NCT04262687

Brief Summary

About 85% of cases of non-metastatic colorectal cancer (CRC) are related to chromosomal instability and have a proficient DNA Mismatch-Repair system (pMMR); which are also called CRC with microsatellite stability (MSS). Other CRC, i.e. 15%, are "microsatellite unstable" (MSI) with deficient DNA Mismatch-Repair system (dMMR). These latter are characterised by generation of many neo-antigens, which result in a high anti-tumour immune response and a high peri- and/or intra-tumour lymphocyte infiltration (TIL). Investigators recently showed, with a prospectively validated immune score, that 14% of localised MSS/pMMR CRC are also highly infiltrated by CD3+ lymphocytes. This same immune score has made it possible to measure high lymphocyte infiltration in hepatic metastases, in particular, in patients treated with XELOX/FOLFOX. Pembrolizumab, an anti-PD1 monoclonal antibody (programmed death-1) is an immune checkpoint inhibitor (ICI) of PD1/PD-L1 axis, recently approved in many cancers. Anti-PD1 antibodies have recently been reported as being very effective in patients with dMMR metastatic CRC (mCRC). In the study by Le DT et al. pMMR mCRC did not seem to benefit from anti-PD1 antibodies. However, it is possible that 20% of pMMR mCRC with a high CD3+ infiltrate in the tumour may be a subgroup of pMMR mCRC sensitive to ICI, as is the case for dMMR mCRC. Lastly, immunogenic cell death induced by chemotherapy, such as oxaliplatin, can increase the efficacy of ICI. The prognostic value of lymphocyte infiltrate has been demonstrated in CRC by several teams. However, no validated test is used in routine clinical practice. Previously, investigators described an automated and reproducible method for analysis of TIL and investigators validated it for clinical use. Automated tests evaluating TIL are performed on virtual slides and have showed that, out of 1,220 tumours tested, 20% were highly infiltrated by CD3+ T cells. Patients presenting with a pMMR CRC with a high immune infiltrate had a better progression-free survival (HR=0.70; p=0.02). An immunoscore® described by Galon et al. has also a high prognostic value in CRC and is based on CD3+ and CD8+ T cells infiltration in the center and periphery of the tumour. Finally, approximately 14% of tumours with a high immune infiltrate have been found in patients with metastatic CRC. Investigators formulated the hypothesis that patients with a pMMR CRC with a high immune infiltrate can be sensitive to ICI . Therefore, blocks of resected primary tumour will be collected and analysed prospectively. For each patient, slides containing tumour tissue and adjacent non-tumour tissue will be analysed using two techniques : immunoscore® and TuLIS score.It consist in Immunohistochemistry with CD3 and CD8 staining. Slides will be scanned and analysed by image analysis as previously described . Tumours will then be classified as having a "high" or "low" immune response according to type of lymphocyte infiltrate, which is independent of pre-analytic conditions. Only patients with a high immune response will be eligible for the POCHI trial. Other biomarkers will be analysed like other immune populations or mutational load. If investigators identify an immune score which seems clinically relevant to predict sensitivity to ICI in pMMR mCRC, this will make it possible to plan a randomised phase III trial comparing chemotherapy and anti-angiogenic antibody versus chemotherapy and anti-angiogenic antibody plus pembrolizumab in patients with a pMMR mCRC with a high immune score and/or a hypermutated genotype. Investigators choose PFS at 10 months as primary endpoint in POCHI trial because it is a surrogate marker of OS. Actually median PFS in first-line setting with a doublet plus a biological agent is range from 8 to 11 months in unresectable mCRC, corresponding to a PFS of 50% at 10 months. The alternative clinical hypothesis to obtain 70% of patients alive and without progression at 10 months is ambitious and currently not achieved with current chemotherapies plus a biological agent. Up until now there is no data concerning survivals outcomes of patients with a MSS mCRC with high immune infiltration score.

