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A Trial of CXD101 in Combination With Nivolumab in Patients With Metastatic Microsatellite-Stable Colorectal Cancer (CAROSELL)

Primary Purpose

Colorectal Neoplasms Malignant

Status
Unknown status
Phase
Phase 1
Locations
United Kingdom
Study Type
Interventional
Intervention
CXD101 in Combination With Nivolumab
Sponsored by
Celleron Therapeutics Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Colorectal Neoplasms Malignant

Eligibility Criteria

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

Inclusion Criteria:

  • Written informed consent
  • Biopsy-confirmed MSS, MMR-P CRC. It is acceptable for this test to be performed on the archived primary colorectal cancer tissue and repeat biopsy for MSS testing is not required unless assay not yet performed and insufficient material available
  • Previous first and second line treatment (unless contra-indicated) including use of oxaliplatin and irinotecan unless documented intolerance of these
  • Measurable disease: longest diameter≥10mm (short axis ≥15mm for nodal lesions)
  • Age > 18 years
  • Eastern Cooperative Oncology Group (ECOG) performance status 0, 1 or 2
  • Predicted life expectancy > 3 months
  • Adequate organ and bone marrow function: Hb> 10.0g/dL (may be transfused to this level), neutrophils> 1.5x10^9/L and platelets> 100x10^9/L
  • Female patients with reproductive potential must have a negative urine and serum pregnancy test prior to starting treatment. Both women of reproductive potential and men must agree to use a medically acceptable method of contraception throughout the treatment period and for 5 months after discontinuation of treatment (i.e., combined oestrogen and progestogen ovulation inhibition; progestogen-only ovulation inhibition; intrauterine device; intrauterine hormone-releasing system; bilateral tubal occlusion; or vasectomised partner). Oral contraception and parenteral hormonal contraceptives (patches, injectables and implants) that may be affected by enzyme-inducing drugs should only be used in combination with a barrier method. All males with partners of childbearing potential or whose partners are pregnant must use barrier contraception for the duration of dosing and for 5 months post-dosing.

Exclusion Criteria:

  • Pregnant or breast feeding
  • Pre-existing auto-immune conditions
  • Medical conditions requiring systemic immunosuppression
  • Previous treatment with an HDAC inhibitor or PD-1/PD-L1 inhibitor
  • Other chemotherapy, radiotherapy, or investigational therapy within 4 weeks of the Screening /Baseline Assessment
  • Unresolved clinically significant toxicity from a previous treatment
  • History of recent active chronic inflammatory bowel disease and/or bowel obstruction
  • Renal function: Serum creatinine > 1.5 x ULN, or creatinine clearance < 60mL/min (Cockcroft-Gault formula)
  • Liver function: AST > 3.0 x ULN; OR total bilirubin > 1.5 x ULN
  • Clinically significant myocardial infarction, severe/unstable angina pectoris, congestive heart failure NYHA Class III or IV, or pulmonary disease within 6 months
  • Symptomatic brain metastasis, uncontrolled seizure disorder, spinal cord compression, or carcinomatous meningitis
  • Clinically significant active infection requiring antibiotic or antiretroviral therapy
  • History of malignancy other than MSS CRC, unless there is the expectation that the malignancy has been cured, and tumour specific treatment for the malignancy has not been administered within the previous 5 years
  • History of pneumonitis, immune hepatitis or myocarditis, or current uncontrolled thyroid disease
  • Current positive serology for Hepatitis B or C virus
  • History of any allergy to excipients of the Investigational Medicinal Products (sodium citrate dihydrate, sodium chloride, mannitol, pentetic acid, Polysorbate 80, sodium hydroxide, hydrochloric acid, hydroxypropyl methylcellulose)
  • Receipt of any live vaccine 30 days or fewer prior to administration of first dose IMP
  • Inability to comply with the study protocol

Sites / Locations

  • Celleron Therapeutics Ltd

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

CXD101 and Nivolumab combination

Arm Description

CXD101 will be presented as 10mg HPMC capsules and will be taken orally for 5 consecutive days repeated every three weeks on an outpatient basis. Nivolumab will be presented as a 10 mg/mL solution in a single-dose vial, administered as iv infusion over 60 mins, repeated every two weeks. CXD101 in combination with nivolumab will be administered in the Phase II component of the trial at doses determined in the Phase Ib component.

Outcomes

Primary Outcome Measures

Immune Disease Control Rate (iDCR)
complete response [iCR], partial response [iPR], and stable disease [iSD] rate) after Seymour et al, 2017.

