CClinicalTrials.gg
CompletedNCT03428126Updated Jun 15, 2023Results posted

Study of Durvalumab (MEDI4736) (Anti-PD-L1) and Trametinib (MEKi) in MSS Metastatic Colon Cancer

A Phase 2 interventional study of Durvalumab and Trametinib in Malignant Neoplasms of Digestive Organs, Colorectal Cancer and Colon Cancer, 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 2023-06-15.

Sponsored by M.D. Anderson Cancer Center · Phase 2, Interventional, and Treatment

Phase
Phase 2
Study type
Interventional
Enrollment
29
Allocation
Not applicable
Ages
18 Years and older
Sex
All
01

Study summary

The goal of this clinical research study is to learn if durvalumab and trametinib can help to control microsatellite stable (MSS) colorectal cancer. The safety of these drugs will also be studied.

This is an investigational study. Durvalumab is FDA approved and commercially available for the treatment of previously treated advanced bladder cancer. Trametinib is FDA approved in combination with another drug called dabrafenib for the treatment of unresectable or metastatic melanoma with BRAF V600E or BRAF V600K.

It is investigational to use durvalumab and trametinib to treat MSS colorectal cancer.

Up to 56 participants will be enrolled in this study. All will take part at MD Anderson.

Read the detailed description

Study Drug Administration:

Each cycle is 28 days.

Participant will take trametinib tablets by mouth every day with at least 8 ounces of water. Each dose should be taken at about the same time each day, 1 hour before or 2 hours after a meal. Participant should not crush, cut, or chew the tablets. If participant misses a dose of trametinib, participant may take the tablets as soon as participant remembers but only if participant's next scheduled dose is at least 12 hours later. If participant's next scheduled dose is less than 12 hours, participant should wait and take participant's next dose as scheduled.

Participant will take trametinib alone for the first 7 days of the study and then participant will begin receiving it in combination with durvalumab.

Every 4 weeks, participant will receive durvalumab by vein over about 60 minutes.

Length of Treatment:

Participant will be able to receive the study drugs for as long as the doctor thinks it is in participant's best interest. Participant no longer will take the study drugs if intolerable side effects occur or if the study doctor decides that the drugs are no longer working.

It is expected that participation in this study may last about 12 months.

Participation in this study will be over after follow-up.

Study Visits:

On Day 1 of Weeks 0, 2, 4, 6, 12, and then every 4 weeks after that (Weeks 16, 20, 24, and so on):

  • Participant will have a physical exam.
  • Blood (about 6 tablespoons) will be drawn for routine tests, immune system testing, and biomarker testing.
  • If participant had a biopsy at screening, participant will have another biopsy during Week 4 to check the status of the disease and for biomarker testing. Depending on when participant joins the study, this biopsy may be optional.

On Day 1 of Week 8:

  • Participant will have a physical exam.
  • Blood (about 6 tablespoons) will be drawn for routine tests, immune system testing, and biomarker testing.
  • Participant will have a CT scan.

On Day 1 of Week 16 and then every 8 weeks after that (Weeks 24, 32, 40, and so on), participant will have a CT scan.

End-of-Treatment:

About 28 days after participant's last dose of study drugs, participant will have a physical exam.

Follow-Up:

After participant's end-of-treatment visit, participant will be called by the study staff every 3 months for up to 18 months to ask how participant is doing. Each call should last about 5-10 minutes.

