Standard of Care Alone or in Combination With Ad-CEA Vaccine and Avelumab in People With Previously Untreated Metastatic Colorectal Cancer QUILT-2.004

• Sponsor: National Cancer Institute (NCI) (NIH)
• Overall Status: Terminated
• CT.gov ID: NCT03050814
• Collaborator: (none)
• Enrollment: 30
• Locations: 2
• Arms: 2
• Actual Duration (Months): 52.7
• Patients Per Site: 15
• Patients Per Site Per Month: 0.3

Study Details

Study Description

Brief Summary

Background:

Colorectal cancer is a common cancer in the Unites States (U.S.) It causes the second most cancer-related deaths. The drug avelumab and vaccine Ad-CEA together help the immune system fight cancer.

Objective:

To test if avelumab and Ad-CEA plus standard therapy treats colorectal cancer that has spread to other sites better than standard therapy alone.

Eligibility:

People ages 18 and older with untreated colorectal cancer that has spread in the body

Design:

Participants will be screened with:

Test to see if their cancer has a certain deficiency

Blood, urine, and heart tests

Scans

Medical history

Physical exam

Tumor sample. This can be from a previous procedure.

A small group of participants will get Ad-CEA and avelumab plus standard therapy. This is leucovorin calcium (folinic acid), fluorouracil, and oxaliplatin (FOLFOX) plus bevacizumab for up to 24 weeks then capecitabine plus bevacizumab.

The others will have treatment in 2-week cycles. They will be Arm A or B:

Arm A: FOLFOX and bevacizumab by intravenous (IV) days 1 and 2 for 12 cycles. After that, capecitabine by mouth twice a day and bevacizumab by IV on day 1.

Arm B: Ad-CEA injection every 2-12 weeks. Avelumab by IV on day 1 of each cycle. FOLFOX and bevacizumab by IV days 2 and 3 for 12 cycles. Then, capecitabine by mouth twice a day and bevacizumab through IV on day 2.

Participants will repeat screening tests during the study.

Participants will be treated until their disease gets worse or they have bad side effects. Arm A participants can join Arm B. They will have a visit 4 5 weeks after they stop therapy.

Condition or Disease	Intervention/Treatment	Phase
Colorectal Tumors; Colorectal Neoplasms; Colorectal Carcinoma; Colorectal Adenocarcinoma; Colorectal Cancer	Drug: Avelumab; Biological: Ad-CEA vaccine; Drug: Bevacizumab; Drug: 5-Fluorouracil (FU); Drug: Leucovorin; Drug: Oxaliplatin; Drug: Capecitabine; Drug: 5-Fluorouracil (FU)	Phase 2

Detailed Description

Background

• Colorectal cancer (CRC) is the fourth most common cancer diagnosis in the United States and accounts for the second most cancer-related deaths.

• Programmed death ligand 1 (PD-L1) is a transmembrane protein that was first identified for its role in the maintenance of self-tolerance and prevention of autoimmunity. Blockade of the interaction between PD-L1 on tumor cells and PD-1 on T cells is expected to reverse T cell suppression within tumors. These agents are dependent on underlying T cell activation against the tumor cell to be effective.

• Avelumab is a fully human immunoglobulin G 1 (IgG1) anti-PDL1 antibody that selectively binds to PD-L1 and competitively blocks its interaction with PD-1.

• In ongoing phase 1 trials of avelumab, the agent has been well tolerated and has shown clinical activity.

• Clinical trials with anti-PD-1/L1 agents in colorectal cancer have resulted in minimal activity in patients who do not have mismatch repair deficiency (MMR-D).

• Therapeutic cancer vaccines targeting overexpressed proteins offer a potential method to activate T cells against tumors.

• A novel adenovirus-based, carcinoembryonic antigen (CEA)-targeting vaccine has demonstrated cytolytic T cell responses in patients with metastatic colorectal cancer.

• Standard of care agents in first line metastatic colorectal cancer (CRC) have properties been associated with improved immune response via immunologic cell death and immunogenic modulation.

Primary Objective

-To determine if there is an improvement progression free survival among patients with metastatic colorectal cancer lacking a mismatch repair deficiency who are treated with standard of care + anti- PDL1 monoclonal antibody + Ad-CEA therapeutic cancer vaccine compared with standard of care alone.

Eligibility

• Subject's age 18 and older with previously untreated pathologically confirmed metastatic or unresectable colorectal cancer; prior adjuvant therapy is acceptable.

• Eastern Cooperative Oncology Group (ECOG) performance status less than or equal to 2.

• Normal organ and bone marrow function.

• Subjects with active autoimmune diseases requiring treatment and subjects requiring system steroids (except for physiologic doses for steroid replacement) are not allowed.

• Tumor sample and whole blood sample must be available for proteomics, genomics and transcriptomics analyses.

• Subjects with metastatic or unresectable colorectal cancer with mismatch repair deficiency (MMR-D or microsatellite instability (MSI)-High) will not be eligible.

Design

• This is a randomized, multicenter phase II clinical trial designed to evaluate the potential improvement in progression free survival (PFS) when Avelumab and Ad-CEA vaccine are used in combination with standard of care therapy in metastatic or unresectable colorectal cancer when compared with standard of care alone (FOLFOX-A).

• A lead in cohort, comprising the first 6 evaluable subjects enrolled, will be treated with avelumab + Ad- CEA vaccine + standard of care in order to assess the safety of the combination.

• If no more than 1 subject in the lead in cohort experiences a dose limiting toxicity attributable to the investigational new drug (IND) agents, 70 evaluable subjects will be randomized on a 1:1 basis to receive either Avelumab + Ad-CEA vaccine + standard of care (Arm B) or standard of care alone (Arm A).

• Standard of care therapy consists of 6 - 12 two-week cycles of bevacizumab + FOLFOX (5-FU, leucovorin, oxaliplatin) followed by two-week cycles of bevacizumab + capecitabine until disease progression.

• Subjects assigned to Arm A that have progressive disease will be offered Avelumab + Ad-CEA vaccine in combination with a standard chemotherapy regimen.

• Kaplan-Meier curves and a two-tailed log-rank test will be the primary analysis methods.

• The accrual ceiling for the study is set at 97.

