EO2040 in Combination With Nivolumab, for Treatment of Patients With Minimal Residual Disease of Colorectal Cancer

The current study will evaluate the microbiome-derived therapeutic vaccine EO2040 in combination with nivolumab in patients with circulating tumor DNA-defined Minimal Residual Disease (MRD) of colorectal cancer stage II, III, or IV after completion of standard curative therapy.

The microbiome-derived therapeutic vaccine concept utilized in conjunction with anti-Programmed cell Death protein 1 (PD1) blockade is an innovative option for testing of a rational immunotherapy in colorectal cancer. The concept as such, including the combination with nivolumab, has already been tested in the clinical setting (i.e. in recurrent glioblastoma and adrenal tumors) and shown to be well tolerated.

Eligibility Criteria:
Inclusion Criteria:

To be eligible to receive study treatment, a patient must meet all the criteria below:

1. Provided written informed consent prior to any study-related procedures .
2. Histological confirmation of colorectal cancer.
3. Post R0-resection of stages II, III, or IV CRC and completion of all planned standard of care adjuvant therapies.
4. Presence of minimal residual disease as defined by a positive ctDNA assay after completion of all planned standard of care therapies.
5. Age ≥ 18 years old.
6. Human leukocyte antigen (HLA)-A2 positive.
7. No evidence of radiographic disease
8. Predefined performance status
9. Female patients of childbearing potential must have a negative serum pregnancy test within 72 hours prior to randomization.
10. Considering the embryofetal toxicity of the immune checkpoint inhibitor (ICI) shown in animals' models, recommendations for contraception must be followed.
11. Patients willing and able to comply with the scheduled visits, treatment plan, laboratory tests, and other study procedures indicated in the protocol.

Exclusion Criteria:

Patients who meet any of the following criteria will not be eligible to participate in the study:

1. Patients treated with dexamethasone \> 2 mg/day or equivalent .
2. Patients treated with radiotherapy within 12 weeks, and cytotoxic chemotherapy therapy within 28 days (or 5 half lives of the compound(s) administered if longer) before study treatment start.
3. Patients with persistent Grade ≥ 2 toxicities (according to NCI-CTCAE v5.0). Toxicities must be resolved for at least 2 weeks to Grade 1 or less. However, alopecia, neuropathy, and other persisting toxicities not constituting a safety risk based on Investigator's judgment are acceptable.
4. Patients who have received any prior treatment with compounds targeting PD1, PD-L1, Cytotoxic T-lymphocyte-associated Antigen 4 (CTLA-4), or similar compounds where general resistance against therapeutic vaccination approaches might have developed.
5. Patients with defined abnormal laboratory values:
6. Patients with presence of other concomitant active, invasive malignancies .
7. Patients with clinically significant active infection, cardiac disease, significant medical or psychiatric disease/condition that, in the opinion of the Investigator, would interfere with the interpretation of patient safety or study results or that would prohibit the understanding or rendering of informed consent
8. Patients with suspected autoimmune or active autoimmune disorder or known history of an autoimmune neurologic condition (e.g., Guillain-Barré syndrome)..
9. Patients with a history of solid organ transplantation or allogeneic hematopoietic stem cell transplantation.
10. Patients with a history or known presence of tuberculosis.
11. Pregnant and breastfeeding patients.
12. Patients with a history or presence of human immunodeficiency virus (HIV) and/or active hepatitis B virus (HBV)/hepatitis C virus (HCV).
13. Patients who have received live or attenuated vaccine therapy used for prevention of infectious diseases including seasonal (influenza) vaccinations within 4 weeks of the first dose of study drug.
14. Patients with a history of hypersensitivity to any excipient, or active substance, present in the pharmaceutical forms of applicable study treatments.
15. Patients under treatment with immunostimulatory or immunosuppressive medications, including herbal remedies, or herbal remedies known to potentially interfere with major organ function.
16. Patients who have received treatment with any other investigational agent, or participation in another clinical trial

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