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A Study of IMM-101 in Combination With Radiation Induced Tumour Necrosis in Colorectal Cancer

Primary Purpose

Metastatic Colorectal Cancer

Status
Completed
Phase
Phase 2
Locations
United Kingdom
Study Type
Interventional
Intervention
Mycobacterium obuense
SBRT
Sponsored by
Immodulon Therapeutics Ltd
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Metastatic Colorectal Cancer

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Patients are eligible to be included in the study if they:

Are male or female; aged ≥ 18 years. Have a histologically confirmed colorectal adenocarcinoma. Have documented evidence of disease progression following at least one line of chemotherapy.

Have no further standard chemotherapy options available have refused further chemotherapy.

Have metastatic lesions in at least two sites in the liver (+/- other sites) suitable for bidimensional and volumetric evaluation by CT scan.

Have WHO performance status of 0-2. Have a Cockcroft calculated Glomerular Filtration Rate of > 40mL/min at screening.

Have a life expectancy, in the opinion of the Investigator, of > 3 months from screening.

Patients are not eligible if one or more of the following statements are applicable:

Patient has evidence of central nervous system metastasis. Patient has severe, active uncontrolled infection requiring systemic antibiotics, antiviral or antifungal treatments.

Patient has any previous or concurrent malignancy, except adequately treated carcinoma in situ of the cervix, basal cell carcinoma of the skin and/or non-melanoma skin cancer, or if previous malignancy was more than 5 years earlier and there are no signs of recurrence.

Patient has serum albumin < 30 g/L at screening. Patient has a C-reactive protein (CRP) > 70 mg/L at screening. Patient has transaminases (ALT or AST) > 5 X Upper Limit of Normal at screening.

Patient has a bilirubin level > 2 X Upper Limit of Normal at screening. Patient has had radiotherapy in the 12 weeks before screening. Patient has used depot corticosteroids in the 6 weeks before screening. Patient has had chronic use of any systemic corticosteroids (> 10 mg per day of prednisolone or equivalent for a period of 2 weeks or more) and/or immunosuppressant drugs (such as azathioprine, tacrolimus, cyclosporin) within the 2-week period before the first administration of study drug.

Patient of child-bearing potential who is not using an approved method of birth control (e.g., physical barrier [patient and partner], contraceptive pill or patch, spermicide and barrier, or intrauterine device [IUD]). Those patients that utilise hormonal contraceptives must have used the same method for at least three months before study dosing. Patients of non-child-bearing potential are defined as having 12 month amenorrhoea or are surgically sterile.

Patient who is pregnant, breast feeding or planning a pregnancy during the course of the study. Where appropriate, a pre-treatment serum pregnancy test measuring human chorionic gonadotrophin (hCG) must be negative.

Patient has been administered any investigational product in the 3 months before screening.

Contraindication to CT scan, e.g., allergy to iodine based contrast medium. Patient has a surgical or medical condition which, in the judgement of the Investigator, might interfere with the activity of IMM-101, or with the performance of this study.

Patient has presence of any uncontrolled concomitant disease (e.g., unstable angina pectoris, congestive heart failure, myocardial infarction, cardiac arrhythmias, uncontrolled severe hypertension) which, in the judgement of the Investigator, might interfere with the activity of IMM-101, or with the performance of this study.

Patient has a history of serious adverse reaction or serious hypersensitivity to any drug that in the opinion of the Investigator may raise a safety concern.

Patient has had any previous treatment with IMM-101 or related mycobacterial immunotherapy (prior BCG vaccination against TB is allowed).

Patient is known to have a history of human immunodeficiency virus (HIV) or syphilis, current symptomatic Hepatitis B or C.

Patient is unable or unwilling to comply with the protocol.

Sites / Locations

  • HCA International, The Sarah Cannon Research Institute
  • The London Clinic

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

IMM-101 plus SBRT

Arm Description

The treatment regimen with IMM-101 (Mycobacterium obuense) will be every 2 weeks for the first three doses with the last of these doses being on the same day as the radiotherapy by CyberKnife treatment on a liver lesion targeted by the Principal Investigator. Following a rest of 4 weeks, patients will again receive IMM-101 every 2 weeks for the next 3 doses followed by a further 4 weeks rest. Thereafter, IMM-101 will be given at 4 week intervals for up to 12 months or until patient withdrawal for any reason

Outcomes

Primary Outcome Measures

Disease stabilisation rate
The disease stabilisation rate at 24 weeks defined as the proportion of patients with a complete response, partial response or stable disease in accordance with immune-related response criteria.

