A Phase 1 interventional study of Durvalumab and Laboratory Biomarker Analysis in Metastatic Carcinoma in the Liver, Resectable Mass and Stage IV Colorectal Cancer AJCC v7, sponsored by M.D. Anderson Cancer Center. Completed at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2024-10-09.
Sponsored by M.D. Anderson Cancer Center · Phase 1, Interventional, and Treatment
This phase I trial studies the side effects and how well tremelimumab and durvalumab work in treating patients with colorectal cancer that has spread to the liver and can be removed by surgery. Immunotherapy with monoclonal antibodies, such as tremelimumab and durvalumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread.
PRIMARY OBJECTIVES:
I. Assess the safety and feasibility of adding tremelimumab 75 mg intravenously (IV) plus durvalumab (MEDI4736) 1500 mg administered once pre-operatively and 4 cycles of durvalumab 1500 mg IV every 4 weeks for 4 cycles post-operatively in patients who are candidates for resection for colorectal cancer liver metastases.
SECONDARY OBJECTIVES:
I. Explore the changes in various immune parameters, including programmed cell death-1 ligand 1 (PD-L1) and programmed cell death1 (PD-1) expression in the tumor, over treatment and correlate with response and survival with goal of biomarker discovery.
II. Estimate the relapse-free survival (RFS) in all enrolled subjects.
OUTLINE:
Patients receive tremelimumab IV over 1 hour and durvalumab IV over 4 hours during week 11. Between weeks 15 and 17, patients undergo liver surgery. Patients then receive durvalumab IV over 1 hour during weeks 21, 25, 29, and 33.
After completion of study treatment, patients are followed up twice a year for 5 years.
5,599 studies on the registry are indexed under Colorectal Neoplasms; 1,459 are open to participants now.
This study's enrollment of 24 is below the median of 77 across 4,123 interventional studies indexed under Colorectal Neoplasms.
Browse Colorectal Neoplasms studies →M.D. Anderson Cancer Center is the lead sponsor of 2,999 studies on the registry; 581 are open to participants now.
Of its 599 completed or terminated interventional studies of FDA-regulated products, 402 (67%) have results posted.
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Evidence of post-menopausal status or negative urinary or serum pregnancy test for female pre-menopausal patients; women will be considered post-menopausal if they have been amenorrheic for 12 months without an alternative medical cause; the following age-specific requirements apply:
Exclusion Criteria:
Patients receive tremelimumab IV over 1 hour and durvalumab IV over 4 hours during week 11. Between weeks 15 and 17, patients undergo liver surgery. Patients then receive durvalumab IV over 1 hour during weeks 21, 25, 29, and 33.
Biological: Durvalumab · Other: Laboratory Biomarker Analysis · Procedure: Therapeutic Conventional Surgery · Biological: Tremelimumab
Given IV
Also known as: Imfinzi, Immunoglobulin G1, Anti-(Human Protein B7-H1) (Human Monoclonal MEDI4736 Heavy Chain), Disulfide with Human Monoclonal MEDI4736 Kappa-chain, Dimer, MEDI-4736, MEDI4736
Correlative studies
Undergo liver surgery
Given IV
Also known as: Anti-CTLA4 Human Monoclonal Antibody CP-675,206, CP-675, CP-675,206, CP-675206, Ticilimumab
Post-operative Toxicity
Post-operative toxicity graded by the Clavien-Dindo classification. The Clavien Dindo Classification is used to rank the severity of a surgical complication. It is based on the type of therapy needed to correct the complication. The scale consists of several grades (Grade I, II, IIIa, IIIb, IVa, IVb and V). Grade I complications are usually mild but Grade II and higher complications are more significant.
Time frame: 3 years
Feasibility and Safety in the Conduct of the Trial
Feasibility and safety assessed by the rate of on-trial surgical resection of liver metastases, post-operative toxicity graded by the Clavien-Dindo classification, and treatment related toxicity graded by CTCAE v5. The combination was defined as feasible if at least 80% of participants could undergo resection or if between 60% and 80% could undergo resection with a positive toxicity and efficacy profile.
Time frame: 3 years
Treatment Related Toxicity
Treatment related toxicity graded by CTCAE v5
Time frame: 3 years
Pre-operative Response Rate
Pre-operative response rate evaluation using RECIST v1.1. RECIST 1.1 will be used to identify measurable disease on baseline CT scans. Tumor measurements will be made upon restaging CT scans prior to surgery. No tumor measurements will take place post-operatively as the goal of therapy is no evidence of disease. Pre-surgery response will be classified into Complete Response, Partial Response, Stable Disease and Progressive Disease.
Time frame: 2 years
Relapse-Free Survival (RFS)
The time from date of curative surgery to the time of recurrence or death
Time frame: 3 years
Overall Survival
The time from treatment to death, regardless of disease recurrence.
