Phase II single-arm study of durvalumab and tremelimumab with concurrent radiotherapy in patients with mismatch repair-proficient metastatic colorectal cancer Journal Article


Authors: Segal, N. H.; Cercek, A.; Ku, G.; Wu, A. J.; Rimner, A.; Khalil, D. N.; Reidy-Lagunes, D.; Cuaron, J.; Yang, T. J.; Weiser, M. R.; Romesser, P. B.; Stadler, Z. K.; Varghese, A. M.; Ganesh, K.; Yaeger, R.; Connell, L. C.; Faleck, D.; Abou-Alfa, G. K.; McAuliffe, K. C.; Vaiskauskas, P.; Solter, M. L.; Ogle, M.; Adamow, M. J.; Holland, A.; Vedantam, P.; Wong, P.; Merghoub, T.; Vakiani, E.; Hollmann, T. J.; Juluru, K.; Chou, J. F.; Capanu, M.; Erinjeri, J.; Solomon, S.; Yamada, Y.; Kemeny, N.; Crane, C. H.; Saltz, L. B.
Article Title: Phase II single-arm study of durvalumab and tremelimumab with concurrent radiotherapy in patients with mismatch repair-proficient metastatic colorectal cancer
Abstract: PURPOSE: Immune checkpoint inhibition (ICI) alone is not active in mismatch repair-proficient (MMR-P) metastatic colorectal cancer (mCRC), nor does radiotherapy alone result in objective systemic benefit. However, combined radiotherapy plus ICI can induce systemic antitumor immunity in preclinical and clinical models. PATIENTS AND METHODS: In this single-center, phase II study, patients with chemotherapy-refractory MMR-P mCRC received durvalumab 1,500 mg plus tremelimumab 75 mg every 4 weeks plus radiotherapy. The primary endpoint was objective response rate (ORR) in nonirradiated lesions. Treatment and efficacy were correlated with peripheral immune cell profiles. RESULTS: We enrolled 24 patients, and report outcomes after a median follow-up of 21.8 (range: 15.9-26.3) months. The ORR was 8.3% (2 patients) [95% confidence interval (CI), 1.0-27.0]. The median progression-free survival was 1.8 (95% CI, 1.7-1.9) months, median overall survival was 11.4 (95% CI, 10.1-17.4) months. Twenty five percent of patients (n = 6) had treatment-related grade 3-4 adverse events. We observed increased circulating CD8+ T lymphocyte activation, differentiation, and proliferation in patients with objective response. CONCLUSIONS: This combination of radiotherapy plus ICI study did not meet the prespecified endpoint criteria to be considered worthwhile for further study. However, rare instances of systemic immune augmentation and regression in nonirradiated lesions were observed (an abscopal response). Combination durvalumab and tremelimumab plus radiotherapy is feasible in MMR-P mCRC with a manageable safety profile. Further studies of novel immunotherapy combinations, and identification of biomarkers predictive of abscopal response are warranted. ©2021 American Association for Cancer Research.
Journal Title: Clinical Cancer Research
Volume: 27
Issue: 8
ISSN: 1078-0432
Publisher: American Association for Cancer Research  
Date Published: 2021-04-15
Start Page: 2200
End Page: 2208
Language: English
DOI: 10.1158/1078-0432.Ccr-20-2474
PUBMED: 33504552
PROVIDER: scopus
PMCID: PMC8499477
DOI/URL:
Notes: Article -- Export Date: 3 May 2021 -- Source: Scopus
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MSK Authors
  1. Joanne Fu-Lou Chou
    332 Chou
  2. Leonard B Saltz
    791 Saltz
  3. Taha Merghoub
    364 Merghoub
  4. Neil Howard Segal
    210 Segal
  5. Yoshiya Yamada
    479 Yamada
  6. Anna Mary Varghese
    146 Varghese
  7. Geoffrey Yuyat Ku
    233 Ku
  8. Ghassan Abou-Alfa
    570 Abou-Alfa
  9. Zsofia Kinga Stadler
    393 Stadler
  10. Phillip Wong
    80 Wong
  11. Marinela Capanu
    387 Capanu
  12. Diane Lauren Reidy
    294 Reidy
  13. Martin R Weiser
    539 Weiser
  14. Rona Denit Yaeger
    322 Yaeger
  15. Andreas Rimner
    527 Rimner
  16. Abraham Jing-Ching Wu
    404 Wu
  17. Stephen Solomon
    425 Solomon
  18. Joseph Patrick Erinjeri
    203 Erinjeri
  19. Efsevia Vakiani
    265 Vakiani
  20. Nancy Kemeny
    544 Kemeny
  21. Jonathan T Yang
    166 Yang
  22. Matthew J Adamow
    24 Adamow
  23. Danny Nejad Khalil
    65 Khalil
  24. Travis Jason Hollmann
    126 Hollmann
  25. Paul Bernard Romesser
    193 Romesser
  26. John Jacob Cuaron
    143 Cuaron
  27. Krishna   Juluru
    35 Juluru
  28. Karuna   Ganesh
    68 Ganesh
  29. Louise Catherine Connell
    46 Connell
  30. Christopher   Crane
    204 Crane
  31. David M. Faleck
    51 Faleck
  32. Aliya Rose Ming Holland
    18 Holland
  33. Martinique M. Ogle
    3 Ogle
  34. Mark Larry Solter
    2 Solter