Sponsor: Georgetown University (other)
Phase: 2
Start date: Jan. 31, 2024
Planned enrollment: 54
TG01 (apricoxib; also known as CS-706, Capoxigem) is an oral, selective cyclo‑oxygenase‑2 (COX‑2) inhibitor that has been investigated as an anticancer agent, most prominently in non‑small cell lung cancer (NSCLC) and pancreatic adenocarcinoma, often in biomarker‑selected populations using urinary prostaglandin E2 metabolite (PGE‑M) as a pharmacodynamic marker. Note: TG01 is also a code used elsewhere for a RAS peptide vaccine; in this context TG01 refers to apricoxib (the COX‑2 inhibitor developed by Tragara Pharmaceuticals). (prnewswire.com)
NSCLC (previously treated, biomarker‑selected):
Apricoxib + erlotinib (400 mg/day + 150 mg/day) vs placebo + erlotinib in a randomized, placebo‑controlled phase II trial (n=120 after PGE‑M suppression run‑in): primary endpoint (time to progression) was not improved overall (1.8 vs 2.1 months); objective response rate (ORR) 12% in both arms. A pre‑specified subgroup analysis suggested potential benefit in patients ≤65 years (TTP HR 0.5; OS 12.2 vs 4.0 months), but the study did not meet its primary endpoint. (pubmed.ncbi.nlm.nih.gov)
Apricoxib + docetaxel or pemetrexed vs placebo + the same chemotherapy in a randomized, double‑blind, biomarker‑selected phase II study (n=72 randomized after PGE‑M suppression): no improvement in progression‑free survival (median 85 vs 97 days). (pubmed.ncbi.nlm.nih.gov)
Pancreatic adenocarcinoma (locally advanced/metastatic):
Early‑phase signal:
Overall, apricoxib has not demonstrated a consistent efficacy benefit in randomized phase II trials despite biomarker‑based selection, although exploratory and preclinical data suggest potential context‑specific activity tied to COX‑2 biology. (pubmed.ncbi.nlm.nih.gov)
Last updated: Oct 2025
Goal: Evaluate the anti-tumor activity and safety of adding the anti-CD38 antibody daratumumab to a KRAS-targeted vaccine (TG01 with Stimulon QS-21) plus the anti–PD-1 antibody nivolumab in advanced PDAC and NSCLC after prior standard therapy, with the aim of improving response, disease control, and survival after PD-1/PD-L1 failure (NSCLC) or after one prior line (PDAC).
Patients: Adults ≥18 years with measurable disease by irRECIST. Two cohorts: refractory advanced NSCLC with progression on frontline PD-1/PD-L1–containing therapy (excluding rapid progressors) and PDAC after one prior regimen. Tumors must harbor mutant KRAS at codon 12 (G12A/C/D/R/S/V) or 13 (G13D). Prior KRAS G12C inhibitor exposure is allowed with a 1-week washout. ECOG 0–2 and adequate organ function required. Key exclusions include prior anti-CD38 therapy, active autoimmune disease requiring systemic therapy, uncontrolled comorbidities, significant pulmonary disease, active CNS disease not meeting protocol criteria, active infections including uncontrolled HBV/HCV or HIV, and recent major therapy within protocol-defined washouts.
Design: Phase 2, non-randomized, open-label, two-arm study enrolling approximately 54 participants across PDAC and refractory NSCLC cohorts. Primary purpose is treatment. Efficacy assessed every 8 weeks using irRECIST.
Treatments: Daratumumab (anti-CD38 monoclonal antibody) plus nivolumab (anti–PD-1) in combination with the TG01 KRAS vaccine formulated with the Stimulon QS-21 adjuvant. Daratumumab targets CD38, a surface glycoprotein expressed on plasma cells and some immunosuppressive myeloid and lymphoid subsets; it mediates cell killing via complement-dependent cytotoxicity, antibody-dependent cellular cytotoxicity/phagocytosis, and can modulate the tumor immune microenvironment. Nivolumab is a standard anti–PD-1 checkpoint inhibitor to restore T-cell activity. TG01 is a peptide-based vaccine comprising mutated KRAS peptides intended to elicit KRAS-specific T-cell responses; QS-21 is a saponin adjuvant that enhances antigen-specific immunity. TG01 has shown immunogenicity against KRAS-mutant peptides in early clinical studies, with detectable vaccine-specific T-cell responses; definitive efficacy in PDAC or NSCLC remains unproven. The combination seeks to augment KRAS-specific immunity while relieving checkpoint inhibition and reducing CD38-mediated immunosuppression.
Outcomes: Primary endpoint: objective response rate (CR+PR) by irRECIST. Secondary endpoints: incidence of treatment-emergent adverse events, progression-free survival at 6 and 9 months, duration of response, clinical benefit rate (≥SD), and overall survival. Imaging assessments occur approximately every 8 weeks; survival and response durability followed up to 2–3 years.
