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A Phase II Trial Assessing Nivolumab in Class II Expressing Microsatellite Stable Colorectal Cancer (ANICCA)

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. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03981146
Recruitment Status : Active, not recruiting
First Posted : June 10, 2019
Last Update Posted : September 16, 2021
Sponsor:
Collaborator:
Bristol-Myers Squibb
Information provided by (Responsible Party):
University of Birmingham

Brief Summary:
An open-label, single-arm, phase II, multicentre clinical trial to determine the rate of durable clinical benefit of nivolumab in patients with class II expressing microsatellite stable colorectal cancer.

Condition or disease Intervention/treatment Phase
Colorectal Cancer Drug: Nivolumab Phase 2

Detailed Description:

Immuno-oncology is transforming the care of certain patients with cancer. Not all patients respond to these therapies however, and in some common cancers checkpoint blockade has failed to make any real impact. In 2014 there were over 41,000 new cases of colorectal cancer (CRC) in the UK and nearly 16,000 deaths from the disease, making it the second commonest cause of cancer death (Cancer Research UK Cancer Statistics Key Facts). 15% of patients with CRC develop it as a result of deficient mismatch repair (microsatellite instability - MSI): this cohort of patients respond well to PD-1/PD-L1 blockade as these tumours harbour a very high number of mutations thus increasing the likelihood of the presence of immunogenic neo-epitopes which elicit an immune response1. The majority of CRC patients, particularly those with metastatic disease (around 95%), do not display this hyper-mutator phenotype (microsatellite stable (MSS) CRC) and in these patients the results of PD-1/PD-L1 blockade have been disappointing.

In summary, MSS CRC patients with a class II expression appear to represent immunologically a group of MSI-like MSS patients that may respond to usefully to the immunotherapy agent nivolumab as a single agent and thus a trial of nivolumab in patients with class II expression of their cancer cells appears to be highly justified.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 35 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase II Trial Assessing Nivolumab in Class II Expressing Microsatellite Stable Colorectal Cancer
Actual Study Start Date : August 28, 2019
Estimated Primary Completion Date : February 28, 2023
Estimated Study Completion Date : February 28, 2023

Resource links provided by the National Library of Medicine

Drug Information available for: Nivolumab

Arm Intervention/treatment
Experimental: Nivolumab
Patients will receive 480mg of Nivolumab on a four weekly cycle for a maximum of two years.
Drug: Nivolumab
60 Minute IV Infusion




Primary Outcome Measures :
  1. Durable Clinical Benefit [ Time Frame: Beginning of trial treatment to free of disease progression (104 weeks maximum) ]
    patient will be defined as experiencing DCB if they remain free of disease progression at their third trial specific CT scan since treatment start date (i.e. at approximately 27 weeks) or at any CT scan after 27 weeks that shows the patient remains free of disease progression


Secondary Outcome Measures :
  1. Objective response [ Time Frame: trial treatment until disease progression (104 weeks maximum) ]
    Objective response is the occurrence of CR or PR as the best overall response

  2. Best Percentage Change in Sum of Target Lesions [ Time Frame: Trial Treatment to disease progression (104 weeks maximum) ]
    At each evaluation, the longest diameters of all selected target lesions will be measured and summed and the percentage change from the baseline measurement will be calculated. The best percentage change is the one that reflects either the greatest decrease or the least increase over the whole period of assessment.

  3. Time to Maximal Response [ Time Frame: Occurrence of CR or PR during the trial (104 weeks maximum) ]
    This is defined as the time from commencement of trial treatment to the date of CT scan that first records the best objective response as per RECIST version 1.1.

  4. Progression Free Survival Time [ Time Frame: time from commencement of trial treatment to the date of CT scan when progressive disease first recorded (104 weeks maximum) ]
    This is defined as the time from commencement of trial treatment to the date of CT scan when progressive disease first recorded or date of death without previously recorded progression.first records the best objective response as per RECIST version 1.1.

  5. Overall Survival Time [ Time Frame: Trial Treatment to date of death. ]
    This is defined as the time from commencement of trial treatment to the date of death.