Study Design

• Study Type: Interventional
• Actual Enrollment: 30 participants
• Allocation: Randomized
• Intervention Model: Sequential Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: A Randomized Phase II Trial of Standard of Care Alone or in Combination With Ad-CEA Vaccine and Avelumab in Patients With Previously Untreated Metastatic or Unresectable Colorectal Cancer
• Actual Study Start Date: Apr 5, 2017
• Actual Primary Completion Date: Aug 25, 2021
• Actual Study Completion Date: Aug 25, 2021

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: Standard of Care (SOC) - Arm A Participants will receive leucovorin calcium (folinic acid), fluorouracil, and oxaliplatin (FOLFOX)- + bevacizumab + for up to 12 2-week cycles followed by maintenance therapy with bevacizumab + capecitabine until disease progression.	Drug: Bevacizumab; 5mg/kg intravenous (IV) over 30-90 min on day 1 (Arm A) or 2 (Arm B). Part of the standard of care therapy.; Other Names: Avastin ; Drug: 5-Fluorouracil (FU); 400mg/m^2 (only Arm A) intravenous (IV) bolus on day 1. Part of the standard of care therapy.; Other Names: Tolak ; Drug: Leucovorin; 400mg/m^2 intravenous (IV) over 2 hours on day 1 (Arm A) or Day 2 (Arm B). Part of the standard of care therapy.; Other Names: folinic acid ; Drug: Oxaliplatin; 85mg/m^2 (Arm A) or 68mg/m^2 (Arm B) intravenous (IV) over 2 hours on day 1 (Arm A) or Day 2 (Arm B). Part of the standard of care therapy.; Other Names: Eloxatin ; Drug: Capecitabine; 625 mg/m^2 twice a day by mouth. Part of the standard of care therapy.; Other Names: Xeloda ; Drug: 5-Fluorouracil (FU); 2400 mg/m^2 (Arm A and B) intravenous (IV) over 46 hours (+/-2 hours) to start on Day 1 (ARM A) or Day 2 (Arm B). Part of the standard of care therapy.; Other Names: Tolak
Experimental: Standard of Care (SOC) - Arm B + Lead in Participants will receive leucovorin calcium (folinic acid), fluorouracil, and oxaliplatin (FOLFOX)- + bevacizumab + avelumab + Ad-CEA vaccine (given weeks 0,2,4,8,12,16 and then every 12 weeks) for up to 12 2-week cycles followed by maintenance therapy with bevacizumab + capecitabine + avelumab + Ad-CEA vaccine (following the every 12-week dosing schedule) until disease progression.	Drug: Avelumab; 10 mg/kg intravenous (IV) over 30-60 min on Day 1; Other Names: Bavencio ; Biological: Ad-CEA vaccine; Subcutaneous injection in the thigh prior to Avelumab on Day 1 of cycles 1, 2 3, 5, 7, 9; every 6 cycles thereafter.; Drug: Bevacizumab; 5mg/kg intravenous (IV) over 30-90 min on day 1 (Arm A) or 2 (Arm B). Part of the standard of care therapy.; Other Names: Avastin ; Drug: 5-Fluorouracil (FU); 400mg/m^2 (only Arm A) intravenous (IV) bolus on day 1. Part of the standard of care therapy.; Other Names: Tolak ; Drug: Leucovorin; 400mg/m^2 intravenous (IV) over 2 hours on day 1 (Arm A) or Day 2 (Arm B). Part of the standard of care therapy.; Other Names: folinic acid ; Drug: Oxaliplatin; 85mg/m^2 (Arm A) or 68mg/m^2 (Arm B) intravenous (IV) over 2 hours on day 1 (Arm A) or Day 2 (Arm B). Part of the standard of care therapy.; Other Names: Eloxatin ; Drug: Capecitabine; 625 mg/m^2 twice a day by mouth. Part of the standard of care therapy.; Other Names: Xeloda ; Drug: 5-Fluorouracil (FU); 2400 mg/m^2 (Arm A and B) intravenous (IV) over 46 hours (+/-2 hours) to start on Day 1 (ARM A) or Day 2 (Arm B). Part of the standard of care therapy.; Other Names: Tolak

Outcome Measures

Primary Outcome Measures

1. Progression Free Survival Between the Standard of Care (SOC) Arm A, and Standard of Care (SOC) Arm B + lead-in [Up to 1.5 years]

   Progression free survival is defined as the duration of time from start of treatment to time of progression or death, whichever occurs first. Progression was measured by the Response Evaluation Criteria in Solid Tumors (RECIST) and is defined as at least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study. The appearance of one or more new lesions is also considered progressions.

Secondary Outcome Measures

1. Number of Participants That Are Hospitalized Because of Adverse Events Attributed to Disease Progression [Up to 51.5 months]

   Participants hospitalized because of adverse events measured by the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 attributed to disease progression. Progression was measured by the Response Evaluation Criteria in Solid Tumors (RECIST) and is defined as at least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study. The appearance of one or more new lesions is also considered progressions.

Other Outcome Measures

1. Number of Participants With Serious and Non-serious Adverse Events Assessed by the Common Terminology Criteria for Adverse Events (CTCAE v5.0) [Date treatment consent signed to date off study, approximately 33 months and 20 days for Arm A and 51 months and 7 days for Arm B.]

   Here is the number of participants with serious and non-serious adverse events assessed by the Common Terminology Criteria for Adverse Events (CTCAE v5.0). A non-serious adverse event is any untoward medical occurrence. A serious adverse event is an adverse event or suspected adverse reaction that results in death, a life-threatening adverse drug experience, hospitalization, disruption of the ability to conduct normal life functions, congenital anomaly/birth defect or important medical events that jeopardize the patient or subject and may require medical or surgical intervention to prevent one of the previous outcomes mentioned.

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

• INCLUSION CRITERIA:

• Subjects must have previously untreated metastatic or unresectable colorectal cancer and have no contraindications to treatment with the standard of care regimen as determined by the investigator. Prior adjuvant therapy for surgically resectable disease (including oligometastatic disease) is acceptable (including immunotherapy) but must have been completed at least 6 months prior to enrollment.

• Patients should not be eligible for potentially curative surgical intervention in the case of oligometastatic disease at the time of enrollment or must have actively refused after explicit discussion of potential benefit of this intervention with multidisciplinary team.

• Histologically confirmed colorectal cancer

• Patients must have measurable disease by Response Evaluation Criteria in Solid Tumors (RECIST) criteria.

• Age greater than or equal to 18 years. Because safety data is not known with this agent in patients less than 18 years old, children are excluded from this study.

• Eastern Cooperative Oncology Group (ECOG) performance status less than or equal to 2.

• Patients must have normal organ and marrow function as defined below:

• Creatinine clearance (per Institutional standard or 24-hour urine) greater than or equal to 30 mL/min.

• Adequate hepatic function defined by a total bilirubin level less than or equal to 1.5 the upper limit of normal range (ULN), an aspartate aminotransferase (AST), level less than or equal to 2.5 ULN, and an alanine aminotransferase (ALT) level less than or equal to 2.5 ULN or, for subjects with documented metastatic disease to the liver, AST and ALT levels less than or equal to 5 ULN.

• Hematological eligibility parameters (within16 days of enrollment):

• Granulocyte count greater than or equal to 1,500/mm^3

• Platelet count greater than or equal to 100,000/mm^3

• Hemoglobin greater than or equal to 9 g/dL

• The effects of Ad-CEA vaccine and Avelumab on the developing human fetus are unknown. For this reason and because Ad-CEA vaccine and Avelumab as well as other therapeutic agents used in this trial are known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation and for a period of 4 months after the last treatment with avelumab or 6 months after the last administration of bevacizumab, whichever occurs later. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately.

• Ability of subject to understand and the willingness to sign a written informed consent document.

EXCLUSION CRITERIA:

• Metastatic or unresectable colorectal cancer with mismatch repair deficiency (MMR-D or microsatellite instability (MSI)-High).

• Concurrent treatment for cancer except agents specified within the treatment protocol.

• Prior surgery or gastrointestinal perforation within 28 days of enrollment.

• Persisting toxicity related to prior therapy (National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v4.03 Grade > 1); however, alopecia, sensory neuropathy Grade <=2, or other Grade <=2 AEs not constituting a safety risk based on investigator's judgment are acceptable.

