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A Study of a Patient-Specific Neoantigen Vaccine in Combination With Immune Checkpoint Blockade for Patients With Metastatic Colorectal Cancer

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT05141721
Recruitment Status : Recruiting
First Posted : December 2, 2021
Last Update Posted : April 28, 2023
Sponsor:
Information provided by (Responsible Party):
Gritstone bio, Inc.

Study Description
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Brief Summary:
The primary objective of the Phase 2 portion of the study is to characterize the clinical activity of maintenance therapy with GRT-C901/GRT-R902 (patient-specific vaccines) in combination with checkpoint inhibitors in addition to fluoropyrimidine/bevacizumab versus a fluoropyrimidine/bevacizumab alone as assessed by changes in circulating tumor (ct)DNA. The primary objective of the Phase 3 portion is to demonstrate clinical efficacy of the regimen as assessed by progression-free survival.

Condition or disease Intervention/treatment Phase
Colorectal Neoplasms Drug: GRT-C901 Drug: GRT-R902 Drug: Atezolizumab Drug: Ipilimumab Drug: Fluoropyrimidine plus leucovorin Drug: Bevacizumab Phase 2 Phase 3

Detailed Description:
Tumors harboring non-synonymous deoxyribonucleic acid (DNA) mutations can present peptides containing these mutations as non-self antigens in the context of human leukocyte antigens (HLAs) on the tumor cell surface. A fraction of mutated peptides result in neoantigens capable of generating T-cell responses that exclusively target tumor cells. Sensitive detection of these mutations allows for the identification of neoantigens unique to each patient's tumor to be included in a patient-specific cancer vaccine that targets these neoantigens. This vaccine regimen uses two vaccine vectors as a heterologous prime/boost approach (GRT-C901 first followed by GRT-R902) to stimulate an immune response. This study will explore the anti-tumor activity of this patient-specific immunotherapy in combination with checkpoint inhibitors in addition to fluoropyrimidine/bevacizumab.
Study Design
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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 665 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase 2/3, Randomized, Open-Label Study of Maintenance GRT-C901/GRT-R902, A Neoantigen Vaccine, in Combination With Immune Checkpoint Blockade for Patients With Metastatic Colorectal Cancer
Actual Study Start Date : February 12, 2022
Estimated Primary Completion Date : March 2027
Estimated Study Completion Date : March 2027

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Vaccines

Arms and Interventions
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Arm Intervention/treatment
Experimental: Vaccine Arm
After receiving up to 24 weeks induction therapy with a fluoropyrimidine/oxaliplatin/bevacizumab (with or without irinotecan), per standard of care and after completing vaccine production screening, patients will receive a total of 6 administrations of GRT-C901/GRT-R902 plus ipilimumab co-administered only with the first dose of GRT-C901 and GRT-R902. All patients will receive atezolizumab in addition to maintenance therapy of a fluoropyrimidine and bevacizumab according to standard of care.
 Drug: GRT-C901
A patient-specific neoantigen cancer vaccine administered via intramuscular (IM) injection as prime and single boost at a dose of 1x10^12 viral particles 2 times over the course of the first year.

Drug: GRT-R902
A patient-specific neoantigen cancer vaccine boost, administered via IM injection at a dose of 30ug 4 times over the course of the first year.

Drug: Atezolizumab
Atezolizumab will be administered via intravenous (IV) infusion at a dose of 1680 mg once every 4 weeks.
Other Name: Tecentriq

Drug: Ipilimumab
Ipilimumab will be administered via subcutaneous (SC) injection at a dose of 30 mg with the first dose of GRT-C901 and GRT-R902.
Other Name: Yervoy

Drug: Fluoropyrimidine plus leucovorin
Fluoropyrimidine (infusional 5-FU or capecitabine) and leucovorin administered as maintenance therapy per standard of care.
Other Name: Xeloda

Drug: Bevacizumab
Bevacizumab administered as maintenance therapy per standard of care.
Other Name: Avastin
Active Comparator: Control Arm
After receiving up to 24 weeks induction therapy with a fluoropyrimidine/oxaliplatin/bevacizumab (with or without irinotecan), per standard of care and undergoing vaccine production screening, patients will receive maintenance therapy of a fluoropyrimidine and bevacizumab according to standard of care.
 Drug: Fluoropyrimidine plus leucovorin
Fluoropyrimidine (infusional 5-FU or capecitabine) and leucovorin administered as maintenance therapy per standard of care.
Other Name: Xeloda

Drug: Bevacizumab
Bevacizumab administered as maintenance therapy per standard of care.
Other Name: Avastin


Outcome Measures
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Primary Outcome Measures :
  1. Phase 2: Molecular response defined as ≥ 50% decrease from baseline in circulating tumor DNA (ctDNA) [ Time Frame: Baseline and up to 27 months ]
  2. Phase 3: Progression-free survival per Immune-based Response Evaluation Criteria in Solid Tumors (iRECIST) as assessed by blinded independent review committee (IRC) [ Time Frame: Up to 60 months ]
    defined by time from randomization until disease progression as per iRECIST or death from any cause


Secondary Outcome Measures :
  1. Phase 2 and 3: Incidence of treatment-emergent adverse events (TEAEs), immune-related AEs, treatment-related AEs, serious AEs, AEs leading to death, AEs leading to dose delays, and AEs leading to discontinuation of study treatment [ Time Frame: Phase 2 up to 27 months, Phase 3 up to 60 months ]
  2. Phase 2 and 3: Progression-free survival per RECIST v1.1 and iRECIST as assessed by the investigator [ Time Frame: Phase 2: up to 27 months, Phase 3: up to 60 months ]
  3. Phase 3: Progression-free survival per RECIST v1.1 as assessed by blinded IRC [ Time Frame: Up to 60 months ]
  4. Phase 2 and 3: Overall Survival as time from randomization to death from any cause [ Time Frame: Phase 2 up to 27 months, Phase 3 up to 60 months ]
  5. Phase 2 and 3: Overall Response Rate [ Time Frame: Phase 2 up to 27 months, Phase 3 up to 60 months ]
    measured by the proportion of patients with best overall response (BOR) of partial response (PR) or complete response (CR) by REICST v1.1 or , immune-based PR (iPR) or immune-based by iRECIST

  6. Phase 2 and 3: Duration of response (DOR) defined by time from the first objective response of PR or PR until disease progression or death [ Time Frame: Phase 2 up to 27 months, Phase 3 up to 60 months ]
  7. Phase 2 and 3: Clinical benefit rate (CBR) as defined by the proportion of patients with best overall response of stable disease (SD), PR or CR using RECIS v1.1 or immune-based SD (iSD), iPR, or iCR by iRECIST. [ Time Frame: Phase 2 up to 27 months, Phase 3 up to 60 months ]
  8. Phase 2 and 3: Deepening of Response the proportion of patients who have a BOR of SD or PR during the VPS and who convert from SD to PR or CR, or from PR to CR after start of the study treatment and/or SOC maintenance treatment in the STS per RECIST v1.1 [ Time Frame: Phase 2 up to 27 months, Phase 3 up to 60 months ]
  9. Phase 2 and 3: The feasibility of manufacturing a patient-specific vaccine defined by the proportion of patients for whom vaccine was successfully manufactured from those randomized to the vaccine arm. [ Time Frame: Study Treatment Screening visit (up to 28 days before Day 1 of study drug administration) ]

Eligibility Criteria
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Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients with histologically confirmed metastatic colorectal cancer (CRC) who are planned for, or have received <30 days of first-line treatment in the metastatic setting with FOLFOX/bev, CAPEOX/bev, FOLFOXIRI/bev, or CAPOXIRI/bev per SOC
  • Measurable and unresectable metastatic disease according to RECIST v1.1
  • Availability of formalin-fixed paraffin-embedded (FFPE) tumor specimens.
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
  • Patient has adequate organ function per defined criteria
  • If women of childbearing potential (WCBP), must be willing to undergo pregnancy testing and agrees to the use at least 1 highly effective contraceptive method during the study treatment period and for 150 days after last investigational study treatment.

Exclusion Criteria:

  • Patients with deficient mismatch repair (dMMR) or microsatellite instability (MSI-H) phenotype
  • Patient has a known tumor mutation burden <1 non-synonymous mutations/megabase
  • Known DNA Polymerase Epsilon mutations
  • Patients with known BRAFV600E mutations
  • Bleeding disorder or history of significant bruising or bleeding following IM injections or blood draws
  • Immunosuppression anticipated at time of study treatment
  • History of allogeneic tissue/solid organ transplant
  • Active or history of autoimmune disease or immune deficiency
  • Patient with symptomatic or actively progressing central nervous system (CNS) metastases, carcinomatous meningitis, or has been treated with whole brain radiation
  • History of other cancer within 2 years with the exception of neoplasm that has undergone potentially curative therapy
  • Any severe concurrent non-cancer disease that, in the judgment of the Investigator, would make the patient inappropriate for the current study
  • Active tuberculosis or recent (<2 weeks) clinically significant infection, evidence of active hepatitis B or hepatitis C, or known history of positive test for HIV
  • History of pneumonitis requiring systemic steroids for treatment (with the exception of prior resolved in-field radiation pneumonitis)
  • Myocardial infarction within previous 3 months, unstable angina, serious uncontrolled cardiac arrhythmia, history of myocarditis, or congestive heart failure
  • Pregnant, planning to become pregnant, or nursing.
Contacts and Locations
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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): NCT05141721


Contacts
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Contact: Brian Chauder (510) 871-6100 go-010@gritstone.com
Contact: Natasha Goodson (510) 871-6100 go-010@gritstone.com

Locations
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Sponsors and Collaborators
Gritstone bio, Inc.
More Information
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Responsible Party: Gritstone bio, Inc.
ClinicalTrials.gov Identifier: NCT05141721    
Other Study ID Numbers: GO-010
First Posted: December 2, 2021    Key Record Dates
Last Update Posted: April 28, 2023
Last Verified: April 2023

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Gritstone bio, Inc.:
Colorectal cancer vaccine
mCRC
colon
rectum
CRC
rectal
 immunotherapy
MSS-CRC
personal cancer vaccine
personalized cancer vaccine
individualized cancer vaccine
Additional relevant MeSH terms:
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Colorectal Neoplasms
Intestinal Neoplasms
Gastrointestinal Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Neoplasms
Digestive System Diseases
Gastrointestinal Diseases
Colonic Diseases
Intestinal Diseases
Rectal Diseases
Leucovorin
Bevacizumab
Ipilimumab
Atezolizumab
 Antineoplastic Agents, Immunological
Antineoplastic Agents
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Physiological Effects of Drugs
Growth Inhibitors
Antidotes
Protective Agents
Vitamin B Complex
Vitamins
Micronutrients
Immune Checkpoint Inhibitors
Molecular Mechanisms of Pharmacological Action