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Two Combination Treatment Regimens of Nivolumab and Ipilimumab in Patients With dMMR and / or MSI mCRC.

Recruiting
18 years of age
Both
Phase 2

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Overview

NIPISAFE is open-label, phase II study to identify a combination scheme of nivolumab and ipilimumab with a high level of clinical activity, but with a lower toxicity in MSI/dMMR metastatic colorectal cancer patients.

Description

This is a randomized non-comparative two-stage phase II study with a co-primary endpoint (toxicity and progression-free survival) to evaluate two different schemes of the nivolumab and ipilimumab combination in terms of the toxicity and efficacy in MSI/dMMR metastatic colorectal cancer patients in order to identify a combination scheme with a higher level of clinical activity and a lower toxicity.

Patients will be randomized in a 2:1 ratio to receive one of the following treatments:

Experimental ARM A: Nivolumab 480 mg every 4 weeks and ipilimumab 1 mg/kg every 6 weeks for a total of 24 months of treatment Control ARM B: Nivolumab 240 mg and ipilimumab 1 mg/kg every 3 weeks for 4 dosing cycles.

Maintenance of 96 weeks: Nivolumab 480 mg every 4 weeks for 24 dosing cycles for a total of 24 months of treatment (or less in case of RECIST PD or limiting toxicity, whichever occurs first).

Eligibility

Inclusion Criteria:

  1. Signed and dated patient informed consent form and willingness to comply with all study procedures and availability for the study duration,
  2. Age ≥ 18 years,
  3. Eastern Cooperative Oncology Group performance status (ECOG PS) of 0, 1, or 2,
  4. Histologically or cytologically confirmed colorectal adenocarcinoma,
  5. Documented advanced or metastatic disease not suitable for complete surgical resection,
  6. At least one measurable lesion as assessed by CT-scan or magnetic resonance imaging (MRI) according to RECIST v1.1 and feasibility of repeated radiological assessments. Participants with lesions in a previously irradiated field as the sole site of measurable disease will be permitted to enroll provided the lesion(s) have demonstrated clear progression and can be measured accurately,
  7. Deficient mismatch repair (dMMR) and/or Microsatellite instability (MSI) tumor status defined by:
    • Loss of MMR protein expression using immunohistochemistry with four (anti-MLH1, anti-MSH2, anti-MSH6, and anti-PMS2) antibodies Nota Bene (NB): if loss of only one protein, necessary to have Polymerase Chain Reaction (PCR)
    • and/or ≥ two instable markers by pentaplex polymerase chain reaction (BAT-25, BAT-26, NR-21, NR-24, and NR-27), NB: if two instable markers in the pentaplex panel, it is required to present confirmation of the dMMR status by immunohistochemistry or a comparison of the tumor PCR test with matched normal tissue.
             NB: Agreement of the Sponsor (GERCOR) is mandatory to include the patient (the
             patient's file will be verified to confirm MSI/dMMR status before inclusion [an
             anonymized fax] and confirmation of a patient's allocation will be sent by mail to the
             Investigator within 24h),
          8. No or one prior line of systemic treatment for metastatic disease:
               -  No prior systemic treatment; if patient received neoadjuvant/adjuvant therapy
                  this therapy should be completed > 6 months prior the diagnosis of metastatic or
                  recurrent disease is made,
               -  Maximum one prior line of systemic treatment; if patient received one prior line
                  of systemic therapy in the metastatic setting and experienced progression or
                  patient received neoadjuvant/adjuvant therapy and experienced recurrence within ≤
                  6 months after completion of therapy,
          9. Availability of a representative tumor specimen for exploratory translational
             research; tumor tissue specimens, either formalin-fixed, paraffin-embedded (FFPE)
             tissue block or unstained tumor tissue sections (minimum of 30 positively charged
             slides) from primary or metastatic site must be submitted to the central laboratory,
         10. Adequate hematologic and end-organ function, defined by the following laboratory test
             results, obtained within 14 days prior to initiation of study treatment:
             - Hematological status: White blood cell > 2000/µL; Neutrophils > 1500/µL; Platelets >
             100.000/µL; Hemoglobin > 9.0 g/dL;
             - Adequate renal function: Serum creatinine level < 150 µM;
             - Adequate liver function: Serum bilirubin ≤ 1.5 x upper normal limit (ULN); Alkaline
             phosphatase (ALP) ≤ 3 x ULN; Alanine aminotransferase (ALT) ≤ 3.0 x ULN ; Aspartame
             aminotransferase (AST) ≤ 3.0 x ULN; Prothrombin time (PT)/International normalized
             ratio (INR) and partial PT (PTT) ≤ 1.5 x ULN unless participants are receiving
             anticoagulant therapy and their INR is stable and within the recommended range for the
             desired level of anticoagulation,
         11. Females of childbearing potential must have negative serum pregnancy test within 7
             days before starting study treatment,
         12. Women of childbearing potential should use effective contraception during treatment
             and 5 months thereafter. Males should use condoms during treatment and 7 months
             thereafter,
         13. Registration in a national health care system ( "Protection Universelle Maladie"
             (PUMa) included).
        Exclusion Criteria:
          1. Known brain metastases or leptomeningeal metastases,
          2. Persistence of toxicities related to prior chemotherapies grade > 1 (NCI CTCAE v5.0;
             except alopecia, fatigue, or peripheral sensory neuropathy, which can be grade 2),
          3. Concomitant unplanned antitumor therapy (e.g. chemotherapy, molecular targeted
             therapy, radiotherapy, immunotherapy),
          4. Major surgical procedure within 4 weeks prior to initiation of study treatment,
          5. Prior treatment with an anti-PD1, anti-programmed death (PD)-L1, anti-PD-L2,
             anti-cytotoxic T-lymphocyte-associated (CTLA)-4 antibody, or any other antibody or
             drug specifically targeting T-cell co-stimulation or immune checkpoint pathways,
             including prior therapy with anti-tumor vaccines or other immuno-stimulatory antitumor
             agents,
          6. Patients receiving any investigational drug, biological, immunological therapy within
             the previous 28 days before study treatment,
          7. Impossibility of submitting to the medical follow-up of the study for geographical,
             social or psychic reasons,
          8. Patients with an active, known or suspected autoimmune disease. Patients with type I
             diabetes mellitus, hypothyroidism only requiring hormone replacement, skin disorders
             (such as vitiligo, psoriasis, or alopecia) not requiring systemic treatment, or
             conditions not expected to recur in the absence of an external trigger are permitted
             to be enrolled,
          9. History of interstitial lung disease or pneumonitis,
         10. Patients with a condition requiring systemic treatment with either corticosteroids
             (>10 mg daily prednisone or equivalent) or other immunosuppressive medications within
             14 days of randomization. Inhaled or topical steroids, and adrenal replacement steroid
             doses >10 mg daily prednisone or equivalent are permitted in the absence of active
             autoimmune disease,
         11. Prior malignancy active within the previous 3 years, except for:
               -  Locally curable cancers that have been apparently cured (e.g. squamous cell skin
                  cancer, superficial bladder cancer, or carcinoma in situ of the prostate, cervix,
                  or breast);
               -  Lynch syndrome-related non-colorectal cancer in complete remission for > 1 year;
         12. Active hepatitis B (defined as having a positive hepatitis B surface antigen [HBsAg]
             test prior to randomization) virus (HBV) or hepatitis C virus (HCV), or human
             immunodeficiency virus (HIV) infection. Patients with past HBV infection or resolved
             HBV infection (defined as having a negative HBsAg test and a positive antibody to
             hepatitis B core antigen antibody test) are eligible. Patients positive for HCV
             antibody are eligible only if polymerase chain reaction testing is negative for HCV
             ribonucleic acid.
         13. Prior allogeneic bone marrow transplantation or prior solid organ transplantation,
         14. Any serious or uncontrolled medical disorder that, in the opinion of Investigator, may
             increase the risk associated with study participation or study drug administration,
             impair the ability of the participant to receive protocol therapy, or interfere with
             the interpretation of study results,
         15. Known allergy/hypersensitivity to any component of study agents,
         16. Administration of a (attenuated) live vaccine within 28 days of planned start of study
             therapy of known need for this vaccine during treatment,
         17. Patient on tutelage or guardianship or under the protection of justice.

Study details

Colorectal Cancer Metastatic, MSI-H Colorectal Cancer

NCT04730544

GERCOR - Multidisciplinary Oncology Cooperative Group

25 January 2024

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