• Known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome.

• Hepatitis B virus (HBV) or hepatitis C virus (HCV) infection at screening (positive HBV surface antigen or HCV RNA if anti-HCV antibody screening test positive)

• Any significant disease that, in the opinion of the investigator, may impair the patient's tolerance of study treatment.

• Active autoimmune disease that might deteriorate when receiving an immuno-stimulatory agent. Patients with diabetes type I, vitiligo, psoriasis, or hypo- or hyperthyroid diseases not requiring immunosuppressive treatment are eligible.

• Current use of immunosuppressive medication, EXCEPT for the following: a. intranasal, inhaled, topical steroids, or local steroid injection (e.g., intra-articular injection); b. Systemic corticosteroids at physiologic doses less than or equal to 10 mg/day of prednisone or equivalent; c. Steroids as premedication for hypersensitivity reactions (e.g., computed tomography (CT) scan premedication).

• Patients who are receiving any other investigational agents within 28 days before start of study treatment.

• Prior organ transplantation including allogenic stem-cell transplantation.

• Subjects with active central nervous system (CNS) metastases causing clinical symptoms or metastases that require therapeutic intervention are excluded. Subjects with a history of treated CNS metastases (by surgery or radiation therapy) are not eligible unless they have fully recovered from treatment, demonstrated no progression for at least 2 months, and do not require continued steroid therapy. Subjects with CNS metastases incidentally detected during Screening which do not cause clinical symptoms and for which standard of care suggests no therapeutic intervention is needed are eligible.

• Active infection, requiring systemic therapy,

• Clinically significant (i.e., active) cardiovascular disease: cerebral vascular accident/stroke (< 3 months prior to enrollment), myocardial infarction (< 3 months prior to enrollment), unstable angina, congestive heart failure (greater than or equal to New York Heart Association Classification Class II), or uncontrolled arrhythmias.

• Other severe acute or chronic medical conditions including immune colitis, inflammatory bowel disease, immune pneumonitis, pulmonary fibrosis or psychiatric conditions including recent (within the past year) or active suicidal ideation or behavior; or laboratory abnormalities that may increase the risk associated with study participation or study treatment administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the patient inappropriate for entry into this study.

• Pregnant women and breastfeeding mothers are excluded due to unknown impact on embryos or infants.

• Known alcohol or drug abuse.

• Known prior severe hypersensitivity to investigational product or any component in its formulations, including known severe hypersensitivity reactions to monoclonal antibodies (NCI CTCAE v4.03 Grade greater than or equal to 3).

• Patients with a known hypersensitivity/allergy to any of the standard of care agents used in this study or related compounds (e.g., platinum compounds) are excluded.

• Prior history of hypertensive emergency or hypertensive encephalopathy (for those expected to receive bevacizumab.

• Serious, non-healing wound, active ulcer, or untreated bone fracture, including tumor related pathological fracture.

• Evidence of bleeding diathesis or significant coagulopathy (in the absence of therapeutic anticoagulation).

• Patients being treated with medications with drug-drug interactions with study agents will require evaluation by to determine if full doses of all study treatments can be given safely. Significant drug-drug interactions will need to be addressed prior to enrollment. Alternatively, the patient will not be eligible.

• Vaccination within 4 weeks of the first dose of avelumab and while on trials is prohibited except for administration of inactivated vaccines.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Lombardi Comprehensive Cancer Center	Washington	District of Columbia	United States	20007
2	National Institutes of Health Clinical Center	Bethesda	Maryland	United States	20892

Sponsors and Collaborators

• National Cancer Institute (NCI)

Investigators

• Principal Investigator: Julius Y Strauss, M.D., National Cancer Institute (NCI)

Study Documents (Full-Text)

• Study Protocol and Statistical Analysis Plan - Oct 30, 2019
• Informed Consent Form - Dec 23, 2019

More Information

Additional Information:

• NIH Clinical Center Detailed Web Page

Publications

• Balint JP, Gabitzsch ES, Rice A, Latchman Y, Xu Y, Messerschmidt GL, Chaudhry A, Morse MA, Jones FR. Extended evaluation of a phase 1/2 trial on dosing, safety, immunogenicity, and overall survival after immunizations with an advanced-generation Ad5 [E1-, E2b-]-CEA(6D) vaccine in late-stage colorectal cancer. Cancer Immunol Immunother. 2015 Aug;64(8):977-87. doi: 10.1007/s00262-015-1706-4. Epub 2015 May 9.
• Herbst RS, Soria JC, Kowanetz M, Fine GD, Hamid O, Gordon MS, Sosman JA, McDermott DF, Powderly JD, Gettinger SN, Kohrt HE, Horn L, Lawrence DP, Rost S, Leabman M, Xiao Y, Mokatrin A, Koeppen H, Hegde PS, Mellman I, Chen DS, Hodi FS. Predictive correlates of response to the anti-PD-L1 antibody MPDL3280A in cancer patients. Nature. 2014 Nov 27;515(7528):563-7. doi: 10.1038/nature14011.
• Morse MA, Chaudhry A, Gabitzsch ES, Hobeika AC, Osada T, Clay TM, Amalfitano A, Burnett BK, Devi GR, Hsu DS, Xu Y, Balcaitis S, Dua R, Nguyen S, Balint JP Jr, Jones FR, Lyerly HK. Novel adenoviral vector induces T-cell responses despite anti-adenoviral neutralizing antibodies in colorectal cancer patients. Cancer Immunol Immunother. 2013 Aug;62(8):1293-301. doi: 10.1007/s00262-013-1400-3. Epub 2013 Apr 30.

• Responsible Party: Julius Strauss, M.D., Principal Investigator, National Cancer Institute (NCI)
• ClinicalTrials.gov Identifier: NCT03050814
• Other Study ID Numbers: 170057; 17-C-0057
• First Posted: Feb 13, 2017
• Last Update Posted: Dec 20, 2021
• Last Verified: Dec 1, 2021

• Individual Participant Data (IPD) Sharing Statement: No
• Plan to Share IPD: No
• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No
• Keywords provided by Julius Strauss, M.D., Principal Investigator, National Cancer Institute (NCI): Anti-PDL1 Antibody; Therapeutic Cancer Vaccine; Mismatch Repair Deficiency; Progression Free Survival; Adenovirus Based, CEA-Targeting Vaccine
• Additional relevant MeSH terms: Colorectal Neoplasms; Leucovorin; Bevacizumab; Avelumab; Fluorouracil; Capecitabine; Oxaliplatin

