Clinical Trials /

Cabozantinib in Combination With Durvalumab in Patients With Gastroesophageal Cancer and Other Gastrointestinal Malignancies

NCT03539822

Description:

The investigators propose to evaluate cabozantinib in combination with durvalumab in patients with advanced gastroesophageal cancer and other gastrointestinal (GI) malignancies. Finding effective novel therapies for patients with advanced gastric cancer and other GI malignancies is an area of great unmet need. The investigators believe that modulating the tumor microenvironment with biologic agents like cabozantinib will have synergistic effect when combined with checkpoint-based immunotherapeutics like durvalumab in this patient population. This is a phase I/II, open label, multi-cohort trial looking at safety, tolerability and efficacy endpoints.

Related Conditions:
  • Adenocarcinoma of the Gastroesophageal Junction
  • Colorectal Adenocarcinoma
  • Esophageal Adenocarcinoma
  • Gastric Adenocarcinoma
  • Hepatocellular Carcinoma
Recruiting Status:

Recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Cabozantinib in Combination With Durvalumab in Patients With Gastroesophageal Cancer and Other Gastrointestinal Malignancies
  • Official Title: A Phase I/II Trial of Cabozantinib in Combination With Durvalumab (MEDI4736) in Patients With Advanced Gastroesophageal Cancer and Other Gastrointestinal (GI) Malignancies (CAMILLA)

Clinical Trial IDs

  • ORG STUDY ID: IIT-2017-Cabozant+DurvaGI
  • NCT ID: NCT03539822

Conditions

  • Gastric Cancer
  • Esophageal Adenocarcinoma
  • Hepatocellular Carcinoma
  • Colorectal Cancer

Interventions

DrugSynonymsArms
Cabozantinibmulti-tyrosine kinase InhibitorCabozantinib combined with Durvalumab
Durvalumabanti-Programmed cell death protein 1 (PD-L1) inhibitorCabozantinib combined with Durvalumab

Purpose

The investigators propose to evaluate cabozantinib in combination with durvalumab in patients with advanced gastroesophageal cancer and other gastrointestinal (GI) malignancies. Finding effective novel therapies for patients with advanced gastric cancer and other GI malignancies is an area of great unmet need. The investigators believe that modulating the tumor microenvironment with biologic agents like cabozantinib will have synergistic effect when combined with checkpoint-based immunotherapeutics like durvalumab in this patient population. This is a phase I/II, open label, multi-cohort trial looking at safety, tolerability and efficacy endpoints.

Trial Arms

NameTypeDescriptionInterventions
Cabozantinib combined with DurvalumabExperimentalCabozantinib By mouth (PO) once daily on days 1-28 of every 28 day cycle Dose will be 60mg Durvalumab *Flat dose of 1500mg intravenous (IV) Infusion on day 1 of every 28 day cycle
  • Cabozantinib
  • Durvalumab

Eligibility Criteria

        Inclusion Criteria:

          1. Age ≥ 18 years

          2. Eastern Cooperative Oncology Group (ECOG) Performance Status 0-1

          3. Histologically confirmed diagnosis of any of the following:

             • Gastric or gastroesophageal junction adenocarcinomaEsophageal adenocarcinomaColorectal adenocarcinoma (CRC)

               -  Hepatocellular carcinoma (HCC)

          4. Patients should have advanced (stage 4) or locally unresectable (stage III) disease.

          5. Patients must have measurable disease per Response Evaluation Criteria in Solid Tumors
             (RECIST) version 1.1

          6. Patients must consent to undergo a required screening/baseline biopsy procedure (and
             potentially another tumor biopsy at time of disease response and progression) for
             correlative testing.

          7. Patients with gastric, gastroesophageal, or esophageal adenocarcinoma must show
             evidence of progression or intolerance to at least two previous standard of care
             systemic therapy.

          8. Patients with CRC must show evidence of progression or intolerance to at least 2
             previous standard of care systemic therapy. Ras wild type patients should fail
             epidermal growth factor receptor (EGFR) monoclonal antibody (panitumumab or cetuximab)
             to be eligible.

          9. Patients with HCC must must be treatment naive or show evidence of disease progression
             or intolerance to at least 1 previous standard of care systemic therapy.

         10. Adequate organ and marrow function.

         11. Evidence of post-menopausal status or negative urinary or serum pregnancy test for
             female pre-menopausal patients.

         12. Women of child-bearing potential and men with partners of child-bearing potential must
             agree to use the highly effective forms of contraception prior to study entry, for the
             duration of study participation, and for 180 Days post completion of therapy. Men of
             child-bearing potential must not donate sperm while on this study and for 180 Days
             after their last study treatment.

        Exclusion Criteria:

          1. Prior randomization or treatment in a previous durvalumab and/or tremelimumab clinical
             study regardless of treatment arm assignment (HCC patients fulfilling this criterion
             are eligible).

          2. Prior treatment with a Programmed cell death protein 1 (PD1) or (PD-L1) inhibitor,
             including durvalumab, or anti PD-L2 (HCC patients with prior exposure to these agents
             are eligible).

               -  Prior treatment with cabozantinib or other Receptor for hepatocyte growth factor
                  (MET) or Dual MET/ Hepatocyte growth factor (HGF) monoclonal antibodies or
                  MET/HGF tyrosine kinase inhibitors (TKIs), including crizotinib, foretinib,
                  tivantinib, rilotumumab, and onartuzumab.

