Single Arm Study of Neoadjuvant Dostarlimab in Stage II and III Deficient Mismatch Repair Colon Cancers

Study Overview
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Brief Summary
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This is a Phase II, single arm study looking at the rate of major clinical response and non-operative management in Stage II and III colon cancer after 18 weeks (up to 6 cycles) of neoadjuvant dostarlimab.

Detailed Description
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The purpose of this research study is to look at the effects of the immunotherapy drug dostarlimab on dMMR colon cancer tumors and to see if these patients can avoid surgical resection, with the option to go to surgery only if the tumor does not respond.

Official Title
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Phase II, Single Arm Study of Neoadjuvant Dostarlimab (TSR-042) in Stage II and III Deficient Mismatch Repair Colon Cancers

Conditions
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Colon Cancer, dMMR Colorectal Cancer

Intervention / Treatment
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* Drug: Dostarlimab


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Capable of understanding and complying with the protocol requirements and have signed the informed consent document. Patients with mild cognitive impairment may be considered for enrollment in the study if their legally authorized representative provides written informed consent for the patient. 18 years or older in age Biopsy proven Stage II or III dMMR (by IHC AJCC 8th edition, 2017) ) Colon Cancer patients amendable to en block surgical resection as determined by colorectal surgeon. Biopsy specimen for diagnosis of dMMR Colon cancer should have enough tissue for minimum 4 and max 6 maximum adjacent unstained FFPE slides (4µm each) as determined by Protocol Pathologist Dr. Anthony Snow for CD3+ and CD8+ analysis. If there is not enough tissue present in original sample, a repeat colonoscopy and biopsy may be performed; otherwise patient is not eligible. Potentially surgically resectable Stage II or III patients who are willing to forgo surgical resection if study endpoints are met ECOG performance status less than or equal to 1 Absence of metastatic disease on CT CAP with Contrast within 28 days from treatment start Absolute neutrophil count greater than or equal to 1,500/µL Platelets greater than or equal to 100,000/µL Hemoglobin greater than or equal to 9 g/dL Serum creatinine less than or equal to 1.5 x upper limit of normal (ULN) or calculated creatinine clearance 60mL/min using the Cockcroft-Gault equation Total bilirubin less than or equal to 1.5 x ULN (less than or equal to 2.0 in patients with known Gilberts syndrome) OR direct bilirubin less than or equal to 1 x ULN Aspartate aminotransferase and alanine aminotransferase less than or equal to 3.0 x ULN International normalized ratio (INR) or prothrombin time (PT) less than or equal to 1.5× ULN unless patient is receiving anticoagulant therapy if PT or partial thromboplastin (PTT) is within therapeutic range of intended use of anticoagulants. Activated partial thromboplastin time (aPTT) less than or equal to 1.5× ULN unless patient is receiving anticoagulant therapy if PT or PTT is within therapeutic range of intended use of anticoagulants Participants of childbearing potential must have a negative serum pregnancy test within 72 hours prior to taking study treatment and agree to use an adequate method of contraception from screening through 180 days after the last dose of study treatment. Information must be captured appropriately within the site's source documents. Note: Abstinence is acceptable if this is the established and preferred contraception for the patient. For males of reproductive potential: use of condoms or other methods to ensure effective contraception with partner starting with first dose of study treatment through 180 days after the last dose of study treatment. Note: Abstinence is acceptable if this is the established and preferred contraception for the patient. Exclusion Criteria: Known hypersensitivity to dostarlimab components or excipients. Major surgery less than or equal to 3 weeks prior to initiating protocol therapy Received investigational therapy less than or equal to 3 months, or within a time interval less than at least 5 half- lives of the investigational agent, whichever is shorter, prior initiating protocol therapy. Heavy bleeding from the colon cancer tumors requiring PRBC transfusions that would require palliative surgical resection Symptomatic, partially obstructing tumors (patients with diverting ostomies are allowed) Concurrent, clinically significant, active malignancies within two years of study enrollment. 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. Active autoimmune disease that has required systemic treatment in the past 2 years (i.e., with use of disease-modifying agents, glucocorticoids, or immunosuppressive drugs). Other than Replacement hormone therapy with thyroxine for hypothyroidism , insulin for T1 diabetes mellitus , or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) Diagnosis of immunodeficiency or has received any systemic glucocorticoid therapy or any other form of immunosuppressive therapy within 7 days prior to initiating protocol therapy. History of greater than or equal to Grade 3 immune-related AE with prior immunotherapy, except for non-clinically significant lab abnormalities. Patients with known HIV (Human Immunodeficiency Virus) infection on effective retroviral therapy regardless of CD4 count who have had an opportunistic infection within the past 12 months. Organ transplant recipients on immunosuppressive medications Patients with chronic HBV infection with active disease who meet the criteria for anti HBV therapy but not on suppressive antiviral therapy prior to initiation of treatment of this protocol are excluded. Also, patients with history of HCV infection that have not completed curative antiviral treatment and the HCV viral load is not below the limit of quantification areexcluded.(e.g. a patient who is HCV Ab positive but HCV RNA negative due to prior treatment or natural resolution is eligible.) Prior history of interstitial lung disease. Received a live vaccine within 30 days of initiating protocol therapy.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Neoadjuvant Dostarlimab<br>Participants will receive Dostarlimab 500 mg IV every 3 weeks for 9 cycles followed by 1000 mg every 6 weeks for 12 cycles until 2 years | Drug: Dostarlimab<br>* Participants will receive Dostarlimab 500 mg IV every 3 weeks for 9 cycles followed by 1000 mg every 6 weeks for 12 cycles until 2 years<br>* Other names: TSR-042;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Major Clinical Response (MCR) Rate | MCR rate is defined as the proportion of patients meeting the following criteria at 18 weeks: 1) ctDNA is stable or declining, 2) a clinically asymptomatic primary tumor, and 3) no metastatic disease. | From Dostarlimab initiation to 18 weeks. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Metastasis-Free Survival (MFS) Prior to Surgery | MFS is defined as the time from treatment initiation to the date of metastasis or death due to any cause, if occurring prior to surgery. Otherwise, patients will be censored at the date of surgery or last radiographic assessment, whichever occurs first. | From Dostarlimab initiation until surgery or Dostarlimab completion, up to 2 years. | 
| Progression-Free Survival (PFS) | PFS is defined as the time from treatment initiation to the date of first documentation of disease progression (defined as increasing ctDNA, symptomatic primary tumor or metastasis), or death due to any cause. Otherwise, patients will be censored at last radiographic assessment. | From treatment Dostarlimab until study completion, up to 5 years. | 
| Overall Response Rate (ORR) | ORR is defined as the proportion of patients with RECIST disease response (CR, PR). All patients that do not meet the criteria for an objective response by the analysis cutoff date will be considered non-responders. | From Dostarlimab initiation until surgery or Dostarlimab completion, up to 2 years. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Colon cancer, dMMR, Deficient mismatch repair colon cancer, MSI-High, MSI-H, Non-operative management, No surgery