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| Name | Class |
|---|---|
| Oncovir, Inc. | INDUSTRY |
| Merck Sharp & Dohme LLC | INDUSTRY |
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The main purpose of this study is to determine the dose of poly-ICLC that is safe and tolerable when it is combined with pembrolizumab in patients with colon cancer. This study will also evaluate how the combination of pembrolizumab and poly-ICLC activates the immune system in the patient's blood and inside the tumor; how it affects the size and number of tumor(s) in each patient; and how effective the combination is in patients with colon cancer that is unlikely to respond to pembrolizumab alone.
Mismatch repair genes normally serve to fix the small glitches that occur when DNA is copied as cells divide. In 1993, researchers discovered that mutations in human mismatch repair genes play a key role in the development of certain forms of colorectal cancer; individuals who are deficient in these mismatch repair genes are at high risk for colorectal cancer. Accumulating evidence has shown that immunotherapy may be most effective against these cancers.
Programmed cell death protein 1, also known as PD-1, functions as an immune checkpoint, down-regulating the immune system by preventing the activation of T-cells, which in turn reduces autoimmunity and promotes self-tolerance. A new class of immunotherapy drugs that block PD-1, the PD-1 inhibitors, activate the immune system to attack tumors and are therefore used with varying success to treat some types of cancer.
Current clinical trials are showing that patients whose tumors are mismatch repair deficient are more likely to respond to immune-boosting anti-PD-1 drugs-such as pembrolizumab-than those with tumors proficient in mismatch repair. The idea is that the greater the number of DNA glitches in a tumor cell, the more abnormal proteins it will produce-and the more abnormal proteins that are generated, the greater the odds that the body's immune cells will regard the tumor cells as "foreign" and target them for destruction. Thus far, PD-1 inhibitors have shown great promise for mismatch repair deficient cancer patients, but not for mismatch repair proficient (MRP) cancer patients.
In this clinical trial, the investigators hypothesize that treating MRP colon cancer patients with immunostimulating agent poly-ICLC will generate an inflammatory response, increasing epitope recognition and development of tumor reactive T-cells at the tumor site. However, interferon alpha and gamma produced by the poly-ICLC will increase PD-L1 expression and limit new T-cell development. Thus, PD1 blockade will increase the effectiveness of treatment with pembrolizumab.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Phase 1 | Experimental | This "Run In" phase is aimed to determine if poly-ICLC can be safely combined with standard dosages of pembrolizumab: i. Pembrolizumab will be administered 200 mg intravenously (IV) every 3 weeks (q3w) ii. Poly-ICLC will be administered intramuscularly (IM) twice weekly at one of two dose levels: 1 mg or 2 mg Each dose level will enroll 3-6 participants, up to 12 participants total, depending on the occurrence of dose limiting toxicities (DLT) at each dosing level. Participants may receive treatment for 1 year (~17 cycles). |
|
| Phase 2 | Experimental | In Phase 2, all participants will receive the standard pembrolizumab dose (200 mg IV q3w) in addition to the maximum tolerated dose of poly-ICLC (either 1 mg or 2 mg), as determined by the Phase 1 arm. Up to 30 participants will be treated in Phase 2. Participants may receive treatment for 1 year (~17 cycles). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| pembrolizumab | Drug | 200mg pembrolizumab will be given intravenously on Day 1 of each 3-week cycle |
|
| Measure | Description | Time Frame |
|---|---|---|
| Phase 1: Determine the Maximum Tolerated Dose of Poly-ICLC That Can be Combined With Pembrolizumab | A minimum of 3 participants will be treated at dose level 1 (1mg).
| 12 months |
| Phase 1 and 2: Determine the Response Rate of Metastatic MRP Colon Cancer (That Has Progressed Following Two Lines of Therapy in the Metastatic Setting) to the Combination of Pembrolizumab and Poly-ICLC | Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR. | From baseline to disease progression (Expected 12-24 months) |
| Determine the Overall Survival Rate for Recurrent Metastatic MRP Colon Cancer Response to the Combination of Pembrolizumab and Poly-ICLC | The overall survival rate of response to the combination of pembrolizumab and poly-ICLC administered at the Recommended Phase 2 Dose (RP2D) will be estimated along with the correspondent 95% confidence interval. | From baseline to disease progression (up to 24 months) |
| Measure | Description | Time Frame |
|---|---|---|
| Determine the Adverse Event Profile and Dose Limiting Toxicities of the Combination of Pembrolizumab and Poly-ICLC | The adverse event profile will be presented by dose level of the combination treatment for the phase I portion | 12 months |
| Determine the 20-week Progression Free Survival Rate of Recurrent Metastatic MRP Colon Cancer to the Combination of Pembrolizumab and Poly-ICLC |
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Diagnosis/Condition for Entry into the Trial Phase 1 - Presence of histologically confirmed malignancy that has progressed following at least one therapy and able to be visualized on imaging. Measurable disease is not required. Patients with known targetable mutations must have progressive disease on the appropriated targeted drug therapy.
