TREATMENT FOR REFRACTORY METASTATIC MICROSATELLITE STABLE COLORECTAL CANCER
Conditions
Interventions
Trade Name: Irinotecan
Pharmaceutical Form: Solution for injection
INN or Proposed INN: IRINOTECAN
CAS Number: 97682-44-5
Concentration unit: mg/ml milligram(s)/millilitre
Concentration type: equal
Co
Sponsors
Cliniques universitaires Saint-Luc
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Male or female = 18 years at time of study entry 2. Histologically proven metastatic colorectal adenocarcinoma, refractory to standard chemotherapy (fluoropyrimidine, oxaliplatin, irinotecan) and anti-EGFR treatment (only for RAS WT tumor). a. Patients who are received prior anti-angiogenic therapy (e.g, bevacizumab, aflibercept) are eligible b. Patients must have had documented disease progression within 3 months of the last systemic therapy administration c. Patients who were intolerant to prior systemic oxaliplatin-based chemotherapy regimens are eligible if there is documented evidence of clinically significant intolerance despite adequate supportive measures. d. For patients who had disease recurrence within 6 months of completing adjuvant chemotherapy, the adjuvant regimen can be considered as one chemotherapy regimen for metastatic disease 3. MSS tumor, BRAF V600E WT tumor. 4. Measurable disease according RECIST 1.1 5. Availability of protocol required screening tumor and blood samples: Metastases must be accessible for sequential biopsies. Patient must consent for metastasis biopsies 6. ECOG performance status of 0 or 1 7. Adequate normal organ and marrow function For women who are not postmenopausal (= 12 months of non-therapyinduced amenorrhea) or surgically sterile (absence of ovaries and/or uterus): agreement to remain abstinent (refrain from heterosexual intercourse) or use two highly efficient methods of contraception, including at least one method with a failure rate of =65 years) yes F.1.3.1 Number of subjects for this age range 14
Exclusion criteria
Exclusion criteria: 1.BRAF V600E mutated tumor, MSI-High tumor 2. Patient has not received all of the standard chemotherapy (fluoropyrimidine, oxaliplatin, irinotecan) 3.Previous treatment with regorafenib or TAS-102 (trifluridine/tipiracil) 4. Patients not consent for metastasis biopsy. 5. Major surgery or radiotherapy within 21 days prior to Cycle 1 Day 1 or anticipation of needing such procedure while receiving study treatment. 6. Uncontrolled tumor-related pain. Patients requiring narcotic pain medication must be on a stable regimen at study entry. a. Symptomatic lesions (e.g., bone metastases or metastases causing nerve impingement) amenable to palliative radiotherapy should be treated prior to start of study treatment. b. Asymptomatic metastatic lesions whose further growth would likely cause functional deficits or intractable pain (e.g., epidural metastasis that is not presently associated with spinal cord compression) should be considered for loco-regional therapy if appropriate prior to the start of study treatment. 7. Active or untreated CNS metastases are excluded. Patients with treated and asymptomatic CNS metastases are eligible with some criteria. 8. Any previous treatment with a PD1 or PD-L1 inhibitor (including avelumab), CD137 agonists or anti-CTLA4 9. Participation in another clinical study with an investigational product for any other indication until 4 weeks before study participation. 10. Receipt of the last dose of anti-cancer therapy (chemotherapy, endocrine therapy, targeted therapy, biologic therapy, tumor embolization, monoclonal antibodies, other investigational agent) = 21 days prior to the first dose of study drug. 11. History of another primary malignancy except for exceptions (see protocol) 12. Any prior Grade =3 immune-related adverse event (irAE) while receiving anyprevious immunotherapy agent, or any unresolved irAE >Grade 1 13. Current or prior use of immunosuppressive medication within 28 days beforethe first dose of avelumab, with the exceptions of intranasal and inhaled corticosteroids or systemic corticosteroids at physiological doses, which are not to exceed 10 mg/day of prednisone, or an equivalent corticosteroid 14. Treatment with systemic immunostimulatory agents (including but not limitedto interferons or IL-2) within 4 weeks or five half-lives of the drug(whichever is shorter) prior to start the study treatment. 15. Receipt of live attenuated vaccination within 30 days prior first avelumab planned administration. 16. Mean QT interval corrected for heart rate (QTc) =470 ms 17. Active or prior documented autoimmune disease within the past 2 years. 18. Active or prior documented inflammatory bowel disease. 19. History of idiopathic pulmonary fibrosis, of primary immunodeficiency, of allogeneic organ transplant, of hypersensitivity to avelumab or any excipient, of hypersensitivity or unacceptable toxicity to cetuximab (anaphylactic reaction) or irinotecan or any excipient. 20. History of primary immunodeficiency, of allogeneic organ transplant, of hypersensitivity to avelumab or any excipient, of hypersensitivity to avelumab or any excipient. 21. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, active peptic ulcer disease or gastritis, active bleeding diatheses, any subject known to have evidence of acute or chronic hepatitis B, hepatit
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Main Objective: To evaluate the safety and tolerability of avelumab associated to cetuximab and irinotecan separately in each cohort of RAS WT (cohort A) and RAS mutated (cohort B) metastatic CRC. To evaluate in term of ORR the efficacy of avelumab associated to cetuximab and irinotecan separately in each cohort of RAS WT (cohort A) and RAS mutated (cohort B) metastatic CRC;Secondary Objective: To further explore efficacy of avelumab combined with cetuximab and irinotecan. To characterize the mechanistic pathways of mCRC immune response during treatment and potentially identify predictive biomarkers for mCRC response to avelumab;Primary end point(s): The overall tumor response rate (ORR) defined as the proportion of all included patient with a confirmed best overall tumor response of PR or CR according to irRECIST 1.1 occuring until 19 weeks after study treatment start.;Timepoint(s) of evaluation of this end point: 19 weeks | — |
Secondary
| Measure | Time frame |
|---|---|
| Secondary end point(s): The safety and tolerability of the study treatment measured by the frequency and grade of Adverse Events, laboratory analysis and vital signs.;Timepoint(s) of evaluation of this end point: During all the clincial trial period | — |
Countries
Belgium
Contacts
Public ContactMarc Van Den Eynde
Cliniques universitaires Saint-Luc
Outcome results
None listed