Study of Durvalumab and Tremelimumab After Radiation for Microsatellite Stable Metastatic Colorectal Cancer Progressing on Chemotherapy
Condition: Colorectal Cancer Metastatic
MeSH terms: Colorectal Neoplasms
Intervention: durvalumab; Tremelimumab
Intervention description: Following three doses of hypofractionated palliative radiation (Days -2, -1, and Day 0 prior to Cycle 1), patients will receive durvalumab (1500 mg IV infusion) on Day 1 for 4 cycles (in combination with tremelimumab). Beginning with Cycle 5 through Cycle 12, patients will receive durvalumab alone (1500 mg/IV infusion) on Day 1 of each 28 day cycle.; Following three doses of hypofractionated palliative radiation (Days -2, -1, and Day 0 prior to Cycle 1), patients will receive tremelimumab (75 mg IV infusion) on Day 1 for 4 cycles (in combination with durvalumab).
Intervention MeSH terms: Durvalumab; Tremelimumab
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 33.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: microsatellite stable; MSS; durvalumab; tremelimumab; mCRC; NSABP

Summary:

      This study is being done to look at the safety and response to the combination of two
      investigational drugs, tremelimumab and durvalumab, when given after radiation therapy for
      patients with microsatellite stable (MSS) metastatic colorectal cancer. Tremelimumab and
      durvalumab recognize specific proteins on the surface of cancer cells and trigger the immune
      system to destroy the cancer cells.

      In order to learn more about certain characteristics of colorectal cancer tumors, this study
      includes special research tests using samples from diagnostic tumors, fresh tumor samples
      from an area where the cancer has spread, and blood samples.
    

Eligibility criteria:

        Inclusion Criteria:

          -  The ECOG performance status must be 0 or 1.

          -  There must be histologic confirmation of a diagnosis of colorectal adenocarcinoma.

          -  The tumor must have been determined to be microsatellite stable (MSS).

          -  There must be documentation by positron emission tomography (PET)/computed tomography
             (CT) scan, CT scan, or magnetic resonance imaging (MRI), that the patient has evidence
             of measurable metastatic disease per RECIST 1.1.

          -  Patients must have an accessible metastatic lesion for pretreatment core biopsy.

          -  Unless either drug is medically contraindicated, patients must have received
             oxaliplatin and irinotecan as part of standard metastatic chemotherapy regimens.

          -  The patient must have multiple sites of metastatic disease with at least one lesion
             amenable to treatment with stereotactic radiation therapy (SBRT) in the lung or liver
             and at least one lesion not being irradiated and meeting RECIST 1.1.

          -  At the time of study entry, blood counts performed within 2 weeks prior to study entry
             must meet the following criteria:

               -  ANC (absolute neutrophil count) must be greater than or equal to 1500/mm3,

               -  Platelet count must be greater than or equal to 100,000/mm3; and

               -  Hemoglobin must be greater than or equal to 9 g/dL.

          -  The following criteria for evidence of adequate hepatic function performed within 2
             weeks prior to study entry must be met:

               -  Total bilirubin must be less than or equal to 1.5 x ULN (upper limit of normal)
                  for the lab unless the patient has a bilirubin elevation greater than 1.5 x ULN
                  to 3 x ULN due to Gilbert's disease or similar syndrome involving slow
                  conjugation of bilirubin; and

               -  AST (aspartate aminotransferase)and ALT (alanine transaminase) must be less than
                  or equal to 2.5 x ULN for the lab with the following exception: for patients with
                  documented liver metastases, AST and ALT must be less than or equal to 5 x ULN.

          -  Adequate renal function within 4 weeks prior to study entry, defined as serum
             creatinine less than or equal to 1.5 x ULN for the lab or measured or calculated
             creatinine clearance greater than 40 mL/min by Cockcroft-Gault formula.

          -  All hematologic, gastrointestinal, and genitourinary chemotherapy toxicities must be
             less than Grade 2 at the time study therapy is to begin. (Note: Transfusions may be
             used to correct hemoglobin for patients experiencing anemia from therapy who otherwise
             would be eligible for the study.

          -  Patients with reproductive potential (male/female) must agree to use accepted and
             highly effective methods of contraception while receiving study therapy and for at
             least 6 months after the completion of study therapy. The definition of effective
             method of contraception will be based on the investigator's discretion.

