- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06006923
Regorafenib in Combination With Pembrolizumab or Pembrolizumab for MSI-H Colorectal Cancer
May 3, 2024 updated by: Ibrahim Halil Sahin
Randomized Trial of Regorafenib in Combination With Pembrolizumab or Pembrolizumab Monotherapy With an Efficacy Lead-in of Regorafenib and Pembrolizumab for Patients With MSI-H Colorectal Cancer
This is a trial of Regorafenib in combination with pembrolizumab for patients with MSI-H colorectal cancer consisting of lead-in phase examining preliminary efficacy and safety, followed by a randomized phase to further examine efficacy.
Study Overview
Status
Not yet recruiting
Conditions
Intervention / Treatment
Detailed Description
Regorafenib is a multi-kinase inhibitor that targets several receptor tyrosine kinases including vascular endothelial growth factor receptor (VEGFR).
Regorafenib may also have immunomodulatory affect in the tumor microenvironment.
Preclinical and early clinical studies indicate there is a potential for synergistic activity of regorafenib with immune checkpoint inhibitors that can be leveraged to augment antitumor immunity.
Pembrolizumab, anti-PD1 blockade, has been approved for patients with high microsatellite instability (MSI-H) colorectal cancer (CRC) as first line therapy.
However, there is still an unmet need to enhance the efficacy of immune checkpoint inhibitors for patients with MSI-H colorectal cancer.
The efficacy of TKI and immune checkpoint inhibitor combination have been shown in clinical studies for solid tumors particularly for those that are responsive to immune checkpoint inhibitors therapy.
Therefore, there is strong rationale for the combination of regorafenib and pembrolizumab in MSI-H colorectal cancer in which there is increased VEGF activity compared to MSS counterpart.
A recent retrospective study showed significantly improved response to regorafenib among patients with MSI-H colorectal cancer, compared to patients with MSS colorectal cancer.
Collectively, this combination may increase anti-tumor immune response and clinical effectiveness of immunotherapy for patients with MSI-H colorectal cancer.
Based on prior clinical trials, the target regorafenib dose in this study is determined to be 90 mg.
However, patients in the lead-in phase will receive regorafenib 60 mg in combination with 200mg of pembrolizumab Q3 weeks in the first cycle to increase tolerance and study compliance.
The dose of regorafenib will be increased to 90 mg by Cycle 2. An interim analysis will be performed after completion of data collection for the lead-in phase.
Target enrollment for the lead-in phase is approximately 22 patients.
Following the futility analysis in lead-in phase, the randomized phase target enrollment is determined to be 66 patients per arm, for a total trial enrollment of 154 participants.
Patients who received 3 or less cycles of chemotherapy prior to the determination of MMR-D and MSI-H disease can be enrolled in this trial.
Study Type
Interventional
Enrollment (Estimated)
154
Phase
- Phase 2
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Clare Grzejka, RN, BSN
- Phone Number: 412-623-4891
- Email: grzejkac@upmc.edu
Study Contact Backup
- Name: Debra Diecks, RN, BSN
- Phone Number: 412-623-8364
- Email: diecksda@upmc.edu
Study Locations
-
-
Pennsylvania
-
Pittsburgh, Pennsylvania, United States, 15232
- UPMC Hillman Cancer Center
-
Contact:
- Clare Grzejka, RN, BSN
- Phone Number: 412-623-4891
- Email: grzejkac@upmc.edu
-
Contact:
- Debra Diecks, RN, BSN
- Phone Number: 412-623-8364
- Email: diecksda@upmc.edu
-
Principal Investigator:
- Ibrahim H Sahin, MD
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Histologically confirmed mismatch repair deficient or microsatellite instability high advanced stage colorectal cancer
- Measurable disease (per RECIST v1.1)
- Eastern Cooperative Oncology Group (ECOG) performance status 0 to 1
- Age > 18
- The patient must be able to swallow oral medication.
