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Regorafenib and Nivolumab Simultaneous Combination Therapy (REGONIVO)

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ClinicalTrials.gov Identifier: NCT03406871
Recruitment Status : Active, not recruiting
First Posted : January 23, 2018
Last Update Posted : August 2, 2019
Sponsor:
Collaborators:
Ono Pharmaceutical Co. Ltd
Bayer Yakuhin, Ltd.
Information provided by (Responsible Party):
Kohei Shitara, National Cancer Center Hospital East

Brief Summary:
the efficacy and safety ofhe use of regorafenib in combination with nivolumab

Condition or disease Intervention/treatment Phase
Advanced and Metastatic Solid Tumor Drug: Regorafenib Drug: Nivolumab Phase 1 Phase 2

Detailed Description:

The present trial consists of a dose-escalation cohort to verify the tolerability of nivolumab and regorafenib when used in combination for patients with solid tumors, and to examine the clinical recommended dose(RD). The trial also consists of an expansion cohort to examine the safety and efficacy when the clinical RD is administered for several advanced solid tumors.

In the dose-escalation cohort, three patients with solid tumors will be administered 3.0 mg/kg of nivolumab once every 2 weeks and regorafenib daily for 21days, with a 1-week washout period at dose of 80 mg (level 1), 120 mg (level 2), or 160 mg (level 3). As a general rule, one cycle will last 28 days (day 1-29); however, in the event of treatment prolongation, the cycle period will be extended. The Dose Limiting Toxicity(DLT) evaluation period will be 28 days. Furthermore, for each level, three additional subjects will be added depending on the state of DLT.

In the expansion cohort, the target subject sample will consist of approximately 30 patients who will be administered 3.0 mg/kg of nivolumab once every 2 weeks, and the clinical RD of regorafenib will be determined in the dose-escalation cohort.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 48 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Regorafenib and Nivolumab Simultaneous Combination Therapy for Advanced and Metastatic Solid Tumors: Phase I Clinical Trial
Actual Study Start Date : January 25, 2018
Actual Primary Completion Date : April 23, 2019
Estimated Study Completion Date : July 31, 2022

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Nivolumab + Regorafenib
Nivolumab and Regorafenib
Drug: Regorafenib
One course will last 28 days. Oral administration at a dose of 80 mg/day, 120mg/day or 160 mg/day for 21 consecutive days, with a 1-week washout period.
Other Name: Regorafenib (BMS-936558, MDX1106, ONO-4538)

Drug: Nivolumab
One course will last 28 days. Given once every 2 weeks at a dose of 3.0 mg/kg.
Other Name: Nivolumab (BAY73-4506)




Primary Outcome Measures :
  1. RD [ Time Frame: 4 weeks ]
    Recommended Dose of Regorafenib

  2. Maximum Tolerated Dose(MTD) [ Time Frame: 4 weeks ]
    Maximum tolerated dose


Secondary Outcome Measures :
  1. ORR [ Time Frame: 1year ]
    Objective response rate (ORR) according to Response Evaluation Criteria in Solid Tumours (RECIST) version. 1.1, and immune-related (ir) RECIST

  2. Progression-Free Survival(PFS) [ Time Frame: 1year 6 months ]
    Progression-free survival

  3. Overall Survival(OS) [ Time Frame: 1year 6 months ]
    Overall survival

  4. Disease Control Rate(DCR) [ Time Frame: 1year ]
    Disease control rate

  5. Incidence of Treatment-Emergent Adverse-Events [Safety and Tolerability] [ Time Frame: 1year 6 months ]
    Incidence of adverse events



Information from the National Library of Medicine

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Ages Eligible for Study:   20 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Patients who provided written informed consent to be subjects in this trial
  2. Patients at least 20 years of age on the day of providing consent
  3. Dose-escalation cohort: Patients with histologically or cytologically confirmed advanced or metastatic solid tumors.

    Expansion cohort: Patients with histologically or cytologically confirmed advanced or metastatic solid tumors (gastric, colorectal, or hepatocellular cancer).

  4. Patients with an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0 or 1
  5. Patients capable of taking oral medication
  6. Patients with evaluable or measurable lesions as per RECIST version 1.1
  7. Patients with adequate organ function at the time of enrollment as defined below:

    • Neutrophil count ≥1500mm3
    • Platelet count ≥10.0 × 104/mm3
    • Hemoglobin (Hb) ≥ 9 g/dL,
    • aspartate transaminase (AST), alanine transaminase (ALT) ≤100 U/L (≤100 U/L in patients with Hepatocellular carcinoma, ≤250 U/L in patients with liver metastasis)
    • Total bilirubin ≤1.5-mg /dL
    • Creatinine ≤1.5--mg /dL
    • Lipase ≤ 80 IU/L
    • Urinary protein: It satisfies one of the following (if any of the inspection criteria are satisfied, other examination may not be carried out) (i) urinary protein (test paper method) is 2+ or less (ii) Urine Protein Creatinine(UPC) ratio <3.5 (iii) 24-hour urine protein was measured, urinary protein ≦ 3500 mg
    • Prothrombin time (PT)- International normalized ratio(INR): ≤ 1.5 (≦ 3.0 in case of anticoagulant administration)
  8. For women who are likely to become pregnant (including those without menstruation due to medical reasons such as chemical menopause) Note 1, we agreed to double contraceptive Note 2 for at least 5 months from consent acquisition patient to the final administration of the investigational product. Also, patients who agreed not to breast feeding for at least 5 months from acquiring consent to the final investigational drug administration.