Study Results

Participant Flow

Arm/Group Title	Standard of Care (SOC) - Arm A	Standard of Care (SOC) - Arm B + Lead in	Enrolled But Not Assigned to a Treatment Arm
Arm/Group Description	Participants will receive leucovorin calcium (folinic acid), fluorouracil, and oxaliplatin (FOLFOX)- + bevacizumab + for up to 12 2-week cycles followed by maintenance therapy with bevacizumab + capecitabine until disease progression. Bevacizumab: 5mg/kg intravenous (IV) over 30-90 min on day. 5-Fluorouracil (FU): 400mg/m^2 intravenous (IV) bolus on day 1. Leucovorin: 400mg/m^2 intravenous (IV) over 2 hours on day 1. Oxaliplatin: 85mg/m^2 intravenous (IV) over 2 hours on day 1. Capecitabine: 625 mg/m^2 twice a day by mouth. 5-Fluorouracil (FU): 2400 mg/m^2 intravenous (IV) over 46 hours (+/-2 hours) to start on Day 1.	Participants will receive leucovorin calcium (folinic acid), fluorouracil, and oxaliplatin (FOLFOX)- + bevacizumab + avelumab + Ad-CEA vaccine (given weeks 0,2,4,8,12,16 and then every 12 weeks) for up to 12 2-week cycles followed by maintenance therapy with bevacizumab + capecitabine + avelumab + Ad-CEA vaccine (following the every 12-week dosing schedule) until disease progression. Avelumab: 10 mg/kg intravenous (IV) over 30-60 min on day 1 Ad-CEA vaccine: Subcutaneous injection in the thigh prior to Avelumab on Day 1 of cycles 1, 2 3, 5, 7, 9; every 6 cycles thereafter. Bevacizumab: 5mg/kg intravenous (IV) over 30-90 min on day 2. Leucovorin: 400mg/m^2 intravenous (IV) over 2 hours on day 2. Oxaliplatin: 68mg/m^2 intravenous (IV) over 2 hours on day 2. Capecitabine: 625 mg/m^2 twice a day by mouth. 5-Fluorouracil (FU): 2400 mg/m^2 intravenous (IV) over 46 hours (+/-2 hours) to start on day 2.	4 participants were enrolled but not treated on Arm A or Arm B. Only baseline data were captured.
Period Title: Overall Study
STARTED	10	16	4
COMPLETED	10	16	0
NOT COMPLETED	0	0	4

Baseline Characteristics

Arm/Group Title	Standard of Care (SOC) - Arm A	Standard of Care (SOC) - Arm B + Lead in	Enrolled But Not Assigned to a Treatment Arm	Total
Arm/Group Description	Participants will receive leucovorin calcium (folinic acid), fluorouracil, and oxaliplatin (FOLFOX)- + bevacizumab + for up to 12 2-week cycles followed by maintenance therapy with bevacizumab + capecitabine until disease progression. Bevacizumab: 5mg/kg intravenous (IV) over 30-90 min on day. 5-Fluorouracil (FU): 400mg/m^2 intravenous (IV) bolus on day 1. Leucovorin: 400mg/m^2 intravenous (IV) over 2 hours on day 1. Oxaliplatin: 85mg/m^2 intravenous (IV) over 2 hours on day 1. Capecitabine: 625 mg/m^2 twice a day by mouth. 5-Fluorouracil (FU): 2400 mg/m^2 intravenous (IV) over 46 hours (+/-2 hours) to start on Day 1.	Participants will receive leucovorin calcium (folinic acid), fluorouracil, and oxaliplatin (FOLFOX)- + bevacizumab + avelumab + Ad-CEA vaccine (given weeks 0,2,4,8,12,16 and then every 12 weeks) for up to 12 2-week cycles followed by maintenance therapy with bevacizumab + capecitabine + avelumab + Ad-CEA vaccine (following the every 12-week dosing schedule) until disease progression. Avelumab: 10 mg/kg intravenous (IV) over 30-60 min on day 1 Ad-CEA vaccine: Subcutaneous injection in the thigh prior to Avelumab on Day 1 of cycles 1, 2 3, 5, 7, 9; every 6 cycles thereafter. Bevacizumab: 5mg/kg intravenous (IV) over 30-90 min on day 2. Leucovorin: 400mg/m^2 intravenous (IV) over 2 hours on day 2. Oxaliplatin: 68mg/m^2 intravenous (IV) over 2 hours on day 2. Capecitabine: 625 mg/m^2 twice a day by mouth. 5-Fluorouracil (FU): 2400 mg/m^2 intravenous (IV) over 46 hours (+/-2 hours) to start on day 2.	4 participants were enrolled but not treated on Arm A or Arm B. Only baseline data were captured.	Total of all reporting groups
Overall Participants	10	16	4	30
Age (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]	57.94 (10.65)	56.34 (8.45)	59.17 (23.3)	57.82 (14.13)
Age, Customized (Count of Participants)
<= 18 years	0 0%	0 0%	0 0%	0 0%
Between 18 and 65 years	9 90%	12 75%	2 50%	23 76.7%
>= 65 years	1 10%	4 25%	1 25%	6 20%
Missing	0 0%	0 0%	1 25%	1 3.3%
Sex: Female, Male (Count of Participants)
Female	7 70%	5 31.3%	3 75%	15 50%
Male	3 30%	11 68.8%	1 25%	15 50%
Ethnicity (NIH/OMB) (Count of Participants)
Hispanic or Latino	0 0%	1 6.3%	0 0%	1 3.3%
Not Hispanic or Latino	9 90%	15 93.8%	4 100%	28 93.3%
Unknown or Not Reported	1 10%	0 0%	0 0%	1 3.3%
Race (NIH/OMB) (Count of Participants)
American Indian or Alaska Native	0 0%	0 0%	0 0%	0 0%
Asian	0 0%	0 0%	0 0%	0 0%
Native Hawaiian or Other Pacific Islander	0 0%	0 0%	0 0%	0 0%
Black or African American	3 30%	3 18.8%	1 25%	7 23.3%
White	6 60%	13 81.3%	3 75%	22 73.3%
More than one race	0 0%	0 0%	0 0%	0 0%
Unknown or Not Reported	1 10%	0 0%	0 0%	1 3.3%
Region of Enrollment (participants) [Number]
United States	10 100%	16 100%	4 100%	30 100%

Outcome Measures

1. Primary Outcome

Title	Progression Free Survival Between the Standard of Care (SOC) Arm A, and Standard of Care (SOC) Arm B + lead-in
Description	Progression free survival is defined as the duration of time from start of treatment to time of progression or death, whichever occurs first. Progression was measured by the Response Evaluation Criteria in Solid Tumors (RECIST) and is defined as at least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study. The appearance of one or more new lesions is also considered progressions.
Time Frame	Up to 1.5 years

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Standard of Care (SOC) - Arm A	Standard of Care (SOC) - Arm B + Lead in
Arm/Group Description	Participants will receive leucovorin calcium (folinic acid), fluorouracil, and oxaliplatin (FOLFOX)- + bevacizumab + for up to 12 2-week cycles followed by maintenance therapy with bevacizumab + capecitabine until disease progression. Bevacizumab: 5mg/kg intravenous (IV) over 30-90 min on day. 5-Fluorouracil (FU): 400mg/m^2 intravenous (IV) bolus on day 1. Leucovorin: 400mg/m^2 intravenous (IV) over 2 hours on day 1. Oxaliplatin: 85mg/m^2 intravenous (IV) over 2 hours on day 1. Capecitabine: 625 mg/m^2 twice a day by mouth. 5-Fluorouracil (FU): 2400 mg/m^2 intravenous (IV) over 46 hours (+/-2 hours) to start on Day 1.	Participants will receive leucovorin calcium (folinic acid), fluorouracil, and oxaliplatin (FOLFOX)- + bevacizumab + avelumab + Ad-CEA vaccine (given weeks 0,2,4,8,12,16 and then every 12 weeks) for up to 12 2-week cycles followed by maintenance therapy with bevacizumab + capecitabine + avelumab + Ad-CEA vaccine (following the every 12-week dosing schedule) until disease progression. Avelumab: 10 mg/kg intravenous (IV) over 30-60 min on day 1 Ad-CEA vaccine: Subcutaneous injection in the thigh prior to Avelumab on Day 1 of cycles 1, 2 3, 5, 7, 9; every 6 cycles thereafter. Bevacizumab: 5mg/kg intravenous (IV) over 30-90 min on day 2. Leucovorin: 400mg/m^2 intravenous (IV) over 2 hours on day 2. Oxaliplatin: 68mg/m^2 intravenous (IV) over 2 hours on day 2. Capecitabine: 625 mg/m^2 twice a day by mouth. 5-Fluorouracil (FU): 2400 mg/m^2 intravenous (IV) over 46 hours (+/-2 hours) to start on day 2.
Measure Participants	10	16
Median (95% Confidence Interval) [Months]	8.8	10.1