Trial Health

43
At Risk

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Trial has exceeded expected completion date
Enrollment
55

participants targeted

Target at P25-P50 for phase_2

Timeline
Completed

Started Apr 2021

Typical duration for phase_2

Geographic Reach
1 country

88 active sites

Status
unknown

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

Click on a node to explore related trials.

Study Timeline

Key milestones and dates

First Submitted

Initial submission to the registry

February 6, 2020

Completed
4 days until next milestone

First Posted

Study publicly available on registry

February 10, 2020

Completed
1.2 years until next milestone

Study Start

First participant enrolled

April 6, 2021

Completed
3.5 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

September 30, 2024

Completed
Same day until next milestone

Study Completion

Last participant's last visit for all outcomes

September 30, 2024

Completed
Last Updated

August 18, 2023

Status Verified

August 1, 2023

Enrollment Period

3.5 years

First QC Date

February 6, 2020

Last Update Submit

August 16, 2023

Conditions

Keywords

immunotherapyimmune infiltratefirst line

Outcome Measures

Primary Outcomes (1)

  • The rate of patients alive and without progression at 10 months after inclusion

    Progression is evaluated by CT scan, according to RECIST criteria (version 1.1) definition by the investigator. Death was also considered as an event (all causes). Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1), as a 20% increase in the sum of the longest diameter of target lesions compared the little sum of diameters observed during the study (NADIR), or a measurable increase in a non-target lesion, or the appearance of new lesions

    10 months after inclusion

Secondary Outcomes (2)

  • Overall survival

    Up to 2 years after the end of the treatment

  • Histological response in case of secondary resection

    Up to 2 years after the end of the treatment

Study Arms (1)

Immunotherapy + chemotherapy

EXPERIMENTAL

Xelox bevacizumab plus pembrolizumab every 3 weeks up until disease progression, unacceptable toxicity, refusal by the patient, withdrawal of consent, pregnancy or decision by the investigator.

Drug: CapecitabineDrug: OxaliplatinDrug: BevacizumabDrug: Pembrolizumab

Interventions

2000 mg/m²/day, from day 1 to 14 of each cycle

Immunotherapy + chemotherapy

130 mg/m² by IV infusion over 2 hours, on day 1 of each cycle

Immunotherapy + chemotherapy

7.5 mg/kg by IV infusion over 60 minutes, on day 1 of each cycle

Immunotherapy + chemotherapy

200 mg by IV infusion over 30 minutes, on day 1 of each cycle

Immunotherapy + chemotherapy

Eligibility Criteria

Age18 Years+
Sexall
Healthy VolunteersNo
Age GroupsAdult (18-64), Older Adult (65+)

You may qualify if:

  • Age ≥ 18 years
  • MSS and pMMR metastatic colorectal adenocarcinoma (metachronous or synchronous metastases), histologically proven
  • Patients who have had chemotherapy (neo-adjuvant or adjuvant) or radiotherapy (neo-adjuvant or adjuvant) for the treatment of primary tumor or metastatic resected disease R0 can be included if they have a recurrence more than 6 months after the end of this treatment.
  • High immune response defined as the immune infiltration scores obtained on the primary tumour (resection of primary tumour containing at least 2 mm of tumour-free margin between the tumour and non-tumour area)
  • Unresectable cancer with at least one measurable metastatic target according to RECIST v1.1 criteria
  • WHO PS ≤ 1
  • Life expectancy ≥ 3 months
  • Adequate haematological function: neutrophils ≥ 1,500 /mm3, platelets ≥ 100,000/mm3, Hb \> 9 g/dL
  • Adequate liver function: AST/ALT ≤ 5xULN, total bilirubin ≤ 2xULN, alkaline phosphatase. ≤ 5xULN
  • Creatinine clearance \> 50 mL/min according to the MDRD formula
  • Proteinuria \<2+ (dipstick urinalysis) or ≤1g/24hour
  • Patient who is a beneficiary of the social security system
  • Information provided to patient and signature of the informed consent form

You may not qualify if:

  • Active infection requiring intravenous antibiotics at day 1 of cycle 1
  • Active or untreated central nervous system metastases
  • Another concomitant cancer or history of cancer during the last 5 years, except for carcinoma in situ of the uterine cervix or a basal cell or squamous cell skin carcinoma or any other carcinoma in situ considered as cured
  • Previous bone marrow allogenic stem cell transplantation or previous organ transplantation
  • History of idiopathic pulmonary fibrosis, medicinal product-related pneumonia or proof of active pneumonia or pneumonitis on a chest CT-scan prior to therapy
  • HIV infection, active hepatitis B or C infection, active tuberculosis
  • Colorectal cancer with microsatellite instability (dMMR and/or MSI)
  • Patient eligible for curative treatment (resection and/or thermal ablation according to the opinion of the local multidisciplinary tumour meeting board)
  • Patient with only primary tumour biopsies available or only a sample of a metastasis (no surgical resection of the primary tumour)
  • Previous treatment with anti-PD1 or anti-PDL1 or another immunotherapy
  • An auto-immune disease which may worsen during treatment with an immune-stimulating agent (patients with type I diabetes, vitiligo, psoriasis, hypo or hyperthyroidism not requiring immunosuppressant therapy are eligible)
  • Long-term immunosuppressant therapy (patients requiring corticosteroid therapy are eligible if administration at a dose ≤ 10 mg prednisone equivalent dose per day, administration of steroids by a route of administration resulting in minimal systemic exposure (cutaneous, rectal, ocular or inhalation) is authorised)
  • Known severe hypersensitivity to monoclonal antibodies, to one of the medicinal products used or to one of the excipients in the products used or a history of anaphylactic shock or of uncontrolled asthma
  • Vaccinations (live vaccine) within 30 days prior to start of treatment
  • Dihydropyrimidine Dehydrogenase (DPD) deficiency defined by uracilemy level ≥ 16 ng/mL
  • +7 more criteria

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (88)

