Sponsor: AstraZeneca (industry)
Phase: 2
Start date: Aug. 22, 2024
Planned enrollment: 110
Volrustomig (MEDI5752) is an investigational, humanized, monovalent bispecific IgG1 antibody that targets PD‑1 and CTLA‑4. It is being studied across multiple tumor types, including renal cell carcinoma (RCC), non–small cell lung cancer (NSCLC), pleural mesothelioma, hepatobiliary cancers, and head and neck cancer, in phases 1–3. Early clinical data show antitumor activity, with ongoing efforts to optimize dose to balance efficacy and immune‑related toxicities. (aacrjournals.org)
Volrustomig binds PD‑1 and CTLA‑4 with a “DuetMab” monovalent bispecific format engineered to fully block PD‑1 while preferentially inhibiting CTLA‑4 on activated PD‑1–positive T cells within tumors. This design enhances CTLA‑4 engagement in the tumor microenvironment and reduces activity on PD‑1–negative peripheral T cells. Tethering CTLA‑4 to PD‑1 also drives rapid internalization and degradation of PD‑1, providing a distinct mechanism from conventional separate PD‑1 and CTLA‑4 monoclonal antibodies. The Fc region is engineered to reduce effector function. (aacrjournals.org)
Advanced clear‑cell RCC (first‑line, monotherapy): In a phase 1 expansion (NCT03530397), volrustomig 1,500 mg Q3W produced an ORR of 38.5% in all expansion patients (n=26) and 58.3% in the first‑line ccRCC subset (n=12); median duration of response, PFS, and OS were not reached at 14.6 months’ follow‑up in the first‑line subset. Subsequent first‑line cohorts tested lower fixed doses. At ESMO 2023, ORR was 46.9% with 750 mg (n=32) and 45.5% with 500 mg (n=33); complete responses 9.4% and 6.1%, respectively; median PFS 11.1 and 9.9 months. (ascopubs.org)
Metastatic non‑squamous NSCLC (first‑line, with chemotherapy): In ESMO 2022 LBA56 (phase 1b/2, NCT03530397), volrustomig 1,500 mg + carboplatin/pemetrexed improved median PFS (15.1 vs 8.9 mo), DOR (20.5 vs 9.9 mo), and OS (not reached vs 16.5 mo) versus pembrolizumab + chemotherapy in a small randomized signal‑finding cohort (n=41). A separate single‑arm cohort using 750 mg + chemotherapy showed emerging ORR 44% overall and 48% in PD‑L1 <1% with improved tolerability at ~3.9 months’ follow‑up. A phase 3 trial (eVOLVE‑Lung02) is comparing volrustomig + chemotherapy vs pembrolizumab + chemotherapy in PD‑L1 <50% mNSCLC. (oncologypro.esmo.org)
Ongoing phase 3 programs: Volrustomig + carboplatin/pemetrexed is being compared against platinum/pemetrexed or nivolumab/ipilimumab in unresectable pleural mesothelioma; additional phase 3 evaluation is underway as consolidation after chemoradiotherapy in locally advanced head and neck squamous cell carcinoma. Results are pending. (mayo.edu)
Other tumor settings under study: Master protocols include combinations in hepatocellular and biliary tract cancers (e.g., volrustomig ± bevacizumab or lenvatinib; volrustomig + gemcitabine/cisplatin). RCC combinations with VEGF‑TKIs (e.g., lenvatinib/axitinib) are also in early‑phase evaluation. (mskcc.org)
Class‑consistent immune‑related adverse events (irAEs) occur and increase with higher dosing/intensity of CTLA‑4 engagement. In RCC expansion at 1,500 mg Q3W, grade 3–4 treatment‑related AEs occurred in 74.1% with discontinuations in 70.4%; hepatotoxicity was a common reason for discontinuation. In the dose‑escalation/expansion RCC cohorts overall, grade 5 TRAEs occurred in 1 patient per cohort. (ascopubs.org)
In NSCLC (ESMO 2022), volrustomig 1,500 mg + chemotherapy had grade ≥3 TRAEs and discontinuations of 70% each; lowering to 750 mg + chemotherapy reduced grade ≥3 TRAEs to 32% and discontinuations to 20%, while maintaining antitumor activity signals. (oncologypro.esmo.org)
Across first‑line RCC mini‑oral cohorts (ESMO 2023), grade 3–4 immune‑related AEs were more frequent at 750 mg than 500 mg (46.9% vs 24.2%), but most non‑endocrine irAEs resolved and about half did not require steroids; overall disease control remained high. (oncologypro.esmo.org)
Notes: All efficacy and safety data above are from early‑phase or conference abstracts with limited patient numbers and follow‑up; confirmatory phase 3 results are pending.
Last updated: Oct 2025
Goal: Assess the antitumor activity and safety of the bispecific checkpoint inhibitor volrustomig given as monotherapy or combined with standard chemotherapy in advanced/metastatic solid tumors, with a focus on cervical cancer and head and neck squamous cell carcinoma (HNSCC).