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Standard of Care (SOC) - Arm A, Standard of Care (SOC) - Arm B + Lead in
	Comments
	Type of Statistical Test	Other
	Comments
Statistical Test of Hypothesis	p-Value	0.91
	Comments
	Method	Kaplan Meier
	Comments	Kaplan-Meier curves and a two-tailed log-rank test
Method of Estimation	Estimation Parameter	Hazard Ratio (HR)
	Estimated Value	1.061
	Confidence Interval	(2-Sided) 95%; 0.380 to 2.966
	Parameter Dispersion	Type: Value:
	Estimation Comments

2. Secondary Outcome

Title	Number of Participants That Are Hospitalized Because of Adverse Events Attributed to Disease Progression
Description	Participants hospitalized because of adverse events measured by the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 attributed to disease progression. Progression was measured by the Response Evaluation Criteria in Solid Tumors (RECIST) and is defined as at least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study. The appearance of one or more new lesions is also considered progressions.
Time Frame	Up to 51.5 months

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Standard of Care (SOC) - Arm A	Standard of Care (SOC) - Arm B + Lead in
Arm/Group Description	Participants will receive leucovorin calcium (folinic acid), fluorouracil, and oxaliplatin (FOLFOX)- + bevacizumab + for up to 12 2-week cycles followed by maintenance therapy with bevacizumab + capecitabine until disease progression. Bevacizumab: 5mg/kg intravenous (IV) over 30-90 min on day. 5-Fluorouracil (FU): 400mg/m^2 intravenous (IV) bolus on day 1. Leucovorin: 400mg/m^2 intravenous (IV) over 2 hours on day 1. Oxaliplatin: 85mg/m^2 intravenous (IV) over 2 hours on day 1. Capecitabine: 625 mg/m^2 twice a day by mouth. 5-Fluorouracil (FU): 2400 mg/m^2 intravenous (IV) over 46 hours (+/-2 hours) to start on Day 1.	Participants will receive leucovorin calcium (folinic acid), fluorouracil, and oxaliplatin (FOLFOX)- + bevacizumab + avelumab + Ad-CEA vaccine (given weeks 0,2,4,8,12,16 and then every 12 weeks) for up to 12 2-week cycles followed by maintenance therapy with bevacizumab + capecitabine + avelumab + Ad-CEA vaccine (following the every 12-week dosing schedule) until disease progression. Avelumab: 10 mg/kg intravenous (IV) over 30-60 min on day 1 Ad-CEA vaccine: Subcutaneous injection in the thigh prior to Avelumab on Day 1 of cycles 1, 2 3, 5, 7, 9; every 6 cycles thereafter. Bevacizumab: 5mg/kg intravenous (IV) over 30-90 min on day 2. Leucovorin: 400mg/m^2 intravenous (IV) over 2 hours on day 2. Oxaliplatin: 68mg/m^2 intravenous (IV) over 2 hours on day 2. Capecitabine: 625 mg/m^2 twice a day by mouth. 5-Fluorouracil (FU): 2400 mg/m^2 intravenous (IV) over 46 hours (+/-2 hours) to start on day 2.
Measure Participants	10	16
Count of Participants [Participants]	4 40%	4 25%

3. Other Pre-specified Outcome

Title	Number of Participants With Serious and Non-serious Adverse Events Assessed by the Common Terminology Criteria for Adverse Events (CTCAE v5.0)
Description	Here is the number of participants with serious and non-serious adverse events assessed by the Common Terminology Criteria for Adverse Events (CTCAE v5.0). A non-serious adverse event is any untoward medical occurrence. A serious adverse event is an adverse event or suspected adverse reaction that results in death, a life-threatening adverse drug experience, hospitalization, disruption of the ability to conduct normal life functions, congenital anomaly/birth defect or important medical events that jeopardize the patient or subject and may require medical or surgical intervention to prevent one of the previous outcomes mentioned.
Time Frame	Date treatment consent signed to date off study, approximately 33 months and 20 days for Arm A and 51 months and 7 days for Arm B.

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Standard of Care (SOC) - Arm A	Standard of Care (SOC) - Arm B + Lead in
Arm/Group Description	Participants will receive leucovorin calcium (folinic acid), fluorouracil, and oxaliplatin (FOLFOX)- + bevacizumab + for up to 12 2-week cycles followed by maintenance therapy with bevacizumab + capecitabine until disease progression. Bevacizumab: 5mg/kg intravenous (IV) over 30-90 min on day. 5-Fluorouracil (FU): 400mg/m^2 intravenous (IV) bolus on day 1. Leucovorin: 400mg/m^2 intravenous (IV) over 2 hours on day 1. Oxaliplatin: 85mg/m^2 intravenous (IV) over 2 hours on day 1. Capecitabine: 625 mg/m^2 twice a day by mouth. 5-Fluorouracil (FU): 2400 mg/m^2 intravenous (IV) over 46 hours (+/-2 hours) to start on Day 1.	Participants will receive leucovorin calcium (folinic acid), fluorouracil, and oxaliplatin (FOLFOX)- + bevacizumab + avelumab + Ad-CEA vaccine (given weeks 0,2,4,8,12,16 and then every 12 weeks) for up to 12 2-week cycles followed by maintenance therapy with bevacizumab + capecitabine + avelumab + Ad-CEA vaccine (following the every 12-week dosing schedule) until disease progression. Avelumab: 10 mg/kg intravenous (IV) over 30-60 min on day 1 Ad-CEA vaccine: Subcutaneous injection in the thigh prior to Avelumab on Day 1 of cycles 1, 2 3, 5, 7, 9; every 6 cycles thereafter. Bevacizumab: 5mg/kg intravenous (IV) over 30-90 min on day 2. Leucovorin: 400mg/m^2 intravenous (IV) over 2 hours on day 2. Oxaliplatin: 68mg/m^2 intravenous (IV) over 2 hours on day 2. Capecitabine: 625 mg/m^2 twice a day by mouth. 5-Fluorouracil (FU): 2400 mg/m^2 intravenous (IV) over 46 hours (+/-2 hours) to start on day 2.
Measure Participants	10	16
Count of Participants [Participants]	10 100%	16 100%

