Clinical Trials /

INNATE: Immunotherapy During Neoadjuvant Therapy for Rectal Cancer

NCT04130854

Description:

Determine the complete pathologic complete response (pCR) rate in patients with locally advanced rectal adenocarcinoma.

Related Conditions:
  • Rectal Adenocarcinoma
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: INNATE: Immunotherapy During Neoadjuvant Therapy for Rectal Cancer
  • Official Title: INNATE: Immunotherapy During Neoadjuvant Therapy for Rectal Cancer, a Phase II Randomized Multi-center Trial With and Without APX005M, an Anti-CD40 Agonist

Clinical Trial IDs

  • ORG STUDY ID: STU 2019-1492
  • NCT ID: NCT04130854

Conditions

  • Locally Advanced Rectal Adenocarcinoma

Interventions

DrugSynonymsArms
APX005M, mFOLFOX, and Radiation Therapy 5Gy x 5 daysAPX005M on day 3 of RT & day 3 of cycles 1-5 of mFOLFOX
mFOLFOX and Radiation Therapy 5Gy x 5 daysRadiation Therapy 5Gy x 5 days, mFOLFOX

Purpose

Determine the complete pathologic complete response (pCR) rate in patients with locally advanced rectal adenocarcinoma.

Detailed Description

      A phase II randomized trial 3:2 with short course radiotherapy followed by mFOLFOX
      chemotherapy prior to trans abdominal resection with or without an antiCD40 agonist antibody
      (APX005M). There will be continuous safety assessment for at least 6 patients. Planned
      accrual of 58 patients. An interim analysis after 30 patients have completed treatment and
      there will be early stopping criteria for futility or efficacy. Short course radiotherapy
      will consist of 5Gy x 5 to the pelvis and patients on APX005M arm will receive one infusion
      during radiotherapy course, have a two week break, then start FOLFOX with APX005M in
      conjunction with five out of six cycles of chemotherapy. Patients will be restaged and then
      undergo definitive surgery.
    

Trial Arms

NameTypeDescriptionInterventions
APX005M on day 3 of RT & day 3 of cycles 1-5 of mFOLFOXExperimentalOn Day 3 of Cycles 1-5 of each mFOLFOX treatment, participants will receive another dose of APX005M. The sequence of administration of APX005M in combination with mFOLFOX. In Cycle 6, participants will receive only mFOLFOX. After completing the last planned dose of mFOLFOX, participants will be considered off-protocol directed therapy and undergo planned TME, per institutional standards, and proceed to the follow-up portion of this study.
  • APX005M, mFOLFOX, and Radiation Therapy 5Gy x 5 days
Radiation Therapy 5Gy x 5 days, mFOLFOXActive ComparatorParticipants randomized to Arm 2 will receive short-course RT and mFOLFOX regimen, except that participants will not receive any of the study drug. After completing the last planned dose of mFOLFOX, participants will be considered off-protocol directed therapy and undergo planned TME, per institutional standards, and proceed to the follow-up portion of this study.
  • mFOLFOX and Radiation Therapy 5Gy x 5 days

Eligibility Criteria

        Inclusion Criteria:

          1. At least 18 years of age. Both men and women and members of all races and ethnic
             groups will be included.

          2. Willing and able to provide written informed consent

          3. Pathologic diagnosis of rectal adenocarcinoma

          4. Stage III or Stage II with at least 1 of the following high-risk features:

               -  Distal (<1cm from anal ring)

               -  cT4 or within 3mm of MR fascia

               -  Not candidate for sphincter preservation

               -  Extramural venous invasion

          5. No prior treatment for rectal adenocarcinoma

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

          7. Laboratory values supporting acceptable organ and marrow function within 21 days of
             eligibility confirmation. Defined as follows:

               -  WBC ≥ 3,000/mL;

               -  ANC WBC ≥ 1,500/mL;

               -  PLT ≥ 100,000/mL;

               -  T Bili ≤ 1.5 x upper limit of normal (ULN);

               -  AST/ALT ≤ 2.5 x ULN;

               -  Creatinine not above ULN, or creatinine clearance ≥60 mL/min/1.73 m2 for
                  participants with creatinine levels above institutional normal.

          8. Female participants of childbearing potential (FOCBP) must have a negative serum or
             urine pregnancy test (per institutional standards) within 72 hours prior to the start
             of study drug.

             FOCBP must agree to use highly-effective method(s) of contraception (Appendix A)
             during the study and for 90 days after the last dose of study drugs.

             FOCBP are those who have not been surgically sterilized or have not been free from
             menses for >1 year without an alternative medical cause.

          9. Male participants must agree to use an adequate method of contraception (Appendix A)
             starting with the first dose of study therapy through 90 days after the last dose of
             study drugs.

        Exclusion Criteria:

          1. Distant nodal disease (retroperitoneal nodes) including inguinal nodes, or any
             metastatic disease by CT or PET

          2. Prior RT to the pelvis.

          3. Uncontrolled comorbid illness or condition including an active infection, congestive
             heart failure, unstable angina, cardiac arrhythmia, or psychiatric illness that would
             limit compliance with the study requirements.

          4. Prior treatment with any anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, or anti-CTLA-4
             antibody, or any other antibody or drug specifically targeting T-cell co-stimulation
             or checkpoint pathways.

          5. Any positive history for HIV/AIDS, HTLV, hepatitis B or hepatitis C virus indicating
             acute or chronic infection.

          6. Any active known or suspected autoimmune disease. Participants with vitiligo, type I
             diabetes mellitus, residual hypothyroidism due to autoimmune condition only requiring
             hormone replacement, psoriasis not requiring systemic treatment, or conditions not
             expected to recur in the absence of an external trigger are permitted to enroll.

          7. Any condition requiring systemic treatment with either corticosteroids (> 10 mg daily
             prednisone equivalent) or other immunosuppressive medications within 14 days prior to
             the first dose of study drug. Inhaled steroids and adrenal replacement steroid doses
             up to 10 mg daily prednisone equivalent are permitted (although not encouraged) in the
             absence of active autoimmune disease.

          8. Malignancy in the past 3 years that required active treatment except locally curable
             cancers or cancers deemed by the treating physicians to not impact the subject's
             survival duration.

          9. Participants receiving any other investigational agent, standard antineoplastic
             agents, or immunosuppressive agents.

         10. Known history of interstitial lung disease.

         11. Received live vaccine within 6 weeks prior to randomization.

         12. Psychiatric illness/social situations that would limit consenting and compliance with
             study requirements.

         13. Participants who are pregnant or nursing due to the potential for congenital
             abnormalities and the potential of this regimen to harm nursing infants.

         14. Patient is not a candidate for the full treatment regimen.
      
Maximum Eligible Age:99 Years
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Pathological Complete Response Rate
Time Frame:3 years
Safety Issue:
Description:The primary objective of this study is to determine the pathologic complete response (pCR) rate of the combined treatment modality.

Secondary Outcome Measures

Measure:Overall Survival
Time Frame:3 years
Safety Issue:
Description:To evaluate overall survival (OS), defined as the time between date of randomization and the date of death due to any cause.
Measure:Toxicity analysis
Time Frame:3 years
Safety Issue:
Description:To evaluate toxicity analysis comparing the experimental from the standard arm measured according to CTCAE v5.0.
Measure:Disease free survival
Time Frame:3 years
Safety Issue:
Description:To evaluate the disease free survival (DFS) and patterns of failure at three years. DFS is defined as the time between the date of definitive surgery and the first date of documented disease progression or death.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:University of Texas Southwestern Medical Center

Last Updated

July 1, 2021