Clinical trial NCT05947669: Efficacy and Safety of Infliximab for Immune Checkpoint Inhibitor Induced Colitis
Official title: Efficacy and Safety of Infliximab for Immune Checkpoint Inhibitor Induced Colitis: a Multinational, Randomised, Open Label, Phase III Trial - The iCaD Study
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE3
Conditions: Colitis
Lead sponsor: Odense University Hospital
Sponsor class: OTHER
Collaborators: name: Aalborg University Hospital
name: Royal Marsden NHS Foundation Trust
First posted: 2023-07-17
Enrollment: 195
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The goal of this clinical trial is to assess whether the early introduction of biological treatment with a TNF-alpha inhibitor (infliximab) in addition to corticosteroids for severe ir-colitis/diarrhoea will reduce the time to grade ≤ 1 ir-colitis/diarrhoea compared to corticosteroids alone in patients scheduled for ICI treatment for solid tumors and untreated mCTCAE grade 2-4 diarrhoea or colitis.

The main question it aims to answer is:

• Can an early introduction of biological treatment with a TNF-alpha inhibitor (infliximab) in addition to corticosteroids reduce the time to grade ≤ 1 ir-colitis/diarrhoea compared to corticosteroids alone.

Participants will be randomised 1:1:

Arm A: All patients will receive same dose of methylprednisolone i.v. daily. Arm B: Patients allocated to Arm B will in addition receive infliximab i.v. day 1 or 2.

Study patients are evaluated with blood samples, faecal samples and by sigmoidoscopy. Procedures are performed before randomisation and as part of follow up.


Eligibility criteria: Inclusion Criteria

* Untreated mCTCAE grade 2-4 diarrhoea or colitis, or persistent mCTCAE grade 2 diarrhoea after administration of loperamide or equivalent for mCTCAE grade ≤ 2 diarrhoea
* No signs of colonic perforation or infection
* Age ≥ 18
* Understands the nature and purpose of the study and the study procedures and has signed informed consent
* Is able to read, understand, and complete questionnaires and daily components of the patient Diary for the study period
* Histologically confirmed malignant solid tumours
* Treatment with immune checkpoint inhibitors (anti-CTLA-4, anti-PD-1 or anti-PD-L1) within the past 12 weeks. Immune checkpoint inhibitors can be administered as single agents or as combination therapy with anti-CTLA-4 and anti-PD-1
* No probability of a concomitant treatment (e.g. laxatives) other than the immune checkpoint inhibitor being the causal drug for the colitis or diarrhoea
* Prior treatment with immune checkpoint inhibitors is allowed
* Usage of prednisolone ≤ 10 mg daily for non irAE is allowed
* Diagnostic work up including screening for viral hepatic infection and QuantiFERON-TB for mycobacterium tuberculosis must be requisitioned but will not need to be reported prior to study enrolment
* Women of child bearing potential must have a negative serum (preferred) or urine pregnancy test within 72 hours prior to registration.

  * Note: women of childbearing potential are defined as premenopausal females capable of becoming pregnant (i.e. females who have had evidence of menses in the past 12 months, with the exception of those who had prior hysterectomy). However, women who have been amenorrheic for 12 or more months are still considered to be of childbearing potential if the amenorrhea is possibly due to prior chemotherapy, antiestrogens, low body weight, ovarian suppression or other reasons.
* Patients of childbearing / reproductive potential should use adequate birth control measures, as defined by the investigator, during the study treatment period and after the study treatment:

  * for at least 6 months after the last study treatment, or depending on the duration antineoplastic treatment
  * Note: A highly effective method of birth control is defined as a method which results in a low failure rate (i.e. less than 1% per year) when used consistently and correctly. Such methods include:

    * Combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation (oral, intravaginal, transdermal)
    * Progestogen-only hormonal contraception associated with inhibition of ovulation (oral, injectable, implantable)
    * Intrauterine device (IUD)
    * Intrauterine hormone-releasing system (IUS)
    * Bilateral tubal occlusion
    * Vasectomized partner
    * Sexual abstinence

Exclusion Criteria

* Prior history of inflammatory bowel disease, colitis, or diarrhoea requiring treatment with any corticosteroid, or any other immunosuppressant medication
* Prior history of recurrent bowel disease including symptomatic diverticulosis
* Current positive testing for Clostridium difficile or other colonic infection
* Current bacterial infection requiring antibiotic treatment, or systemic fungal infection
* Ongoing antibiotic treatment for any reason
* Treatment with systemic corticosteroids within the last four weeks prior to study enrolment (daily usage of prednisolone ≤ 10 mg for non irAE conditions is accepted)
* Concurrent immune-related adverse events requiring immunosuppressant medication of any kind
* Known hypersensitivity or contraindications to systemic corticosteroids or infliximab
* Prior history of viral hepatitis with a positive viral load, known untreated mycobacterium tuberculosis, or known active herpes zoster infection

Primary outcomes:
measure: Time (days) to persistent modified CTCAE grade ≤ 1 ir-colitis/diarrhoea.
timeFrame: From the first day of grade ≤ 1 ir-colitis/diarrhoea of that period (time frame: seven weeks)
Secondary outcomes:
measure: Proportion of study subjects with grade ≤ 1 ir-colitis/diarrhoea at 72 hours.
timeFrame: Time frame: 72 hours
measure: Proportion of study subjects with persistent grade ≤ 1 ir-colitis/diarrhoea at three weeks.
timeFrame: The event will be calculated from the first day of grade ≤ 1 ir-colitis/diarrhoea of that period (time frame: three weeks)
measure: Proportion of study subjects with a corticosteroid-free clinical remission (grade ≤ 1 ir-colitis/diarrhoea) after seven weeks.
timeFrame: Time frame: seven weeks
measure: Proportion of study subjects requiring rescue immunosuppressive medication
timeFrame: Time frame: seven days
measure: Cumulative corticosteroid exposure
timeFrame: Time frame: seven weeks
measure: QoL by means of EORTC-QLQ-C30
timeFrame: Change in score from baseline to 3, 12, 24, and 52 weeks after randomisation
measure: QoL by means of selected PRO-CTCAE items
timeFrame: Change in score from baseline to 3, 12, 24, and 52 weeks after randomisation
measure: Proportion of study subjects with treatment related adverse events as assessed by CTCAE v5.0
timeFrame: Time frame: 12 weeks
measure: Proportion of study subjects with colectomy or colitis-specific mortality
timeFrame: Time frame: seven weeks
Other outcomes:
measure: Proportion of study subjects with recurrence of ir-colitis/diarrhoea on subsequent reintroduction of ICI.
timeFrame: Timeframe: Up to 24 weeks
measure: Subgroup analyses stratified for ipilimumab containing ICI for time (days) to persistent grade ≤ 1 ir-colitis/diarrhoea.
timeFrame: week 3
measure: Progression Free Survival stratified by cancer type
timeFrame: Time frame: duration of time from start of randomisation to time of progression or death, whichever occurs first or up to 24 months
measure: Overall Survival stratified by cancer type
timeFrame: Time frame: the duration of time from start of randomisation to time of death or up to 24 months
Locations:
city: Aalborg
country: Denmark
facility: Department of Oncology, Aalborg University Hospital
city: Odense
country: Denmark
facility: Department of Oncology Odense University Hospital
city: London
country: United Kingdom
facility: The Royal Marsden Hospital
Study officials:
affiliation: Department of Oncology, OUH
name: Christina H. Ruhlmann, PhD
role: PRINCIPAL_INVESTIGATOR
References: