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

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