Phase 2 - Presence of MRP colon cancer that has progressed following at least two lines of therapy. Ten patients will be included who have disease that can be biopsied pre- and post-therapy.
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Asha Nayak, MD | Georgia Cancer Center at Augusta University | Principal Investigator |
| Sharad Ghamande, MD | Georgia Cancer Center at Augusta University | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Georgia Cancer Center at Augusta University | Augusta | Georgia | 30912 | United States |
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| ID | Title | Description |
|---|---|---|
| FG000 | Phase 1: Poly-ICLC: 1mg | Cohort 1: Participants were administrated 1mg Poly-ICLC intramuscularly (IM) twice weekly. Pembrolizumab was administrated 200 mg intravenously (IV) every 3 weeks (q3W) |
| FG001 | Phase 1: Poly-ICLC 2mg | Cohort 2: Participants were administrated 2mg Poly-ICLC intramuscularly (IM) twice weekly. Pembrolizumab was administrated 200 mg intravenously (IV) every 3 weeks (q3W) |
| FG002 | Phase 2: Poly-ICLC: 2mg | Cohort 3: Participants were administrated 2mg Poly-ICLC intramuscularly (IM) twice weekly. Pembrolizumab was administrated 200 mg intravenously (IV) every 3 weeks (q3W) |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Phase 1: Poly-ICLC: 1mg | Cohort 1: Participants were administrated 1mg Poly-ICLC intramuscularly (IM) twice weekly. Pembrolizumab was administrated 200 mg intravenously (IV) every 3 weeks (q3W) |
| BG001 | Phase 1: Poly-ICLC: 2mg |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Phase 1: Determine the Maximum Tolerated Dose of Poly-ICLC That Can be Combined With Pembrolizumab | A minimum of 3 participants will be treated at dose level 1 (1mg).
| The safety population for this trial includes all participants who received at least one dose of the investigational product and excludes any participants who were screen fails. | Posted | Number | mg | 12 months |
|
3 years
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Phase 1: Poly-ICLC: 1mg | Cohort 1: Participants were administrated 1mg Poly-ICLC intramuscularly (IM) twice weekly. Pembrolizumab was administrated 200 mg intravenously (IV) every 3 weeks (q3W) |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Abdominal Distention | Gastrointestinal disorders | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr Asha Nayak | AUGUSTA UNIVERSITY MEDICAL CENTER | 7067216748 | anayak@augusta.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP_ICF | Yes | Yes | Yes | Study Protocol, Statistical Analysis Plan, and Informed Consent Form | Nov 15, 2022 | Jul 17, 2023 | Prot_SAP_ICF_001.pdf |
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| ID | Term |
|---|---|
| D003110 | Colonic Neoplasms |
| C565324 | Parkinson Disease 4, Autosomal Dominant Lewy Body |
| ID | Term |
|---|---|
| D015179 | Colorectal Neoplasms |
| D007414 | Intestinal Neoplasms |
| D005770 | Gastrointestinal Neoplasms |
| D004067 | Digestive System Neoplasms |
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| ID | Term |
|---|---|
| C582435 | pembrolizumab |
| C019531 | poly ICLC |
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| Poly-ICLC | Drug | The maximum tolerated dose of Poly ICLC will be given twice weekly, in each 3-week cycle: Week 1, Days 1 and 4 Week 2, Days 8 and 11 Week 3, Days 15 and 18 |
|
|
The 20-week progression free survival rate for the combination of pembrolizumab and poly-ICLC administered at the Recommended Phase 2 Dose (RP2D) will be estimated along with the correspondent 95% confidence interval. |
| 20 weeks |
| Determine the Duration of Response of Recurrent Metastatic MRP Colon Cancer to the Combination of Pembrolizumab and Poly-ICLC | The duration of response to the combination of pembrolizumab and poly-ICLC administered at the Recommended Phase 2 Dose (RP2D) will be estimated along with the correspondent 95% confidence interval. | From baseline to disease progression (up to 24 months) |
Cohort 2: Participants were administrated 2mg Poly-ICLC intramuscularly (IM) twice weekly. Pembrolizumab was administrated 200 mg intravenously (IV) every 3 weeks (q3W)
| BG002 | Phase 2: Poly-ICLC: 2mg | Cohort 3: Participants were administrated 2mg Poly-ICLC intramuscularly (IM) twice weekly. Pembrolizumab was administrated 200 mg intravenously (IV) every 3 weeks (q3W) |
| BG003 | Total | Total of all reporting groups |
| Participants |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
|
|
| Primary | Phase 1 and 2: Determine the Response Rate of Metastatic MRP Colon Cancer (That Has Progressed Following Two Lines of Therapy in the Metastatic Setting) to the Combination of Pembrolizumab and Poly-ICLC | Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR. | The analysis population is the number of patients who received treatment. The outcome measure population below is determined by the number of patients within each dataset (each cohort) with complete response (CR) or partial response (PR) defined by RECIST criteria. | Posted | Count of Participants | Participants | From baseline to disease progression (Expected 12-24 months) |
