NIVACOR: Phase II study of nivolumab in combination with FOLFOXIRI/bevacizumab in first-line chemotherapy for advanced colorectal cancer RASm/BRAFm patients.

Authors

null

Angela Damato

Medical Oncology Unit. Clinical Cancer Center. AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy

Angela Damato , Francesco Iachetta , Nicola Normanno , Francesca Bergamo , Evaristo Maiello , Alberto Zaniboni , Lorenzo Antonuzzo , Guglielmo Nasti , Giuseppe Tonini , Roberto Bordonaro , Francesca Di Fabio , Alessandra Romagnani , Annalisa Berselli , Carmine Pinto

Organizations

Medical Oncology Unit. Clinical Cancer Center. AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy, Medical Oncology Unit, Clinical Cancer Center, AUSL-IRCCS, Reggio Emilia, Italy, INT Pascale, Naples, Italy, Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy, Oncology Unit, Foundation IRCSS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy, Medical Oncology Unit, Poliambulanza Foundation, Brescia, Italy, Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy, Istituto Nazionale Tumori Fondazione G.Pascale, Naples, Italy, Unit of Clinical Oncology, Università Cattolica del Sacro Cuore, Rome, Italy, Medical Oncology, National Specialist Hospital Garibaldi, Catania, Italy, Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy, Medical Oncology Unit, Clinical Cancer Centre, IRCCS-AUSL di Reggio Emilia, Reggio Emilia, Italy, Oncology Unit, Clinical Cancer Center, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy

Research Funding

Pharmaceutical/Biotech Company
Bristol-Myers Squibb

Background: FOLFOXIRI (fluorouracil, leucovorin, oxaliplatin, and irinotecan) plus bevacizumab has been shown to be one of the therapeutic regimens in first line with the highest activity profile in patients (pts) with metastatic colorectal cancer (mCRC) unselected for biomolecular alterations. Tumors co-opt the PD-1/PD-L1 signaling pathway as one key mechanism to evade immune destruction. Anti-PD-1 monoclonal antibodies are FDA approved only for DNA mismatch repair deficient/microsatellite instability-high (MMRd/MSI-H), which are only about 5% among all mCRC. Nowadays, there are no data demonstrating anti-PD1 activity in stable and proficient (MMRp/MSS) disease. Another critical therapeutic target is the Vascular Endothelial Growth Factor A (VEGF-A), which acts on endothelial cells to stimulate angiogenesis; his inhibition with bevacizumab increase immune cell infiltration, giving a strong rationale for combining VEGF targeted agents with immune checkpoint inhibitors. Based on evidence, we explore the combination of triplet chemotherapy (FOLFOXIRI) with bevacizumab and nivolumab in pts with mCRC all-RAS/BRAF mutant regardless of microsatellite status. Methods: This is a prospective, open-label, multicentric phase II trial where pts with mCRC RAS/BRAF mutant in first line will receive nivolumab in combination with FOLFOXIRI/Bevacizumab every 2 weeks for 8 cycles followed by maintenance with bevacizumab plus nivolumab every 2 weeks. Bevacizumab will be administered intravenously at dose of 5 mg/kg every 2 weeks and nivolumab intravenously as a flat dose of 240 mg every 2 weeks. The primary endpoint is the overall response rate (ORR) and our hypothesis is that the treatment is able to improve the ORR from 66% to 80%. Secondary endpoints include overall survival, safety, time to progression, duration of response. Collateral translational studies evaluate the tumor mutational burden, and genetic alterations by circulating free DNA (cfDNA) obtained from plasma samples. The trial is open to enrollment, 4 of planned 70 pts have been enrolled. Clinical trial information: EudraCT Number: 2018-002893-38. Clinical trial information: NCT04072198.

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Abstract Details

Meeting

2020 ASCO Virtual Scientific Program

Session Type

Poster Session

Session Title

Gastrointestinal Cancer—Colorectal and Anal

Track

Gastrointestinal Cancer—Colorectal and Anal

Sub Track

Colorectal Cancer–Advanced Disease

Clinical Trial Registration Number

NCT04072198

Citation

J Clin Oncol 38: 2020 (suppl; abstr TPS4118)

DOI

10.1200/JCO.2020.38.15_suppl.TPS4118

Abstract #

TPS4118

Poster Bd #

110

Abstract Disclosures