Secondary Outcome Measures

safety and tolerability profiles
No clinically relevant deleterious effect of IMM-101 on safety and tolerability profiles as judged by: Local and systemic toxicities. Number, type and degree of toxicities as measured by the National Cancer Institute (NCI) Common Toxicity Criteria for Adverse Events (CTCAE) v4.0. Safety and tolerability will be monitored through the study by a Data Monitoring Committee (DMC)
Objective response rate
Disease stabilisation rate
Overall disease stabilisation rate
Overall response rate
Progression-free survival
Survival
Tumour Markers

Full Information

First Posted
February 22, 2012
Last Updated
December 1, 2016
Sponsor
Immodulon Therapeutics Ltd
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1. Study Identification

Unique Protocol Identification Number
NCT01539824
Brief Title
A Study of IMM-101 in Combination With Radiation Induced Tumour Necrosis in Colorectal Cancer
Official Title
A Phase II, Single Arm, Investigative Study of IMM-101 in Combination With Radiation Induced Tumour Necrosis in Patients With Previously Treated Colorectal Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
December 2016
Overall Recruitment Status
Completed
Study Start Date
February 2012 (undefined)
Primary Completion Date
August 2014 (Actual)
Study Completion Date
August 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Immodulon Therapeutics Ltd

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to investigate the safety and effects of IMM 101 in combination with a single targeted dose of radiation in patients with metastatic colorectal cancer in whom chemotherapy or other treatment has not been effective. Administration of radiation (using the CyberKnife) to the target tumour growth in the liver results in the release of tumour material. IMM-101 may help the immune system to react to the tumour material released from the damaged tumour, and so have a beneficial effect in slowing down the rate of growth of other tumour growths in the liver and other organs.
Detailed Description
Radiotherapy given in standard fractionation regimes leads to cell death by causing double stranded DNA breaks via production of oxygen free radicals. At the very high doses of stereotactic body radiotherapy (SBRT) administered with extreme accuracy in a single fraction by the CyberKnife system, there is induction of tumour necrosis due to endothelial cell damage and vascular collapse, cell membrane breakdown, and the release of cellular material and tumour antigens into the circulation, in addition to DNA strand breaks. It is hypothesised that the combination of modulation of the body's immune responses in the presence of an increased exposure to tumour antigen will provide sufficient induction of the immune system to suppress tumour growth.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Colorectal Cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
12 (Actual)

