FOLFOXIRI/Bevacizumab Plus Nivolumab as First-Line Treatment in Metastatic Colorectal Cancer RAS/BRAF Mutated: Safety Run-In of Phase II NIVACOR Trial

Angela Damato, Francesca Bergamo, Lorenzo Antonuzzo, Guglielmo Nasti, Francesco Iachetta, Alessandra Romagnani, Erika Gervasi, Mario Larocca, Carmine Pinto, Angela Damato, Francesca Bergamo, Lorenzo Antonuzzo, Guglielmo Nasti, Francesco Iachetta, Alessandra Romagnani, Erika Gervasi, Mario Larocca, Carmine Pinto

Abstract

The NIVACOR trial is a phase II study assessing the efficacy and safety of nivolumab in combination with FOLFOXIRI/bevacizumab in first-line setting in patients affected by metastatic colorectal cancer (mCRC) RAS/BRAF mutated. We report safety run-in results in the first 10 patients enrolled. Patients received triplet chemotherapy with FOLFOXIRI scheme plus bevacizumab, in association with nivolumab every 2 weeks for 8 cycles (induction phase) followed by bevacizumab plus nivolumab every 2 weeks (maintenance phase), until progression of disease or unacceptable toxicities. The first ten patients were evaluated: 7 experienced at least one adverse event (AE) related to FOLFOXIRI/bevacizumab and 2 related to nivolumab. The most frequent grade 1-2 AEs related to FOLFOXIRI/bevacizumab were diarrhea and fatigue (71%), nausea and vomiting (57%); 3 (43%) had grade 3-4 neutropenia, and 2 (20%) patients developed grade 1-2 AEs nivolumab related: skin rash and salivary gland infection. Two patients delayed the dose because of serious AEs, proteinuria and salivary gland infection; one patient discontinued experimental treatment due to the ileo-urethral fistula and concurrent Clostridium infection diarrhea. No treatment- related death occurred. The safety run-in analysis of NIVACOR trial reassured using co-administration of FOLFOXIRI/bevacizumab and nivolumab was well tolerated with an acceptable toxicity profile.

Clinical trial registration: https://ichgcp.net/clinical-trials-registry/NCT04072198" title="See in ClinicalTrials.gov">NCT04072198).

Keywords: BRAF mutation; FOLFOXIRI; RAS mutation; bevacizumab; colorectal cancer; nivolumab; safety run-in.

Conflict of interest statement

CP reports outside the submitted work personal fees for advisory role, speaker engagements, and travel and accommodation expenses from Amgen, Astellas, Astra-Zeneca, Bayer, Bristol Meyer Squibb, Clovis Oncology, Ipsen, Janssen, Incyte, Merck-Serono, Merck Sharp and Dohme, Novartis, Roche, and Sanofi. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Copyright © 2021 Damato, Bergamo, Antonuzzo, Nasti, Iachetta, Romagnani, Gervasi, Larocca and Pinto.

Figures

Figure 1
Figure 1
NIVACOR Study design. FOLFOXIRI, 5-fluorouracil, irinotecan, oxaliplatin; SD, stable disease; PR, partial response; CR, complete response; PD, progression disease.

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