comprehensive Cancer Centers of Nevada-Horizon Ridge
Lake Huron Medical Center
Las Vegas Cancer Center-Medical Center
Las Vegas Cancer Center-Henderson
Cancer and Blood Specialists-Tenaya
Comprehensive Cancer Centers of Nevada - Town Center
Comprehensive Cancer Centers of Nevada-Southeast Henderson
OptumCare Cancer Care at Seven Hills
Hope Cancer Care of Nevada-Pahrump
OptumCare Cancer Care at Charleston
Hope Cancer Care of Nevada
OptumCare Cancer Care at MountainView
Cancer and Blood Specialists-Henderson
Alliance for Childhood Diseases/Cure 4 the Kids Foundation
Comprehensive Cancer Centers of Nevada
Radiation Oncology Associates
Kingman Regional Medical Center
Radiation Oncology Centers of Nevada Central
Comprehensive Cancer Centers of Nevada - Northwest
Carson Tahoe Regional Medical Center
Summerlin Hospital Medical Center
Comprehensive Cancer Centers of Nevada - Henderson
HealthCare Partners Medical Group Oncology/Hematology-Tenaya
GenesisCare USA - Las Vegas
GenesisCare USA - Henderson
Urology Specialists of Nevada - Green Valley
Las Vegas Urology - Pecos
Las Vegas Urology - Pebble
Las Vegas Urology - Cathedral Rock
Las Vegas Urology - Sunset
Las Vegas Prostate Cancer Center
Urology Specialists of Nevada - Northwest
Urology Specialists of Nevada - Southwest
Las Vegas Urology - Green Valley
Urology Specialists of Nevada - Central