Adverse Events

Time Frame	Date treatment consent signed to date off study, approximately 33 months and 20 days for Arm A and 51 months and 7 days for Arm B.
Arm/Group Title	Standard of Care (SOC) - Arm A		Standard of Care (SOC) - Arm B + Lead in
Arm/Group Description	Participants will receive leucovorin calcium (folinic acid), fluorouracil, and oxaliplatin (FOLFOX)- + bevacizumab + for up to 12 2-week cycles followed by maintenance therapy with bevacizumab + capecitabine until disease progression. Bevacizumab: 5mg/kg intravenous (IV) over 30-90 min on day. 5-Fluorouracil (FU): 400mg/m^2 intravenous (IV) bolus on day 1. Leucovorin: 400mg/m^2 intravenous (IV) over 2 hours on day 1. Oxaliplatin: 85mg/m^2 intravenous (IV) over 2 hours on day 1. Capecitabine: 625 mg/m^2 twice a day by mouth. 5-Fluorouracil (FU): 2400 mg/m^2 intravenous (IV) over 46 hours (+/-2 hours) to start on Day 1.		Participants will receive leucovorin calcium (folinic acid), fluorouracil, and oxaliplatin (FOLFOX)- + bevacizumab + avelumab + Ad-CEA vaccine (given weeks 0,2,4,8,12,16 and then every 12 weeks) for up to 12 2-week cycles followed by maintenance therapy with bevacizumab + capecitabine + avelumab + Ad-CEA vaccine (following the every 12-week dosing schedule) until disease progression. Avelumab: 10 mg/kg intravenous (IV) over 30-60 min on day 1 Ad-CEA vaccine: Subcutaneous injection in the thigh prior to Avelumab on Day 1 of cycles 1, 2 3, 5, 7, 9; every 6 cycles thereafter. Bevacizumab: 5mg/kg intravenous (IV) over 30-90 min on day 2. Leucovorin: 400mg/m^2 intravenous (IV) over 2 hours on day 2. Oxaliplatin: 68mg/m^2 intravenous (IV) over 2 hours on day 2. Capecitabine: 625 mg/m^2 twice a day by mouth. 5-Fluorouracil (FU): 2400 mg/m^2 intravenous (IV) over 46 hours (+/-2 hours) to start on day 2.
All Cause Mortality
	Standard of Care (SOC) - Arm A		Standard of Care (SOC) - Arm B + Lead in
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	1/10 (10%)		1/16 (6.3%)
Serious Adverse Events
	Standard of Care (SOC) - Arm A		Standard of Care (SOC) - Arm B + Lead in
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	9/10 (90%)		10/16 (62.5%)
Blood and lymphatic system disorders
Anemia	1/10 (10%)	1	0/16 (0%)	0
Febrile neutropenia	2/10 (20%)	2	1/16 (6.3%)	1
Cardiac disorders
Atrial fibrillation	0/10 (0%)	0	1/16 (6.3%)	1
Cardiac disorders - Other, coronary vasospasm	0/10 (0%)	0	1/16 (6.3%)	1
Sinus tachycardia	1/10 (10%)	2	1/16 (6.3%)	1
Gastrointestinal disorders
Abdominal pain	1/10 (10%)	1	1/16 (6.3%)	1
Ascites	0/10 (0%)	0	1/16 (6.3%)	1
Diarrhea	0/10 (0%)	0	1/16 (6.3%)	1
Nausea	0/10 (0%)	0	1/16 (6.3%)	1
Small intestinal obstruction	1/10 (10%)	3	0/16 (0%)	0
Small intestinal perforation	0/10 (0%)	0	1/16 (6.3%)	1
Vomiting	0/10 (0%)	0	1/16 (6.3%)	1
General disorders
Death NOS	1/10 (10%)	1	0/16 (0%)	0
Fatigue	0/10 (0%)	0	2/16 (12.5%)	2
Injection site reaction	1/10 (10%)	1	0/16 (0%)	0
Pain	1/10 (10%)	1	2/16 (12.5%)	2
Infections and infestations
Infections and infestations - Other, ureter	0/10 (0%)	0	1/16 (6.3%)	1
Lung infection	0/10 (0%)	0	1/16 (6.3%)	1
Sepsis	1/10 (10%)	1	1/16 (6.3%)	1
Sinusitis	0/10 (0%)	0	1/16 (6.3%)	1
Upper respiratory infection	1/10 (10%)	1	1/16 (6.3%)	1
Injury, poisoning and procedural complications
Infusion related reaction	0/10 (0%)	0	2/16 (12.5%)	2
Spinal fracture	0/10 (0%)	0	1/16 (6.3%)	1
Investigations
Creatinine increased	1/10 (10%)	2	0/16 (0%)	0
Neutrophil count decreased	2/10 (20%)	2	0/16 (0%)	0
Platelet count decreased	1/10 (10%)	2	0/16 (0%)	0
White blood cell decreased	1/10 (10%)	2	0/16 (0%)	0
Metabolism and nutrition disorders
Acidosis	0/10 (0%)	0	1/16 (6.3%)	1
Dehydration	1/10 (10%)	1	0/16 (0%)	0
Hypoalbuminemia	1/10 (10%)	1	0/16 (0%)	0
Hypokalemia	1/10 (10%)	1	0/16 (0%)	0
Musculoskeletal and connective tissue disorders
Generalized muscle weakness	1/10 (10%)	1	0/16 (0%)	0
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Neoplasms benign, malignant and unspecified (incl cysts and polyps) - Other, death	0/10 (0%)	0	1/16 (6.3%)	1
Renal and urinary disorders
Acute kidney injury	1/10 (10%)	1	1/16 (6.3%)	1
Renal and urinary disorders - Other, anuric renal failure	1/10 (10%)	1	0/16 (0%)	0
Respiratory, thoracic and mediastinal disorders
Respiratory failure	0/10 (0%)	0	1/16 (6.3%)	1
Surgical and medical procedures
Surgical and medical procedures - Other, Cystoscopy	0/10 (0%)	0	1/16 (6.3%)	1
Surgical and medical procedures - Other, specify	1/10 (10%)	1	0/16 (0%)	0
Surgical and medical procedures - Other, specify	1/10 (10%)	1	0/16 (0%)	0
Surgical and medical procedures - Other, Hepatic RFA, Biopsy	0/10 (0%)	0	1/16 (6.3%)	1
Surgical and medical procedures - Other, hepatic ablation	1/10 (10%)	1	0/16 (0%)	0
