Background:
- mCRC is incurable and available standard therapies offer a median overall survival
of approximately 2 years.
- Most cases (approximately 95%) of mCRC have an intact expression of DNA mismatch
repair enzymes (MLH1, MSH2, MSH6, and PMS2), and are commonly classified as having
mismatch repair proficient (pMMR) or microsatellite stable (MSS) mCRC.
- MSS mCRC does not respond to immune checkpoint inhibitor (ICI) therapy whereas
mismatch repair deficient (or microsatellite instability-high) mCRC is responsive to
ICI therapy.
- Preclinical and clinical studies conducted at the NCI in the Laboratory of Tumor
Immunology Biology (LTIB) indicate that the combination of programmed cell death
protein 1 (PD-1) / Programmed death-ligand 1 (PD-L1) blockade, tumor-associated
antigens (TAA) targeted vaccine, IL15 agonist, and CXCR1/2 inhibition may include
sufficient immune enhancements to produce anti-tumor activity in MSS mCRC.
- Retifanlimab is a humanized IgG4 monoclonal antibody that targets PD-1. Retifanlimab
has been studied in several clinical trials, and several malignancies, and has a
safety and clinical activity profile similar to approved anti-PD-1 therapies (e.g.,
pembrolizumab).
- The TriAdeno Vaccine employs 3 adenovirus serotype 5 vectors, encoding three TAAs
(CEA, MUC1, and brachyury). These vaccines have completed the phase 1 study and are
safe and well tolerated. Vaccination generates antigen-specific T cell responses to
CEA, MUC1, and brachyury.
- N-803 is an IL-15 agonist that activates and expands T cells and NK cells. N-803
enhances anti-tumor activity in combination with tumor-targeted vaccines.
Clinically, multiple studies have demonstrated the safety of tumor-targeted vaccine
in combination with PD- 1/PD-L1 blockade. Adding N-803 to PD-1/PD-L1 blockade can
produce antitumor responses in disease states where responses to PD-1/PD-L1 alone
would not be expected.
- SX-682 is a small molecule, orally bioavailable, allosteric antagonist of the
chemokine receptors CXCR1 and CXCR2. Inhibition of CXCR1 and CXCR2 addresses a major
component of intratumoral T cell suppression by myeloid-derived suppressor cells and
tumor-associate macrophages. SX-682 has shown to be tolerable in combination with
PD- 1/PD-L1 blockade.
Objectives:
- Phase I: to describe the safety profile of the Immuno-Oncology (IO) regimens
consisting of retifanlimab, TriAdeno vaccine, N-803 (A1), and retifanlimab, TriAdeno
vaccine, N- 803, SX 682 (A2) in participants with metastatic colorectal cancer
(mCRC).
- Phase II: to determine the objective response rate (ORR) (complete response (CR) +
partial response (PR)) of the IO regimen in mCRC.
Eligibility:
- Age >=18 years.
- Previously treated metastatic colorectal cancer with measurable disease.
- Eastern Cooperative Oncology Group (ECOG) performance status <= 2.
- Adequate organ function.
Design:
- This is an open-label Phase I/II trial to evaluate the safety and efficacy of the
Immuno- Oncology regimen, consisting of retifanlimab, TriAdeno vaccine, N-803, and
SX-682 in participants with mCRC.
- During Phase I, we will assess the safety of the three- and the four-drug IO
regimens.
- Phase II uses a Simon optimal two-stage design at SX-682 200 mg BID. Enrollment at
200 mg BID begins with a safety lead-in of 5 to 6 DLT-evaluable participants.
Provided the predefined safety criteria are met (0 DLTs among the first 5
participants or <=1 DLT among the first 6), accrual will continue without
interruption until a total of 9 responseevaluable participants have been treated
with the four drug regimen with SX-682 at 200 mg BID. Participants enrolled during
the safety lead-in who are response-evaluable will count toward the Stage 1 total of
9.
- If 0 to 1 confirmed responses (CR+PR by RECIST v1.1 within 24 weeks) are observed
among these 9 participants, accrual will stop for futility. If >=2 responses are
observed, enrollment will expand to a total of 23 response-evaluable participants at
200 mg BID.
- Participants will receive treatment in cycles consisting of 28 (+7) days for 2
years.
- To allow for a small number of inevaluable participants, and screen failures the
accrual ceiling will be set at 60.