Clinical Trials /

M7824 in Treating Patients With Metastatic or Unresectable Color or Rectal Cancer With Microsatellite Instability

NCT03436563

Description:

This phase Ib/II trial studies how well anti-PD-L1/TGFbetaRII fusion protein M7824 (M7824) works in treating patients with colorectal cancer that has spread to other places in the body or cannot be removed by surgery with microsatellite instability. Immunotherapy with monoclonal antibodies, such as M7824, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread.

Related Conditions:
  • Colorectal Adenocarcinoma
  • Malignant Solid Tumor
Recruiting Status:

Recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: M7824 in Treating Patients With Metastatic or Unresectable Color or Rectal Cancer With Microsatellite Instability
  • Official Title: A Phase Ib/II Trial of M7824 in Solid Tumors With Microsatellite Instability With Consensus Molecular Subtype 4 Metastatic Colorectal Cancer in Combination With Radiation, or in Colorectal Cancer Patients With Detectable Circulating Tumor DNA Following Definitive Therapy

Clinical Trial IDs

  • ORG STUDY ID: 2017-0339
  • SECONDARY ID: NCI-2018-00919
  • SECONDARY ID: 2017-0339
  • SECONDARY ID: P30CA016672
  • NCT ID: NCT03436563

Conditions

  • Colon Adenocarcinoma
  • High-Frequency Microsatellite Instability
  • Metastatic Malignant Solid Neoplasm
  • Rectal Adenocarcinoma
  • Refractory Colorectal Carcinoma
  • Stage IV Colon Cancer AJCC v8
  • Stage IV Rectal Cancer AJCC v8
  • Stage IVA Colon Cancer AJCC v8
  • Stage IVA Rectal Cancer AJCC v8
  • Stage IVB Colon Cancer AJCC v8
  • Stage IVB Rectal Cancer AJCC v8

Interventions

DrugSynonymsArms
Anti-PD-L1/TGFbetaRII Fusion Protein M7824Anti-PDL1/TGFb Trap MSB0011359C, M7824, MSB0011359CTreatment (M7824)

Purpose

This phase Ib/II trial studies how well anti-PD-L1/TGFbetaRII fusion protein M7824 (M7824) works in treating patients with colorectal cancer that has spread to other places in the body or cannot be removed by surgery with microsatellite instability. Immunotherapy with monoclonal antibodies, such as M7824, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread.

Detailed Description

      PRIMARY OBJECTIVES:

      I. To estimate efficacy with objective response rate (ORR) to treatment with M7824.

      SECONDARY OBJECTIVES:

      I. To estimate progression-free survival (PFS) for M7824. II. To estimate overall survival
      (OS) for M7824. III. To evaluate safety and tolerability of treatment with M7824.

      EXPLORATORY OBJECTIVES:

      I. To evaluate intratumoral pharmacodynamic changes in immune populations using paired
      biopsies from patients with microsatellite instability-high (MSI-H) metastatic colorectal
      cancer (mCRC) or consensus molecular subtype 4 (CMS4) mCRC treated with M7824.

      II. To characterize circulating immune cell populations and cytokine profiles in tumor and
      circulation following treatment with M7824.

      III. To describe changes in levels of TGF- beta following treatment with M7824. IV. To
      correlate the presence of microsatellite instability with CMS1 profile. V. To correlate MSI-H
      and CMS4 to CpG island methylator phenotype (CIMP) status, Kirsten rat sarcoma viral oncogene
      homolog (KRAS) and BRAF mutation status.

      VI. To quantify correlation with CMS4 and immune populations within tumor infiltrate.

      VII. To correlate anti-tumor response to M7824 with PD-L1 expression. VIII. To conduct
      ribonucleic acid (RNA) sequencing (seq), RNA scope, whole exome sequencing (WES) targeted
      sequencing and tissue IO gene expression by Nanostring.

      IX. To evaluate novel markers in blood by liquid biopsy including, but not limited to,
      circulating-free deoxyribonucleic acid (DNA) (cfDNA), exosomes, and circulating tumor cells
      (CTC).

      X. To describe changes in microbiome profiling upon treatment with M7824 (with or without
      radiation).

      OUTLINE:

      Patients receive M7824 intravenously (IV) over 1 hour on days 1 and 15. Cycles repeat every
      28 days in the absence of disease progression or unacceptable toxicity.

      After completion of study treatment, patients are followed up at 28 days.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (M7824)ExperimentalPatients receive M7824 IV over 1 hour on days 1 and 15. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
  • Anti-PD-L1/TGFbetaRII Fusion Protein M7824

Eligibility Criteria

        Inclusion Criteria:

          -  Histologically or cytologically confirmed adenocarcinoma of the colon or the rectum
             that is metastatic or unresectable (cohorts A,B); histologically or cytologically
             confirmed carcinoma not originating in the colon or rectum (cohort C); or
             histologically or cytologically confirmed adenocarcinoma of the colon or the rectum
             following resection of the primary tumor and metastatic disease, following completion
             of standard-of-care perioperative therapy at the discretion of the treating provider
             (cohort D).

          -  Confirmation of: a) Cohort A: microsatellite instability in colorectal cancer (CRC);
             b) Cohort B: CMS4 CRC classification on pretreatment primary tumor; c) Cohort C:
             microsatellite instability in non-CRC solid tumor; d. Cohort D: microsatellite
             stability.

          -  Ability to provide written informed consent.

          -  Documented progression to prior therapies (Cohorts A, B, and C): a) Cohort A: Disease
             progression following prior immune checkpoint blockade therapy; b) Cohort B:
             Progression or intolerance to at least 2 prior lines of standard therapy for
             unresectable or metastatic CRC; c) Cohort C: Disease progression following prior
             immune checkpoint blockade therapy.

          -  Available primary tumor tissue for CMS4 biomarker assessment.

          -  Life expectancy >= 12 weeks as judged by the treating physician.

          -  Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.

          -  Measurable disease according to Response Evaluation Criteria in Solid Tumors (RECIST)
             version (v) 1.1(Cohorts A, B, and C). For cohort B, measureable lesions must be
             identified apart from the irradiated tumor lesion. Patients in cohort D must have no
             evidence of radiographically evident disease at the time of study entry.

          -  Absolute neutrophil count (ANC) >= 1.5 x 10^9/L (in absence of blood transfusion).

          -  Lymphocyte count >= 0.5 x 10^9/L (in absence of blood transfusion).

          -  Platelet count >= 100 x 10^9/L (in absence of blood transfusion).

          -  Hemoglobin (Hgb) >= 9 g/dL (in absence of blood transfusion).

          -  Total bilirubin level =< 1.5 x the upper limit of normal (ULN).

          -  An aspartate aminotransferase (AST) level =< 2.5 x ULN, and an alanine
             aminotransferase (ALT) level =< 2.5 x ULN. If liver metastases are present, then it is
             acceptable for AST level =< 5.0 x ULN, and an ALT level =< 5.0 x ULN.

          -  International normalized ratio (INR) < 1.5.

          -  An estimated creatinine clearance > 30 mL/min according to the Cockcroft-Gault formula
             or be measure for creatinine clearance from 24-hour urine collection.

          -  Highly effective contraception for both male and female subjects if the risk of
             conception exists. Highly effective contraception must be used 30 days prior to first
             trial administration, for the duration of trial treatment, and at least for 4 months
             after stopping trial treatment. Should a woman become pregnant or suspect she is
             pregnant while she or her partner is participating in this trial, the treating
             physician should be informed immediately.

          -  Ability to tolerate receipt of radiotherapy to a metastasis not adjacent to a normal
             dose-limiting structure, at the discretion of the treating radiation oncologist
             (cohort B).

          -  Presence of detectable ctDNA following completion of R0 resection with or without
             perioperative therapy, with confirmation of somatic mutations in the resected tumor
             (cohort D only).

          -  Completion of all standard-of-care adjuvant therapy (cohort D).

        Exclusion Criteria:

          -  Concurrent treatment with non-permitted drugs and other interventions.

          -  Anticancer treatment within 14 days before the start of trial treatment (e.g.,
             cytoreductive therapy, radiotherapy [with the exception of palliative radiotherapy
             delivered in a normal organ-sparing technique], immune therapy, or cytokine therapy).

          -  Major surgery as determined by the investigator within 28 days before the start of
             trial treatment (prior diagnostic biopsy is permitted).

          -  Systemic therapy with immunosuppressive agents within 7 days before the start of
             treatment; or use of any investigational drug within 28 days before the start of trial
             treatment.

          -  Cohort A and C only: Intolerance or serious adverse immune related adverse events
             (irAEs) that were symptomatic or required or continues to require ongoing
             immunosuppression to previous immune checkpoint therapy.