Adequate organ function based on the following lab assessments:
- ANC must be ≥ 1500/mm3
- platelet count must be ≥ 100,000/mm3
- WBC count ≥ 2.5 × 109 /L
- Hemoglobin must be ≥ 9 g/dL
- Alkaline phosphatase ≤ 2.5× upper limit of normal (ULN) with the exception of patients with documented liver or bone metastases who should have ALP ≤ 5.0× ULN
- AST and ALT ≤ 2.5× ULN with the exception of patients with documented liver metastases who may have AST and/or ALT ≤ 5.0× ULN
- International normalized ratio (INR) ≤ 1.5 x ULN and partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT) ≤ 1.5 x ULN unless receiving treatment with therapeutic anticoagulation
- Total bilirubin ≤ 1.5× ULN (≤ 3× ULN if Gilbert syndrome present)
- Serum albumin ≥ 2.8 g/dL or 28 g/L
- Creatinine clearance ≥ 50 mL/min (calculated using the Cockcroft-Gault formula) or creatinine ≤ 1.5× ULN
- No more than three cycles of prior fluoropyrimidine-based chemotherapy including folinic acid, fluorouracil, and oxaliplatin (FOLFOX); folinic acid, fluorouracil, and irinotecan (FOLFIRI); and, folinic acid, fluorouracil, oxaliplatin, and irinotecan (FOLFOXIRI) excluding adjuvant treatment
- Patients (male or female) of reproductive potential must agree to use an effective method of contraception (as discussed with treating physician) from the time consent is signed, during study therapy, and for at least 8 weeks after the last dose of study therapy.
- Patients who received no more than 1 cycle of pembrolizumab monotherapy will be still eligible to be enrolled in lead in phase of the trial
Exclusion Criteria:
- Prior anti-programmed death 1 (anti-PD-1) or anti-cytotoxic T-lymphocyte-associated antigen 4 (anti-CTLA-4) based therapy
- More than 3 cycles of chemotherapy or progression of disease on first line therapy excluding adjuvant treatment and any systemic anticancer treatment within 2 weeks or 5 half-lives (whichever is shorter) prior to start of study treatment
- Active autoimmune disease
- Pregnant or lactating females
- Uncontrolled human immunodeficiency virus (HIV), hepatitis B virus (HBV), and/or hepatitis C virus (HCV); patients with undetectable viral load and CD4 count > 200 will be eligible for enrollment
- Active untreated brain metastasis
- Uncontrolled hypertension (HTN: systolic pressure > 150 mmHg or diastolic pressure > 90 mmHg on repeated measurements) and cardiovascular events within 12 months of start of treatment
- Active infection or chronic infection requiring chronic suppressive antibiotics
- No active cancer such as colon cancer other than adenocarcinoma (e.g., sarcoma, lymphoma, carcinoid) within 1 year
- Patients with severe hepatic impairment (Child-Pugh C) are excluded as regorafenib has not been studied in this population and exposure might be increased in these patients
- Major surgical procedure or significant traumatic injury within 28 days before start of study medication
- Non-healing wound, non-healing ulcer, or non-healing bone fracture
- Patients with evidence or history of any bleeding diathesis, irrespective of severity
Any hemorrhage or bleeding event ≥ CTCAE Grade 3 within 4 weeks prior to the start of study medication:
- Major surgical procedure or significant traumatic injury within 28 days before start of study medication
- Non-healing wound, non-healing ulcer, or non-healing bone fracture
- Patients with evidence or history of any bleeding diathesis, irrespective of severity
- Any hemorrhage or bleeding event ≥ CTCAE Grade 3 within 4 weeks prior to the start of study medication
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Sequential Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Pembrolizumab + Regorafenib
Pembrolizumab: 200mg, Q3 weeks Regorafenib: 60mg Cycle 1 Day 1 90 mg Cycle 2 Day 1 |
A multi-kinase inhibitor that targets several receptor tyrosine kinases including vascular endothelial growth factor receptor (VEGFR), which may also have immunomodulatory affect in the tumor microenvironment.
Other Names:
An anti-PD1 blockade / immune checkpoint inhibitor treatment approved for patients with high microsatellite instability (MSI-H) colorectal cancer (CRC) as first line therapy.
Other Names:
|
Active Comparator: Pembrolizumab
Pembrolizumab: 200mg, Q3 weeks
|
An anti-PD1 blockade / immune checkpoint inhibitor treatment approved for patients with high microsatellite instability (MSI-H) colorectal cancer (CRC) as first line therapy.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Objective Response Rate (ORR), Lead-in Phase
Time Frame: Up to 12 months (lead-in phase)
|
Percentage of patients with partial response (PR) or complete response (CR) to the treatment per RECIST 1.1.
criteria.
v1.1.
