Phase II study of ipilimumab, nivolumab, and panitumumab in patients with KRAS/NRAS/BRAF wild-type (WT) microsatellite stable (MSS) metastatic colorectal cancer (mCRC).

Authors

Michael Lee

Michael Sangmin Lee

The University of Texas MD Anderson Cancer Center, Houston, TX

Michael Sangmin Lee , Patrick J. Loehrer Sr., Iman Imanirad , Stacey Cohen , Kristen Keon Ciombor , Dominic T. Moore , Cheryl Ann Carlson , Hanna Kelly Sanoff , Autumn Jackson McRee

Organizations

The University of Texas MD Anderson Cancer Center, Houston, TX, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, Moffitt Cancer Center, Tampa, FL, University of Washington, Seattle, WA, Vanderbilt University Medical Center, Nashville, TN, Biostatistics and Data Management, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, University of North Carolina Hospitals, Chapel Hill, NC, UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC

Research Funding

Pharmaceutical/Biotech Company
Amgen, Bristol-Myers Squibb

Background: Panitumumab is a monoclonal antibody (mAb) targeting the epidermal growth factor receptor (EGFR) and is a standard therapy in KRAS/NRAS/BRAF WT mCRC. Preclinical data shows that anti-EGFR therapy causes a tumor-specific adaptive immune response and immunogenic apoptosis, with functional adaptive immunity required to mediate efficacy. However, resistance to anti-EGFR antibody therapy inevitably develops and is associated with increased expression of CTLA-4 and PD-L1. We hypothesized that addition of ipilimumab (anti-CTLA-4) and nivolumab (anti-PD-1) to panitumumab will increase response rate in patients with KRAS/NRAS/BRAF WT MSS mCRC. Methods: LCCC1632 was a multicenter, single-arm, Simon’s two stage phase II clinical trial with a pre-specified safety run-in of panitumumab, ipilimumab, and nivolumab in KRAS/NRAS/BRAF WT, MSS mCRC (NCT03442569). Eligible patients must have received 1-2 prior lines of therapy and no prior anti-EGFR or immune checkpoint inhibitor therapy. Subjects received ipilimumab 1 mg/kg IV q6wk, nivolumab 240 mg IV q2wk, and panitumumab 6 mg/kg IV q2wk until progression, toxicity, or patient withdrawal. The primary endpoint was response rate at 12 weeks per RECIST 1.1, and key secondary endpoints included progression-free survival and duration of response. Results: A total of 56 subjects were enrolled 3/2018-6/2020. This included the 6-subject safety run-in, with 0/6 dose-limiting toxicities in first 12 weeks. The first stage of the Simon’s two-stage clinical trial (n=32) had sufficient response rate to merit full enrollment. There were 7 unevaluable subjects for the primary endpoint of 12-week response rate. Among 49 evaluable subjects, 12-week response rate was 35% (95% CI 21-48; n=17 responses). Twenty subjects had at least an unconfirmed response at any time. Median PFS was 5.7 months (95% CI 5.5-7.9). There was one treatment-related grade 5 adverse event of myocarditis. The most common treatment-related grade 3-4 AEs included lipase increased (9%), amylase increased (7%), ALT increased (5%), AST increased (5%), diarrhea (5%), hypophosphatemia (5%), and maculopapular rash (5%). Conclusions: The combination of panitumumab, ipilimumab, and nivolumab demonstrated evidence of activity and met its prespecified primary endpoint of 12-wk response rate criteria to merit further study. The PFS in this single-arm study compares favorably to expected PFS for anti-EGFR monotherapy in RAS wild-type patients, and results suggest activity of immune checkpoint inhibitors combined with anti-EGFR therapy in MSS mCRC. Clinical trial information: NCT03442569

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Abstract Details

Meeting

2021 Gastrointestinal Cancers Symposium

Session Type

Rapid Oral Abstract Session

Session Title

Rapid Abstract Session: Anal and Colorectal Cancer

Track

Colorectal Cancer

Sub Track

Therapeutics

Clinical Trial Registration Number

NCT03442569

Citation

J Clin Oncol 39, 2021 (suppl 3; abstr 7)

DOI

10.1200/JCO.2021.39.3_suppl.7

Abstract #

7

Abstract Disclosures