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Colorectal CancerPhase 2NCT04907539

A Study to Assess Efficacy of RXC004 +/- Nivolumab in Ring Finger Protein 43 (RNF43) or R-spondin (RSPO) Aberrated, Metastatic, Microsatellite Stable, Colorectal Cancer After Progression on Standard of Care (SOC)

A Phase 2 study testing RXC004, Nivolumab and Denosumab in people with Colorectal Cancer, run by Redx Pharma Ltd at 22 sites in 4 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

This is a Phase II, open label, multicentre, multi-arm, study to evaluate the preliminary efficacy and safety of RXC004 as monotherapy and in combination with nivolumab in patients with Ring finger protein 43 (RNF43) or R-spondin (RSPO) aberrated, microsatellite stable (MSS), colorectal cancer (CRC), that have… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Colorectal Cancer
What is being tested?
RXC004, Nivolumab and Denosumab
Could I receive a placebo?
No, everyone receives an active treatment
How many people
25 participants
Where
22 sitesin 4 countries
Study dates
8 Nov 2021to 2 Apr 2024
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Histological documentation of metastatic (Stage IV) Colorectal cancer (CRC) and
  • Documented tumour tissue aberration in RNF43 and/or RSPO
  • Documented confirmation of microsatellite stable (MSS) status
  • Patients must have had documented radiological progression following a minimum of 1 prior SOC treatment regimen for metastatic disease
  • Eastern Cooperative Oncology Group performance status 0 or 1
  • At least one lesion that is measurable by RECIST 1.1 at baseline
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  • Patients must have at least one lesion suitable for biopsy at screening and be willing to provide mandatory tumour biopsy samples
  • Patients with adequate organ functions
  • Female patients of childbearing potential must have a negative pregnancy test prior to start of dosing
  • Female patients of childbearing potential and male patients with female partners of childbearing potential must agree to use a highly effective method of contraception during the study and for at least 5 months after the last dose of study drug.
  • For patients on RXC004 monotherapy treatment (Arm A) the following inclusion criteria will also apply to enter the RXC004 + nivolumab treatment phase:
  • Patients must have had documented RECIST1.1 defined radiological progression on RXC004 monotherapy treatment on the first scheduled scan (week 8 +/- 1 week)
  • Patients must receive Cycle 1 Day 1 of combination study treatment within 28 days of the first scheduled scan (week 8 +/- 1 week).

Who cannot join

  • Prior therapy with a compound of the same mechanism of action as RXC004
  • Patients at higher risk of bone fractures
  • Any known uncontrolled inter-current illness or persistent clinically significant toxicity related to prior anti-cancer treatment
  • Patients who have any history of an active (requiring treatment) other malignancy within 2 years of study entry
  • Patients with known or suspected brain metastases
  • Use of anti-neoplastic agents, immunosuppressants and other investigational drugs
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  • Patients with a known hypersensitivity to any RXC004 excipients
  • Patients with a contra-indication for denosumab treatment
  • Patients who are pregnant or breast-feeding
  • Use of any live or live-attenuated vaccines against infectious diseases (e.g., influenza nasal spray, varicella) within 4 weeks (28 days) of initiation of study treatment
  • Patients with a mean resting corrected QTcF >470 ms, obtained from triplicate electrocardiograms performed at screening
  • For patients on RXC004 + nivolumab combination treatment (Arm B or Arm A RXC004 + nivolumab treatment phase):
  • Patients with any contraindication to the use of nivolumab
  • Patients with active or prior documented autoimmune or inflammatory disorders within the past 5 years
  • Patients with active infections, including tuberculosis, hepatitis B, hepatitis C or human immunodeficiency virus
  • Patients with a history of allogeneic organ transplant or active primary immunodeficiency
  • Patients with a known hypersensitivity to nivolumab or any of the excipients of the product

Trial locations and contacts

22 sites in 4 countries.