8. Arms, Groups, and Interventions

Arm Title
IMM-101 plus SBRT
Arm Type
Experimental
Arm Description
The treatment regimen with IMM-101 (Mycobacterium obuense) will be every 2 weeks for the first three doses with the last of these doses being on the same day as the radiotherapy by CyberKnife treatment on a liver lesion targeted by the Principal Investigator. Following a rest of 4 weeks, patients will again receive IMM-101 every 2 weeks for the next 3 doses followed by a further 4 weeks rest. Thereafter, IMM-101 will be given at 4 week intervals for up to 12 months or until patient withdrawal for any reason
Intervention Type
Biological
Intervention Name(s)
Mycobacterium obuense
Other Intervention Name(s)
IMM-101
Intervention Description
IMM-101 is a suspension of heat-killed whole cell M. obuense in borate-buffered saline.
Intervention Type
Radiation
Intervention Name(s)
SBRT
Other Intervention Name(s)
stereotactic body radiation, CyberKnife
Intervention Description
The CyberKnife system is normally used for the treatment of cancerous tumours in cases where the type and position of the tumour and the condition of the patient indicate that treatment may be curative. In this study, the CyberKnife is being used in an experimental way to deliver a targeted dose of stereotactic body radiation with extreme accuracy in order to damage a single tumour growth (metastasis) in the liver.
Primary Outcome Measure Information:
Title
Disease stabilisation rate
Description
The disease stabilisation rate at 24 weeks defined as the proportion of patients with a complete response, partial response or stable disease in accordance with immune-related response criteria.
Time Frame
24 weeks
Secondary Outcome Measure Information:
Title
safety and tolerability profiles
Description
No clinically relevant deleterious effect of IMM-101 on safety and tolerability profiles as judged by: Local and systemic toxicities. Number, type and degree of toxicities as measured by the National Cancer Institute (NCI) Common Toxicity Criteria for Adverse Events (CTCAE) v4.0. Safety and tolerability will be monitored through the study by a Data Monitoring Committee (DMC)
Time Frame
48 weeks
Title
Objective response rate
Time Frame
12, 24, 36 and 48 weeks
Title
Disease stabilisation rate
Time Frame
12, 36 and 48 weeks
Title
Overall disease stabilisation rate
Time Frame
End of study
Title
Overall response rate
Time Frame
End of study
Title
Progression-free survival
Time Frame
12, 24, 36 and 48 weeks
Title
Survival
Time Frame
12, 24, 36 and 48 weeks
Title
Tumour Markers
Time Frame
12, 24, 36 and 48 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Patients are eligible to be included in the study if they: Are male or female; aged ≥ 18 years. Have a histologically confirmed colorectal adenocarcinoma. Have documented evidence of disease progression following at least one line of chemotherapy. Have no further standard chemotherapy options available have refused further chemotherapy. Have metastatic lesions in at least two sites in the liver (+/- other sites) suitable for bidimensional and volumetric evaluation by CT scan. Have WHO performance status of 0-2. Have a Cockcroft calculated Glomerular Filtration Rate of > 40mL/min at screening. Have a life expectancy, in the opinion of the Investigator, of > 3 months from screening. Patients are not eligible if one or more of the following statements are applicable: Patient has evidence of central nervous system metastasis. Patient has severe, active uncontrolled infection requiring systemic antibiotics, antiviral or antifungal treatments. Patient has any previous or concurrent malignancy, except adequately treated carcinoma in situ of the cervix, basal cell carcinoma of the skin and/or non-melanoma skin cancer, or if previous malignancy was more than 5 years earlier and there are no signs of recurrence. Patient has serum albumin < 30 g/L at screening. Patient has a C-reactive protein (CRP) > 70 mg/L at screening. Patient has transaminases (ALT or AST) > 5 X Upper Limit of Normal at screening. Patient has a bilirubin level > 2 X Upper Limit of Normal at screening. Patient has had radiotherapy in the 12 weeks before screening. Patient has used depot corticosteroids in the 6 weeks before screening. Patient has had chronic use of any systemic corticosteroids (> 10 mg per day of prednisolone or equivalent for a period of 2 weeks or more) and/or immunosuppressant drugs (such as azathioprine, tacrolimus, cyclosporin) within the 2-week period before the first administration of study drug. Patient of child-bearing potential who is not using an approved method of birth control (e.g., physical barrier [patient and partner], contraceptive pill or patch, spermicide and barrier, or intrauterine device [IUD]). Those patients that utilise hormonal contraceptives must have used the same method for at least three months before study dosing. Patients of non-child-bearing potential are defined as having 12 month amenorrhoea or are surgically sterile. Patient who is pregnant, breast feeding or planning a pregnancy during the course of the study. Where appropriate, a pre-treatment serum pregnancy test measuring human chorionic gonadotrophin (hCG) must be negative. Patient has been administered any investigational product in the 3 months before screening. Contraindication to CT scan, e.g., allergy to iodine based contrast medium. Patient has a surgical or medical condition which, in the judgement of the Investigator, might interfere with the activity of IMM-101, or with the performance of this study. Patient has presence of any uncontrolled concomitant disease (e.g., unstable angina pectoris, congestive heart failure, myocardial infarction, cardiac arrhythmias, uncontrolled severe hypertension) which, in the judgement of the Investigator, might interfere with the activity of IMM-101, or with the performance of this study. Patient has a history of serious adverse reaction or serious hypersensitivity to any drug that in the opinion of the Investigator may raise a safety concern. Patient has had any previous treatment with IMM-101 or related mycobacterial immunotherapy (prior BCG vaccination against TB is allowed). Patient is known to have a history of human immunodeficiency virus (HIV) or syphilis, current symptomatic Hepatitis B or C. Patient is unable or unwilling to comply with the protocol.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Andrew Gaya
Organizational Affiliation
Leaders In Oncology Care, Harley St, London
Official's Role
Principal Investigator
Facility Information:
Facility Name
HCA International, The Sarah Cannon Research Institute
City
London
ZIP/Postal Code
W1G 6AD
Country
United Kingdom
Facility Name
The London Clinic
City
London
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
No

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A Study of IMM-101 in Combination With Radiation Induced Tumour Necrosis in Colorectal Cancer

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