          -  Cohort B and D: prior exposure to any immune checkpoint blockade agent or any other
             immunomodulatory agent used for antineoplastic therapy for mCRC.

          -  Previous malignant disease (other than the target malignancy to be investigated in
             this trial) within 3 years prior to study treatment initiation. Subjects with a
             history of cervical carcinoma in situ, superficial or non-invasive bladder cancer, or
             basal cell or squamous cell carcinoma in situ, previously treated with curative intent
             are NOT excluded. Subjects with other localized malignancies treated with curative
             intent need to be discussed with the principal investigator.

          -  Subjects with active central nervous system (CNS) metastases are excluded. Subjects
             with a history of treated CNS metastases (by surgery or radiation therapy) are not
             eligible unless they have fully recovered from treatment, demonstrated no progression
             for at least 2 months, and do not require continued steroid therapy.

          -  Receipt of any organ transplantation, including allogeneic stem-cell transplantation,
             but with the exception of transplants that do not require immunosuppression (e.g.,
             corneal transplant, hair transplant).

          -  Significant acute or chronic infections including, among others: a) Known history of
             testing positive test for human immunodeficiency virus (HIV) or known acquired
             immunodeficiency syndrome; b) Hepatitis B virus (HBV) or hepatitis C virus (HCV)
             infection (HBV surface antigen positive and HBV core antibody positive with reflex to
             positive HBV DNA or HBV core antibody positive alone with reflex to positive HBV DNA
             or positive HCV antibody with reflex to positive HCV ribonucleic acid [RNA]); c)
             Subjects with active tuberculosis (history of exposure or history of positive
             tuberculosis test plus presence of clinical symptoms, physical or radiographic
             findings).

          -  Active autoimmune disease that might deteriorate when receiving an immunostimulatory
             agent: a) Subjects with type I diabetes, vitiligo, alopecia, psoriasis, hypo- or
             hyperthyroid disease not requiring immunosuppressive treatment are eligible; b)
             Subjects requiring hormone replacement with corticosteroids are eligible if the
             steroids are administered only for the purpose of hormonal replacement and at doses =<
             10 mg of prednisone or equivalent per day; c) Administration of steroids for other
             conditions through a route known to result in a minimal systemic exposure (topical,
             intranasal, intro-ocular, or inhalation) is acceptable.

          -  Known severe hypersensitivity reactions to monoclonal antibodies (grade >= 3 National
             Cancer Institute [NCI]-Common Terminology Criteria for Adverse Events [CTCAE] v4.03),
             any history of anaphylaxis, or recent (within 5 months) history of uncontrolled
             asthma.

          -  Persisting toxicity (except alopecia and vitiligo) related to prior oncologic therapy
             grade > 1 NCI-CTCAE v4.03, however, sensory neuropathy grade =< 2 is acceptable.

          -  Clinically significant cardiovascular/ cerebrovascular disease as follows: cerebral
             vascular accident / stroke (< 6 months prior to enrollment), myocardial infarction (<
             6 months prior to enrollment), unstable angina, congestive heart failure (New York
             Heart Association Classification class > II), or serious cardiac arrhythmia.

          -  Clinically relevant diseases (for example, inflammatory bowel disease) and / or
             uncontrolled medical conditions, which, in the opinion of the Investigator, might
             impair the subject's tolerance or ability to participate in the trial.

          -  Vaccine administration within 4 weeks of M7824 administration. Vaccination with live
             vaccines while on trial is prohibited. Administration of inactivated vaccines is
             allowed (for example, inactivated influenza vaccines).

          -  Cohort D: peritoneal carcinomatosis.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Objective Response Rate (ORR)
Time Frame:Baseline up to 12 months
Safety Issue:
Description:ORR confirmed according to RECIST 1.1.

Secondary Outcome Measures

Measure:Progression-Free Survival (PFS)
Time Frame:Baseline up to 2 years
Safety Issue:
Description:PFS determined according to RECIST 1.1.
Measure:Overall Survival (OS)
Time Frame:Baseline up to 2 years
Safety Issue:
Description:
Measure:Adverse Events of Treatment with M7824
Time Frame:Start of study treatment up to 28 days after end of treatment
Safety Issue:
Description:Adverse events confirmed per NCI-CTCAE v4.03.

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:M.D. Anderson Cancer Center

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