Per RECIST v1.1: Complete Response (CR): Disappearance of all target lesions.
Any pathological lymph nodes (target or nontarget) with reduction in short axis to <10 mm.
Partial Response (PR): ≥30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.
|
Up to 12 months (lead-in phase)
|
Progression-free Survival (PFS), Randomize Phase
Time Frame: Up to 24 months
|
Median number of months from time of randomization to the date of disease progression or death from any cause.
Per RECISIT v1.1: Progressive Disease (PD):≥20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study).
The sum must also demonstrate an absolute increase of ≥5 mm.
The appearance ≥1 new lesion(s) is considered progression.
|
Up to 24 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Adverse Events and Serious Adverse Events Related to Treatment
Time Frame: Up to 24 months (lead-in phase)
|
Percentage of patients that experience Adverse Events (AEs) and/or Serious Adverse Events (SAEs) related to study treatment, per NCI Common Terminology Criteria for Adverse Events (CTCAE) v5.0.
The maximum grade for each type of toxicity will be recorded for each patient.
|
Up to 24 months (lead-in phase)
|
Adverse Events and Serious Adverse Events Related to Treatment
Time Frame: Up to 24 months (beginning at start of post lead-in phase)
|
Percentage of patients that experience Adverse Events (AEs) and/or Serious Adverse Events (SAEs) related to study treatment, per NCI Common Terminology Criteria for Adverse Events (CTCAE) v5.0.
The maximum grade for each type of toxicity will be recorded for each patient.
|
Up to 24 months (beginning at start of post lead-in phase)
|
Progression-free Survival (PFS), Lead-In Phase
Time Frame: Up to 24 months
|
Median number of months from time of randomization to the date of disease progression or death from any cause.
Per RECISIT v1.1: Progressive Disease (PD):≥20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study).
The sum must also demonstrate an absolute increase of ≥5 mm.
The appearance ≥1 new lesion(s) is considered progression.
|
Up to 24 months
|
Overall Survival (OS)
Time Frame: Up to 48 months (lead-in phase)
|
Median number of months from start of treatment to death from any cause.
|
Up to 48 months (lead-in phase)
|
Overall Survival (OS)
Time Frame: Up to 24 months (beginning at start of post lead-in phase)
|
Median number of months from time of randomization to death from any cause.
|
Up to 24 months (beginning at start of post lead-in phase)
|
Objective Response Rate (ORR), Randomized Phase
Time Frame: Up to 12 months (beginning at start of post lead-in phase)
|
Percentage of patients with partial response (PR) or complete response (CR) to the treatment per RECIST 1.1.
criteria.
v1.1.
Per RECIST v1.1: Complete Response (CR): Disappearance of all target lesions.
Any pathological lymph nodes (target or nontarget) with reduction in short axis to <10 mm.
Partial Response (PR): ≥30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.
|
Up to 12 months (beginning at start of post lead-in phase)
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Ibrahim H Sahin, MD, UPMC Hillman Cancer Center
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Estimated)
May 1, 2024
Primary Completion (Estimated)
April 1, 2026
Study Completion (Estimated)
April 1, 2029
Study Registration Dates
First Submitted
August 17, 2023
First Submitted That Met QC Criteria
August 17, 2023
First Posted (Actual)
August 23, 2023
Study Record Updates
Last Update Posted (Actual)
May 6, 2024
Last Update Submitted That Met QC Criteria
May 3, 2024
Last Verified
May 1, 2024
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Digestive System Diseases
- Neoplasms
- Neoplasms by Site
- Gastrointestinal Neoplasms
- Digestive System Neoplasms
- Gastrointestinal Diseases
- Colonic Diseases
- Intestinal Diseases
- Intestinal Neoplasms
- Rectal Diseases
- Colorectal Neoplasms
- Molecular Mechanisms of Pharmacological Action
- Antineoplastic Agents
- Antineoplastic Agents, Immunological
- Immune Checkpoint Inhibitors
- Pembrolizumab
Other Study ID Numbers
- HCC 23-041
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
Yes
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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