02

Conditions studied

  • Malignant Neoplasms of Digestive Organs
  • Colorectal Cancer
  • Colon Cancer

Keywords

  • Malignant neoplasms of digestive organs
  • Colorectal Cancer
  • Colon Cancer
  • Durvalumab
  • MEDI4736
  • Trametinib
  • GSK1120212
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  1. Patients must have histologically or cytologically confirmed metastatic colorectal cancer.
  2. Patients must have measurable disease per RECIST v1.1 criteria.
  3. Patients must have had at least prior treatment with a fluoropyrimidine and either oxaliplatin or irinotecan.
  4. Age >/=18 years. Because no dosing or adverse event data are currently available on the use of this combination in patients \<18 years of age, children are excluded from this study.
  5. Body weight > 30kg.
  6. Life expectancy of greater than 6 months.
  7. ECOG performance status 0-1 (Karnofsky >/=70%).
  8. Patients must have normal organ and marrow function as defined below: - Leukocytes >/=3,000/mcL, Absolute neutrophil count >/=1,500/mcL, Hemoglobin >/=9.0g/dL, Platelets >/=75,000/mcL, Total bilirubin \< 1.5 X institutional normal limits (subjects with known Gilbert syndrome are eligible with total bilirubin \< 3.0 mg/dL), AST(SGOT)/ALT(SGPT) \</=2.5 X institutional ULN (\</= 5 if liver metastases present), Creatinine within normal institutional limits OR, Creatinine clearance > 40mL/min by Cockcroft-Gault or 24h urine collection.
  9. Known MSS status by either IHC or PCR. Known or evaluable BRAF and KRAS status.
  10. Evidence of post-menopausal status or negative urinary or serum pregnancy test for female pre-menopausal subjects. 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: -- Women \<50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of exogenous hormonal treatments and if they have luteinizing hormone and follicle-stimulating hormone levels in the post-menopausal range for the institution or underwent surgical sterilization (bilateral oophorectomy or hysterectomy).
  11. Inclusion #10 cont'd -- Women >/=50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of all exogenous hormonal treatments, had radiation-induced menopause with last menses >1 year ago, had chemotherapy-induced menopause with last menses >1 year ago, or underwent surgical sterilization (bilateral oophorectomy, bilateral salpingectomy or hysterectomy).
  12. Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately and will be removed from the study.
  13. Ability to understand and the willingness to sign a written informed consent document.
  14. Willingness to have 2 tumor biopsies; the first before and the second while on therapy (optional for all patients and may become mandatory in order to ensure 15 patients at MTD have paired biopsies).

Exclusion criteria

Exclusion Criteria:

  1. Patients who have had chemotherapy within 2 weeks prior to first dose of study drug.
  2. Any unresolved toxicity NCI CTCAE Grade >/=2 from previous anticancer therapy with the exception of alopecia, vitiligo, and the laboratory values defined in the inclusion criteria: -- Subjects with Grade >/=2 neuropathy will be evaluated on a case-by-case basis after consultation with the Principal investigator.-- Subjects with irreversible toxicity not reasonably expected to be exacerbated by treatment with durvalumab may be included only after consultation with the Principal investigator.
  3. Patients may not be receiving any other investigational agents.
  4. Major surgical procedure (as defined by the Investigator) within 28 days prior to the first dose of study medication. Note: Local surgery of isolated lesions for palliative intent is acceptable.
  5. Patients with known brain metastases or leptomeningeal carcinomatosis will be excluded from this clinical trial. Patients with suspected brain metastases at screening should have an MRI (preferred) or CT each preferably with IV contrast of the brain prior to study entry.
  6. Mean QT interval corrected for heart rate (QTc) >/= 470 ms calculated from 3 electrocardiograms (ECGs) using Fridericia's Correction.
  7. History of pneumonitis or interstitial lung disease (ILD).
  8. History of allogenic organ transplantation.
  9. Subjects with active, known, or suspected autoimmune disease including patients with a history of inflammatory bowel disease (ulcerative colitis or Crohn's disease); patients with a history of symptomatic disease (e.g., rheumatoid arthritis, systemic sclerosis [scleroderma], systemic lupus erythematosus, autoimmune vasculitis (e.g., Wegener's granulomatosis), and central nervous system or motor neuropathy considered of autoimmune origin (e.g., Guillain-Barre Syndrome, myasthenia gravis, multiple sclerosis). Subjects with vitiligo, type I diabetes mellitus, Grave's disease, Hashimoto thyroiditis, psoriasis, and other mild autoimmune disease not requiring systemic treatment are permitted to enroll at the discretion of the investigator.
  10. Subjects with a condition requiring systemic treatment with either corticosteroids (>10 mg daily prednisone equivalents) or other immunosuppressive medications within 14 days of study drug administration. Inhaled or topical steroids and adrenal replacement doses > 10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease.
  11. Receipt of live attenuated vaccine within 30 days prior to the first dose of IP. Note: Subjects, if enrolled, should not receive live vaccine whilst receiving IP and up to 30 days after the last dose of IP.
  12. Prior exposure to T cell checkpoint inhibitor therapies.
  13. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, interstitial lung disease, serious chronic gastrointestinal conditions associated with diarrhea, or psychiatric illness/social situations that would limit compliance with study requirements, substantially increase risk of incurring AEs or compromise the ability of the patient to give written informed consent.
  14. History of active primary immunodeficiency.
  15. Active infection including tuberculosis (clinical evaluation that includes clinical history, physical examination and radiographic findings, and TB testing in line with local practice for patients suspected of having active infection), hepatitis B (known positive HBV surface antigen (HBsAg) result), hepatitis C, or human immunodeficiency virus (positive HIV 1/2 antibodies). Subjects with a past or resolved HBV infection (defined as the presence of hepatitis B core antibody [anti-HBc] and absence of HBsAg) are eligible. Subjects positive for hepatitis C (HCV) antibody are eligible only if polymerase chain reaction is negative for HCV RNA.
  16. Female subjects who are pregnant or breastfeeding or male or female subjects of reproductive potential who are not willing to employ effective birth control from screening to 90 days after the last dose of study medications.
  17. Known allergy or hypersensitivity to any of the study drugs or any of the study drug excipients.
04