22 sites in 4 countries

United Kingdom7 sites
  • Queen Elizabeth Hospital - Clinical Reasearch

    Birmingham, B152TH

  • Beatson West of Scotland Cancer Centre - Oncology

    Glasgow, Scotland, G12 0YN

  • University College of London (UCL)

    London, NW1 2PG

  • The Royal Marsden NHS Foundation Trust - Royal Marsden Hospital

    London, SW3 6JJ

  • Christie Hospital

    Manchester, CB2 0QQ

  • Oxford Cancer Centre

    Oxford, OX3 7LJ

  • The Royal Marsden Hospital (Surrey)

    Surrey Quays, SM25PT

Other trials in United Kingdom

United States5 sites
  • UT MD Anderson Cancer Center

    Houston, Texas, 77030-4000

  • Community Health Network Cancer Center North - Community Hospital Network

    Indianapolis, Indiana, 46250

  • Lumi Research

    Kingswood, Texas, 77339

  • OptumCare Cancer Care

    Las Vegas, Nevada, 89102

  • Providence Medical Foundation

    Santa Rosa, California, 95403

Other trials in United States

South Korea5 sites
  • National Cancer Center

    Goyang-si, Gyeonggido [Kyonggi-do], 10408

  • Seoul National University Hospital

    Seoul, 03080

  • Severance Hospital, Yonsei University Health System - Medical Oncology

    Seoul, 3722

  • Asan Medical Center - Oncology

    Seoul, 5505

  • Samsung Medical Center - Hematology-Oncology

    Seoul, 6351

Other trials in South Korea

Spain5 sites
  • Hospital del Mar

    Barcelona, 08003

  • Hospital Universitario Vall d'Hebrón

    Barcelona, 08035

  • Hospital Clìnic de Barcelona

    Barcelona, 08036

  • Hospital Universitario 12 de Octubre

    Madrid, 28041

  • Hospital Universitario Virgen del Rocio

    Seville, 41013

Other trials in Spain

About this study

Official title: A Multi-arm, Phase II, Open-Label, Multicentre Study to Assess the Preliminary Efficacy of RXC004 in Monotherapy and in Combination With Nivolumab, in Patients With Ring Finger Protein 43 (RNF43) or R-spondin (RSPO) Aberrated, Metastatic, Microsatellite Stable, Colorectal Cancer Who Have Progressed Following Therapy With Current Standard of Care (PORCUPINE)

This is a Phase II, open label, multicentre, multi-arm, study to evaluate the preliminary efficacy and safety of RXC004 as monotherapy and in combination with nivolumab in patients with Ring finger protein 43 (RNF43) or R-spondin (RSPO) aberrated, microsatellite stable (MSS), colorectal cancer (CRC), that have progressed following current standard of care treatment.

Read the detailed description

The study is composed of two arms, RXC004 monotherapy (Arm A) and RXC004 in combination with nivolumab (Arm B). 20 evaluable patients will be enrolled in Arm A and 20 eligible patients in Arm B.

The study initially opened with Arm A; Arm B will be opened once a recommended Phase II dose (RP2D) for RXC004 in combination with nivolumab is established in the phase I dose escalation study (NCT03447470).

Once Arm B is opened, patients who are eligible for both Arm A and Arm B will be randomised 2:1 to Arm B: Arm A in an open-label manner.

Patients in Arm A may be treated with RXC004 + nivolumab if they have progressive disease on the 8 week scan, as long as they are eligible for Arm B and have Sponsor approval.

Being tested
RXC004, Nivolumab, Denosumab
Keywords
Open label, RXC004, Nivolumab, Ring finger protein 43, R-spondin, Efficacy, Safety, Pharmacokinetics
Medical subject headings
Colorectal Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • RXC004Drug

    RXC004 will be administered orally, 2 mg QD (Monotherapy); and 1.5 mg QD (Combination therapy)

    Dose Formulation: 0.5 mg or 1 mg capsules.

  • NivolumabBiological

    Nivolumab will be administered via IV infusion, 480 mg q4w.

  • DenosumabBiological

    Denosumab will be administered via subcutaneous (SC) injection, 120 mg once every month.