Ch - Centre Hospitalier D'Abbeville

Abbeville, 80090, France

NOT YET RECRUITING

Chu - Hôpital Sud

Amiens, France

RECRUITING

Privé - Clinique de L'Europe

Amiens, France

NOT YET RECRUITING

Privé - Ico - Site Paul Papin

Angers, 49055, France

NOT YET RECRUITING

Privé - Hôpital Privé Pays de Savoie

Annemasse, 74100, France

NOT YET RECRUITING

Privé - Hôpital Privé D'Antony

Antony, 92160, France

RECRUITING

Ch - Hôpital Henri Duffaut

Avignon, 84902, France

RECRUITING

Prive - Institut Du Cancer Avignon Provence

Avignon, France

RECRUITING

Ch - Centre Hospitalier de La Côte Basque

Bayonne, 64100, France

RECRUITING

Privé - Clinique Capio Balharra

Bayonne, France

NOT YET RECRUITING

Ch - Centre Hospitalier de Beauvais

Beauvais, 60021, France

NOT YET RECRUITING

Chu - Hôpital Jean Minjoz

Besançon, 25030, France

NOT YET RECRUITING

Ch - Centre Hospitalier de Béziers

Béziers, France

RECRUITING

Privé - Cac - Clinique Bergonié

Bordeaux, 33076, France

RECRUITING

Privé - Polyclinique Bordeaux Nord

Bordeaux, 33077, France

RECRUITING

Privé - Clinique Tivoli

Bordeaux, France

RECRUITING

Chu - Hôpital Ambroise Paré - Service Anatomie Pathologique

Boulogne, France

RECRUITING

Ch - Hôpital Duchenne

Boulogne-sur-Mer, France

RECRUITING

Chu - Hôpital Morvan - Institut de Cancérologie

Brest, 29609, France

RECRUITING

Privé - Clinique Pasteur Lanroze Cfro

Brest, France

RECRUITING

Privé - Centre Maurice Tubiana

Caen, 14000, France

NOT YET RECRUITING

Privé - Cac - Centre Francois Baclesse

Caen, 14076, France

RECRUITING

Prive - Polyclinique Du Parc Caen

Caen, France

NOT YET RECRUITING

Privé - Infirmerie Protestante de Lyon

Caluire-et-Cuire, 69300, France

NOT YET RECRUITING

Privé - Médipole de Savoie

Challes-les-Eaux, 73190, France

NOT YET RECRUITING

Privé - Hôpital Privé Paul D'Egine

Champigny-sur-Marne, 94500, France

RECRUITING

Ch - Centre Hospitalier de Cholet

Cholet, 49300, France

RECRUITING

Chu - Hôpital Estaing

Clermont-Ferrand, France

RECRUITING

Ch - Hôpitaux Civils de Colmar

Colmar, 68024, France

NOT YET RECRUITING

Privé - Clinique Saint Come

Compiègne, 60204, France

NOT YET RECRUITING

Privé - Clinique de Flandre

Coudekerque-Branche, 59210, France

RECRUITING

Ch - Ghpso - Site de Creil

Creil, 60100, France

NOT YET RECRUITING

Chu - Hôpital Henri Mondor

Créteil, 94000, France

RECRUITING

Ch - Chic de Créteil

Créteil, France

NOT YET RECRUITING

Chu - Hôpital François Mitterrand

Dijon, 21079, France

RECRUITING

Privé - Cac - Centre Georges-Francois Leclerc

Dijon, 21079, France

NOT YET RECRUITING

Privé - Polyclinique de Blois - 3Eme Etage

La Chaussée-Saint-Victor, 41260, France

RECRUITING

Ch - Chd Vendée

La Roche-sur-Yon, 85925, France

RECRUITING

CH - GROUPE HOSPITALIER DE La Rochelle RE AUNIS

La Rochelle, France

RECRUITING

Privé - Hôpital Franco Britannique

Levallois-Perret, France

RECRUITING

Privé - Clinique Du Bois

Lille, France

NOT YET RECRUITING

Chu - Centre Hospitalier Dupuytren

Limoges, 87042, France

RECRUITING

Ch - Chbs - Hôpital Du Scorff

Lorient, 56322, France

RECRUITING

Privé - Hôpital Jean Mermoz

Lyon, 69008, France

RECRUITING

Privé - Hôpital Saint Joseph

Marseille, 13008, France

RECRUITING

Privé - Hôpital Europeen

Marseille, 13331, France

RECRUITING

Chu - Hôpital La Timone

Marseille, 13385, France

NOT YET RECRUITING

Privé - Haliodx

Marseille, France

RECRUITING

Ch - Ghi - Groupe Hospitalier de L'Est Francilien - Site de Meaux

Meaux, 77100, France

RECRUITING

Ch - Hôpital Layné

Mont-de-Marsan, 40 000, France

RECRUITING

Privé - Centre Azureen de Cancerologie

Mougins, 06250, France

RECRUITING

Privé - Hôpital Prive Arnault Tzanck

Mougins, 06250, France

RECRUITING

Privé - Polyclinique de Gentilly

Nancy, 54100, France

NOT YET RECRUITING

Chu - Hôpital Carémeau

