A phase II study of hypofractionated radiation therapy to augment immune response in patients with metastatic gastrointestinal malignancies progressing on immune therapy (ARM-GI).

Authors

null

Hewitt Chang

University Of California, San Francisco, San Francisco, CA;

Hewitt Chang , Luchia Andemicael , Moshiur Mekhail Anwar , John Gordan , Jamese Johnson , Bridget P Keenan , Robin Kate Kelley , Andrew H. Ko , Katherine Van Loon , Alan P. Venook , Lawrence Fong , Melody Ju Xu , Mary Uan-Sian Feng

Organizations

University Of California, San Francisco, San Francisco, CA; , University of California, San Francisco, San Francisco, CA; , UCSF, San Francisco, CA; , University of California San Francisco Cancer Center, San Francisco, CA; , Division of Hematology and Oncology, University of California, San Francisco, CA; , Kaiser Permanente, Santa Clara, CA;

Research Funding

Pharmaceutical/Biotech Company
Varian, a Siemens Healthineers company, University of California San Francisco

Background: Metastatic disease remains a consistent challenge for patients with gastrointestinal (GI) malignancies. Multiple immune checkpoint inhibitors (ICI) have been FDA approved for several GI indications. Still, patients will progress on these therapies, either immediately or after initial response. Palliative radiation therapy (RT) is an effective treatment that can be delivered to symptomatic metastases. It also has been reported to lead to an abscopal effect, which is an induction of response in a distant tumor. This is thought to result from increased tumor immunogenicity, tumor microenvironment modulation, and immune cell recruitment. Thus, palliative RT could not only relieve symptoms, but also potentially reinvigorate the immune response, prolong ICI efficacy, and delay next-line systemic therapy that carries risks of unknown efficacy and tolerability. Ongoing studies seek to elucidate prognostic and predictive biomarkers of the abscopal effect. However, cohorts of patients with GI malignancies are limited, so there remains a need for research in combining RT and immunotherapy in the context of metastatic GI cancer. ARM-GI aims to study the radiation-augmented immune response in patients with metastatic GI cancers progressing on immunotherapy. Methods: ARM-GI is a phase 2, single arm study. Key eligibility criteria include confirmed metastatic GI malignancy, progressive disease per RECIST v1.1 on any ICI, and at least 2 metastases, one of which can be safely left unirradiated. The target prescription dose is 30 Gy in 5 fractions to symptomatic sites through intensity modulated RT or stereotactic body RT. Patients will continue the same immunotherapy after RT and be evaluated per RECIST v1.1 longitudinally. The primary endpoint is overall response rate (ORR) per RECIST v1.1. Secondary endpoints include ORR per iRECIST, progression free survival, overall survival, local control in radiated lesion(s), effect of distant radiation on unirradiated target lesions, incidence of new metastatic lesions, safety by CTCAE v5.0, and time to new systemic therapy. The study will enroll 28 patients, with recruitment ongoing. Serial peripheral blood samples are collected for exploratory studies that will analyze for association with disease response and quantification of changes in circulating immune cell subsets after RT compared to baseline. Clinical trial information: NCT04221893.

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Abstract Details

Meeting

2023 ASCO Gastrointestinal Cancers Symposium

Session Type

Trials in Progress Poster Session

Session Title

Trials in Progress Poster Session A: Cancers of the Esophagus and Stomach and Other GI Cancers

Track

Esophageal and Gastric Cancer,Other GI Cancer

Sub Track

Therapeutics

Clinical Trial Registration Number

NCT04221893

Citation

J Clin Oncol 41, 2023 (suppl 4; abstr TPS817)

DOI

10.1200/JCO.2023.41.4_suppl.TPS817

Abstract #

TPS817

Poster Bd #

P7

Abstract Disclosures