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Grapiprant and Pembrolizumab in Patients With Advanced or Progressive MSS Colorectal Cancer

Primary Purpose

Microsatellite Stable Colorectal Cancer

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
grapiprant
grapiprant and pembrolizumab
Sponsored by
Arrys Therapeutics
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Microsatellite Stable Colorectal Cancer focused on measuring Keynote-878, ARY-007, Immuno-Oncology, checkpoint inhibitor, EP4, IK-007

Eligibility Criteria

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

Key Inclusion Criteria:

  • Male and female adult patients 18 years of age or older on day of signing informed consent.
  • Patients must have a histologically confirmed advanced, metastatic, or progressive Microsatellite Stable (MSS) Colorectal Cancer (CRC) per institutional standards.
  • Patient has received at least two prior lines of therapy for advanced or metastatic CRC, at least one of which included fluorouracil.
  • Highly effective birth control.
  • Measurable disease.
  • Accessible tumor that can be safely accessed for multiple core biopsies and patient is willing to provide tissue from newly obtain biopsies before and during treatment.
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1.
  • Adequate organ function.
  • Able to swallow and absorb oral tablets.

Key Exclusion Criteria:

  • Prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor
  • Current use of NSAIDs, COX-2 inhibitors and aspirin products within 3 days (preferably 7 days) before treatment initiation or at anytime during the study unless used for management of AE.
  • History of severe hypersensitivity reactions to chimeric or humanized antibodies
  • Has received prior systemic anticancer therapy including investigational agents within 4 weeks prior to treatment, or 5 half-lives, whichever is shorter.
  • Diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior the first dose of study drug.
  • Known additional malignancy that is progressing or has required active treatment within the past 3 years.
  • Known active CNS metastases and/or carcinomatous meningitis.
  • Active autoimmune disease that has required systemic treatment in past 2 years.
  • History of non-infectious pneumonitis that required steroids or has current pneumonitis.
  • Active infection requiring systemic therapy.
  • Recent (within the last 12 months) or current GI ulcer, colitis or non-immune colitis.
  • Known history of human immunodeficiency virus (HIV) infection, Hepatitis B, or active Hepatitis C virus infection.
  • Clinically significant (i.e. active) cardiovascular disease
  • Allogeneic tissue/solid organ transplant
  • Medical conditions requiring concomitant administration of strong CYP3A4 or P glycoprotein inhibitors or inducers.

Sites / Locations

  • Mayo Clinic Cancer Center - Scottsdale
  • University of Colorado Denver-Anschutz Medical Campus
  • Sarah Cannon Research Institute, LLC (SCRI)
  • New Experimental Therapeutics of San Antonio-NEXT Oncology

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Cohort 1

Cohort 2

Arm Description

Single Agent run-in with grapiprant and then combination treatment of grapiprant and pembrolizumab.

Participants will be treated with grapiprant in combination with pembrolizumab.

Outcomes

Primary Outcome Measures

Safety and tolerability of grapiprant alone and in combination with pembrolizumab
Number of incidence, severity, and duration of treatment emergent adverse events using CTCAE v5.0
Define the recommended phase 2 dose (RP2D) of grapiprant combined with pembrolizumab
Number, incidence and severity of treatment related adverse events as assessed by CTCAE 5.0

Secondary Outcome Measures

Overall Response Rate (ORR)
Proportion of participants who achieved PR or better during the study per RECIST 1.1
Duration of Response (DOR)
Time when criteria for response are met, to the first documentation of relapse or progression
Progression -free survival (PFS)
Participants who discontinue treatment without disease progression
Disease control rate (DCR)
Percentage of participants who achieved a CR, PR and stable disease
Overall survival (OS)
Date of study drug to date of death due to any cause. If no documentation of death at time of the analysis will be censored as of the date last known to be alive, or the data cutoff date, whichever is earlier.
Duration of treatment (DOT)
Time of duration on treatment
Serum tumor marker changes
Assess changes in serum tumor markers including but not limited to carcinoembryonic antigen (CEA), when appropriate (eg. CA-19.9, CA125, and lactate dehyrogenase (LDH)) with disease response.
Pharmacodynamic immune effects in paired tumor biopsies
Assess changes in tumor infiltrating helper T cells, cytotoxic T cells and regulatory monocyte/macrophages with study drug treatment
PGEM as a pharmacodynamic and predictive biomarker
Evaluate disease response in all evaluable participants and in those with a positive initial assessment of Urine prostaglandin E2 metabolite (PGEM)
PK of grapiprant: Tmax
First time to reach maximum [peak] observed plasma concentration
PK of grapiprant: AUC0 last
Area under the plasma concentration time curve from time 0 to the end of the dosing interval (AUC0 last)
Plasma decay half-life (t1/2)
Measurement of half-life of grapiprant after dosing
Apparent oral clearance (CL/F)
Rate of elimination of the drug from plasma after oral administration
Peak to trough ratio
Measure how drug effect is sustained over dose interval
Observed accumulation ratio
Relationship between the dosing interval and the rate of elimination for the drug.

