Regorafenib + Pembrolizumab for Colorectal Cancer

Recruiting at 3 trial locations

Overseen By Richard D. Kim, MD

Age: 18+

Sex: Any

Trial Phase: Phase 1 & 2

Sponsor: University of Southern California

Must not be taking: CYP3A4 inhibitors, CYP3A4 inducers

Disqualifiers: Hypertension, Brain metastasis, Autoimmune disease, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Breakthrough Therapy This drug has been fast-tracked for approval by the FDA given its high promise

Compensation: Varies

Number of Visits: Unknown

Duration: 21 days per course, repeated

75 Participants Needed

Trial Summary

What is the purpose of this trial?

This trial is testing a combination of regorafenib and pembrolizumab in patients with advanced colorectal cancer. Regorafenib directly attacks cancer cells, and pembrolizumab helps the immune system fight the cancer.

Will I have to stop taking my current medications?

The trial does not specify if you must stop all current medications, but you cannot take certain medications like strong CYP3A4 inhibitors or inducers, and you cannot have had certain treatments like chemotherapy or immunotherapy within 2 weeks before starting the trial. It's best to discuss your specific medications with the trial team.

What data supports the effectiveness of the drug Regorafenib + Pembrolizumab for colorectal cancer?

Regorafenib has shown to improve survival and disease control in patients with metastatic colorectal cancer who have already tried other treatments. It has also been found to work well with immune checkpoint inhibitors, like Pembrolizumab, in preclinical models of colorectal cancer. ^{1 2 3 4 5}

Is the combination of Regorafenib and Pembrolizumab safe for humans?

Regorafenib has been used in treating various cancers and is generally considered to have a manageable safety profile, with common side effects including skin issues and liver enzyme changes. Pembrolizumab has been tested in lung cancer patients, and early safety results are available, but specific safety data for the combination of these two drugs in colorectal cancer is not provided in the available research. ^{2 4 6 7 8}

What makes the drug combination of Regorafenib and Pembrolizumab unique for treating colorectal cancer?

The combination of Regorafenib and Pembrolizumab is unique because it pairs a multi-kinase inhibitor (Regorafenib) that targets various cancer growth pathways with an immune checkpoint inhibitor (Pembrolizumab) that helps the immune system recognize and attack cancer cells. This dual approach may offer a novel treatment option for patients with colorectal cancer who have already tried standard therapies. ^{1 2 4 9 10}

Research Team

Heinz-Josef Lenz

Principal Investigator

University of Southern California

Eligibility Criteria

This trial is for adults with advanced or metastatic colorectal cancer who have not responded to standard treatments. They must be able to take oral medication, have certain blood and liver function levels within specific ranges, and agree to use contraception during and after the trial. Those with severe heart conditions, uncontrolled hypertension, active infections or autoimmune diseases are excluded.

Inclusion Criteria

I am fully active or restricted in physically strenuous activity but can do light work.

Aspartate transaminase (AST), alanine transaminase (ALT) =< 2.5-times the upper limit of normal (=< 5-times in patients with liver metastasis)

My colorectal cancer is advanced, and I can't tolerate standard treatments.

Exclusion Criteria

I take medication to control my seizures.

I haven't had severe bleeding in the last 4 weeks.

I haven't received any live vaccines in the last 30 days and won't during the trial.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive pembrolizumab IV on day 1 and regorafenib PO daily on days 1-14, with courses repeating every 21 days

21 days per course, repeated

Follow-up

Participants are monitored for safety and effectiveness after treatment

Up to 30 months

Treatment Details

Interventions

• Pembrolizumab
• Regorafenib

Trial Overview The study is testing the combination of two drugs: Regorafenib (a chemotherapy drug) and Pembrolizumab (an immunotherapy monoclonal antibody). The goal is to find out if this combo is more effective in stopping the growth or spread of colorectal cancer cells compared to current treatments.

Participant Groups

Group I: Treatment (pembrolizumab, regorafenib) Experimental Treatment 2 Interventions

Participants receive pembrolizumab IV over 30 minutes on day 1 and regorafenib PO QD on days 1-14. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Pembrolizumab is already approved in United States, European Union, United Kingdom for the following indications:

Approved in United States as KEYTRUDA for:

• Head and neck squamous cell carcinoma (HNSCC) with PD-L1 CPS ≥1
• Melanoma
• Non-small cell lung cancer (NSCLC)
• Urothelial carcinoma
• Colorectal cancer
• Gastric cancer
• Hepatocellular carcinoma
• Renal cell carcinoma
• Cervical cancer
• Endometrial carcinoma

Approved in European Union as KEYTRUDA for:

• Head and neck squamous cell carcinoma (HNSCC) with PD-L1 CPS ≥1
• Melanoma
• Non-small cell lung cancer (NSCLC)
• Urothelial carcinoma
• Colorectal cancer
• Gastric cancer
• Hepatocellular carcinoma
• Renal cell carcinoma
• Cervical cancer
• Endometrial carcinoma

Approved in United Kingdom as KEYTRUDA for:

• Untreated metastatic or unresectable recurrent head and neck squamous cell carcinoma (HNSCC) with PD-L1 CPS ≥1

Who Is Running the Clinical Trial?

University of Southern California

Lead Sponsor

Trials

956

Recruited

1,609,000+

National Cancer Institute (NCI)

Collaborator

Trials

14,080

Recruited

41,180,000+

Findings from Research

In a study of 72 patients with microsatellite stable metastatic colorectal cancer, regorafenib or fruquintinib combined with sintilimab showed a median progression-free survival of 4.2 months and an overall survival of 10.5 months, indicating these combinations are viable third-line treatment options.

The treatment was generally well-tolerated, with only 15.3% of patients experiencing severe adverse events, and patients without liver metastasis showed better response rates and overall survival, suggesting they may benefit more from this regimen.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Microsatellite stable metastatic colorectal cancer without liver metastasis may be preferred population for regorafenib or fruquintinib plus sintilimab as third-line or above therapy:A real-world study. Nie, C., Lv, H., Chen, B., et al.[2022]

Regorafenib is an oral multi-kinase inhibitor that has shown significant survival benefits in metastatic colorectal cancer and has been FDA approved for this use since 2012.

The drug also improves progression-free survival in patients with metastatic gastrointestinal stromal tumors and advanced hepatocellular carcinoma, leading to its FDA approval for these conditions as well.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Regorafenib. Ettrich, TJ., Seufferlein, T.[2018]

Regorafenib has shown statistically significant improvements in overall survival, progression-free survival, and disease control in patients with metastatic colorectal cancer, based on results from two phase III trials (CORRECT and CONCUR) and two real-world studies (REBECCA and CONSIGN).

Despite these positive outcomes, there are concerns that the clinical benefits of regorafenib may not be meaningful for all patients, and some subgroups may not experience the same level of benefit, highlighting the need for further investigation into its efficacy across different patient populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is regorafenib providing clinically meaningful benefits to pretreated patients with metastatic colorectal cancer? García-Alfonso, P., Feliú, J., García-Carbonero, R., et al.[2018]

Regorafenib significantly improves median overall survival and progression-free survival in patients with previously treated metastatic colorectal cancer (mCRC), as shown in the CORRECT trial with a regimen of 160 mg daily for 3 weeks of each 4-week cycle.

The drug has a generally acceptable tolerability profile and does not compromise health-related quality of life, making it a valuable addition to treatment options for patients with progressive mCRC.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Regorafenib: a review of its use in previously treated patients with progressive metastatic colorectal cancer. Carter, NJ.[2021]

In a phase II trial involving 48 patients with microsatellite stable colorectal cancer, the combination of regorafenib and avelumab showed a best response of stable disease in 53.5% of patients, with a median progression-free survival of 3.6 months and overall survival of 10.8 months.

The study found that higher infiltration of CD8+ T cells in tumors was linked to better outcomes, suggesting that assessing immune cell presence could help identify patients who might benefit more from this treatment combination.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Regorafenib-Avelumab Combination in Patients with Microsatellite Stable Colorectal Cancer (REGOMUNE): A Single-arm, Open-label, Phase II Trial. Cousin, S., Cantarel, C., Guegan, JP., et al.[2022]

Regorafenib, a multikinase inhibitor used for advanced solid tumors, was associated with a range of adverse events (AEs) in a meta-analysis of 2,065 patients, with the most common being hand-foot skin reaction (54%), diarrhea (33%), and fatigue (32%).

The analysis revealed that regorafenib significantly increases the risk of developing AEs compared to placebo, highlighting the importance of monitoring these effects to improve patient safety and treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events risk associated with regorafenib in the treatment of advanced solid tumors: meta-analysis of randomized controlled trials. Yin, X., Yin, Y., Shen, C., et al.[2022]

Regorafenib significantly improves overall survival by up to 2.5 months and progression-free survival by up to 1.5 months in patients with metastatic colorectal cancer (mCRC) who have not responded to standard therapies, based on phase 3 studies.

The treatment is generally well-tolerated, with most side effects being mild to moderate, and it does not negatively impact health-related quality of life compared to placebo.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Regorafenib: A Review in Metastatic Colorectal Cancer. Dhillon, S.[2019]

In a phase II trial involving 15 patients with resectable non-small cell lung cancer (NSCLC), neoadjuvant treatment with pembrolizumab showed a major pathologic response in 27% of patients, indicating promising antitumor activity before surgery.

The treatment was found to be feasible and safe, with only 33% of patients experiencing moderate adverse events, and no postoperative mortality, suggesting that pembrolizumab does not compromise surgical outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neoadjuvant anti-programmed death-1 immunotherapy by pembrolizumab in resectable non-small cell lung cancer: First clinical experience. Eichhorn, F., Klotz, LV., Kriegsmann, M., et al.[2022]

In a study of 23 patients with metastatic colorectal cancer who had previously undergone multiple treatments, regorafenib showed some efficacy, with 34.8% achieving stable disease and 8.7% showing partial response, although 56.5% experienced disease progression.

Regorafenib treatment was associated with significant side effects, with 65% of patients experiencing severe toxicity, primarily hand-foot syndrome and fatigue, leading to dose reductions in 86.9% of cases.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Toxicity and early outcomes of regorafenib in multiply pre-treated metastatic colorectal adenocarcinoma-experience from a tertiary cancer centre in India. Zanwar, S., Ostwal, V., Gupta, S., et al.[2022]

Regorafenib is an effective oral multikinase inhibitor approved by the FDA for treating metastatic colorectal cancer in patients who have not responded to standard chemotherapy and other targeted therapies, showing significant efficacy compared to placebo in the CORRECT trial.

While regorafenib has a greater antiangiogenic effect than sorafenib, it is associated with common severe side effects such as hand-foot skin reactions, diarrhea, hypertension, and fatigue, which require careful management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Management of regorafenib-related toxicities: a review. Krishnamoorthy, SK., Relias, V., Sebastian, S., et al.[2022]

References

1. Switzerland pubmed.ncbi.nlm.nih.gov

Microsatellite stable metastatic colorectal cancer without liver metastasis may be preferred population for regorafenib or fruquintinib plus sintilimab as third-line or above therapy:A real-world study. [2022]

2. Germany pubmed.ncbi.nlm.nih.gov

Regorafenib. [2018]

3. Italy pubmed.ncbi.nlm.nih.gov

Is regorafenib providing clinically meaningful benefits to pretreated patients with metastatic colorectal cancer? [2018]

4. New Zealand pubmed.ncbi.nlm.nih.gov

Regorafenib: a review of its use in previously treated patients with progressive metastatic colorectal cancer. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

Regorafenib-Avelumab Combination in Patients with Microsatellite Stable Colorectal Cancer (REGOMUNE): A Single-arm, Open-label, Phase II Trial. [2022]

6. New Zealand pubmed.ncbi.nlm.nih.gov

Adverse events risk associated with regorafenib in the treatment of advanced solid tumors: meta-analysis of randomized controlled trials. [2022]

7. New Zealand pubmed.ncbi.nlm.nih.gov

Regorafenib: A Review in Metastatic Colorectal Cancer. [2019]

8. Ireland pubmed.ncbi.nlm.nih.gov

Neoadjuvant anti-programmed death-1 immunotherapy by pembrolizumab in resectable non-small cell lung cancer: First clinical experience. [2022]

9. China pubmed.ncbi.nlm.nih.gov

Toxicity and early outcomes of regorafenib in multiply pre-treated metastatic colorectal adenocarcinoma-experience from a tertiary cancer centre in India. [2022]

10. England pubmed.ncbi.nlm.nih.gov

Management of regorafenib-related toxicities: a review. [2022]