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:

  • Histologically confirmed locally advanced or metastatic MSS CRC with class II expression (greater than 1% cancer cell positivity for class II expression on immunohistochemistry).
  • Eastern Cooperative Oncology Group (ECOG) performance status 0-2 (APPENDIX 1)
  • Age ≥ 18 years
  • Patients must have completed all standard of care therapy that the treating oncologist deems appropriate. Trial treatment as first line therapy is permitted if the patient has declined standard of care therapy.
  • CT scan of chest, abdomen, pelvis within 28 days of registration demonstrating unidimensionally measurable disease as per RECIST version 1.1 (APPENDIX 3).
  • Demonstrate adequate haematological function:

    • Platelet count ≥100 x 109 /L
    • Neutrophils ≥1.5 x 109/L
    • Haemoglobin ≥ 90 g/L
  • Demonstrate adequate hepatic function:

    • Serum bilirubin ≤1.5 x upper limit of normal (ULN)
    • Serum AST or ALT ≤2.5 x ULN or <5 x ULN in the presence of liver metastases
  • Demonstrate adequate renal function

    o Creatinine clearance <1.5 times ULN and >30ml/min (as per institutional standard).

  • Provision of signed and dated, written informed consent prior to any trial specific procedures, sampling and analyses.
  • Negative pregnancy test (female patients of reproductive potential). (Serum Test must be negative)
  • Patients must agree to the use of contraception as detailed in section 7.8

Exclusion Criteria:

  • Previous treatment with PD1/PDL1 inhibitors.

    • Untreated symptomatic brain or leptomeningeal metastatic disease.
    • Medical or psychiatric conditions compromising informed consent.
    • Any medical condition which, in the opinion of the Investigator, would compromise the ability of the patient to participate in the trial or which would jeopardise compliance with the protocol.
    • Administration of chemotherapy, radioactive or biological cancer therapy within 4 weeks prior to the first dose of trial therapy Patient has not recovered to CTCAE grade 1 or better from the Adverse Event (AE) due to cancer therapeutics administered more than 4 weeks earlier.
    • Active autoimmune disease that has required systemic treatment in past 2 years (i.e.

with use of disease modifying agents, corticosteroids or immunosuppressive drugs).

Replacement therapy (e.g. thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment.

  • Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to the first dose of trial treatment. Replacement therapy (e.g. thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment. Patient has risk factors for bowel obstruction or bowel perforation (examples include but not limited to a history of acute diverticulitis, intra-abdominal abscess and abdominal carcinomatosis).
  • Patient has a known history of other malignancy, unless the patient has undergone potentially curative therapy with no evidence of that disease for 3 years.
  • Has a history of non-infectious pneumonitis requiring steroids or has active pneumonitis.
  • Female patients that are either pregnant or breast feeding.
  • Male and female patients (of childbearing age) not willing to use adequate contraception.
  • Patient previously had a severe hypersensitivity reaction to treatment with another monoclonal antibody.
  • Patient is positive for Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies), active Hepatitis B (HBsAg reactive) or Hepatitis C (HCV RNA (qualitative) is detected); patients with negative Hepatitis C antibody testing may not need RNA testing.
  • Known history of tuberculosis.
  • Patient has an active infection requiring therapy.
  • Has received a live vaccine within 30 days prior to the first dose of trial treatment.
  • Patient is, at the time of signing informed consent, a regular user (including "recreational use") of any illicit drugs or had a recent history (within the last year) of substance abuse (including alcohol).

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): NCT03981146


Locations
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United Kingdom
Belfast City Hospital
Belfast, United Kingdom
Queen Elizabeth Hospital
Birmingham, United Kingdom
Velindre Cancer Centre
Cardiff, United Kingdom
Western General Hospital
Edinburgh, United Kingdom
St James Leeds
Leeds, United Kingdom, LS9 7TF
Leicester Royal Infirmary
Leicester, United Kingdom, LE1 5WW
Clatterbridge Cancer Centre
Liverpool, United Kingdom
The Royal Free Hospital
London, United Kingdom, NW3 2QG
Guys Hospital
London, United Kingdom
The Royal Marsden NHS Foundation Trust
London, United Kingdom
University College Hospital
London, United Kingdom
The Christie Hospital, The Christie NHS Foundation Trust
Manchester, United Kingdom
Freemans Hospital
Newcastle Upon Tyne, United Kingdom
Weston Park
Sheffield, United Kingdom, S10 2SJ
Sponsors and Collaborators
University of Birmingham
Bristol-Myers Squibb
Investigators
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Principal Investigator: Gary Middleton, MB,BS,FRCP University of Birmingham
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Responsible Party: University of Birmingham
ClinicalTrials.gov Identifier: NCT03981146    
Other Study ID Numbers: RG_17-215
2018-000318-39 ( EudraCT Number )
40245896 ( Registry Identifier: ISRCTN )
First Posted: June 10, 2019    Key Record Dates
Last Update Posted: September 16, 2021
Last Verified: September 2021
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 University of Birmingham:
Class II Microsatellite Status
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
Nivolumab
Antineoplastic Agents, Immunological
Antineoplastic Agents
Immune Checkpoint Inhibitors
Molecular Mechanisms of Pharmacological Action