          3. Abdominal fistula, GI perforation, bowel obstruction, or intra-abdominal abscess
             within 6 months before first dose.

             * Evidence of tumor invading the GI tract, (Defined as T4 primary tumor in patients
             with gastric, gastroesophageal and esophageal adenocarcinoma and CRC).

          4. Evidence of active peptic ulcer disease, inflammatory bowel disease (eg, Crohn's
             disease), diverticulitis, cholecystitis, symptomatic cholangitis or appendicitis,
             acute pancreatitis, acute obstruction of the pancreatic duct or common bile duct, or
             gastric outlet obstruction.

          5. Inability to swallow tablets.

          6. Uncontrollable ascites or pleural effusion.

          7. Cavitating pulmonary lesion(s) or known endotracheal or endobronchial disease
             manifestation.

          8. Clinically significant hematuria, hematemesis, or hemoptysis of >0.5 tsp (2.5ml) of
             red blood, or other history of significant bleeding within 12 weeks.

             * Any sign indicative of pulmonary hemorrhage within 3 months.

               -  Lesions invading any major blood vessels. HCC subjects with lesions invading the
                  hepatic portal vasculature are eligible.

          9. Any unresolved toxicity CTCAE Grade ≥2 from previous anticancer therapy

         10. Radiotherapy treatment to more than 30% of the bone marrow or with a wide field of
             radiation within 4 weeks of the first dose of study drug

         11. Major surgery (eg, Gastrointestinal (GI) surgery, removal or biopsy of brain
             metastasis) within 8 weeks before first dose of study treatment.

         12. Current or prior use of immunosuppressive medication within 14 days before the first
             dose of durvalumab, with the exceptions of intranasal and inhaled corticosteroids or
             systemic corticosteroids at physiological doses.

         13. History of allogenic organ transplantation.

         14. Active or prior documented autoimmune or inflammatory disorders

         15. History of active primary immunodeficiency

         16. Active infection including tuberculosis, hepatitis B, hepatitis C, or human
             immunodeficiency virus. HCC patients with hepatitis B or C infection are allowed per
             protocol specific criteria.

         17. Receipt of live attenuated vaccine within 30 days prior to the first dose.

         18. Uncontrolled hypertension defined as sustained blood pressure (BP) > 150 millimeter of
             mercury (mm Hg) systolic or > 100 mm Hg diastolic despite optimal antihypertensive
             treatment.

         19. Stroke, including transient ischemic attack (TIA), myocardial infarction (MI), or
             other ischemic event, or thromboembolic event (eg, deep venous thrombosis, pulmonary
             embolism) within 6 months before first dose. Participants with a diagnosis of deep
             venous thrombosis (DVT) within 6 months are allowed if stable, asymptomatic, and
             treated with Low Molecular Weight Heparin (LMWH) for at least 2 weeks before first
             dose.

         20. Has untreated central nervous system (CNS) metastases and/or carcinomatous meningitis

         21. Clinically significant disorders that would preclude safe study participation.

         22. History of another primary malignancy except for:

               -  Malignancy treated with curative intent/ resection and with no known active
                  disease before the first dose of investigational product (IP) and of low
                  potential risk for recurrence.

               -  Adequately treated non-melanoma skin cancer or lentigo maligna without evidence
                  of disease.

               -  Adequately treated carcinoma in situ without evidence of disease.

        24. Concomitant anticoagulation with oral anticoagulants (e.g., warfarin, direct thrombin
        and Factor Xa inhibitors) or platelet inhibitors (e.g., clopidogrel). Allowed
        anticoagulants are the following:

          1. Low-dose aspirin for cardioprotection (per local applicable guidelines) is permitted.

          2. Low-dose (prophylactic) low molecular weight heparins (LMWH) are permitted.

          3. Anticoagulation with therapeutic doses of LMWH is allowed in subjects with no known
             brain metastases, clinically significant hemorrhage, or complications from a
             thromboembolic event on the anticoagulation regimen (subjects with HCC must also have
             a screening platelet count >100,000/μl), and who have been on a stable dose of LMWH
             for at least 1 week before first dose.

             25. Known allergy or hypersensitivity to any of the study drugs or any of the study
             drug excipients.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Phase I- Maximum Tolerated Dose (MTD)
Time Frame:9 months
Safety Issue:
Description:Defined as the highest dose studied for which the observed incidence of dose limiting toxicities (DLT) is less than 33%. Determined per Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.

Secondary Outcome Measures

Measure:Proportion of participants with adverse events (AEs).
Time Frame:18 months
Safety Issue:
Description:Determined per Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
Measure:Overall Benefit Rate (OBR)
Time Frame:18 months
Safety Issue:
Description:Defined as the proportion of patients with overall benefit to therapy. Overall benefit is defined as the best response recorded, (including complete Response (CR), Partial Response (PR), and Stable Disease (SD)), from the start of the treatment until the end of treatment. Determined per Modified Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1.
Measure:Progression Free Survival (PFS)
Time Frame:24 months
Safety Issue:
Description:Defined as the time from the start of treatment until the first documentation of disease progression or death due to any cause, whichever occurs first. Determined per Modified Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1.
Measure:Overall Survival (OS)
Time Frame:24 months
Safety Issue:
Description:Defined as the time from the start of treatment until death due to any cause. Determined per Modified Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1.

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Anwaar Saeed

Trial Keywords

  • Cabozantinib
  • Durvalumab
  • MEDI4736

Last Updated

November 10, 2020