WITHDRAWN

A Phase II Study Evaluating an Organ Preservation Strategy Using Immune Checkpoint Blockade for Participants With Primary Colorectal or Gastroesophageal Cancer

Conditions

Colorectal Cancer Gastroesophageal Cancer nivolumab Ipilimumab Immune Checkpoint Blockade mismatch repair

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Study Overview

This clinical trial focuses on testing the efficacy of different digital interventions to promote re-engagement in cancer-related long-term follow-up care for adolescent and young adult (AYA) survivors of childhood cancer.

Description

Background: People with colorectal cancer (CRC) or gastroesophageal cancer (GEC) must often have major surgery to remove tumors from the esophagus, stomach, colon, or rectum. These surgeries can have adverse effects on their quality of life. Researchers want to know if one or two approved drugs (nivolumab with or without ipilimumab) can help people with CRC or GEC delay or avoid surgery. Objective: To test 1 or 2 drugs in people with CRC or GEC. Eligibility: People aged 18 years and older with CRC or GEC. People with GEC must also have changes in a particular gene. Design: Participants will visit the clinic about 15 times over the first 2 years. Each visit will last 4 to 8 hours. Participants will be screened. They will have a physical exam with blood and urine tests. They will have imaging scans. Small samples of tissue will be collected from their upper or lower digestive tract where the tumor is located. Both ipilimumab and nivolumab are administered through a tube attached to a needle inserted into a vein in the arm. Some participants will receive both drugs. Some will receive only nivolumab. Treatment will be given once every 3 weeks for up to 8 cycles up to (24 weeks). Participants will be evaluated every 6 weeks. Those who are responding well will continue with the drug treatments. If their disease progresses, they will go to surgery. After treatment ends, participants will have follow-up visits every 6 months for up to 5 years....

Official Title

A Phase II Study Evaluating an Organ Preservation Strategy Using Immune Checkpoint Blockade for Participants With Primary Colorectal or Gastroesophageal Cancer

Quick Facts

Study Start:2025-09-09

Study Completion:2025-09-09

Study Type:Not specified

Phase:Not Applicable

Enrollment:Not specified

Status:WITHDRAWN

Study ID

NCT06410534

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Ages Eligible for Study:18 Years to 120 Years

Sexes Eligible for Study:ALL

Accepts Healthy Volunteers:No

Standard Ages:ADULT, OLDER_ADULT

Inclusion Criteria	Exclusion Criteria
* Participants must have biopsy-proven stage I-III colorectal cancer (CRC) \[any MMR or Tumor Mutational Burden (TMB) status\] or stage I-III gastroesophageal cancer (GEC) (MMR deficient only). * Participants with known mismatch repair protein expression by immunohistochemical staining and/ or known next-generation sequencing report of tumor mutational burden and/or microsatellite status. Note: For participants that come to NIH with an equivocal MMR status, next-generation sequencing (NGS) by TSO500 will be done at NIH. * More than four weeks must have elapsed since completion of any prior systemic therapy or radiotherapy at the time of enrollment. Participants are permitted to have undergone prior treatment with systemic chemotherapy (e.g. FOLFOX, FOLFIRI, FLOT) and/or radiotherapy. Note: Participant may have undergone minor surgical procedures within the four weeks prior to enrollment, if related major organ toxicities have recovered to \<= grade 1. * Participants must have endoscopically evaluable disease. * Age \>=18 years. * ECOG performance status =\<1. * Participants must have adequate organ and marrow function as defined below: * White Blood Cell (WBC), \>=3,000/mm\^3 * Hemoglobin \>8.0 d/dL, (transfusion permitted) * platelets, \>=100,000/mm\^3 * total bilirubin, \< 1.5 mg/dL (except in participants with Gilbert s Syndrome, who must have a total bilirubin \< 3.0 mg/dL) * AST(SGOT)/ALT(SGPT), 5.0 X institutional upper limit of normal * serum creatinine, \< 1.6 mg/dL * No pre-existing autoimmune or infectious conditions for which treatment with immune checkpoint blockade is contraindicated. * Serology * Seronegative for HIV antibody. * Seronegative for hepatitis B surface antigen and seronegative for hepatitis C antibody. If hepatitis C antibody test is positive, then the participant must be tested for the presence of antigen by RT-PCR and be HCV RNA negative * Must have a negative pregnancy test. * Women of childbearing potential must be willing to must agree to use adequate contraception (surgical sterilization, partner vasectomy, hormonal or barrier method of birth control; abstinence) from the time of enrollment through 3 months after ipilimumab or for 5 months after nivolumab, whichever is later. * Breastfeeding participants must be willing to discontinue breastfeeding from study treatment initiation through 3 months after ipilimumab or for 5 months nivolumab, whichever is later. * Ability of participant to understand and the willingness to sign a written informed consent document. * Participants with MMR proficient colon tumors must have extenuating circumstances that make surgical treatment an unacceptable option. This must be documented in the medical record. Some examples: * Religious or strong personal objections * Prior colorectal surgery, such that another resection could lead to short gut, permanent stoma or detriment to quality of life * Participant must be co-enrolled on protocol 03-C-0277	* Participants who are receiving any other investigational agents. * Previous treatment with checkpoint inhibitors (anti-CTLA-4, anti-PD-1 or anti-PD-L1 antibodies) for the primary tumor in question. * History of allergic reactions attributed to compounds of similar chemical or biologic composition to nivolumab and ipilimumab or other agents used in study. * Concomitant medications, such as steroids or other immunosuppressive agents, that have the potential to affect the activity of the study agents. * Any active or uncompensated major medical illness that would preclude major intraabdominal surgery. * Any form of primary immunodeficiency (such as Severe Combined Immunodeficiency Disease) or any immune disorder that would be a contraindication to ICB treatment. * Concurrent opportunistic infections * Tumor is causing symptomatic bowel obstruction (participants with a diverting ostomy are eligible). * History of significant autoimmune adverse events due to administration of anti-PD-1, anti-PD L1 or anti-CTLA-4 antibodies when given for prior indication. * Participants who are medically unfit to undergo major abdominal surgery. * Participants with tumors that are unable to be endoscopically evaluated. * Uncontrolled intercurrent illness that would limit compliance with study requirements.