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
29 participants (actual)

Study arms

  • Experimental
    Durvalumab + Trametinib

    Participants take Trametinib tablets by mouth every day. Trametinib taken alone for the first 7 days of the study then participants begin receiving it in combination with Durvalumab. Participants receive Durvalumab by vein every 4 weeks. Each cycle is 28 days.

    Drug: Durvalumab · Drug: Trametinib

Interventions

  • DrugDurvalumab

    Dose Escalation and Dose Expansion Dose: 1500 mg by vein every 4 weeks in a 28 day cycle.

    Also known as: MEDI4736

  • DrugTrametinib

    Dose Escalation Starting Dose: 2mg by mouth daily in a 28 day cycle. Dose Expansion Dose: MTD from Dose Escalation.

    Also known as: GSK1120212

05

What researchers measure

Primary outcomes

  1. Immune-related Best Overall Response Rate.

    Best overall response rate (CR+PR) by immune-related response rate.

    Time frame: From Baseline to 2 years

Secondary outcomes

  1. Progression Free Survival as Determined by irRC

    The Kaplan-Meier method GraphPad software, V.8 was used for statistical analyses.

    Time frame: From Baseline to up to 2 years

  2. Overall Survival

    The Kaplan-Meier method GraphPad software, V.8 was used for statistical analyses.

    Time frame: From Baseline to 2 years

  3. Disease Control Rate

    Disease control rate (DCR) describes the percentage of patients with advanced cancer whose therapeutic intervention has led to a complete response, partial response, or stable disease.

    Time frame: From Baseline to 2 years.

06

Results

Posted Jun 15, 2023

Participant flow

29 patients were enrolled to the first stage at The University of Texas MD Anderson Cancer Center.

Participant flow — Overall Study
MilestoneDurvalumab + Trametinib
Started29
Completed29
Not completed0

Outcome measures

PrimaryImmune-related Best Overall Response Rate.

Best overall response rate (CR+PR) by immune-related response rate.

Time frame:
From Baseline to 2 years
Reported as:
Count of participants · Participants
Immune-related Best Overall Response Rate.
ParticipantsDurvalumab + Trametinib
Immune-related Best Overall Response Rate.1
SecondaryProgression Free Survival as Determined by irRC

The Kaplan-Meier method GraphPad software, V.8 was used for statistical analyses.

