A Clinical Trial of a New Combination Treatment, Domvanalimab and Zimberelimab, Plus Chemotherapy, for People With an Upper Gastrointestinal Tract Cancer That Cannot be Removed With Surgery That Has Spread to Other Parts of the Body (STAR-221)

Arcus Biosciences

Status and phase: Active, not recruiting; Phase 3

Conditions: Advanced Upper Gastrointestinal Tract Adenocarcinoma

Treatments: Drug: Domvanalimab; Drug: Zimberelimab; Drug: Nivolumab; Drug: Oxaliplatin; Drug: Capecitabine; Drug: Fluorouracil; Drug: Leucovorin

Study type: Interventional

Funder types: Industry

Identifiers

NCT05568095

CTR20233469 (Registry Identifier)

CTR20233470 (Registry Identifier)

2023-507522-16-00 (Other Identifier)

MOH_2023-04-30_012590 (Registry Identifier)

STAR-221

2022-002222-27 (EudraCT Number)

jRCT2051220179 (Registry Identifier)

Details and patient eligibility

About

This randomized Phase 3 open-label study will compare the efficacy of the T-cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif (ITIM) domain (TIGIT) monoclonal antibody domvanalimab, the anti programmed cell death protein 1 (PD-1) monoclonal antibody zimberelimab, and multiagent chemotherapy versus the anti PD-1 monoclonal antibody nivolumab and multiagent chemotherapy in the first-line treatment of participants with locally advanced unresectable or metastatic gastric, gastroesophageal junction (GEJ), and esophageal adenocarcinoma.

Enrollment: 1,040 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Key Inclusion Criteria:

• Capable of giving signed informed consent which is in compliance with the requirements and restrictions listed in the informed consent form (ICF) and in protocol.
• Histologically confirmed diagnosis of locally advanced unresectable or metastatic gastric, GEJ, or esophageal adenocarcinoma.
• Eastern Cooperative Oncology Group (ECOG) performance status of 0-1.
• At least one measurable target lesion per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1.

Key Exclusion Criteria:

• Underlying medical or psychiatric conditions that, in the investigator's or sponsor's opinion, will make the administration of study-specified therapy hazardous, including but not limited to:
• Interstitial lung disease, including history of interstitial lung disease or non-infectious pneumonitis. Active viral, bacterial, or fungal infections requiring parenteral treatment within 14 days of randomization.
• Clinically significant cardiovascular disease, such as New York Heart Association Class II or greater cardiac disease or cerebrovascular accident within 3 months prior to randomization, unstable angina, or new onset angina within 3 months prior to randomization, myocardial infarction within 6 months prior to randomization, or unstable arrhythmia within 3 months prior to randomization.
• History of prior solid-organ transplantation, including allogenic bone marrow transplantation.
• Dementia, psychiatric, or substance abuse disorders that would interfere with satisfying the requirements of the trial.
• Known human epidermal growth factor receptor 2 (HER-2) positive tumor.
• Known untreated, symptomatic, or actively progressing central nervous system (CNS) (brain) metastases. Participants with leptomeningeal metastases are excluded from enrollment.
• Received prior systemic treatment for locally advanced unresectable or metastatic gastric, GEJ, or esophageal adenocarcinoma.
• Disease progression within 6 months of completion of neoadjuvant or adjuvant therapy.

Note: Other protocol defined Inclusion/Exclusion criteria may apply.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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1,040 participants in 2 patient groups

Domvanalimab + Zimberelimab + FOLFOX/CAPOX (PI Choice)

Experimental group

Description:

Participants in this arm will receive Domvanalimab and zimberelimab doses once every 4 weeks (Q4W) in addition to chemotherapy with FOLFOX (oxaliplatin, leucovorin, fluorouracil) once every 2 weeks (Q2W) or Domvanalimab and zimberelimab once every 3 weeks (Q3W) in addition to chemotherapy with CAPOX (capecitabine and oxaliplatin) Q3W.

Treatment:

Drug: Leucovorin

Drug: Fluorouracil

Drug: Capecitabine

Drug: Oxaliplatin

Drug: Zimberelimab

Drug: Domvanalimab

Nivolumab + FOLFOX/CAPOX (PI Choice)

Active Comparator group

Description:

Participants in this arm will receive Nivolumab Q2W and FOLFOX Q2W or Nivolumab Q3W + CAPOX Q3W.

Treatment:

Drug: Leucovorin

Drug: Fluorouracil

Drug: Capecitabine

Drug: Oxaliplatin

Drug: Nivolumab