PDE5 Inhibition Via Tadalafil to Enhance Anti-Tumor Mucin 1 (MUC1) Vaccine Efficacy in Patients With HNSCC
PDE5 Inhibition Via Tadalafil to Enhance Anti-Tumor Mucin 1 (MUC1) Vaccine Efficacy in Patients With HNSCC
The investigators hypothesize that Tadalafil treatment, by lowering Myeloid Derived
 Suppressor Cells (MDSCs) and regulatory T cells (Tregs), can prime an antitumor immune
 response and promote a permissive environment that should increase the efficacy of anti-tumor
 vaccine in a setting of minimal residual disease.
This study is halting accrual at the end of the phase 1 portion of the study as data from the
 phase I study suggest that an alternative approach for the phase 2 portion of the study be
 undertaken. A newly designed Phase II trial is being developed and will be submitted as a new
 study protocol.
Inclusion Criteria:

 1. Biopsy-proven recurrent or second primary HNSCC of the oral cavity, oropharynx,
 hypopharynx or larynx (second primary includes unknown primary)

 2. Stage III or IV (AJCC, 7th ed., 2010) recurrent or second primary HNSCC (For recurrent
 tumors, staging is determined by the recurrent stage, not by the original pretreatment
 stage.)

 3. Surgically resectable, recurrent or second primary HNSCC

 4. Prior radiation, with or without prior surgery and/or chemotherapy, to the head and
 neck for definitive treatment of HNSCC of the oral cavity, oropharynx, hypopharynx or
 larynx with previously documented complete clinical or radiographic response to
 initial treatment

 -  a. Prior radiation and any chemotherapy, must have been completed >4 months prior
 to biopsy-proven recurrence or second primary site disease

 -  b. Recurrent or second primary HNSCC arises within the previously irradiated
 field

 5. Age ≥ 18 years

 6. Eastern Cooperative Oncology Group (ECOG) Performance Status of 0, 1 or 2 or
 equivalent scale score. See Appendix D for equivalent scale criteria.

 7. Acceptable organ function as defined by all of the following:

 -  Alkaline phosphatase < 4.0 x upper limit of normal (ULN)

 -  Aspartate transaminase (AST) ≤ 2.5 x ULN

 -  Alanine transaminase (ALT) ≤ 2.5 x ULN

 -  calculated Creatinine Clearance ≥ 51ml/min as determined by the Cockcroft-Gault
 Equation:

 -  [(140-age) * (Weight in kg) * (0.85, if female)] / (72 * Cr)

 8. Suitable venous access to allow for all study related blood sampling (safety and
 research)

 9. Ability to understand and willingness to sign the written informed consent and Health
 Insurance Portability and Accountability Act (HIPAA) document/s.

 Inclusion Criteria (non-randomized control)

 1. Biopsy-proven recurrent or second primary HNSCC of the oral cavity, oropharynx,
 hypopharynx or larynx (second primary includes unknown primary)

 2. Stage III or IV (AJCC, 7th ed., 2010) recurrent or second primary HNSCC (For recurrent
 tumors, staging is determined by the recurrent stage, not by the original pretreatment
 stage.)

 3. Surgically resectable, recurrent or second primary HNSCC

 4. Prior radiation with or without prior surgery and/or chemotherapy, to the head and
 neck for definitive treatment of HNSCC of the oral cavity, oropharynx, hypopharynx or
 larynx with previously documented complete clinical or radiographic response to
 initial treatment

 -  a. Prior radiation and any chemotherapy, must have been completed >4 months prior
 to biopsy-proven recurrence or second primary site disease

 -  b. Recurrent or second primary HNSCC arises within the previously irradiated
 field

 5. Age ≥18 years

 6. Eastern Cooperative Oncology Group (ECOG) Performance Status of 0, 1 or 2 or
 equivalent scale score.

 7. Suitable venous access to allow for all study related blood sampling (safety and
 research)

 8. Ability to understand and willingness to sign the written informed consent and HIPAA
 document/s.

 Exclusion Criteria:

 1. Salvage surgery is not recommended as per National Comprehensive Cancer Network (NCCN)
 guidelines, or after multidisciplinary treatment evaluation, including those with
 surgically unresectable disease at primary site or regional lymph nodes

 2. Recurrent or second primary AJCC Stage I or II HNSCC (for recurrent tumors, staging is
 determined by the recurrent stage, not by the original pretreatment stage).

