Neoadjuvant chemoradiotherapy with sequential ipilimumab and nivolumab in rectal cancer (CHINOREC): A prospective randomized, open-label, multicenter, phase II clinical trial.

Authors

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Johannes Laengle

Division of Visceral Surgery, Department of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria

Johannes Laengle , Irene Kuehrer , Dietmar Pils , Julijan Kabiljo , Judith Stift , Friedrich Herbst , Bernhard Dauser , Matthias Monschein , Peter Razek , Stefanie Haegele , Wolfgang Huller , Reinhold Fuegger , Hans Geinitz , Andreas L. Petzer , Clemens Bitterman , Friedrich Laengle , Dietmar Tamandl , Joachim Widder , Rainer Schmid , Michael Bergmann

Organizations

Division of Visceral Surgery, Department of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria, Department of Pathology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria, Department of Surgery, Hospital of St. John of God, Vienna, Austria, Department of Surgery, Clinic Floridsdorf, Vienna, Austria, Department of Pathology, Clinic Floridsdorf, Vienna, Austria, Institute of Pathology, State Hospital Wiener Neustadt, Wiener Neustadt, Austria, Department of General and Visceral Surgery, Congregational Hospital Linz, Sisters of Mercy, Linz, Austria, Department of Radiation Oncology, Congregational Hospital Linz, Sisters of Mercy, Linz, Austria, Department of Internal Medicine I, Congregational Hospital Linz, Sisters of Mercy, Linz, Austria, Department of Surgery, State Hospital Wiener Neustadt, Wiener Neustadt, Austria, Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-guided Therapy, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria, Department of Radiation Oncology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria

Research Funding

Pharmaceutical/Biotech Company
This is an investigator-initiated trial (IIT), which received a research grant and the study medications from Bristol-Myers Squibb (BMS)

Background: Immune checkpoint inhibitors (ICI), such as ipilimumab (anti-cytotoxic T-lymphocyte-associated protein 4) or nivolumab (anti-programmed cell death protein 1) have been proven to be an effective strategy in solid cancers. However, ICI seem not to be effective in microsatellite stable (MSS) cancers. As they might lack an immunogenic priming, radiotherapy (RT) is capable to induce an immunogenic cell death (ICD) and subsequently an immunogenic tumor immune microenvironment (TIME). Thus, RT might restore the susceptibility of MSS tumors to ICI and consequently leading to an effective anti-tumor immune response. Methods: This is a prospective, randomized, open-label, multicenter, phase II investigator-initiated clinical trial (IIT), including patients with locally advanced rectal cancer (LARC). Patients receive either neoadjuvant chemoradiotherapy (CRT) alone (50 Gy in 2 Gy fractions over 25 working days + capecitabine 1650 mg/m2/d PO) or in combination with ipilimumab (1 mg/kg IV on day 7) and nivolumab (3 mg/kg IV on day 14, 28 and 42). Patients will undergo surgery within 10-12 weeks post CRT. The primary endpoint is incidence of treatment-emergent adverse events (AEs) assessed by the Clavien-Dindo classification of surgical complications and the common terminology criteria of adverse events (CTCAE). Secondary objectives are radiographic and pathological therapy response. Serial liquid (plasma, serum and peripheral blood mononuclear cells) and tissue biopsies will be taken before, during and after neoadjuvant treatment. Genomic, transcriptomic, epigenomic and proteomic pattern of liquid and tissue biopsies, as well as the immune cell infiltrate of resected specimen, will be correlated with therapy response and clinical outcome. Currently 8 of planned 80 patients have been enrolled. Registration numbers: NCT no. NCT04124601, EudraCT no. 2019-003865-17. Clinical trial information: NCT04124601

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Gastrointestinal Cancer—Colorectal and Anal

Track

Gastrointestinal Cancer—Colorectal and Anal

Sub Track

Colorectal Cancer–Local-Regional Disease

Clinical Trial Registration Number

NCT04124601

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr TPS3623)

DOI

10.1200/JCO.2021.39.15_suppl.TPS3623

Abstract #

TPS3623

Poster Bd #

Online Only

Abstract Disclosures