Patient case: 68-year-old male with colon cancer; genetic feature: MLH1 methylation suppression (microsatellite instability)

Clinical trial: Phase I Study of SGI-110 With Irinotecan Followed by Randomized Phase II Study of SGI-110 With Irinotecan Versus Regorafenib or TAS-102 in Previously Treated Metastatic Colorectal Cancer

Summary: This is a phase I/randomized phase II study of the combination of SGI-110 and previously treated metastatic colorectal cancer patients. This study will be conducted in two components. First, patients will be enrolled in a phase I study of SGI-110 combined with irinotecan in a standard 3+3 design. After the maximum tolerated dose (MTD) is determined, patients will subsequently be enrolled in a 2:1 randomized phase II study of SGI-110 and irinotecan versus the standard of care regorafenib or TAS-102.


Eligibility: Inclusion Criteria:
  -  Participants must have histologically or cytologically confirmed adenocarcinoma of the colon or rectum
  -  Patients in the phase II cohort must be amenable to having two research biopsies. This applies to the first 36 patients enrolled to Arm A, who have both biopsiable disease and are randomized to SGI-110 + Irinotecan.
  -  Archival tissue must be procured if available
  -  Participants must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as > 20 mm with conventional techniques or as > 10 mm with spiral CT scan. See section 10 for the evaluation of measureable disease.
  -  Patients in the phase II cohort must have progressed while receiving irinotecan therapy in the metastatic setting. There are no limitations on number of prior therapies in the metastatic setting.
  -  Age minimum of 18 years.
  -  Life expectancy of greater than 12 weeks.
  -  Eastern Cooperative Oncology Group (ECOG) performance status <1
  -  Participants must have normal organ and marrow function
  -  The effects of SGI-110 on the developing human fetus are unknown. For this reason and because oncological agents are known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 3 months after completion of the study.
  Should a woman become pregnant or suspect she is pregnant while participating in this study or within 30 days of last dose, she should inform her treating physician immediately.
  -  Ability to understand and the willingness to sign a written informed consent document.
  Exclusion Criteria:
  -  Participants who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to enrolling in the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier.
  -  Participants may not be receiving any other study agents.
  -  Participants with known brain metastases should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events.
  -  History of allergic reactions attributed to compounds of similar chemical or biologic composition to irinotecan, decitabine or SGI-110.
  -  Subjects who have received prior therapy with any hypomethylating agents.
  -  Uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
  -  Pregnant women are excluded from this study because SGI-110 is a/an hypomethylating agent with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk of adverse events in nursing infants secondary to treatment of the mother with SGI-110, breastfeeding should be discontinued. These potential risks may also apply to other agents used in this study.
  -  Individuals with a history of a different malignancy are ineligible except for the following circumstances: Individuals with a history of other malignancies who have been disease-free for at least 5 years and are deemed by the investigator to be at low risk for recurrence of that malignancy. Individuals with the following cancers are eligible if diagnosed and treated within the past 5 years: cervical cancer in situ, definitively treated early stage prostate cancer (confined to prostate with Gleason 6 or below), definitely treated breast ductal or lobular carcinoma in situ, and basal cell or squamous cell carcinoma of the skin.
  -  HIV-positive individuals on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with SGI-110. In addition, as these individuals are at increased risk of lethal infections when treated with marrow-suppressive therapy. Appropriate studies will be undertaken in participants receiving combination antiretroviral therapy when indicated.
  -  Previous treatment with regorafenib and TAS-102 (This applies to phase II only.) If patients have previously received either regorafenib OR TAS-102, they must be able to receive the alternate regimen if randomized to the standard of care arm).
  -  Hospitalization for an acute medical issue within 4 weeks prior to screening visit that would not otherwise be managed in an infusion center or outpatient clinic setting (e.g., a patient admitted to complete a transfusion would not be ineligible.).
  -  Symptomatic bowel obstruction within 6 months prior to enrollment, Patients who undergo surgical correction of obstructing lesion will be eligible within 6 months.

Relevance to patient case: not relevant