Secondary Outcome Measures

20-week immune-related progression-free survival (PFS)
Progression-free survival will be measured from the date of first dose until death from any cause, with measurement cut-off at 20 weeks. Subjects who discontinue from treatment will classed as "censored" at the last timepoint when their PFS status was known. Subjects who discontinue from the study will be classed as "censored" at the time they discontinue. A Kaplan-Meier survival curve will be plotted and the 20-week PFS rate determined, with a 95% confidence interval.
Best Objective Response Rate
iCR + iPR / iCR + iPR + iSD + iPD x 100. The Objective Response Rate will be calculated as the combined percentage of subjects who have achieved as best response: complete response, or partial response.
Overall Survival (OS)
Overall Survival will be measured from the date of first dose until death from any cause. Subjects who discontinue from treatment will be followed up for survival but will be classed as "censored" at the last timepoint when their survival status was known. Subjects who discontinue from the study will be classed as "censored" at the time they discontinue. A Kaplan-Meier survival curve will be plotted for overall survival.
Number of Participants With Abnormal Laboratory Values and/or Adverse Events That Are Related to Treatment
AEs may be directly observed, evident in laboratory or diagnostic results, reported spontaneously by the subject, or by questioning the subject at each study visit. All subjects who complete screening, receive at least one dose of study medication and who have at least one safety assessment (including "death") will be in the Safety Set.

Full Information

First Posted
June 19, 2019
Last Updated
June 20, 2019
Sponsor
Celleron Therapeutics Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT03993626
Brief Title
A Trial of CXD101 in Combination With Nivolumab in Patients With Metastatic Microsatellite-Stable Colorectal Cancer
Acronym
CAROSELL
Official Title
A Phase Ib/ II Trial to Assess the Safety and Efficacy of CXD101 in Combination With the PD-1 Inhibitor Nivolumab in Patients With Metastatic, Previously-Treated, Microsatellite-Stable Colorectal Carcinoma
Study Type
Interventional

2. Study Status

Record Verification Date
June 2019
Overall Recruitment Status
Unknown status
Study Start Date
May 22, 2018 (Actual)
Primary Completion Date
December 15, 2019 (Anticipated)
Study Completion Date
June 15, 2020 (Anticipated)

3. Sponsor/Collaborators

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

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a study to assess the safety and efficacy of CXD101 in combination with the PD-1 Inhibitor Nivolumab in patients with metastatic, previously-treated, Microsatellite-Stable (MSS) Colorectal Carcinoma (CRC). The primary hypothesis of this study is that CXD101 and anti-PD1 monoclonal antibody synergise the anti-tumour activity in MSS colorectal cancer patients (~95% of CRC) who do not seem to respond to anti-PD1 or -PD-L1 immunotherapy alone.
Detailed Description
Phase Ib trial: This single-arm dose escalation trial will determine the safety, tolerability and dose limiting toxicities (DLT) and therefore the maximum tolerated dose (MTD) of repeat doses of nivolumab combined with CXD101. The incidence and severity of adverse events (evaluated according to CTCAE version 4.03), vital signs, ECG parameters, biochemistry, haematology and urinalysis will be recorded to determine tolerability. Dose escalation will proceed as follows: Dose Level 1 Nivolumab 240 mg iv q 2 weekly; with CXD101 30 mg (20mg mane, 10mg nocte) po for 5 days q 3 weekly (n=3-6) with both drugs commencing on the same day in cycle 1. Dose Level 2 Nivolumab 240 mg iv q 2 weekly; with CXD101 40mg (20 mg bid) po for 5 days q 3 weekly (n=6) with both drugs commencing on the same day in cycle 1. A maximum of 15 subjects will be required. Phase II trial: Following completion of the Phase Ib study, a Phase II CXD101/ nivolumab combination dose will be selected by the Data and Safety Monitoring Committee. Up to a further 40 subjects will then be treated at the selected Phase II CXD101/ nivolumab combination dose. Subjects may continue to receive CXD101/ nivolumab until complete response, disease progression, unacceptable toxicity, withdrawal of consent, or other medical problems supervene. Efficacy will be measured using Immune Response Evaluation Criteria in Solid Tumours (iRECIST) Imaging studies, typically CT scan of chest, abdomen & pelvis, supplemented by MRI of liver when required, will be performed at Baseline and after every 6 weeks, with objective confirmation of response 6 weeks (+/- 1 week) after observation. Safety parameters will be assessed as in the Phase I study. In addition there will be a series of translational analyses including correlation of tumour biomarker expression with response.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Colorectal Neoplasms Malignant

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Model Description
Open label, single arm, phase 1b/2 safety; and efficacy using Simon Two-Stage analysis
Masking
None (Open Label)
Allocation
N/A
Enrollment
55 (Actual)

