This is a multi-center Phase II randomized study. We plan to enroll 78 patients with biopsy-proven hepatic-limited metastatic colorectal cancer deemed resectable after multi-disciplinary discussion. Eligible patients must have confirmed isolated liver metastases by radiographic imaging of the investigators' choosing. Imaging must include the chest, abdomen, and pelvis regardless of imaging modality chosen. Patients will be randomized to either the control arm or the experimental arm. The control arm will receive mFOLFOX6 every 2 weeks for 4 cycles concurrently with Nivolumab. The experimental arm will first be treated with 2 vaccinations of MVA-BN-CV301 given two weeks apart (Days -28, -14) concurrently with Nivolumab followed by 4 vaccinations of FPV-CV301 given two weeks apart concurrently with mFOLFOX6 and Nivolumab, which will again be administered every 2 weeks for 4 cycles (FPV-CV301, mFOLFOX6 and Nivolumab) After Cycle 4, patients will be re-evaluated for surgical resection by re-staging CT chest, abdomen and pelvis (C/A/P). Patients still considered resectable will undergo surgical resection with the goal of complete resection. Patients who cannot be completely resected will continue to be followed on study, and an additional appropriate candidate will be randomized to the corresponding arm. We will collect peripheral blood and tumor tissue at the time of surgical resection, if applicable, or by re-biopsy if resection is not possible. Post-operative therapy will begin when patients are deemed ready by their surgical oncologist team. Patients in the control arm will then undergo another 8 cycles of mFOLFOX6 with Nivolumab administered concurrently. Nivolumab will then be administered every four weeks. The experimental arm will receive the same post-operative regimen but including FPV-CV301 boosters given concurrently with mFOLFOX6 and Nivolumab. FPV-CV301 will then be administered every 12 weeks, and Nivolumab every 4 weeks. We will collect peripheral blood for evaluation of correlates upon the completion of therapy. The vaccination approach of initial immunization during the neoadjuvant period followed by FPV-CV301 boosters for two years postoperatively was chosen to optimize the induction of a long-lasting tumor-specific host response. Neoadjuvant vaccination will also allow for analysis of the tumor microenvironment in resection specimens. Post-therapy patients will be under surveillance per NCCN guidelines with repeat CEA every 3 months for 2 years followed by every 6 months for 1 year (total 3 years), repeat CT of the C/A/P every 3 months for 2 years followed by every 6 months for up to 1 year (total 3 years), and colonoscopy at one year with repetition based on findings at the time of the procedure.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
17
The control arm (Arm A) and experimental arm (Arm B) will receive mFOLFOX6 every 2 weeks for 4 cycles. Once patients in the post-operative period are deemed ready to begin therapy, patients in the control arm will then undergo another 8 cycles of mFOLFOX6.
The experimental arm (Arm B) will receive MVA-BN-CV301 in 4 injections of 4 x 10(8) infectious units/0.5 mL given subcutaneously prior to the start of chemotherapy on days -28 and -14.
The experimental arm (Arm B) will receive FPV-CV301 in 1 dose of 1 x 10(9) infectious units/0.5 mL given subcutaneously concurrently with chemotherapy (at least an hour prior to chemotherapy) on days 0, 14, 28 and 42 pre-operatively, and FVP-CV301 boosters on day 0 and 14 and then every 4 weeks (day 42, 70, 98). After day 98, FVP-CV301 will then be administered every twelve weeks completing therapy at week 110.
Nivolumab at a dose of 240 mg as a 30 minute IV infusion every 2 weeks until progression. Arm B will receive Nivolumab starting with the vaccinations. Arm A will begin the Nivolumab with the initiation mFOLFOX.
City of Hope
Duarte, California, United States
University of Miami
Miami, Florida, United States
University of Kansas Medical Center Research Institute, Inc.
Westwood, Kansas, United States
Rutgers Cancer Institute of New Jersey
New Brunswick, New Jersey, United States
Cleveland Clinic
Cleveland, Ohio, United States
Ohio State University Comprehensive Cancer Center
Columbus, Ohio, United States
Oregon Health & Science University
Portland, Oregon, United States
3-year Overall Survival (OS) Rate From Metastasectomy
3-year Overall Survival (OS) rate is defined as the percentage of patients who are still alive at 3 years.
Time frame: 3 years
3-Year Recurrence Free Survival (RFS) Rate
Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) for target lesions and assessed by MRI: Complete Response(CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Progressive Disease (PD) \>= 20% increase in tumor burden relative to nadir or the appearance of one or more new lesions; Stable Disease (SD), not meet criteria for CR/PR/PD. The 3-year recurrence-free survival (RFS) rate is defined as the percentage of patients who have not experienced disease recurrence three years after treatment, as calculated using Kaplan-Meier survival analysis.
Time frame: 3 years
Overall Response Rate (ORR)
Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) for target lesions and assessed by MRI: Complete Response(CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Progressive Disease (PD) \>= 20% increase in tumor burden relative to nadir or the appearance of one or more new lesions; Stable Disease (SD), not meet criteria for CR/PR/PD. ORR = CR +PR
Time frame: Up to 57 months
Patients Amenable to Complete Resection/Ablation
Compare the percentage of patients amenable to complete resection/ablation between the experimental and control treatment groups in patients who experience a recurrence after surgery
Time frame: Up to 57 months
Perioperative Surgical Outcomes
The Clavien-Dindo classification will be used for grading the severity of postoperative complications. It provides a standardized way to report and compare surgical outcomes, based on the therapy required to treat a complication. It grades from 1 to 5 where 1= Any deviation from normal postoperative course without need for pharmacological, surgical, endoscopic, or radiological interventions. Acceptable treatments: antiemetics, antipyretics, analgesics, physiotherapy, wound dressings. 2 = Requires pharmacological treatment with drugs other than those allowed for Grade 1. Includes blood transfusions, antibiotics and total parenteral nutrition (TPN). 3 = Requiring surgical, endoscoptic or radiological intervention. 3a = Intervention under regional/local anesthesia. 3b = Intervention under general anesthesia. 4= Life-threatening complication requiring intensive care/intensive care unit management.4a= Single organ dysfunction. 4b= Multi-organ dysfunction. 5 = Patient demise.
Time frame: Up to 6 months
3-Year Overall Survival (OS) Rate From Registration
3-Year OS (Overall Survival) rate is defined as the percentage of patients who are still alive at 3 years.
Time frame: 3 years
Pathologic Response Rate
Compare the pathologic response rate to neoadjuvant therapy in resected tumor tissue between the experimental and control groups. Pathologic Response Rate refers to the percentage of patients whose tumors show a specific level of response after it has been surgically removed.
Time frame: Up to 6 months
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