Nîmes, 30029, France

RECRUITING

Privé - Institut Mutualiste Montsouris

Paris, 75014, France

RECRUITING

Chu - Hôpital Europeen Georges Pompidou

Paris, 75015, France

RECRUITING

Privé - Groupe Hospitalier Diaconesses Croix Saint Simon

Paris, 75020, France

RECRUITING

Chu - Hôpital Saint Antoine

Paris, France

NOT YET RECRUITING

Chu - Hôpital Saint-Louis

Paris, France

NOT YET RECRUITING

Ch - Centre Hospitalier de Pau

Pau, 64046, France

RECRUITING

Ch - Centre Hospitalier Saint-Jean

Perpignan, France

RECRUITING

Chu - Hôpital Haut Lévêque

Pessac, France

NOT YET RECRUITING

Privé - Polyclinique Francheville

Périgueux, 24004, France

RECRUITING

Chu Lyon Sud - Pierre Benite

Pierre-Bénite, 69495, France

RECRUITING

Privé - Centre Cario Hpca

Plérin, France

RECRUITING

Chu - Centre Hospitalier Universitaire de Poitiers - La Miletrie

Poitiers, 86021, France

RECRUITING

Ch - Chic de Quimper

Quimper, France

RECRUITING

Chu - Centre Hospitalier Universitaire Robert Debre

Reims, 51092, France

RECRUITING

Privé - Cac - Institut Jean Godinot

Reims, 51726, France

RECRUITING

Chu - Centre Hospitalier Universitaire Pontchaillou

Rennes, 35033, France

RECRUITING

Ch - Hôpital Drome Nord

Romans-sur-Isère, 26100, France

RECRUITING

Privé - Clinique Saint-Grégoire

Saint-Grégoire, France

RECRUITING

Privé - Cac - Ico - Site René Gauducheau

Saint-Herblain, 44805, France

NOT YET RECRUITING

Chu - Centre Hospitalier Universitaire de Saint Etienne - Hôpital Nord - Service Hge

Saint-Priest-en-Jarez, 42270, France

RECRUITING

Privé - Polyclinique Saint-Claude

Saint-Quentin, 02100, France

NOT YET RECRUITING

Privé - Clinique Charcot

Sainte-Foy-lès-Lyon, 69510, France

NOT YET RECRUITING

Ch - Centre Hospitalier de Saint-Malo

St-Malo, 35403, France

RECRUITING

Privé - Clinique Sainte Anne

Strasbourg, 67000, France

RECRUITING

Privé - Cac - Paul Strauss / Institut de Cancérologie de Strasbourg Europe

Strasbourg, 67065, France

RECRUITING

Chu - Hôpital Foch

Suresnes, 92151, France

NOT YET RECRUITING

Privé - Polyclinique de L'Ormeau

Tarbes, 65000, France

NOT YET RECRUITING

Ch - Hôpital Sainte Musse

Toulon, 83000, France

RECRUITING

Chu - Hôpital Trousseau

Tours, 37044, France

RECRUITING

Ch - Centre Hospitalier de Valenciennes

Valenciennes, 59300, France

NOT YET RECRUITING

Privé - Cac - Institut de Cancerologie de Lorraine

Vandœuvre-lès-Nancy, 54519, France

RECRUITING

Chu - Hôpital Bradois

Vandœuvre-lès-Nancy, France

RECRUITING

Chu - Hôpital Paul Brousse

Villejuif, 94804, France

NOT YET RECRUITING

Privé - Cac - Institut Gustave Roussy

Villejuif, France

RECRUITING

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MeSH Terms

Interventions

CapecitabineOxaliplatinBevacizumabpembrolizumab

Intervention Hierarchy (Ancestors)

DeoxycytidineCytidinePyrimidine NucleosidesPyrimidinesHeterocyclic Compounds, 1-RingHeterocyclic CompoundsFluorouracilUracilPyrimidinonesDeoxyribonucleosidesNucleosidesNucleic Acids, Nucleotides, and NucleosidesCoordination ComplexesOrganic ChemicalsAntibodies, Monoclonal, HumanizedAntibodies, MonoclonalAntibodiesImmunoglobulinsImmunoproteinsBlood ProteinsProteinsAmino Acids, Peptides, and ProteinsSerum GlobulinsGlobulins

Study Officials

  • David TOUGERON, MD,PHD

    CHU Poitiers

    PRINCIPAL INVESTIGATOR

Central Study Contacts

Study Design

Study Type
interventional
Phase
phase 2
Allocation
NA
Masking
NONE
Purpose
TREATMENT
Intervention Model
SINGLE GROUP
Sponsor Type
OTHER
Responsible Party
SPONSOR

Study Record Dates

First Submitted

February 6, 2020

First Posted

February 10, 2020

Study Start

April 6, 2021

Primary Completion

September 30, 2024

Study Completion

September 30, 2024

Last Updated

August 18, 2023

Record last verified: 2023-08

Data Sharing

IPD Sharing
Will not share

Locations