Full Information

First Posted
August 24, 2018
Last Updated
October 23, 2023
Sponsor
Arrys Therapeutics
Collaborators
Merck Sharp & Dohme LLC
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1. Study Identification

Unique Protocol Identification Number
NCT03658772
Brief Title
Grapiprant and Pembrolizumab in Patients With Advanced or Progressive MSS Colorectal Cancer
Official Title
An Open-label, Single-arm, Phase 1b Study to Evaluate the Safety and Efficacy of Grapiprant (ARY-007) in Combination With Pembolizumab in Patients With Advanced or Progressive Microsatellite Stable (MSS) Colorectal Cancer (CRC)
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Completed
Study Start Date
September 20, 2018 (Actual)
Primary Completion Date
March 7, 2023 (Actual)
Study Completion Date
March 7, 2023 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Arrys Therapeutics
Collaborators
Merck Sharp & Dohme LLC

4. Oversight

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

5. Study Description

Brief Summary
This study will be conducted in adult participants diagnosed with any form of an advanced or progressive MSS CRC for which 1st and 2nd line standard therapy (at least one of which contained fluorouracil) is no longer effective or is intolerable. This is a phase 1b, multi-center, open label study designed to assess safety and tolerability of grapiprant in combination with pembrolizumab, to determine the recommended phase 2 dose (RP2D) with pembrolizumab, and to evaluate and characterize the PK of grapiprant alone and in combination with pembrolizumab. Disease response, pharmacodynamics, and response biomarkers will also be assessed.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Microsatellite Stable Colorectal Cancer
Keywords
Keynote-878, ARY-007, Immuno-Oncology, checkpoint inhibitor, EP4, IK-007