Surgical and medical procedures - Other, specify	0/10 (0%)	0	1/16 (6.3%)	1
Vascular disorders
Hypotension	0/10 (0%)	0	1/16 (6.3%)	1
Other (Not Including Serious) Adverse Events
	Standard of Care (SOC) - Arm A		Standard of Care (SOC) - Arm B + Lead in
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	10/10 (100%)		16/16 (100%)
Blood and lymphatic system disorders
Anemia	6/10 (60%)	15	9/16 (56.3%)	25
Blood and lymphatic system disorders - Other, Jaundice	0/10 (0%)	0	1/16 (6.3%)	1
Cardiac disorders
Atrial fibrillation	1/10 (10%)	1	0/16 (0%)	0
Cardiac disorders - Other, Coronary vasospasm	0/10 (0%)	0	1/16 (6.3%)	1
Cardiac disorders - Other, Tachycardia , infusion reaction	0/10 (0%)	0	1/16 (6.3%)	1
Cardiac disorders - Other, irregular heart beat	1/10 (10%)	1	0/16 (0%)	0
Electrocardiogram QT corrected interval prolonged	1/10 (10%)	1	0/16 (0%)	0
Sinus bradycardia	0/10 (0%)	0	1/16 (6.3%)	1
Sinus tachycardia	3/10 (30%)	4	3/16 (18.8%)	4
Ventricular arrhythmia	0/10 (0%)	0	1/16 (6.3%)	1
Ear and labyrinth disorders
Ear pain	1/10 (10%)	1	1/16 (6.3%)	1
Tinnitus	0/10 (0%)	0	1/16 (6.3%)	1
Endocrine disorders
Adrenal insufficiency	1/10 (10%)	1	1/16 (6.3%)	1
Hypothyroidism	1/10 (10%)	1	2/16 (12.5%)	2
Eye disorders
Blurred vision	1/10 (10%)	1	3/16 (18.8%)	5
Eye disorders - Other, Cryotherapy	0/10 (0%)	0	1/16 (6.3%)	1
Eye disorders - Other, right eye redness	0/10 (0%)	0	1/16 (6.3%)	1
Watering eyes	0/10 (0%)	0	1/16 (6.3%)	1
Gastrointestinal disorders
Abdominal distension	0/10 (0%)	0	2/16 (12.5%)	2
Abdominal pain	3/10 (30%)	5	7/16 (43.8%)	11
Anal hemorrhage	0/10 (0%)	0	1/16 (6.3%)	1
Bloating	0/10 (0%)	0	1/16 (6.3%)	1
Constipation	3/10 (30%)	3	3/16 (18.8%)	6
Diarrhea	7/10 (70%)	10	7/16 (43.8%)	8
Dry mouth	1/10 (10%)	1	3/16 (18.8%)	3
Duodenal hemorrhage	1/10 (10%)	1	0/16 (0%)	0
Duodenal ulcer	1/10 (10%)	1	0/16 (0%)	0
Dyspepsia	0/10 (0%)	0	1/16 (6.3%)	1
Dysphagia	1/10 (10%)	1	0/16 (0%)	0
Flatulence	1/10 (10%)	1	0/16 (0%)	0
Gastroesophageal reflux disease	1/10 (10%)	1	2/16 (12.5%)	2
Gastrointestinal disorders - Other, Swelling/tightening	0/10 (0%)	0	1/16 (6.3%)	1
Hemorrhoids	0/10 (0%)	0	1/16 (6.3%)	1
Mucositis oral	2/10 (20%)	3	6/16 (37.5%)	7
Nausea	7/10 (70%)	13	9/16 (56.3%)	19
Oral dysesthesia	1/10 (10%)	1	0/16 (0%)	0
Rectal hemorrhage	0/10 (0%)	0	2/16 (12.5%)	3
Rectal pain	0/10 (0%)	0	1/16 (6.3%)	1
Toothache	0/10 (0%)	0	1/16 (6.3%)	1
Vomiting	3/10 (30%)	5	3/16 (18.8%)	5
General disorders
Chills	1/10 (10%)	1	2/16 (12.5%)	2
Edema limbs	2/10 (20%)	3	3/16 (18.8%)	3
Fatigue	9/10 (90%)	13	10/16 (62.5%)	23
Fever	1/10 (10%)	1	9/16 (56.3%)	14
Flu like symptoms	5/10 (50%)	6	6/16 (37.5%)	13
Infusion site extravasation	2/10 (20%)	2	0/16 (0%)	0
Injection site reaction	3/10 (30%)	6	10/16 (62.5%)	14
Localized edema	0/10 (0%)	0	1/16 (6.3%)	1
Pain	3/10 (30%)	3	10/16 (62.5%)	16
Hepatobiliary disorders
Portal vein thrombosis	0/10 (0%)	0	1/16 (6.3%)	1
Immune system disorders
Allergic reaction	0/10 (0%)	0	1/16 (6.3%)	1
Infections and infestations
Eye infection	1/10 (10%)	1	0/16 (0%)	0
Folliculitis	1/10 (10%)	1	0/16 (0%)	0
Infections and infestations - Other, right subclavian port-a-cath	0/10 (0%)	0	1/16 (6.3%)	1
Sepsis	0/10 (0%)	0	1/16 (6.3%)	1
Upper respiratory infection	1/10 (10%)	1	1/16 (6.3%)	1
Urinary tract infection	0/10 (0%)	0	2/16 (12.5%)	3
Vaginal infection	0/10 (0%)	0	1/16 (6.3%)	1
Injury, poisoning and procedural complications
Bruising	2/10 (20%)	3	0/16 (0%)	0
Fall	1/10 (10%)	1	0/16 (0%)	0
Fracture	0/10 (0%)	0	1/16 (6.3%)	1
Infusion related reaction	0/10 (0%)	0	5/16 (31.3%)	10
Investigations
Activated partial thromboplastin time prolonged	0/10 (0%)	0	1/16 (6.3%)	1
Alanine aminotransferase increased	2/10 (20%)	3	7/16 (43.8%)	13
Alkaline phosphatase increased	2/10 (20%)	2	7/16 (43.8%)	11
Aspartate aminotransferase increased	3/10 (30%)	5	7/16 (43.8%)	12
Blood bilirubin increased	1/10 (10%)	1	2/16 (12.5%)	4
Cardiac troponin I increased	0/10 (0%)	0	1/16 (6.3%)	1
Creatinine increased	3/10 (30%)	3	0/16 (0%)	0
Lipase increased	0/10 (0%)	0	2/16 (12.5%)	2
Lymphocyte count decreased	4/10 (40%)	13	9/16 (56.3%)	25
Neutrophil count decreased	7/10 (70%)	15	5/16 (31.3%)	6
Platelet count decreased	5/10 (50%)	10	5/16 (31.3%)	9
Serum amylase increased	1/10 (10%)	1	0/16 (0%)	0
Thyroid stimulating hormone increased	0/10 (0%)	0	1/16 (6.3%)	1
Weight loss	1/10 (10%)	2	3/16 (18.8%)	5
White blood cell decreased	7/10 (70%)	10	6/16 (37.5%)	8
Metabolism and nutrition disorders
Anorexia	2/10 (20%)	3	6/16 (37.5%)	8
Dehydration	1/10 (10%)	2	2/16 (12.5%)	2
Hyperglycemia	2/10 (20%)	3	2/16 (12.5%)	8
Hyperkalemia	1/10 (10%)	1	1/16 (6.3%)	1
Hypermagnesemia	0/10 (0%)	0	1/16 (6.3%)	1
Hypoalbuminemia	3/10 (30%)	3	4/16 (25%)	9
