Phase 1b/2 open-label study evaluates the safety, tolerability, and efficacy of combination immunotherapy with nadunolimab (anti-IL-1RAP) and toripalimab (anti-PD-1) in patients with chemotherapy-refractory metastatic microsatellite stable (MSS) colorectal cancer. Phase 1b will assess dose-limiting toxicity (DLT), while Phase 2 will evaluate objective response rate (ORR), including progression-free survival (PFS), overall survival (OS), disease control rate (DCR), and duration of response (DOR). Exploratory analyses will investigate immunomodulatory effects through tumor and peripheral blood studies, and treatment will continue every 3 weeks for up to 1 year or until disease progression.
This is a Phase 1b/2, open-label study evaluating the safety, tolerability, and efficacy of nadunolimab (anti-IL-1RAP) in combination with toripalimab (anti-PD-1) in adults with chemotherapy-refractory metastatic microsatellite stable (MSS) colorectal cancer. The Phase 1b portion serves as a safety run-in with up to 6 subjects to assess the safety of a single dose of the combination therapy. Following this, Phase 2 will enroll up to 21 subjects, with the first 6 from Phase 1b included in the Phase 2 analysis to assess the primary efficacy endpoint. Eligible participants must have biopsy-confirmed MSS colorectal cancer (non-MSI-high or pMMR), whose disease has progressed during or following 5-FU, oxaliplatin and/or irinotecan-based chemotherapy with or without a biological agent. Subjects must have have measurable disease and tumor accessible for core needle biopsy. Participants will receive nadunolimab 5 mg/kg and toripalimab 240 mg intravenously every three weeks, continuing for up to one year or until disease progression. Primary objectives: For Phase 1/b, to determine the safety and tolerability of combination immunotherapy in subjects with chemotherapy-refractory metastatic non-MSI-high/pMMR CRC. For Phase 2, to determine the efficacy of combination immunotherapy in subjects with chemotherapy-refractory metastatic non-MSI-high/pMMR CRC as measured by the objective response rate (ORR) achieved. Subjects will undergo core needle biopsies, blood collection, and repeat imaging throughout the study. This study is conducted at Mount Sinai Hospital under IRB and PRMC oversight. The results will provide important information on the safety and potential efficacy of combining nadunolimab and toripalimab in a population with limited treatment options.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
24
5 mg/kg intravenously (IV) every 3 weeks (Q3W)
240 mg IV every 3 weeks (Q3W)
Icahn School of Medicine at Mount Sinai
New York, New York, United States
Dose-Limiting Toxicities (DLTs)
For the Phase 1b portion, Dose-Limiting Toxicities (DLTs) will be assessed based on the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 5.0. Adverse events are graded on a scale from 1 (mild) to 5 (death related to AE). Permanent discontinuation of study treatment will occur for any severe (Grade 3) drug-related adverse event that recurs or for any life-threatening (Grade 4) event.
Time frame: The first cycle (day1 - day21) constitutes the DLT window.
Objective Response Rate (ORR)
For the phase 2 portion, ORR will be assessed based on the definition, as the combined percent of the subjects experiencing a partial response (PR) or a complete response (CR) at anytime within the first year from the initiation of therapy, or until the documented progression of disease or start of a new anti-cancer therapy. Radiographic response will be determined by the RECIST v1.1
Time frame: Treatment initiation through 12 months, or until documented disease progression or initiation of new anti-cancer therapy, whichever occurs first
Progression-free Survival (PFS)
Progression-free survival (PFS) is defined as the time in days from the first administration of nadunolimab until documented progression of disease on imaging or death.
Time frame: From first dose through disease progression, death, or up to 12 months, whichever occurs first.
Overall survival (OS)
Overall survival (OS) is defined as the time in days from the first administration of nadunolimab until documented death from any cause.
Time frame: From first administration of nadunolimab until documented death from any cause, or up to 12 months, whichever occurs first.
Disease control rate (DCR)
Disease control rate (DCR) is defined as the percent of the subjects experiencing a best objective response of PR, CR or stable disease (SD).
Time frame: From first administration of nadunolimab until best objective response, or up to 12 months, whichever occurs first.
Duration of response (DOR)
Duration of response (DOR) is defined as the time from which a subject achieves either a PR or a CR until subsequent progression of disease is documented radiographically or clinically.
Time frame: up to 12 months
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