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Model Description
Cohort 1 to be enrolled before Cohort 2
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
54 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Cohort 1
Arm Type
Experimental
Arm Description
Single Agent run-in with grapiprant and then combination treatment of grapiprant and pembrolizumab.
Arm Title
Cohort 2
Arm Type
Experimental
Arm Description
Participants will be treated with grapiprant in combination with pembrolizumab.
Intervention Type
Drug
Intervention Name(s)
grapiprant
Other Intervention Name(s)
ARYS-007, IK-007
Intervention Description
Cohort 1 will be treated for 1 week with oral grapiprant as a single agent, followed by 21-day combination treatment cycles of oral grapiprant in combination with IV pembrolizumab.
Intervention Type
Drug
Intervention Name(s)
grapiprant and pembrolizumab
Other Intervention Name(s)
ARYS-007, MK3475, KEYNOTE-878, IK-007
Intervention Description
Cohort 2 will be administered 21-day combination treatment cycles of oral grapiprant in combination with IV pembrolizumab.
Primary Outcome Measure Information:
Title
Safety and tolerability of grapiprant alone and in combination with pembrolizumab
Description
Number of incidence, severity, and duration of treatment emergent adverse events using CTCAE v5.0
Time Frame
Up to 90 days after the end of treatment (average of 7 months)
Title
Define the recommended phase 2 dose (RP2D) of grapiprant combined with pembrolizumab
Description
Number, incidence and severity of treatment related adverse events as assessed by CTCAE 5.0
Time Frame
Through Cycle 1 (21 days)
Secondary Outcome Measure Information:
Title
Overall Response Rate (ORR)
Description
Proportion of participants who achieved PR or better during the study per RECIST 1.1
Time Frame
7 months
Title
Duration of Response (DOR)
Description
Time when criteria for response are met, to the first documentation of relapse or progression
Time Frame
7 months
Title
Progression -free survival (PFS)
Description
Participants who discontinue treatment without disease progression
Time Frame
Up to 12 months
Title
Disease control rate (DCR)
Description
Percentage of participants who achieved a CR, PR and stable disease
Time Frame
7 months
Title
Overall survival (OS)
Description
Date of study drug to date of death due to any cause. If no documentation of death at time of the analysis will be censored as of the date last known to be alive, or the data cutoff date, whichever is earlier.
Time Frame
Up to 2 years from start of study drug.
Title
Duration of treatment (DOT)
Description
Time of duration on treatment
Time Frame
7 months
Title
Serum tumor marker changes
Description
Assess changes in serum tumor markers including but not limited to carcinoembryonic antigen (CEA), when appropriate (eg. CA-19.9, CA125, and lactate dehyrogenase (LDH)) with disease response.
Time Frame
7 months
Title
Pharmacodynamic immune effects in paired tumor biopsies
Description
Assess changes in tumor infiltrating helper T cells, cytotoxic T cells and regulatory monocyte/macrophages with study drug treatment
Time Frame
predose through cycle 3 (each cycle is 21 days)
Title
PGEM as a pharmacodynamic and predictive biomarker
Description
Evaluate disease response in all evaluable participants and in those with a positive initial assessment of Urine prostaglandin E2 metabolite (PGEM)
Time Frame
PreScreening through 7 months
Title
PK of grapiprant: Tmax
Description
First time to reach maximum [peak] observed plasma concentration
Time Frame
Safety Run-in (7 days); Days 1 and 2 of first 2 cycles (every 21 days), followed by Day 1 of every even cycle beginning with cycle 4 (every 42 days) through end of treatment (average of 4 months)
Title
PK of grapiprant: AUC0 last
Description
Area under the plasma concentration time curve from time 0 to the end of the dosing interval (AUC0 last)
Time Frame
Safety Run-in (7 days); Days 1 and 2 of first 2 cycles (every 21 days), followed by Day 1 of every even cycle beginning with cycle 4 (every 42 days) through end of treatment (average of 4 months).
Title
Plasma decay half-life (t1/2)
Description
Measurement of half-life of grapiprant after dosing
Time Frame
Safety Run-in (7 days); Days 1 and 2 of first 2 cycles (every 21 days), followed by Day 1 of every even cycle beginning with cycle 4 (every 42 days) through end of treatment (average of 4 months)
Title
Apparent oral clearance (CL/F)
Description
Rate of elimination of the drug from plasma after oral administration
Time Frame
Safety Run-in (7 days); Days 1 and 2 of first 2 cycles (every 21 days), followed by Day 1 of every even cycle beginning with cycle 4 (every 42 days) through end of treatment (average of 4 months)
Title
Peak to trough ratio
Description
Measure how drug effect is sustained over dose interval
Time Frame
Safety Run-in (7 days); Days 1 and 2 of first 2 cycles (every 21 days), followed by Day 1 of every even cycle beginning with cycle 4 (every 42 days) through end of treatment (average of 4 months)
Title
Observed accumulation ratio
Description
Relationship between the dosing interval and the rate of elimination for the drug.
Time Frame
Safety Run-in (7 days); Days 1 and 2 of first 2 cycles (every 21 days), followed by Day 1 of every even cycle beginning with cycle 4 (every 42 days) through end of treatment (average of 4 months)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Key Inclusion Criteria: Male and female adult patients 18 years of age or older on day of signing informed consent. Patients must have a histologically confirmed advanced, metastatic, or progressive Microsatellite Stable (MSS) Colorectal Cancer (CRC) per institutional standards. Patient has received at least two prior lines of therapy for advanced or metastatic CRC, at least one of which included fluorouracil. Highly effective birth control. Measurable disease. Accessible tumor that can be safely accessed for multiple core biopsies and patient is willing to provide tissue from newly obtain biopsies before and during treatment. Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1. Adequate organ function. Able to swallow and absorb oral tablets. Key Exclusion Criteria: Prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor Current use of NSAIDs, COX-2 inhibitors and aspirin products within 3 days (preferably 7 days) before treatment initiation or at anytime during the study unless used for management of AE. History of severe hypersensitivity reactions to chimeric or humanized antibodies Has received prior systemic anticancer therapy including investigational agents within 4 weeks prior to treatment, or 5 half-lives, whichever is shorter. Diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior the first dose of study drug. Known additional malignancy that is progressing or has required active treatment within the past 3 years. Known active CNS metastases and/or carcinomatous meningitis. Active autoimmune disease that has required systemic treatment in past 2 years. History of non-infectious pneumonitis that required steroids or has current pneumonitis. Active infection requiring systemic therapy. Recent (within the last 12 months) or current GI ulcer, colitis or non-immune colitis. Known history of human immunodeficiency virus (HIV) infection, Hepatitis B, or active Hepatitis C virus infection. Clinically significant (i.e. active) cardiovascular disease Allogeneic tissue/solid organ transplant Medical conditions requiring concomitant administration of strong CYP3A4 or P glycoprotein inhibitors or inducers.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sergio Santillana, MD
Organizational Affiliation
Ikena Oncology
Official's Role
Study Director
First Name & Middle Initial & Last Name & Degree
Sergio Santillana, MD
Organizational Affiliation
Ikena Oncology
Official's Role
Study Chair
Facility Information:
Facility Name
Mayo Clinic Cancer Center - Scottsdale
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85054
Country
United States
Facility Name
University of Colorado Denver-Anschutz Medical Campus
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Name
Sarah Cannon Research Institute, LLC (SCRI)
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37203
Country
United States
Facility Name
New Experimental Therapeutics of San Antonio-NEXT Oncology
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78240
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Citations:
PubMed Identifier
34606846
Citation
Wang D, Cabalag CS, Clemons NJ, DuBois RN. Cyclooxygenases and Prostaglandins in Tumor Immunology and Microenvironment of Gastrointestinal Cancer. Gastroenterology. 2021 Dec;161(6):1813-1829. doi: 10.1053/j.gastro.2021.09.059. Epub 2021 Oct 2.
Results Reference
derived

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Grapiprant and Pembrolizumab in Patients With Advanced or Progressive MSS Colorectal Cancer

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