|
|
|
| Primary | Determine the Overall Survival Rate for Recurrent Metastatic MRP Colon Cancer Response to the Combination of Pembrolizumab and Poly-ICLC | The overall survival rate of response to the combination of pembrolizumab and poly-ICLC administered at the Recommended Phase 2 Dose (RP2D) will be estimated along with the correspondent 95% confidence interval. | Posted | Count of Participants | Participants | From baseline to disease progression (up to 24 months) |
|
|
|
| Secondary | Determine the Adverse Event Profile and Dose Limiting Toxicities of the Combination of Pembrolizumab and Poly-ICLC | The adverse event profile will be presented by dose level of the combination treatment for the phase I portion | The percentage of participants that experienced severe adverse events. | Posted | Number | percentage of participants | 12 months |
|
|
|
| Secondary | Determine the 20-week Progression Free Survival Rate of Recurrent Metastatic MRP Colon Cancer to the Combination of Pembrolizumab and Poly-ICLC | The 20-week progression free survival rate for the combination of pembrolizumab and poly-ICLC administered at the Recommended Phase 2 Dose (RP2D) will be estimated along with the correspondent 95% confidence interval. | Progression is defined using Response Evaluation Criteria in Solid Tumors (RECIST v1.1) as any tumor enlargement greater than 20% and 5mm from baseline. The number of patients analyzed were the patients who received treatment. The outcome measure describes the count of patients who did not progress. | Posted | Count of Participants | Participants | 20 weeks |
|
|
|
| Secondary | Determine the Duration of Response of Recurrent Metastatic MRP Colon Cancer to the Combination of Pembrolizumab and Poly-ICLC | The duration of response to the combination of pembrolizumab and poly-ICLC administered at the Recommended Phase 2 Dose (RP2D) will be estimated along with the correspondent 95% confidence interval. | Only one participant on this trial responded to the study treatment, so the 95% confidence interval could not be calculated. | Posted | Number | weeks | From baseline to disease progression (up to 24 months) |
|
|
|
| 8 |
| 8 |
| 7 |
| 8 |
| 0 |
| 8 |
| EG001 | Phase 1: Poly-ICLC: 2mg | Cohort 2: Participants were administrated 2mg Poly-ICLC intramuscularly (IM) twice weekly. Pembrolizumab was administrated 200 mg intravenously (IV) every 3 weeks (q3W) | 10 | 10 | 7 | 10 | 0 | 10 |
| EG002 | Phase 2: Poly-ICLC: 2mg | Cohort 3: Participants were administrated 2mg Poly-ICLC intramuscularly (IM) twice weekly. Pembrolizumab was administrated 200 mg intravenously (IV) every 3 weeks (q3W) | 23 | 24 | 17 | 24 | 0 | 24 |
| Dyspnea | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Small Bowel Obstruction | Gastrointestinal disorders | Systematic Assessment |
|
| Leukocytosis | Blood and lymphatic system disorders | Systematic Assessment |
|
| Death | General disorders | Systematic Assessment |
|
| Sepsis | Infections and infestations | Systematic Assessment |
|
| Intracranial Hemorrhage | Nervous system disorders | Systematic Assessment |
|
| Acute Kidney Injury | Renal and urinary disorders | Systematic Assessment |
|
| Nausea/Vomitting | Gastrointestinal disorders | Systematic Assessment |
|
| Thrombolytic Event | Cardiac disorders | Systematic Assessment |
|
| Hyperkalemia | Metabolism and nutrition disorders | Systematic Assessment |
|
| Hyperuricemia | Renal and urinary disorders | Systematic Assessment |
|
| Tumor Lysis Syndrome | General disorders | Systematic Assessment |
|
| Hypoxia | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Fever | General disorders | Systematic Assessment |
|
| Malaise | General disorders | Systematic Assessment |
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| Fatigue | General disorders | Systematic Assessment |
|
| Pulmonary Edema | Cardiac disorders | Systematic Assessment |
|
| Hypotension | Cardiac disorders | Systematic Assessment |
|
| Hypoglycemia | Blood and lymphatic system disorders | Systematic Assessment |
|
| Acute Encephalopathy | Nervous system disorders | Systematic Assessment |
|
| Hyponatrenia | Metabolism and nutrition disorders | Systematic Assessment |
|
| Dehydration | General disorders | Systematic Assessment |
|
| Blood Biliruben Increased | Blood and lymphatic system disorders | Systematic Assessment |
|
| Hydrocephalis | General disorders | Systematic Assessment |
|
| Pneumonia | Respiratory, thoracic and mediastinal disorders | Systematic Assessment |
|
| Abdominal Pain | General disorders | Systematic Assessment |
|
| Kidney Infection | General disorders | Systematic Assessment |
|
| Ascites | General disorders | Systematic Assessment |
|
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| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D004066 | Digestive System Diseases |
| D005767 | Gastrointestinal Diseases |
| D003108 | Colonic Diseases |
| D007410 | Intestinal Diseases |