Inclusion Criteria

Exclusion Criteria

* Participants must have biopsy-proven stage I-III colorectal cancer (CRC) \[any MMR or Tumor Mutational Burden (TMB) status\] or stage I-III gastroesophageal cancer (GEC) (MMR deficient only).
* Participants with known mismatch repair protein expression by immunohistochemical staining and/ or known next-generation sequencing report of tumor mutational burden and/or microsatellite status. Note: For participants that come to NIH with an equivocal MMR status, next-generation sequencing (NGS) by TSO500 will be done at NIH.
* More than four weeks must have elapsed since completion of any prior systemic therapy or radiotherapy at the time of enrollment. Participants are permitted to have undergone prior treatment with systemic chemotherapy (e.g. FOLFOX, FOLFIRI, FLOT) and/or radiotherapy. Note: Participant may have undergone minor surgical procedures within the four weeks prior to enrollment, if related major organ toxicities have recovered to \<= grade 1.
* Participants must have endoscopically evaluable disease.
* Age \>=18 years.
* ECOG performance status =\<1.
* Participants must have adequate organ and marrow function as defined below:
* White Blood Cell (WBC), \>=3,000/mm\^3
* Hemoglobin \>8.0 d/dL, (transfusion permitted)
* platelets, \>=100,000/mm\^3
* total bilirubin, \< 1.5 mg/dL (except in participants with Gilbert s Syndrome, who must have a total bilirubin \< 3.0 mg/dL)
* AST(SGOT)/ALT(SGPT), 5.0 X institutional upper limit of normal
* serum creatinine, \< 1.6 mg/dL
* No pre-existing autoimmune or infectious conditions for which treatment with immune checkpoint blockade is contraindicated.
* Serology
* Seronegative for HIV antibody.
* Seronegative for hepatitis B surface antigen and seronegative for hepatitis C antibody. If hepatitis C antibody test is positive, then the participant must be tested for the presence of antigen by RT-PCR and be HCV RNA negative
* Must have a negative pregnancy test.
* Women of childbearing potential must be willing to must agree to use adequate contraception (surgical sterilization, partner vasectomy, hormonal or barrier method of birth control; abstinence) from the time of enrollment through 3 months after ipilimumab or for 5 months after nivolumab, whichever is later.
* Breastfeeding participants must be willing to discontinue breastfeeding from study treatment initiation through 3 months after ipilimumab or for 5 months nivolumab, whichever is later.
* Ability of participant to understand and the willingness to sign a written informed consent document.
* Participants with MMR proficient colon tumors must have extenuating circumstances that make surgical treatment an unacceptable option. This must be documented in the medical record. Some examples:
* Religious or strong personal objections
* Prior colorectal surgery, such that another resection could lead to short gut, permanent stoma or detriment to quality of life
* Participant must be co-enrolled on protocol 03-C-0277

* Participants who are receiving any other investigational agents.
* Previous treatment with checkpoint inhibitors (anti-CTLA-4, anti-PD-1 or anti-PD-L1 antibodies) for the primary tumor in question.
* History of allergic reactions attributed to compounds of similar chemical or biologic composition to nivolumab and ipilimumab or other agents used in study.
* Concomitant medications, such as steroids or other immunosuppressive agents, that have the potential to affect the activity of the study agents.
* Any active or uncompensated major medical illness that would preclude major intraabdominal surgery.
* Any form of primary immunodeficiency (such as Severe Combined Immunodeficiency Disease) or any immune disorder that would be a contraindication to ICB treatment.
* Concurrent opportunistic infections
* Tumor is causing symptomatic bowel obstruction (participants with a diverting ostomy are eligible).
* History of significant autoimmune adverse events due to administration of anti-PD-1, anti-PD L1 or anti-CTLA-4 antibodies when given for prior indication.
* Participants who are medically unfit to undergo major abdominal surgery.
* Participants with tumors that are unable to be endoscopically evaluated.
* Uncontrolled intercurrent illness that would limit compliance with study requirements.

Contacts and Locations

Principal Investigator

Nicholas D Klemen, M.D.

PRINCIPAL_INVESTIGATOR

National Cancer Institute (NCI)

Study Locations (Sites)

National Institutes of Health Clinical Center

Bethesda, Maryland, 20892

United States

Collaborators and Investigators

Sponsor: National Cancer Institute (NCI)

Nicholas D Klemen, M.D., PRINCIPAL_INVESTIGATOR, National Cancer Institute (NCI)

Study Record Dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Registration Dates

Study Start Date2025-09-09

Study Completion Date2025-09-09

Study Record Updates

Study Start Date2025-09-09

Study Completion Date2025-09-09

Terms related to this study

Keywords Provided by Researchers

nivolumab
Ipilimumab
Immune Checkpoint Blockade
mismatch repair

Additional Relevant MeSH Terms

Colorectal Cancer
Gastroesophageal Cancer