Burden on patient: Moderate. Participants will receive combination IV immunotherapy with a vaccine schedule plus protocol-mandated safety labs and serial imaging every 8 weeks. Mandatory blood and tissue collections for correlative research add procedures beyond standard care; the tissue requirement may necessitate a new biopsy depending on archival availability. Visit frequency is higher early in treatment due to infusion schedules and vaccine administrations, increasing travel and time in clinic. There are no intensive pharmacokinetic draws typical of phase 1 studies, but ongoing safety assessments and correlative sampling contribute to cumulative burden over a multi-month treatment period.
Last updated: Oct 2025
Inclusion Criteria:
1. Age ≥18 years
2. Patients with advanced NSCLC, progressing on frontline anti-PD-1/PD-L1 containing therapy (patient with rapid tumor progression will be excluded) and PDAC patients who failed one prior treatment.
3. Measurable disease as defined by irRECIST criteria (See Section 7) NOTE: Tumor lesions in a previously irradiated area are not considered measurable disease; Disease that is measurable by physical examination only is not eligible.
4. All patients with mutant KRAS status in either codon 12 (12A, C, D, R, S, V) or 13 (13D) will be included. The status of KRAS and LKB1 will be determined. For patients with KRAS G12C-mutated NSCLC, prior treatment with G12C-targeted therapy will be allowed; a wash-out period of 1 week from the last administration of targeted therapy would be allowed.
5. Patients with known actionable driver alterations such as EGFR, ALK, ROS1, BRAF, NTRK1/2/3, METex14, RET, ERBB2 (HER2) and concurrent KRAS mutations will be reviewed on a case-by-case basis and patients must have experienced progression on appropriate first-line targeted therapy and anti-PD-1/PD-L1 as indicated.
6. Prior treatment:
* For NSCLC: Anti-PD1/PD-L1 containing therapy; a wash-out period of 4 weeks from the last administration of therapy would be allowed.
* For PDAC: Patients who failed one prior treatment.
7. Provide written informed consent.
8. Willing to return to enrolling institution for follow-up (during the Active Monitoring Phase of the study).
9. Ability to complete questionnaire(s) by themselves or with assistance.
10. Willingness to provide mandatory blood specimens for correlative research.
11. Willingness to provide mandatory tissue specimens for correlative research.
12. ECOG Performance Status (PS) 0, 1 or 2.
13. The following laboratory values obtained ≤14 days prior to registration:
• Hemoglobin ≥9.0 g/dL
* Absolute neutrophil count (ANC) ≥1500/mm3
* Platelet count ≥100,000/mm3
* Total bilirubin ≤1.5 x ULN (upper limit of normal)
* ALT and AST ≤3 x ULN (≤5 x ULN for patients with liver involvement)
* PT (prothrombin time)/INR/aPTT (activated partial thromboplastin time) ≤1.5 x ULN OR if patient is receiving anticoagulant therapy and INR or aPTT is within target range of therapy
* Calculated creatinine clearance (CrCl) ≥20 mL/min using the Cockcroft-Gault formula
14. Negative pregnancy test done ≤7 days prior to registration, for persons of childbearing potential only.
Exclusion Criteria:
1. Any of the following because this study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown:
• Pregnant persons
* Nursing persons
* Persons of childbearing potential who are unwilling to employ adequate contraception
2. Any of the following prior therapies:
• Daratumumab or other anti-CD38 therapies
* Surgery ≤3 weeks prior to registration
* Chemotherapy ≤4 weeks prior to registration
* For NSCLC: anti-PD-1/PD-L1 therapy ≤4 weeks prior to registration; for PDAC: Prior treatment with an anti-PD-1, anti-PD-L1, or anti-CTLA-4 antibody, or any other antibody or drug specifically targeting T cell co-stimulation or checkpoint pathways.
* Focal radiation therapy within 14 days prior to first study treatment with the exception of palliative radiotherapy for symptomatic management but not on measurable extramedullary plasmacytoma. Participants must have recovered (ie, Grade ≤1 or at baseline) from radiation-related toxicities prior to first study treatment.
* Treatment with complementary medications (e.g., herbal supplements or traditional Chinese medicines) to treat the disease under study within \<2 weeks prior to first study treatment. Such medications are permitted if they are used as supportive care.
* Treatment with any live / attenuated vaccine within 30 days of first study treatment.
3. Co-morbid systemic illnesses or other severe concurrent disease, which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens.
4. Uncontrolled intercurrent illness including, but not limited to:
• Ongoing or active infection
• Symptomatic CHF (class II and above that are not properly controlled on maintenance therapy or that have been hospitalized in the last 4 weeks for heart failure)
• Unstable angina pectoris
• Cardiac arrhythmia
* Or psychiatric illness/social situations that would limit compliance with study requirements.
5. Receiving any other investigational agent, which would be considered as a treatment for the primary neoplasm.
6. Other active malignancy ≤5 years prior to registration. EXCEPTIONS: Squamous and basal cell carcinomas of the skin, carcinoma in situ of the cervix or breast, or other non-invasive lesions that in the opinion of the investigator, with concurrence with the sponsor's medical monitor, is considered cured with minimal risk of recurrence within 3 years.