 3. Distant metastatic disease

 4. Recurrent or second primary HNSCC of the nasopharynx, paranasal sinuses, or cervical
 esophagus

 5. Use of Phosphodiesterase Type 5 (PDE5) inhibitors such as vardenafil (Levitra®),
 Tadalafil (Cialis®), and sildenafil citrate (Viagra®) ≤15-days prior to (intended)
 enrollment

 6. Patients who have the intention to receive non-study PDE5 inhibitors and flu
 vaccination(s) anytime during the study will be excluded.

 7. Prior or known adverse reactions to PDE5 inhibitors, poly-ICLC (Hiltonol®), and prior
 dose(s) of Influenza vaccine including but not limited to their components

 8. History of severe or unstable cardiac or cerebrovascular disease:

 -  a. Myocardial infarction within the last 90 days

 -  b. Unstable angina or angina occurring during sexual intercourse

 -  c. New York Heart Association (NYHA) Class 2 or greater heart failure in the last
 3 months.

 -  d. Uncontrolled arrhythmias

 -  e. Sustained hypotension (<90/50 mmHg) or uncontrolled Hypertension (>170/100
 mmHg)

 -  f. Stroke within the last 6 months

 9. Therapy with nitrates, alpha-blockers, or cytochrome P450 (CYP3A4) inhibitors within
 7-days prior to study treatment initiation and for whom stopping is unsafe and/or a
 safe substitute is not medically recommended. Some examples are provided in Appendix
 A.

 10. Positive Antinuclear Antibody Test (ANA)

 11. Immunosuppression or immunocompromised for reasons not directly related to patient's
 malignancy (e.g. HIV or kidney transplant)

 12. History of severe or life threatening autoimmune diseases [Exceptions: Mild autoimmune
 diseases determined at the discretion of the Investigator(s), e.g. psoriasis.]

 13. Unilateral blindness, hereditary retinal disorders, or at an increased risk of
 blindness

 14. Unilateral deafness, or severe hearing loss dependent upon hearing aid(s) for
 serviceable communication

 15. Female patients who are pregnant or breastfeeding. (Females of childbearing potential
 are required to have a negative urine β-human chorionic gonadotropin (β-hCG) pregnancy
 test result obtained during screening; pregnancy testing is not required for
 post-menopausal or surgically sterilized women.)

 16. Females of childbearing potential who refuse to practice effective methods of
 contraception or abstain from heterosexual intercourse from the time of signing the
 informed consent through 30-days after the last vaccination.

 17. Serious medical or psychiatric illness/condition, including alcohol or drug abuse
 likely in the judgment of the Investigator(s) to interfere with compliance to protocol
 treatment/research.

 18. Patients of vulnerable populations such as children less than 18 years of age,
 prisoners, institutionalized individuals or others likely to be vulnerable are not
 eligible for participation in this study.

 Exclusion Criteria (non-randomized control)

 1. Salvage surgery is not recommended as per NCCN guidelines, or after multidisciplinary
 treatment evaluation, including those with surgically unresectable disease at primary
 site or regional lymph nodes

 2. Recurrent or second primary AJCC Stage I or II HNSCC (for recurrent tumors, staging is
 determined by the recurrent stage, not by the original pretreatment stage).

 3. Distant metastatic disease

 4. Recurrent or second primary HNSCC of the nasopharynx, paranasal sinuses, or cervical
 esophagus

 5. Use of PDE5 inhibitors such as vardenafil (Levitra®), Tadalafil (Cialis®), and
 sildenafil citrate (Viagra®) ≤15-days prior to (intended) enrollment

 6. Patients who have the intention to receive non-study PDE5 inhibitors and flu
 vaccination(s) anytime during the study will be excluded.

 7. Positive Antinuclear Antibody Test (ANA)

 8. Immunosuppression or immunocompromised for reasons not directly related to patient's
 malignancy (e.g. HIV or kidney transplant)

 9. History of severe or life threatening autoimmune diseases [Exceptions: Mild autoimmune
 diseases determined at the discretion of the Investigator(s), e.g. psoriasis.]