Time frame:
From Baseline to up to 2 years
Reported as:
Median · months
Progression Free Survival as Determined by irRC
monthsDurvalumab + Trametinib
Progression Free Survival as Determined by irRC3.2 (2.5 to 3.8)
SecondaryOverall Survival

The Kaplan-Meier method GraphPad software, V.8 was used for statistical analyses.

Time frame:
From Baseline to 2 years
Reported as:
Median · months
Overall Survival
monthsDurvalumab + Trametinib
Overall Survival6.9 (5.7 to 8)
SecondaryDisease Control Rate

Disease control rate (DCR) describes the percentage of patients with advanced cancer whose therapeutic intervention has led to a complete response, partial response, or stable disease.

Time frame:
From Baseline to 2 years.
Reported as:
Number · percentage
Disease Control Rate
percentageDurvalumab + Trametinib
Complete Response0
Partial Response3.4
Stable Disease24

Adverse events

Collected over from Baseline to 2 years. Non-serious events are listed at a 5% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Durvalumab + Trametinib12/29 (41.4%)0/29 (0%)29/29 (100%)
Most frequent other events
Showing 10 of 18
Most frequent other events
EventDurvalumab + Trametinib
RashSkin and subcutaneous tissue disorders25/29
AnemiaInvestigations12/29
DiarrheaGastrointestinal disorders11/29
AnorexiaGastrointestinal disorders11/29
Alkaline phosphataseInvestigations11/29
FatigueGeneral disorders9/29
Aspartrate aminotransferaseInvestigations9/29
ThrombocytopeniaInvestigations8/29
NauseaGastrointestinal disorders7/29
Alanine aminotransferaseInvestigations7/29

Baseline characteristics

Age, Continuous
Age, Continuous(years)Durvalumab + Trametinib
Median48 (28 to 75)
Sex: Female, Male
Sex: Female, Male(Participants)Durvalumab + Trametinib
Female14
Male15
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)Durvalumab + Trametinib
Hispanic or Latino3
Not Hispanic or Latino0
Unknown or Not Reported26
Race (NIH/OMB)
Race (NIH/OMB)(Participants)Durvalumab + Trametinib
American Indian or Alaska Native0
Asian3
Native Hawaiian or Other Pacific Islander0
Black or African American2
White21
More than one race0
Unknown or Not Reported3
Region of Enrollment
Region of Enrollment(participants)Durvalumab + Trametinib
United States29
07

Study locations

1 site
  • University of Texas MD Anderson Cancer Center
    Houston, Texas 77030, United States
08

References and documents

Publications

  • Johnson B, Haymaker CL, Parra ER, Soto LMS, Wang X, Thomas JV, Dasari A, Morris VK, Raghav K, Vilar E, Kee BK, Eng C, Parseghian CM, Wolff RA, Lee Y, Lorenzini D, Laberiano-Fernandez C, Verma A, Lang W, Wistuba II, Futreal A, Kopetz S, Overman MJ. Phase II study of durvalumab (anti-PD-L1) and trametinib (MEKi) in microsatellite stable (MSS) metastatic colorectal cancer (mCRC). J Immunother Cancer. 2022 Aug;10(8):e005332. doi: 10.1136/jitc-2022-005332. PubMed 36007963 ↗

Study documents

  • Protocol and statistical analysis plan · Dec 19, 2017

Documents are hosted by the registry — open the source record to download them.

09

Registry details

Key details

Study ID
NCT03428126
Lead sponsor
M.D. Anderson Cancer Center
Collaborators
MedImmune LLC, AstraZeneca, Novartis
Responsible party
Sponsor
First posted
Feb 9, 2018
Start date
Mar 21, 2018
Primary completion
May 5, 2022
Completion
May 5, 2022
Results posted
Jun 15, 2023
Last update
Jun 15, 2023

Study contacts

Michael Overman, MD
principal investigator · M.D. Anderson Cancer Center

Oversight

Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is completed, as verified in Jun 2023. You cannot join it, but the record below documents what was studied.

Follow this study

Get an email when the registry record changes — status, dates, results — or when someone posts here.

Sign in to follow

Discussion

Questions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.

Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.

Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.

Start the discussion