PD-1 Antibody Combined With COX Inhibitor in MSI-H/dMMR or High TMB Colorectal Cancer: a Single Arm Phase II Study
试验速览
- 阶段
- 2 期
- 状态
- 招募中
- 发起方
- 入组人数
- 29
- 试验地点
- 2
- 主要终点
- Response rate
研究概览
简要总结
PD-1(programmed death protein 1)antibody has been to approved in patients with MSI-H/dMMR advanced cancer and has achieved significant efficacy. It is reported that the objective response rate of Pembrolizumab and Nivolumab are 40% and 31.1% in MSI-H/dMMR (microsatellite instability-high/deficiency mismatch repair )colorectal cancer. What's more, most of the patients who had response for PD-1 antibody achieved a long duration of disease control. However, not all patients with MSI-H/dMMR was sensitive to PD-1 antibody despite it is a biomarker for PD-1 antibody treatment. There were about 50-60% of patients with MSI-H/dMMR were insensitive and we don't know why. What's more, it's reported that tumor mutation burden (TMB) may be another biomarker of response to PD-1 therapy. COX (cyclooxygenase)inhibitor has been proved to prevent adenomas in colorectal and it is safe for most of the patients. Preclinical models also showed that COX inhibitor could act with PD-1 antibody in mice and control disease progress. So, this study aims to evaluated efficacy and safety of combination of PD-1 antibody and COX inhibitor in patients with MSI-H/dMMR or high tumor mutation burden colorectal cancer.
详细描述
This is a single arm, phase two study. Eligible patients with advanced MSI-H/dMMR colorectal cancer were assigned to receive BAT1306 plus COX inhibitor. All patients will receive the study regimen every 3 weeks. Chest/abdomen/pelvic CT with IV contrast will be performed to assess clinical response.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Signed informed consent; able to comply with study and/or follow- up procedures;
- •Age:18-75 years old;
- •Histological or cytological documentation of colorectal cancer;
- •Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1;
- •There must be documentation by CT scan, MRI, or intraoperative palpation that tumor is unresectable;
- •Have had at least one lines of chemotherapy fail or refuse to receive chemotherapy;
- •Histologically confirmed metastatic or primary colorectal cancer as dMMR/MSI-H or whole exon sequence confirmed tumor mutation burden higher than 1000;
- •Adequate bone marrow, hepatic and renal function as assessed by the following laboratory requirements conducted within 7 days of starting study treatment: Hemoglobin (Hb) ≥ 90g/ L, absolute neutrophil count (ANC) ≥ 1.5×109/ L, platelet count ≥ 100×109/ L; Total bilirubin ≤ 1.5×the upper limit of normal (ULN), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 5 ×ULN; Serum creatinine ≤1.5×the ULN.
排除标准
- •Previous treatment with other therapy targeting T-cell costimulation or immune checkpoint pathways;
- •Active, known, or suspected autoimmune disease (except for type 1 diabetes mellitus, residual hypothyroidism due to autoimmune condition requiring only hormone replacement, or conditions not expected to recur in the absence of an external trigger);
- •A previous cancer active within the previous 5 years;
- •Subjects with known allergy to the study drugs or to any of its excipients;
- •Significant cardiovascular disease including unstable angina or myocardial infarction within 6 months before initiating study treatment;
- •Heart failure grade III/IV (NYHA-classification);
- •Patients with active infection within 1 week before enrollment (infection caused by fever above 38 °C);
- •Patients with severe lung disease (interstitial pneumonia, pulmonary fibrosis, severe emphysema);
- •Patients with active gastrointestinal bleeding;
- •Patients with serious complications (intestinal obstruction, renal insufficiency, hepatic insufficiency, cerebrovascular disorders);
- •Psychiatric disease or a history of central nervous system disease that affects clinical treatment;
- •Receive other anti-tumor treatments (including anti-tumor immunotherapy, interventional therapy and intra-serosal injection of anti-tumor drugs) or participate in other interventional clinical trials within two weeks before enrollment;
- •Breast- feeding or pregnant women;
- •Lack of effective contraception;
- •The investigator determined that the patient was not eligible for this clinical trial.
研究组 & 干预措施
PD-1 antibody + cox inhibitor
BAT1306 + aspirin(celebrex when there is contraindication to aspirin) on day 1-21 every three weeks
干预措施: PD-1 antibody + cox inhibitor (Drug)
结局指标
主要结局
Response rate
时间窗: 6 months
CR(complete response) + PR (partial response)rate will be assessed according to the RECIST version 1.1 guidelines.
次要结局
- Progression free survival(2 years)
- Overall survival time(5 years)
- disease control rate(6 months)
- Toxicity assessed using the NCI common toxicity criteria, version 4.0.(2 years)
- duration of response(2 years)
研究者
Yanhong Deng
professor
Sun Yat-sen University