Hypocalcemia	1/10 (10%)	1	0/16 (0%)	0
Hypoglycemia	0/10 (0%)	0	1/16 (6.3%)	1
Hypokalemia	5/10 (50%)	7	4/16 (25%)	6
Hypomagnesemia	1/10 (10%)	1	0/16 (0%)	0
Hyponatremia	0/10 (0%)	0	3/16 (18.8%)	3
Hypophosphatemia	3/10 (30%)	5	5/16 (31.3%)	15
Musculoskeletal and connective tissue disorders
Arthralgia	0/10 (0%)	0	2/16 (12.5%)	5
Back pain	1/10 (10%)	1	0/16 (0%)	0
Bone pain	0/10 (0%)	0	1/16 (6.3%)	1
Generalized muscle weakness	0/10 (0%)	0	2/16 (12.5%)	2
Muscle weakness lower limb	1/10 (10%)	2	0/16 (0%)	0
Musculoskeletal and connective tissue disorder - Other, Tenosynovitis	0/10 (0%)	0	1/16 (6.3%)	1
Myalgia	0/10 (0%)	0	1/16 (6.3%)	1
Neck pain	1/10 (10%)	1	0/16 (0%)	0
Non-cardiac chest pain	2/10 (20%)	2	2/16 (12.5%)	3
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Neoplasms benign, malignant and unspecified (incl cysts and polyps) - Other, right conjunctiva	0/10 (0%)	0	1/16 (6.3%)	1
Tumor hemorrhage	1/10 (10%)	1	0/16 (0%)	0
Nervous system disorders
Anosmia	1/10 (10%)	1	0/16 (0%)	0
Dizziness	0/10 (0%)	0	2/16 (12.5%)	2
Dysesthesia	1/10 (10%)	1	0/16 (0%)	0
Dysgeusia	1/10 (10%)	1	7/16 (43.8%)	7
Headache	4/10 (40%)	5	5/16 (31.3%)	8
Memory impairment	0/10 (0%)	0	1/16 (6.3%)	1
Nervous system disorders - Other, neuropathy	0/10 (0%)	0	1/16 (6.3%)	2
Paresthesia	10/10 (100%)	12	9/16 (56.3%)	9
Peripheral motor neuropathy	0/10 (0%)	0	3/16 (18.8%)	5
Peripheral sensory neuropathy	6/10 (60%)	7	11/16 (68.8%)	17
Presyncope	1/10 (10%)	1	0/16 (0%)	0
Syncope	2/10 (20%)	2	0/16 (0%)	0
Psychiatric disorders
Anxiety	3/10 (30%)	3	1/16 (6.3%)	1
Confusion	0/10 (0%)	0	1/16 (6.3%)	2
Depression	0/10 (0%)	0	2/16 (12.5%)	3
Insomnia	1/10 (10%)	1	1/16 (6.3%)	2
Libido decreased	1/10 (10%)	1	0/16 (0%)	0
Renal and urinary disorders
Dysuria	2/10 (20%)	2	0/16 (0%)	0
Glucosuria	0/10 (0%)	0	1/16 (6.3%)	1
Hematuria	0/10 (0%)	0	1/16 (6.3%)	2
Hemoglobinuria	0/10 (0%)	0	1/16 (6.3%)	1
Proteinuria	4/10 (40%)	6	2/16 (12.5%)	3
Urinary retention	0/10 (0%)	0	1/16 (6.3%)	2
Reproductive system and breast disorders
Pelvic pain	0/10 (0%)	0	1/16 (6.3%)	1
Vaginal hemorrhage	0/10 (0%)	0	1/16 (6.3%)	1
Respiratory, thoracic and mediastinal disorders
Allergic rhinitis	1/10 (10%)	1	1/16 (6.3%)	1
Atelectasis	1/10 (10%)	1	0/16 (0%)	0
Cough	2/10 (20%)	2	5/16 (31.3%)	8
Dyspnea	2/10 (20%)	2	2/16 (12.5%)	2
Epistaxis	4/10 (40%)	4	6/16 (37.5%)	6
Hiccups	1/10 (10%)	1	2/16 (12.5%)	2
Hypoxia	0/10 (0%)	0	1/16 (6.3%)	1
Nasal congestion	1/10 (10%)	2	2/16 (12.5%)	4
Pleural effusion	1/10 (10%)	1	0/16 (0%)	0
Postnasal drip	2/10 (20%)	2	1/16 (6.3%)	1
Respiratory, thoracic and mediastinal disorders - Other, Pneumonia	1/10 (10%)	1	0/16 (0%)	0
Respiratory, thoracic and mediastinal disorders - Other, Pulmonary embolism	0/10 (0%)	0	1/16 (6.3%)	1
Respiratory, thoracic and mediastinal disorders - Other, cold induced pharyngolaryngeal dysesthesia	0/10 (0%)	0	1/16 (6.3%)	1
Rhinorrhea	4/10 (40%)	6	4/16 (25%)	4
Sinus disorder	0/10 (0%)	0	1/16 (6.3%)	1
Sinus pain	0/10 (0%)	0	1/16 (6.3%)	1
Sore throat	1/10 (10%)	1	0/16 (0%)	0
Skin and subcutaneous tissue disorders
Alopecia	3/10 (30%)	3	1/16 (6.3%)	1
Dry skin	1/10 (10%)	1	2/16 (12.5%)	2
Eczema	0/10 (0%)	0	1/16 (6.3%)	1
Hyperhidrosis	1/10 (10%)	1	1/16 (6.3%)	1
Nail changes	1/10 (10%)	2	0/16 (0%)	0
Nail loss	2/10 (20%)	2	0/16 (0%)	0
Palmar-plantar erythrodysesthesia syndrome	6/10 (60%)	18	7/16 (43.8%)	18
Papulopustular rash	1/10 (10%)	1	0/16 (0%)	0
Rash acneiform	1/10 (10%)	1	3/16 (18.8%)	3
Rash maculo-papular	0/10 (0%)	0	3/16 (18.8%)	3
Skin and subcutaneous tissue disorders - Other, Excoriation and bleeding at the colostomy	1/10 (10%)	1	0/16 (0%)	0
Skin and subcutaneous tissue disorders - Other, Soft tissue infection	0/10 (0%)	0	2/16 (12.5%)	2
Skin and subcutaneous tissue disorders - Other, specify	0/10 (0%)	0	1/16 (6.3%)	1
Skin hyperpigmentation	2/10 (20%)	4	4/16 (25%)	4
Skin hypopigmentation	1/10 (10%)	1	0/16 (0%)	0
Surgical and medical procedures
Surgical and medical procedures - Other, Colonoscopy	0/10 (0%)	0	1/16 (6.3%)	1
Surgical and medical procedures - Other, Kyphoplasty	0/10 (0%)	0	1/16 (6.3%)	1
Surgical and medical procedures - Other, Sigmoidoscopy	1/10 (10%)	1	0/16 (0%)	0
Surgical and medical procedures - Other, specify	1/10 (10%)	1	0/16 (0%)	0
Surgical and medical procedures - Other, Stent change	0/10 (0%)	0	1/16 (6.3%)	1
Surgical and medical procedures - Other, stent ERCP	0/10 (0%)	0	1/16 (6.3%)	1
Vascular disorders
Hematoma	0/10 (0%)	0	1/16 (6.3%)	1
Hypertension	4/10 (40%)	5	4/16 (25%)	4
Hypotension	1/10 (10%)	1	1/16 (6.3%)	1
Thromboembolic event	1/10 (10%)	1	2/16 (12.5%)	2

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

Principal Investigators are NOT employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.