8. Arms, Groups, and Interventions

Arm Title
CXD101 and Nivolumab combination
Arm Type
Experimental
Arm Description
CXD101 will be presented as 10mg HPMC capsules and will be taken orally for 5 consecutive days repeated every three weeks on an outpatient basis. Nivolumab will be presented as a 10 mg/mL solution in a single-dose vial, administered as iv infusion over 60 mins, repeated every two weeks. CXD101 in combination with nivolumab will be administered in the Phase II component of the trial at doses determined in the Phase Ib component.
Intervention Type
Drug
Intervention Name(s)
CXD101 in Combination With Nivolumab
Intervention Description
HDAC inhibitor in combination with anti-PD-1 monoclonal antibody
Primary Outcome Measure Information:
Title
Immune Disease Control Rate (iDCR)
Description
complete response [iCR], partial response [iPR], and stable disease [iSD] rate) after Seymour et al, 2017.
Time Frame
6 months
Secondary Outcome Measure Information:
Title
20-week immune-related progression-free survival (PFS)
Description
Progression-free survival will be measured from the date of first dose until death from any cause, with measurement cut-off at 20 weeks. Subjects who discontinue from treatment will classed as "censored" at the last timepoint when their PFS status was known. Subjects who discontinue from the study will be classed as "censored" at the time they discontinue. A Kaplan-Meier survival curve will be plotted and the 20-week PFS rate determined, with a 95% confidence interval.
Time Frame
20 weeks
Title
Best Objective Response Rate
Description
iCR + iPR / iCR + iPR + iSD + iPD x 100. The Objective Response Rate will be calculated as the combined percentage of subjects who have achieved as best response: complete response, or partial response.
Time Frame
6 months
Title
Overall Survival (OS)
Description
Overall Survival will be measured from the date of first dose until death from any cause. Subjects who discontinue from treatment will be followed up for survival but will be classed as "censored" at the last timepoint when their survival status was known. Subjects who discontinue from the study will be classed as "censored" at the time they discontinue. A Kaplan-Meier survival curve will be plotted for overall survival.
Time Frame
6 months
Title
Number of Participants With Abnormal Laboratory Values and/or Adverse Events That Are Related to Treatment
Description
AEs may be directly observed, evident in laboratory or diagnostic results, reported spontaneously by the subject, or by questioning the subject at each study visit. All subjects who complete screening, receive at least one dose of study medication and who have at least one safety assessment (including "death") will be in the Safety Set.
Time Frame
6 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Written informed consent Biopsy-confirmed MSS, MMR-P CRC. It is acceptable for this test to be performed on the archived primary colorectal cancer tissue and repeat biopsy for MSS testing is not required unless assay not yet performed and insufficient material available Previous first and second line treatment (unless contra-indicated) including use of oxaliplatin and irinotecan unless documented intolerance of these Measurable disease: longest diameter≥10mm (short axis ≥15mm for nodal lesions) Age > 18 years Eastern Cooperative Oncology Group (ECOG) performance status 0, 1 or 2 Predicted life expectancy > 3 months Adequate organ and bone marrow function: Hb> 10.0g/dL (may be transfused to this level), neutrophils> 1.5x10^9/L and platelets> 100x10^9/L Female patients with reproductive potential must have a negative urine and serum pregnancy test prior to starting treatment. Both women of reproductive potential and men must agree to use a medically acceptable method of contraception throughout the treatment period and for 5 months after discontinuation of treatment (i.e., combined oestrogen and progestogen ovulation inhibition; progestogen-only ovulation inhibition; intrauterine device; intrauterine hormone-releasing system; bilateral tubal occlusion; or vasectomised partner). Oral contraception and parenteral hormonal contraceptives (patches, injectables and implants) that may be affected by enzyme-inducing drugs should only be used in combination with a barrier method. All males with partners of childbearing potential or whose partners are pregnant must use barrier contraception for the duration of dosing and for 5 months post-dosing. Exclusion Criteria: Pregnant or breast feeding Pre-existing auto-immune conditions Medical conditions requiring systemic immunosuppression Previous treatment with an HDAC inhibitor or PD-1/PD-L1 inhibitor Other chemotherapy, radiotherapy, or investigational therapy within 4 weeks of the Screening /Baseline Assessment Unresolved clinically significant toxicity from a previous treatment History of recent active chronic inflammatory bowel disease and/or bowel obstruction Renal function: Serum creatinine > 1.5 x ULN, or creatinine clearance < 60mL/min (Cockcroft-Gault formula) Liver function: AST > 3.0 x ULN; OR total bilirubin > 1.5 x ULN Clinically significant myocardial infarction, severe/unstable angina pectoris, congestive heart failure NYHA Class III or IV, or pulmonary disease within 6 months Symptomatic brain metastasis, uncontrolled seizure disorder, spinal cord compression, or carcinomatous meningitis Clinically significant active infection requiring antibiotic or antiretroviral therapy History of malignancy other than MSS CRC, unless there is the expectation that the malignancy has been cured, and tumour specific treatment for the malignancy has not been administered within the previous 5 years History of pneumonitis, immune hepatitis or myocarditis, or current uncontrolled thyroid disease Current positive serology for Hepatitis B or C virus History of any allergy to excipients of the Investigational Medicinal Products (sodium citrate dihydrate, sodium chloride, mannitol, pentetic acid, Polysorbate 80, sodium hydroxide, hydrochloric acid, hydroxypropyl methylcellulose) Receipt of any live vaccine 30 days or fewer prior to administration of first dose IMP Inability to comply with the study protocol
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Rachel Kerr, MD
Organizational Affiliation
Department of Oncology, University of Oxford
Official's Role
Principal Investigator
Facility Information:
Facility Name
Celleron Therapeutics Ltd
City
Oxford
State/Province
Oxfordshire
ZIP/Postal Code
OX4 4GA
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

A Trial of CXD101 in Combination With Nivolumab in Patients With Metastatic Microsatellite-Stable Colorectal Cancer

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