This phase II trial tests the effect of the botensilimab in combination with balstilimab in treating patients with stage II/III colorectal adenocarcinoma with detectable circulating tumor (ct) deoxyribonucleic acid (DNA) in the blood. Immunotherapy with monoclonal antibodies, such as botensilimab and balstilimab, may help the body's immune system attack the tumor, and may interfere with the ability of tumor cells to grow and spread. Giving botensilimab and balstilimab may be an effective combination to remove any remaining microscopic cancer cells in the bloodstream in patients with stage II/III colorectal adenocarcinoma. In addition, clearing the ctDNA from the blood may serve as an early indicator of treatment response.
PRIMARY OBJECTIVE: I. To determine the 6-month circulating tumor DNA (ctDNA) clearance rate following 6 months of therapy with botensilimab (AGEN1181) and balstilimab (AGEN2034) regimen in patients with colorectal cancer (CRC) who present with radiographic occult molecular residual disease (MRD) after completing definitive standard-of-care (SOC) therapy. SECONDARY OBJECTIVES: I. To determine the 3-month ctDNA clearance rate following botensilimab (AGEN1181) and balstilimab (AGEN2034) treatment. II. To determine recurrence-free survival (RFS) at 1-year following 6 months of botensilimab (AGEN1181) and balstilimab (AGEN2034) treatment. III. To determine overall survival (OS) at 1-year following 6 months of botensilimab (AGEN1181) and balstilimab (AGEN2034) treatment. IV. To determine the safety and tolerability of botensilimab (AGEN1181) and balstilimab (AGEN2034). V. To determine if Cancer Immunotherapy Response Classifier (CIRCLE) in archival tumor (using whole exome sequencing \[WES\]) may predict clinical benefit of botensilimab (AGEN1181) plus balstilimab (AGEN2034) in MRD CRC. EXPLORATORY OBJECTIVES: I. To determine changes in profiles of ctDNA (including time to ctDNA negative status, duration of ctDNA negative status, overall ctDNA negative rate, lead time from ctDNA detection to radiographic detection) during and following treatment with botensilimab (AGEN1181) and balstilimab (AGEN2034). II. To determine baseline characteristics in archival tumor and/or plasma that may predict clinical benefit or lack thereof. OUTLINE: Patients receive balstilimab intravenously (IV) over 30 minutes on days 1 and 22 of cycles 1-4 and botensilimab IV over 30 minutes on days 1 of cycles 1 and 2. Treatment repeats every 42 days for up to 4 cycles (6 months) in the absence of disease progression or unacceptable toxicity. Patients also undergo urine and blood sample collection and imaging throughout the study. Additionally, patients may undergo optional tumor tissue biopsy on study. After completion of study treatment, patients are followed for up to 90 days, every 3 months during the first year, every 4 months during the second year, then every 6 months during the third year unless recurrence of tumor or death occurs.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
20
Given IV
Undergo tumor tissue biopsy
Undergo urine and blood sample collection
Given IV
Undergo imaging
Circulating tumor deoxyribonucleic acid (ctDNA) clearance
Will be defined as clearance of ctDNA and no radiographic evidence of disease. Will estimate clearance rate and its 95% confidence interval.
Time frame: Up to 6 months
ctDNA clearance rate
Will evaluate the proportion of all included patients whose ctDNA converts from positive to negative. The proportion is presented together with 90% exact intervals.
Time frame: At 3 months
Recurrence-free survival (RFS)
Median RFS and 95% confidence intervals will be estimated using the Kaplan-Meier method.
Time frame: From the start of botensilimab (AGEN1181) and balstilimab (AGEN2034) to recurrence of tumor or death, whichever occurred first, assessed up to 3 years
Overall survival (OS)
Will use Kaplan-Meier methods to evaluate time to event endpoints and will report median OS and its 95% confidence interval.
Time frame: From the first dose of study treatment to the date of death from any cause, assessed up to 3 years
Incidence and severity of adverse events (AEs)
Severity of AEs will be graded using the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. toxicity grading scale. Safety will be assessed by descriptive statistics and summarized in tabular format.
Time frame: Up to 90 days after last dose of study treatment
Determination if Cancer Immunotherapy Response Classifier may predict benefit
Whole exome sequencing data from archival tumor will be acquired and analyzed.
Time frame: Up to 3 years
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