Using infliximab to treat colitis caused by immune checkpoint inhibitors

Efficacy and Safety of Infliximab for Immune Checkpoint Inhibitor Induced Colitis: a Multinational, Randomised, Open Label, Phase III Trial - The iCaD Study

This study is testing if adding infliximab to standard steroid treatment can help people with severe colitis or diarrhea caused by cancer immunotherapy feel better faster.

Quick facts

• Phase: Phase 3
• Study type: Interventional
• Enrollment: 195 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Odense University Hospital (Academic / other)
• Drugs / interventions: infliximab, chemotherapy
• Locations: 3 sites (Aalborg and 2 other locations)
• Trial ID: NCT05947669 on ClinicalTrials.gov

What this trial studies

This clinical trial aims to evaluate the effectiveness and safety of infliximab, a TNF-alpha inhibitor, in combination with corticosteroids for patients experiencing severe immune-related colitis or diarrhea due to immune checkpoint inhibitors. Participants will be randomly assigned to receive either standard corticosteroid treatment or corticosteroids plus infliximab. The study will measure the time taken to achieve a reduction in colitis or diarrhea severity. Evaluations will include blood and fecal samples, as well as sigmoidoscopy assessments.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18 and older with untreated mCTCAE grade 2-4 diarrhea or colitis related to immune checkpoint inhibitor treatment for solid tumors.

Not a fit: Patients with colonic perforation, infection, or those not receiving immune checkpoint inhibitors may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could significantly reduce the duration and severity of colitis in patients undergoing immune checkpoint inhibitor therapy.

How similar studies have performed: Previous studies have shown promising results with TNF-alpha inhibitors in similar contexts, suggesting potential for success in this approach.

Eligibility criteria

Inclusion Criteria

* Untreated mCTCAE grade 2-4 diarrhoea or colitis, or persistent mCTCAE grade 2 diarrhoea after administration of loperamide or equivalent for mCTCAE grade ≤ 2 diarrhoea
* No signs of colonic perforation or infection
* Age ≥ 18
* Understands the nature and purpose of the study and the study procedures and has signed informed consent
* Is able to read, understand, and complete questionnaires and daily components of the patient Diary for the study period
* Histologically confirmed malignant solid tumours
* Treatment with immune checkpoint inhibitors (anti-CTLA-4, anti-PD-1 or anti-PD-L1) within the past 12 weeks. Immune checkpoint inhibitors can be administered as single agents or as combination therapy with anti-CTLA-4 and anti-PD-1
* No probability of a concomitant treatment (e.g. laxatives) other than the immune checkpoint inhibitor being the causal drug for the colitis or diarrhoea
* Prior treatment with immune checkpoint inhibitors is allowed
* Usage of prednisolone ≤ 10 mg daily for non irAE is allowed
* Diagnostic work up including screening for viral hepatic infection and QuantiFERON-TB for mycobacterium tuberculosis must be requisitioned but will not need to be reported prior to study enrolment
* Women of child bearing potential must have a negative serum (preferred) or urine pregnancy test within 72 hours prior to registration.

  * Note: women of childbearing potential are defined as premenopausal females capable of becoming pregnant (i.e. females who have had evidence of menses in the past 12 months, with the exception of those who had prior hysterectomy). However, women who have been amenorrheic for 12 or more months are still considered to be of childbearing potential if the amenorrhea is possibly due to prior chemotherapy, antiestrogens, low body weight, ovarian suppression or other reasons.
* Patients of childbearing / reproductive potential should use adequate birth control measures, as defined by the investigator, during the study treatment period and after the study treatment:

  * for at least 6 months after the last study treatment, or depending on the duration antineoplastic treatment
  * Note: A highly effective method of birth control is defined as a method which results in a low failure rate (i.e. less than 1% per year) when used consistently and correctly. Such methods include:

    * Combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation (oral, intravaginal, transdermal)
    * Progestogen-only hormonal contraception associated with inhibition of ovulation (oral, injectable, implantable)
    * Intrauterine device (IUD)
    * Intrauterine hormone-releasing system (IUS)
    * Bilateral tubal occlusion
    * Vasectomized partner
    * Sexual abstinence

Exclusion Criteria

* Prior history of inflammatory bowel disease, colitis, or diarrhoea requiring treatment with any corticosteroid, or any other immunosuppressant medication
* Prior history of recurrent bowel disease including symptomatic diverticulosis
* Current positive testing for Clostridium difficile or other colonic infection
* Current bacterial infection requiring antibiotic treatment, or systemic fungal infection
* Ongoing antibiotic treatment for any reason
* Treatment with systemic corticosteroids within the last four weeks prior to study enrolment (daily usage of prednisolone ≤ 10 mg for non irAE conditions is accepted)
* Concurrent immune-related adverse events requiring immunosuppressant medication of any kind
* Known hypersensitivity or contraindications to systemic corticosteroids or infliximab
* Prior history of viral hepatitis with a positive viral load, known untreated mycobacterium tuberculosis, or known active herpes zoster infection

Where this trial is running

Aalborg and 2 other locations

• Department of Oncology, Aalborg University Hospital — Aalborg, Denmark (Not_yet_recruiting)
• Department of Oncology Odense University Hospital — Odense, Denmark (Recruiting)
• The Royal Marsden Hospital — London, United Kingdom (Not_yet_recruiting)

Study contacts

• Principal investigator: Christina H. Ruhlmann, PhD — Department of Oncology, OUH
• Study coordinator: Sören K. Petersen, MD

Conditions Colitis