    Use: Prophylactic

Study groups in NCT04907539
Study groupRoleWhat they receive
Arm A: RXC004 monotherapyExperimentalPatients will receive RXC004 (2 mg once daily [QD], orally). Patients in Arm A may crossover to Arm B treatment if they have progressive disease on the first Response Evaluation Criteria in Solid Tumours, (RECIST) scan (if Arm B is open at the time of progression).
Receives: Drug: RXC004; Biological: Denosumab
Arm B: RXC004 + nivolumabExperimentalPatients will receive RXC004 (1.5 mg QD, orally) in combination with nivolumab (480 mg every 4 weeks [q4w], intravenous [IV] infusion). Arm B will be opened once a RP2D for RXC004 in combination with nivolumab is established in the phase I dose escalation study (NCT03447470). RXC004 dose to be used in combination with nivolumab will be based on data from the phase 1 study (NCT03447470).
Receives: Drug: RXC004; Biological: Nivolumab; Biological: Denosumab

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. RXC004 Monotherapy (Arm A): Disease Control Rate (DCR) Using Each Patient's Best Overall Response (BOR) According to Response Evaluation Criteria in Solid Tumours, Version 1.1 (RECIST 1.1)

    The anti-tumour activity of RXC004 monotherapy was evaluated. DCR is defined as the percentage of patients with a BOR of either complete response (CR), partial response (PR) or stable disease (SD) for at least 16 weeks post baseline.

    Measured: Up to 28 months

  2. RXC004+Nivolumab Combination Therapy (Arm B): Objective Response Rate (ORR) Using Each Patient's BOR According to RECIST 1.1

    The anti-tumour activity as a combination therapy of RXC004 +nivolumab was evaluated. ORR is defined as the percentage of patients with a BOR of CR or PR based on local investigator assessment, as defined in RECIST 1.1.

    Measured: Up to 28 months

Secondary outcomes (15)
  1. Best Percentage Change in Tumor Size

    The preliminary efficacy of RXC004 monotherapy and combination therapy of RXC004 + nivolumab was evaluated. The best percentage change in tumour size was determined at a patient level. Percentage change in tumour size was derived at each visit by the percentage change from baseline in the sum of diameters of target lesions. The best percentage change in tumour size was the patients value representing the largest decrease (or smallest increase) from baseline in tumour size.

    Measured: Up to 28 months

  2. Progression Free Survival (PFS)

    The preliminary efficacy of RXC004 monotherapy and combination therapy of RXC004 + nivolumab was evaluated. PFS is defined as the time from first dose of study treatment until the date of disease progression or death (by any cause in the absence of progression).

    Measured: Up to 28 months

  3. Duration of Response (DOR)

    The preliminary efficacy of RXC004 monotherapy and combination therapy of RXC004 + nivolumab was evaluated. The DOR is as the time from the date of first documented response until date of documented progression or death in the absence of disease progression. DOR was not calculated as 1 patient had PR, and 0 patient had CR. As pre-specified in the SAP that after the review of the available data, DOR would not be summarized and listed.

    Measured: Up to 28 months

  4. RXC004 Monotherapy (Arm A): Objective Response Rate (ORR) Using Investigator Assessments According to RECIST 1.1

    The preliminary efficacy of RXC004 monotherapy was evaluated. ORR is defined as the percentage of patients with a BOR of CR or PR based on local investigator assessment as defined in RECIST 1.1.

    Measured: Up to 28 months

  5. RXC004 + Nivolumab Combination Therapy (Arm B): Disease Control Rate Using Investigator Assessments According to RECIST 1.1

    The preliminary efficacy of combination therapy of RXC004 + nivolumab was evaluated. DCR is defined as the percentage of patients with a BOR of either CR, PR or SD for at least 16 weeks post baseline.

    Measured: Up to 28 months

  6. Overall Survival (OS)

    The preliminary efficacy of RXC004 monotherapy and combination therapy of RXC004 + nivolumab was evaluated. OS is defined as the time from first day of study treatment until death due to any cause.