7. History of myocardial infarction ≤6 months, or CHF (class II and above that are not properly controlled on maintenance therapy or that have been hospitalized in the last 4 weeks for heart failure) requiring use of ongoing maintenance therapy for life-threatening ventricular arrhythmias.
8. Patients with known primary CNS malignancy or symptomatic CNS metastases are excluded, with the following exceptions:
* Patients with asymptomatic untreated CNS disease may be enrolled, provided all of the following criteria are met:
o Evaluable or measurable disease outside the CNS
o No metastases to brain stem, midbrain, pons, medulla, cerebellum, or within 10 mm of the optic apparatus (optic nerves and chiasm)
* No history of intracranial hemorrhage or spinal cord hemorrhage
* No ongoing requirement for dexamethasone for CNS disease; patients on a stable dose of anticonvulsants are permitted.
* No neurosurgical resection or brain biopsy ≤28 days prior to registration
* Patients with asymptomatic treated CNS metastases may be enrolled, provided all the criteria listed above are met as well as the following:
* Radiographic demonstration of improvement upon the completion of CNS-directed therapy and no evidence of interim progression between the completion of CNS-directed therapy and the screening radiographic study
* No stereotactic radiation or whole-brain radiation ≤28 days prior to registration
* Screening CNS radiographic study ≥4 weeks from completion of radiotherapy and ≥ 2 weeks from discontinuation of corticosteroids
9. a. History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins or vaccines.
9. b. Patients with a plan to receive yellow fever or other live (attenuated) vaccines during the course of study.
9. c. Patients who have a history or current evidence of bleeding disorder, i.e., any hemorrhage/bleeding event of CTCAE Grade ≥2, ≤28 days prior to registration.
9. d. Patients on supraphysiologic doses of steroids or use of such ≤ 6weeks prior to registration.
9. e. Known clinically significant liver disease, including active viral, alcoholic, or other hepatitis; cirrhosis; fatty liver; and inherited liver disease.
9. f. History or risk of autoimmune disease, including, but not limited to, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, vascular thrombosis associated with antiphospholipid syndrome, Wegener's granulomatosis, Sjögren's syndrome, Bell's palsy, Guillain-Barré syndrome, multiple sclerosis, autoimmune thyroid disease, vasculitis, or glomerulonephritis. Note: Patients with a history of autoimmune hypothyroidism on a stable dose of thyroid replacement hormone are eligible. Patients with controlled Type 1 diabetes mellitus (T1DM) on a stable insulin regimen are eligible. Patients with eczema, psoriasis, lichen simplex chronicus of vitiligo with dermatologic manifestations only (e.g., patients with psoriatic arthritis would be excluded) are permitted provided that they meet the following conditions:
o Patients with psoriasis must have a baseline ophthalmologic exam to rule out ocular manifestations
* Rash must cover less than 10% of body surface area (BSA)
* Disease is well controlled at baseline and only requiring low potency topical steroids (e.g., hydrocortisone 2.5%, hydrocortisone butyrate 0.1%, flucinolone 0.01%, desonide 0.05%, aclometasone dipropionate 0.05%)
* No acute exacerbations of underlying condition within the last 12 months (not requiring psoralen plus ultraviolet A radiation \[PUVA\], methotrexate, retinoids, biologic agents, oral calcineurin inhibitors; high potency or oral steroids).
9. g. History of idiopathic pulmonary fibrosis, pneumonitis (including drug induced), organizing pneumonia (i.e., bronchiolitis obliterans, cryptogenic organizing pneumonia, etc.), or evidence of active pneumonitis on screening chest CT scan. Note: History of radiation pneumonitis in the radiation field (fibrosis) is permitted.
9. h. Any infection \> Grade 2 ≤4 weeks prior to registration, including, but not limited to, hospitalization for complications of infection, bacteremia, or severe pneumonia.
9. i. History of peripheral neuropathy ≥Grade 2.
10. Subject is Seropositive for HIV. Seropositive for hepatitis B (defined by a positive test for HBsAg). Subjects with resolved infection (i.e., subjects who are HBsAg negative but positive for anti-HBc and/or anti-HBs) must be screened using RT-PCR measurement of HBV DNA levels. Those who are PCR positive will be excluded. EXCEPTION: Subjects with serologic findings suggestive of HBV vaccination (anti-HBs positivity as the only serologic marker) AND a known history of prior HBV vaccination, do not need to be tested for HBV DNA by PCR. Seropositive for hepatitis C (except in the setting of a SVR, defined as aviremia at least 12 weeks after completion of antiviral therapy).
11. COPD with a FEV1 \< 50% of predicted normal. Note that FEV1 testing is required for participants suspected of having COPD and participants must be excluded if FEV1 is \< 50% of predicted normal.
12. Moderate or severe persistent asthma within the past 2 years, or uncontrolled asthma of any classification. Note that participants who currently have controlled intermittent asthma or controlled mild persistent asthma are allowed to participate.
13. Prisoners or subjects who are compulsory detained.
Washington D.C., District of Columbia, 20007, United States
[email protected] / 202-784-5097
Status: Recruiting
Hackensack, New Jersey, 07601, United States
[email protected] / 551-996-1777
Status: Recruiting