Phase 2/3, randomized, open-label study of an individualized neoantigen vaccine (self-amplifying mRNA and adenoviral vectors) plus immune checkpoint blockade as maintenance for patients with newly diagnosed metastatic colorectal cancer (GRANITE).
Authors: Hecht J. Randolph , Shergill Ardaman , Goldstein Mark Gregory , Fang Bruno , Cho May Thet , Lenz Heinz-Josef , Berim Lyudmyla Derby , Oberstein Paul Eliezer , Safyan Rachael A , Sawhney Vivek , Soares Heloisa P. , Spigel David R. , Spira Alexander I. , Ferguson Andrew R. , Chauder Brian , Starodub Alexander 
Published: June 2022

TPS3635

Background: Treatment options for most patients with metastatic colorectal cancer (mCRC) are largely limited to cytotoxic chemotherapy, with little advancement in the last decade. Encouragingly, a small subset of patients deficient in mismatch repair (dMMR/MSI-hi) benefit from checkpoint inhibitors (CPI) whereas those proficient in mismatch repair (pMMR/MSS) do not. The absence of clinical benefit in patients with pMMR/MSS mCRC may relate to a lack of neoantigen-specific T cells and immune infiltration. An individualized neoantigen vaccine that induces CD8 T cells capable of tumor lysis has the potential to expand the number of patients with mCRC who may benefit from immunotherapy. Data from a Phase 1/2 study evaluating neoantigen vaccines in combination with CPIs in patients with previously treated mCRC demonstrated a 44% molecular response (MR) rate (≥50% decrease in ctDNA relative to baseline) in 4/9 patients; this correlated with improvement in OS relative to those without a MR. To further investigate neoantigen vaccines in earlier lines of treatment, a Phase 2/3 study in the1L maintenance setting in mCRC was initiated. Methods: GO-010 is a Phase 2/3, randomized, open-label, multi-center study evaluating the efficacy and safety of 2 neoantigen-containing vectors (GRT-C901-adenoviral vector plus GRT-R902-self-amplifying mRNA vector) as prime/boost in combination with CPIs as an add-on to fluoropyrimidine/bevacizumab (bev) following 1L therapy with FOLFOX/bev in patients with mCRC. During Phase 2, up to 90 patients will be randomized 1:1 to the vaccine or control arm with a primary objective of assessing efficacy by MR. During Phase 3, up to 226 patients will be randomized with a primary objective of assessing PFS per iRECIST in a blinded, independent manner. There are two stages to the study. In the vaccine production stage, while patients receive FOLFOX/bev 1L therapy, neoantigen prediction is performed using a tumor biopsy and Gritstone’s EDGE™ neoantigen prediction model. For patients in the vaccine arm the top 20 predicted neoantigens are included in the vaccine vectors. After completing oxaliplatin, patients will enter the study treatment stage. Patients in the control arm will continue with maintenance therapy whereas patients in the vaccine arm will add the vaccine regimen to maintenance therapy. The vaccine regimen consists of GRT-C901/GRT-R902 as well as SC ipilimumab (30 mg) and IV atezolizumab (1680 mg). Over the first year of treatment, 6 vaccinations will occur. Ipilimumab will be administered SC with the first doses of GRT-C901 and GRT-R902. Atezolizumab will be administered every 4 weeks for up to 2 years. Study assessments include imaging, ctDNA, safety, immunogenicity and exploratory biomarker analysis. Clinical trial information: NCT05141721.