For men, patients agreeing to double contraceptive for at least 7 months from the time of starting investigational drug administration to the final investigational drug administration.

Note 1): A woman who is likely to become pregnant is a woman who has experienced menarche and is not undergoing sterilization surgery (such as hysterectomy, bilateral salpingo ligation or bilateral oophorectomy), a woman without menopause Everything is included. The definition after menopause shall be amenorrhea continuously for 12 months or more even though there is no noteworthy reason. Women who are using oral contraceptives or mechanical contraceptive methods (such as intrauterine contraceptive devices or barrier methods) are considered to be pregnant.

Note 2): With regard to contraception, it is necessary to use two of the vasectomy or condom of a male patient or male male, the uterine tube ligation of a female patient or the other woman, a contraceptive pessary, an intrauterine contraceptive device or an oral contraceptive I need to agree to heavy contraception.

Exclusion Criteria:

  1. Patients who have undergone systemic chemotherapy, radiotherapy, surgery, hormone therapy, or immunotherapy <2 weeks before enrollment. Immune checkpoint blockade as pretreatment is permitted.
  2. Patients with a history of taking regorafenib.
  3. Patients with hypertension that is difficult to control (systolic blood pressure ≥160 mmHg and diastolic blood pressure ≥90 mmHg) despite treatment with several hypotensive agents
  4. Patients with acute coronary syndrome (including myocardial infarction and unstable angina), and with a history of coronary angioplasty or stent placement performed within 6 months before enrollment
  5. Patients with a large amount of pleural effusion or ascites requiring drainage.
  6. Patients with a ≥grade 3 active infection according to NCI-CTCAE version 4.03
  7. Patients with symptomatic brain metastasis
  8. Patients with partial or complete gastrointestinal obstruction
  9. Patients with interstitial lung disease with symptoms or signs of activity
  10. Patients who test positive for either anti-HIV-1 antibodies, anti-HIV-2 antibodies, hepatitis B surface antigen (HBsAg), or anti-hepatitis C virus (HCV) antibodies*

    *Patients who test positive for either anti-Hepatitis B surface(HBs) or anti- Hepatitis B core(HBc) antibodies, and those who have hepatitis B virus (HBV)-DNA measurements greater than the detection sensitivity will also be excluded.

    (However, patients with hepatocellular carcinoma in the expansion cohort will not be excluded even if they test positive for HBsAg and anti-HCV antibodies.)

  11. Patients with concurrent autoimmune disease, or a history of chronic or recurrent autoimmune disease
  12. Patients who require systemic corticosteroids (excluding temporary usage for tests, prophylactic administration for allergic reactions, or to alleviate swelling associated with radiotherapy) or immunosuppressants, or who have received such a therapy <14 days before enrollment in the present study
  13. Patients with a history or findings of ≥grade III congestive heart failure according to the New York Heart Association functional classification
  14. Patients with a seizure disorder who require pharmacotherapy
  15. Patients who had grade 3 or higher bleeding during 4 weeks before enrollment
  16. Patients undergoing major surgery (thoracotomy or laparotomy, etc.), laparotomy biopsy, trauma within 28 days before registration. The same day of the week before 4 weeks can be registered (However, in case of an artificial anastomosis without intestinal resection, it shall be within 14 days before registration).
  17. Patients with non-healing wound, non-healing ulcer, or non-healing bone fracture.
  18. Patients with a history of hypersensitivity to any of the study drugs, similar drugs, or excipients.
  19. Women who are pregnant or breastfeeding, or with the potential for pregnancy.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03406871


Locations
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Japan
NationalCCHE
Kashiwa, Chiba, Japan, 277-8577
Sponsors and Collaborators
Kohei Shitara
Ono Pharmaceutical Co. Ltd
Bayer Yakuhin, Ltd.
Investigators
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Study Chair: Kohei Shitara, Dr National Cancer Center Hospital East

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Responsible Party: Kohei Shitara, Assistant Chief of Gastrointestinal Oncology Division, National Cancer Center Hospital East
ClinicalTrials.gov Identifier: NCT03406871     History of Changes
Other Study ID Numbers: EPOC 1603 study
First Posted: January 23, 2018    Key Record Dates
Last Update Posted: August 2, 2019
Last Verified: July 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Kohei Shitara, National Cancer Center Hospital East:
Regorafenib
Nivolumab
Phase I clinical trial
Additional relevant MeSH terms:
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Nivolumab
Antineoplastic Agents, Immunological
Antineoplastic Agents