A phase II study of monalizumab in patients with recurrent/metastatic squamous cell carcinoma of the head and neck: The I1 cohort of the EORTC-HNCG-1559 UPSTREAM trial.

Monalizumab is a monoclonal antibody targeting the inhibitory natural killer group 2A (NKG2A) receptor localised on natural killer (NK) and T cells. Its ligand, the human leukocyte antigen E (HLA-E), is overexpressed in squamous cell carcinoma of the head and neck (SCCHN). By targeting the HLA-E-NKG2A pathway, monalizumab may enhance NK and T cell activity. The UPSTREAM trial is a biomarker-driven umbrella trial studying targeted therapies and immunotherapies in patients with recurrent/metastatic (R/M) SCCHN progressing after platinum therapy. The immunotherapy 1 (I1) cohort was a phase II, single-arm substudy evaluating monalizumab (10 mg/kg intravenously on day 1 of a 14-day cycle). The primary end-point was the objective response (OR) rate (Response Evaluation Criteria in Solid Tumours 1.1) over the first 16 weeks. A two-stage Simon design was used (H1 15%, H0 3%, α 8%, power 90%) with pre-planned interruption of accrual if no OR was observed after the first 25 patients. Twenty-six eligible patients were enrolled. Seventeen (65%) patients had received ≥2 previous lines of systemic treatment, and 15 (58%) patients were PD(-L)1 inhibitor pretreated. No OR was observed. Stable disease was observed in 6 patients (23%) with a median duration of 3.8 months (95% confidence interval [CI]: 2.7-NE). The median progression-free survival and overall survival were 1.7 months (95% CI: 1.5-1.8) and 6.7 months (95% CI: 3.0-9.6), respectively. The most frequent treatment-related adverse event was grade I/II fatigue (19%). Monalizumab monotherapy has limited activity in R/M SCCHN. The I1 cohort did not meet its primary objective. Monalizumab combined with durvalumab is under investigation within UPSTREAM.

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Déclaration de conflit d'intérêts

Conflict of interest statement The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: R.G. declares a role in an advisory board without compensation for Innate Pharma and travelling compensation from Amgen and Astellas. E.S-B. has received consulting fees for advisory boards and travelling from BMS and MSD. A.D. has received consulting fees or honorarium from MSD, BMS and Merck and accommodation and travelling expenses for meetings from BMS, Merck and AstraZeneca. C.E. has received consulting fees for advisory boards for BMS, MSD, Innate Pharma and Merck Serono. S.H. declares a consulting or advisory role for AstraZeneca, Merck, Novartis, MSD Oncology, BMS and Sanofi and travelling expenses for meetings from Roche and MSD Oncology. A.K. received fees for consulting, advisory, speaker's roles and/or research funding from PUMA BioTechnology, AstraZeneca, Merck, MSD, Bristol-Myers Squibb and Avvinity Therapeutics. J-P.M. declares a role as an advisory board member or speaker with honoraria (managed by his institution) in Pfizer, Roche, AstraZeneca, Bayer, Innate, Merck Serono, Boehringer, BMS, Novartis, Janssen, Incyte, Cue Biopharma, ALX Oncology, iTEOS and eTheRNA; travel expenses from Amgen, BMS, Pfizer and MSD; a role in the data safety monitoring board with honoraria in PsiOxus and an uncompensated advisory role in MSD. The other authors declare no potential conflicts of interest.