Chidamide in Combination With PD-1 Inhibitor, Bevacizumab, and XELOX for Metastatic Colorectal Cancer

NCT06858969 | Not Yet Recruiting Phase 2

• 1 other identifier: CSIIT-Q100
• Study Type: interventional
• Target: 130
• Locations: 0 countries
• Sites: N/A

Brief Summary

This phase II, open-label, dose-escalation study aims to (1) assess the safety and tolerability of chidamide in combination with PD-1 inhibitor, bevacizumab, and XELOX as first-line therapy for treatment-naïve metastatic colorectal cancer patients, (2) establish the recommended phase II dose (RP2D) of the combination regimen, and (3) obtain preliminary efficacy data including objective response rate (ORR) and progression-free survival (PFS).

Conditions

Metastatic Colorectal Cancer

Outcome Measures

Primary Outcomes (1)

• Progression-Free Survival (PFS)

  Evaluated using RECIST 1.1 criteria

  24 months

Secondary Outcomes (3)

• Objective Response Rate (ORR)

  24 months

• Overall Survival (OS)

  24 months

• safety

  24 months

Study Arms (2)

Treatment group

EXPERIMENTAL

PD-1 inhibitor: Dose determined per the manufacturer's instructions or investigator's discretion based on patient status. Bevacizumab: 7.5 mg/kg via intravenous infusion every 3 weeks (Q3W). XELOX regimen: Oxaliplatin: 130 mg/m² via intravenous infusion on Day 1; Capecitabine: 1000 mg/m² orally twice daily on Days 1-14; Repeated every 3 weeks for 6 cycles. Maintenance therapy after 6 cycles (experimental group): Chidamide: Administered at the maximum tolerated dose/recommended phase II dose (MTD/RP2D), orally twice weekly (on Days 1, 4, 8, 11, 15, and 18 of each cycle), 30 minutes after meals. PD-1 inhibitor, Bevacizumab, and Capecitabine: Continued at the same doses and schedules as during the initial treatment phase.

Drug: Treatment group

Standard-of-care control group

ACTIVE COMPARATOR

XELOX + Bevacizumab: Doses identical to the experimental group (Oxaliplatin 130 mg/m², Capecitabine 1000 mg/m², Bevacizumab 7.5 mg/kg Q3W) for 6 cycles. Maintenance therapy after 6 cycles: Bevacizumab (7.5 mg/kg Q3W) and Capecitabine (1000 mg/m² orally twice daily on Days 1-14 of each cycle).

Drug: Standard-of-care control group

Interventions

Treatment group DRUG

Chidamide+XELOX + Bevacizumab+PD-1

Treatment group

Standard-of-care control group DRUG

XELOX + Bevacizumab+PD-1

Standard-of-care control group

Eligibility Criteria

• Age: 18 Years - 75 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age ≥18 years and ≤75 years, regardless of gender; Histologically confirmed unresectable metastatic/recurrent colorectal adenocarcinoma; No prior systemic antitumor therapy received for metastatic/recurrent colorectal adenocarcinoma; For subjects who have received prior neoadjuvant/adjuvant therapy, the interval between the last treatment and recurrence/progression must exceed 12 months; ECOG performance status 0-1; At least one measurable lesion (per RECIST v1.1 criteria); Expected survival ≥3 months;
• Organ function must meet the following requirements prior to the first dose of the investigational drug:
• Hematological function (no blood transfusion or growth factor administration within 14 days before screening):
• Absolute neutrophil count ≥1.5×10\^9/L, Platelet count ≥100×10\^9/L, Hemoglobin ≥90 g/L;
• Hepatic and renal function (no albumin infusion within 14 days before screening):
• Total bilirubin ≤1.5×ULN, Serum albumin ≥25 g/L, ALT and AST ≤2.5×ULN (≤5.0×ULN for patients with liver metastases), Serum creatinine ≤1.5×ULN;
• Coagulation function:
• INR ≤1.5×ULN, PT and APTT ≤1.5×ULN;
• Urinalysis:
• Urine protein \<2+; for subjects with baseline urine protein ≥2+, 24-hour urine protein quantification must be \<1 g; Subjects (including females and males) must agree to use effective contraception from signing the informed consent form until 180 days after the last dose of the investigational drug. Females of childbearing potential must not be pregnant or breastfeeding; Prior treatment-related adverse events (AEs) must have resolved to ≤Grade 1 (per NCI CTCAE v5.0, except alopecia); Voluntary participation in this clinical trial with written informed consent.

You may not qualify if:

• Subjects with known tumor microsatellite instability-high (MSI-H) status.
• Prior treatment with histone deacetylase (HDAC) inhibitors, including but not limited to chidamide or entinostat.
• Prior postoperative adjuvant therapy targeting EGFR or VEGF/VEGFR, including bevacizumab, cetuximab, panitumumab, aflibercept, regorafenib, or biosimilars of these agents.
• Prior treatment with T-cell co-stimulation or immune checkpoint therapies, including CTLA-4 inhibitors, PD-1/PD-L1/PD-L2 inhibitors, or other T-cell-targeted drugs.
• Active hepatitis B (HBV DNA ≥ 500 IU/mL) or hepatitis C (HCV antibody-positive with HCV-RNA above the lower limit of detection).
• Central nervous system (CNS) metastases or leptomeningeal metastases.
• History of cerebrovascular accident, myocardial infarction, unstable angina, or poorly controlled arrhythmia within the past 6 months (including QTc interval ≥ 450 ms in males or ≥ 470 ms in females, calculated via Fridericia's formula).
• Clinically uncontrolled pleural effusion, ascites, or pericardial effusion requiring intervention and deemed ineligible by the investigator.
• Cardiac dysfunction (NYHA class III/IV) or left ventricular ejection fraction (LVEF) \< 50% on echocardiography.
• History of other malignancies within 5 years prior to signing informed consent, except cured basal cell carcinoma, squamous cell carcinoma, or carcinoma in situ.
• Immunodeficiency, including HIV positivity, congenital/acquired immune deficiency, or history of organ/allogeneic bone marrow transplantation.
• Active autoimmune disease or autoimmune disease history (e.g., interstitial pneumonia, colitis, hepatitis, thyroid dysfunction). Exceptions: vitiligo, childhood asthma/allergies in remission without adult intervention, stable hypothyroidism on hormone replacement, or type I diabetes on stable insulin.
• Uncontrolled hypertension (systolic ≥ 150 mmHg and/or diastolic ≥ 100 mmHg).
• History of hypertensive crisis or hypertensive encephalopathy.
• Systemic corticosteroid use (\>10 mg prednisone daily or equivalent) or immunosuppressants within 2 weeks prior to treatment.

Sponsors & Collaborators

• Cancer Institute and Hospital, Chinese Academy of Medical Sciences: lead

MeSH Terms

Conditions

Colorectal Neoplasms

Condition Hierarchy (Ancestors)

Intestinal Neoplasms; Gastrointestinal Neoplasms; Digestive System Neoplasms; Neoplasms by Site; Neoplasms; Digestive System Diseases; Gastrointestinal Diseases; Colonic Diseases; Intestinal Diseases; Rectal Diseases

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Doctor

Study Record Dates

• First Submitted: February 28, 2025
• First Posted: March 5, 2025
• Study Start: April 9, 2025
• Primary Completion: January 8, 2026
• Study Completion (Estimated): January 8, 2028
• Last Updated: March 5, 2025

Record last verified: 2025-02