          -  Female patients must either be of non-reproductive potential (i.e., post-menopausal by
             history: greater than or equal to 60 years old and no menses for greater than or equal
             to 1 year without an alternative medical cause; OR history of hysterectomy, OR history
             of bilateral tubal ligation, OR history of bilateral oophorectomy) or must have a
             negative serum pregnancy test upon study entry.

        Exclusion Criteria:

          -  Diagnosis of anal or small bowel carcinoma.

          -  Colorectal cancer other than adenocarcinoma, e.g., sarcoma, lymphoma, carcinoid.

          -  Previous therapy with any PD-1 or PD-L1 (programmed cell death-1 (PD-1) protein,
             programmed death ligand-1 (PDL-1) protein inhibitor including durvalumab or anti-CTLA4
             (including tremelimumab) for any malignancy.

          -  Receipt of live attenuated vaccination within 30 days prior to study entry or within
             30 days of receiving study therapy.

          -  Active or chronic hepatitis B or hepatitis C.

          -  Symptomatic or uncontrolled brain metastases requiring concurrent treatments,
             uncontrolled spinal cord compression, carcinomatous meningitis, or new evidence of
             brain or leptomeningeal disease; uncontrolled seizures.

          -  Active infection or chronic infection requiring chronic suppressive antibiotics.

          -  Active or documented inflammatory disease.

          -  Known history of human immunodeficiency virus (HIV) or acquired
             immunodeficiency-related (AIDS) illnesses.

          -  Current or prior use of immunosuppressive medication within 28 days before the first
             dose of study therapy with the exceptions of intranasal corticosteroids or systemic
             corticosteroids at physiological doses that do not exceed 10mg/day of prednisone or an
             equivalent corticosteroid.

          -  History of allogeneic organ transplantation.

          -  Any of the following cardiac conditions:

               -  Documented NYHA (New York Heart Association) Class III or IV congestive heart
                  failure,

               -  Myocardial infarction within 6 months prior to study entry,

               -  Unstable angina within 6 months prior to study entry,

               -  Symptomatic arrhythmia. If QTc (corrected QT interval) greater than or equal to
                  470ms, confirmation of eligible QTc requires mean calculation from 2 additional
                  electrocardiograms (ECGs) 2-5 minutes apart using Fridericia's Correction Formula
                  (mean less than 470 ms).

          -  Uncontrolled high blood pressure defined as systolic blood pressure (BP) greater than
             or equal to 150 mmHg or diastolic BP greater than or equal to 100 mmHg with or without
             anti-hypertensive medication. Patients with initial BP elevations are eligible if
             initiation or adjustment of BP medication lowers pressure to meet entry criteria.

          -  Active or prior documented inflammatory bowel disease (e.g., Crohn's disease,
             ulcerative colitis).

          -  Ongoing or active gastritis or peptic ulcer disease.

          -  Active bleeding diatheses.

          -  Known history of previous diagnosis of tuberculosis.

          -  History of hypersensitivity to durvalumab or tremelimumab or any excipients of these
             drugs.

          -  Known history or confirmation of active pneumonia, pneumonitis, symptomatic
             interstitial lung disease, or definitive evidence of interstitial lung disease
             described on CT scan, MRI, or chest x-ray in asymptomatic patients; dyspnea at rest
             requiring current continuous oxygen therapy.

          -  Active or prior documented autoimmune disease within the past 2 years. (Note: Patients
             with vitiligo, Grave disease, or psoriasis not requiring systemic treatment within the
             past 2 years are eligible.)

          -  Other malignancies unless the patient is considered to be disease-free and has
             completed therapy for the malignancy greater than or equal to 12 months prior to study
             entry. Patients with the following cancers are eligible if diagnosed and treated
             within the past 12 months: carcinoma in situ of the cervix, and basal cell and
             squamous cell carcinoma of the skin.

          -  Psychiatric or addictive disorders or other conditions that, in the opinion of the
             investigator, would preclude the patient from meeting the study requirements or
             interfere with interpretation of study results.

          -  Pregnancy or lactation at the time of study entry. (Note: Pregnancy testing should be
             performed within 14 days prior to study entry according to institutional standards for
             women of childbearing potential.)

          -  Use of any investigational agent. Use and/or receipt of the last dose of anti-cancer
             therapy (chemotherapy, immunotherapy, endocrine therapy, targeted therapy, biologic
             therapy, tumor embolization, monoclonal anti-bodies) within 14 days prior to the first
             dose of study therapy.

          -  Use of any investigational agent within 4 weeks of starting study therapy.