    Measured: Up to 28 months

  7. Maximum Observed Plasma Concentration (Cmax)

    The pharmacokinetic (PK) (Cmax) of RXC004 in monotherapy and in combination therapy with nivolumab was evaluated.

    Measured: On Cycle 0 Day 1 (3-7 days cycle in length) and Cycle 1 Day 15 (28 days cycle in length)

  8. Time to Maximum Plasma Concentration (Tmax)

    The PK (Tmax) of RXC004 in monotherapy and in combination therapy with nivolumab was evaluated.

    Measured: On Cycle 0 Day 1 (3-7 days cycle in length) and Cycle 1 Day 15 (28 days cycle in length)

  9. Minimum Observed Concentration Across the Dosing Interval (Cmin)

    The PK (Cmin) of RXC004 in monotherapy and in combination therapy with nivolumab was evaluated.

    Measured: On Cycle 1 Day 15 (28 days cycle in length)

  10. Terminal Rate Constant (λz)

    The PK (λz) of RXC004 in monotherapy and in combination therapy with nivolumab was evaluated.

    Measured: On Cycle 0 Day 1 (3-7 days cycle in length)

  11. Terminal Half-life (t½)

    The PK (t½) of RXC004 in monotherapy and in combination therapy with nivolumab was evaluated.

    Measured: On Cycle 0 Day 1 (3-7 days cycle in length)

  12. Area Under the Plasma Concentration-time Curve From Zero to Infinity (AUC0-∞)

    The PK (AUC0-∞) of RXC004 in monotherapy and in combination therapy with nivolumab was evaluated.

    Measured: On Cycle 0 Day 1 (3-7 days cycle in length)

  13. Total Plasma Clearance After Oral Administration (CL/F)

    The PK (CL/F) of RXC004 in monotherapy and in combination therapy with nivolumab was evaluated.

    Measured: On Cycle 0 Day 1 (3-7 days cycle in length)

  14. Apparent Volume of Distribution After Oral Administration (Vz/F)

    The PK (Vz/F) of RXC004 in monotherapy and in combination therapy with nivolumab was evaluated.

    Measured: On Cycle 0 Day 1 (3-7 days cycle in length)

  15. Number of Patients With Adverse Events (AEs)

    The safety and tolerability profile of RXC004 monotherapy and RXC004 + nivolumab combination was evaluated. The grading scales found in the revised National Cancer Institute Common Terminology Criteria for Adverse events (CTCAE) latest version was utilized for all events with an assigned CTCAE grading. Grade refers to the severity of the AE. The CTCAE displays Grades 1 through 5 with unique clinical descriptions of severity for each AE based on this general guideline: Grade 1 Mild; asymptomatic or mild symptoms; clinical or diagnostic observations only; intervention not indicated. Grade 2 Moderate; minimal, local or noninvasive intervention indicated; limiting age-appropriate instrumental ADL. Grade 3 Severe or medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self-care ADL; Grade 4: Life-threatening, urgent intervention required; Grade 5: Death related to AE.

    Measured: From time of signature of informed consent form throughout the treatment period and until 30 days after the last dose of RXC004 (for RXC004 monotherapy only) or 90 days after the last dose of Nivolumab (for RXC004 + nivolumab) (up to 28 months)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted28 May 2021
  2. Study start8 Nov 2021
  3. Primary completion2 Apr 2024
  4. Study completion2 Apr 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Sequential
Masking
None (open label)
Enrolment
25 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04907539
Sponsor's protocol ID
RXC004/0002
Status last verified
Mar 2025
First submitted
25 May 2021
Last updated
16 Apr 2025
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing RXC004, Nivolumab and Denosumab in people with Colorectal Cancer, run by Redx Pharma Ltd at 22 sites in 4 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 13 inclusion and 17 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 16 Apr 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 22 sites in United Kingdom, United States, South Korea, Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 16 Apr 2025). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

RXC004 Monotherapy (Arm A): Disease Control Rate (DCR) Using Each Patient's Best Overall Response (BOR) According to Response Evaluation Criteria in Solid Tumours, Version 1.1 (RECIST 1.1) (time frame: Up to 28 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Apr 2025.

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