Time frame: 3 years
Translational Evaluation of Various Immune-relevant Factors
Tumor immune markers was evaluated using flow cytometry, Multiplex Immunofluorescence (mIF) and Immunohistochemistry (IHC) analyses, RNA sequencing, Microbial DNA isolation and 16S rRNA gene sequencing (using QIAamp DNA stool mini kit on pretreatment feacal samples)
Time frame: 3 years
8/2016 -1/2019
| Milestone | Durvalumab/Tremelimumab |
|---|---|
| Started | 24 |
| Completed | 23 |
| Not completed | 1 |
| Withdrew: Withdrawal by subject | 1 |
Post-operative toxicity graded by the Clavien-Dindo classification. The Clavien Dindo Classification is used to rank the severity of a surgical complication. It is based on the type of therapy needed to correct the complication. The scale consists of several grades (Grade I, II, IIIa, IIIb, IVa, IVb and V). Grade I complications are usually mild but Grade II and higher complications are more significant.
| Participants | Durvalumab/Tremelimumab |
|---|---|
| Post-operative Toxicity | 8 |
Feasibility and safety assessed by the rate of on-trial surgical resection of liver metastases, post-operative toxicity graded by the Clavien-Dindo classification, and treatment related toxicity graded by CTCAE v5. The combination was defined as feasible if at least 80% of participants could undergo resection or if between 60% and 80% could undergo resection with a positive toxicity and efficacy profile.
| Participants | Durvalumab/Tremelimumab |
|---|---|
| Surgical resection | 17 |
| Exploration, no resection | 3 |
Treatment related toxicity graded by CTCAE v5
| percentage of participants | Durvalumab/Tremelimumab |
|---|---|
| Treatment Related Toxicity | 22 (10 to 44) |
Pre-operative response rate evaluation using RECIST v1.1. RECIST 1.1 will be used to identify measurable disease on baseline CT scans. Tumor measurements will be made upon restaging CT scans prior to surgery. No tumor measurements will take place post-operatively as the goal of therapy is no evidence of disease. Pre-surgery response will be classified into Complete Response, Partial Response, Stable Disease and Progressive Disease.
| Participants | Durvalumab/Tremelimumab |
|---|---|
| Stable Disease | 15 |
| Patial Response | 3 |
| Progressive disease | 5 |
The time from date of curative surgery to the time of recurrence or death
| Months | Durvalumab/Tremelimumab |
|---|---|
| Relapse-Free Survival (RFS) | 9.7 (1.3 to 28) |
The time from treatment to death, regardless of disease recurrence.
| months | Durvalumab/Tremelimumab |
|---|---|
| Overall Survival | 24.5 (16.5 to 28.4) |
Tumor immune markers was evaluated using flow cytometry, Multiplex Immunofluorescence (mIF) and Immunohistochemistry (IHC) analyses, RNA sequencing, Microbial DNA isolation and 16S rRNA gene sequencing (using QIAamp DNA stool mini kit on pretreatment feacal samples)
| Participants | Durvalumab/Tremelimumab |
|---|---|
| POLE mutation B | 2 |
| BRAF mutation | 1 |
| KRAS mutation | 12 |
| TP53 mutation | 14 |
| APC mutation | 11 |
| pMMR | 21 |
| dMMR | 2 |
| CMS1 | 0 |
| CMS2 | 7 |
| CMS3 | 4 |
| CMS4 | 4 |
Collected over Up to 3 years. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Durvalumab/Tremelimumab | 1/23 (4.3%) | 0/23 (0%) | 23/23 (100%) |
| Event | Durvalumab/Tremelimumab |
|---|---|
| FatigueGeneral disorders | 10/23 |
| PruritisSkin and subcutaneous tissue disorders | 4/23 |
| Decreased platelet countInvestigations | 3/23 |
| Increased aspartate aminotransferaseInvestigations | 3/23 |
| HypothyroidismEndocrine disorders | 3/23 |
| DiarrheaGastrointestinal disorders | 3/23 |
| NauseaGastrointestinal disorders | 3/23 |
| FeverGeneral disorders | 3/23 |
| AnemiaInvestigations | 2/23 |
| Decreased neutrophil countInvestigations | 2/23 |
| Age, Continuous(Years) | Durvalumab/Tremelimumab |
|---|---|
| Median | 56 (28 to 69) |
| Sex: Female, Male(Participants) | Durvalumab/Tremelimumab |
|---|---|
| Female | 11 |
| Male | 12 |
| Ethnicity (NIH/OMB)(Participants) | Durvalumab/Tremelimumab |
|---|---|
| Hispanic or Latino | 0 |
| Not Hispanic or Latino | 0 |
| Unknown or Not Reported | 23 |
| Race (NIH/OMB)(Participants) | Durvalumab/Tremelimumab |
|---|---|
| American Indian or Alaska Native | 0 |
| Asian | 0 |
| Native Hawaiian or Other Pacific Islander | 0 |
| Black or African American | 0 |
| White | 0 |
| More than one race | 0 |
| Unknown or Not Reported | 23 |
| Region of Enrollment(Participants) | Durvalumab/Tremelimumab |
|---|---|
| United States | 23 |
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M.D. Anderson Cancer Center