Patients: Adults (≥18 years) with ECOG 0–1, measurable disease by RECIST 1.1, adequate organ function, and life expectancy ≥12 weeks. Sub-study 1 enrolls previously treated recurrent/metastatic cervical cancer (squamous, adeno, or adenosquamous) after 1–2 prior lines. Sub-study 2 enrolls recurrent/metastatic HNSCC (oropharynx, oral cavity, hypopharynx, larynx); treatment-naive R/M patients require PD-L1 positivity, and platinum-refractory patients are eligible. Sub-study 3 enrolls untreated R/M HNSCC ineligible for curative local therapy. Key exclusions include active CNS disease requiring steroids, autoimmune disease, uncontrolled infections (HBV/HCV/HIV not well controlled), prior immune-mediated therapy, recent anticancer therapy or major surgery, and contraindications to 5-FU, paclitaxel, or carboplatin for the combination cohort.
Design: Phase 2, multi-center, randomized study with three sub-studies evaluating volrustomig as monotherapy in cervical cancer (approximately 30 evaluable) and HNSCC (approximately 20 evaluable), and volrustomig plus chemotherapy in HNSCC (approximately 60 evaluable). Primary purpose is treatment; allocation is randomized; total planned enrollment is about 110.
Treatments: Volrustomig (MEDI5752) is a monovalent bispecific antibody targeting PD-1 and CTLA-4. It fully blocks PD-1 and preferentially inhibits CTLA-4 on activated PD-1–positive intratumoral T cells, aiming to concentrate CTLA-4 blockade in the tumor microenvironment and reduce peripheral toxicity. The bispecific format promotes PD-1 internalization and degradation, differentiating it from conventional PD-1 plus CTLA-4 combinations. Early phase data across solid tumors, including first-line renal cell carcinoma, have shown objective response rates around 45%–48% with median duration of response of 11–17 months at doses ≤750 mg every 3 weeks; toxicity is dose-dependent with fewer grade 3–4 events at doses below 1500 mg. In Sub-studies 1 and 2, volrustomig is administered as monotherapy. In Sub-study 3, volrustomig is combined with standard platinum-based chemotherapy regimens used in R/M HNSCC: either carboplatin plus paclitaxel or a 5-FU plus platinum regimen (cisplatin or carboplatin).
Outcomes: Primary endpoints are confirmed objective response rate by RECIST 1.1 and safety, including adverse and serious adverse events, labs, ECGs, vitals, and clinical observations. Secondary endpoints include duration of response, progression-free survival, time to response, overall survival, pharmacokinetics of volrustomig, anti-drug antibodies, disease control rate, and PFS/OS landmark rates at prespecified time points.
Burden on patient: Moderate. Requirements include provision of tumor tissue for PD-L1 assessment, regular imaging per RECIST 1.1, safety labs, vitals, and ECGs typical of immunotherapy trials. As a phase 2 study with PK sampling and immunogenicity assessments, additional blood draws are expected at multiple time points. Monotherapy cohorts resemble standard checkpoint inhibitor visit schedules, while the combination HNSCC cohort adds the higher visit frequency and infusion time associated with multi-agent chemotherapy (carboplatin/paclitaxel or 5-FU plus platinum), with potential need for antiemetic premedication and management of chemotherapy-related toxicities. Travel burden aligns with q3–4 week infusion schedules and more frequent early visits for safety and PK; no mandatory invasive serial biopsies are specified beyond baseline tissue, which helps limit procedural burden.
Last updated: Oct 2025
Inclusion Criteria:
For inclusion in the study, patients should fulfill the following criteria:
1. Age ≥18 at the time of signing the ICF.
2. Provision of tumor sample to assess the PD-L1 expression.
3. Measurable disease according to RECIST 1.1.
4. ECOG performance status of 0 or 1.
5. Life expectancy ≥ 12 weeks.
6. Adequate organ and bone marrow function.
7. Body weight \> 35 kg.
8. Capable of giving signed informed consent.
9. For sub-study 1, participants with R/M cervical cancer with squamous cell, adenocarcinoma or adenosquamous histology, that: have experienced disease progression during or after treatment with standard systematic therapy per local guideline; have received at least 1 line but no more than 2 lines of prior systemic treatment regimens for R/M cervical cancer.
10. For sub-study 2, for participants with OPC must have documented HPV status.
11. For sub-study 2, participants with R/M HNSCC, that: (a) Are histologically or cytologically documented R/M HNSCC of the OP, OC, HP, and LX that is considered incurable by local therapies; (b) Participants that have not been treated in R/M setting must have: (i) a documented PD-L1 positive result, (ii) with no prior systemic anti-cancer therapy for R/M HNSCC; (c) Platinum refractory participants must have relapsed from or are refractory to the first line of prior platinum-containing regimen.
12. For sub-study 3, participants with R/M HNSCC, that: (a) Are histologically or cytologically documented R/M HNSCC of the OP, OC, HP, and LX that is considered incurable by local therapies; (b) Participants that have not been treated in R/M setting
Exclusion Criteria
Patients should not enter the study if any of the following exclusion criteria are fulfilled:
1. Spinal cord compression.
2. Brain metastases unless asymptomatic, stable, and not requiring steroids for at least 14 days prior to start of study intervention.
3. Participants with primary neuroendocrine, mesenchymal, sarcomatoid histologies, or other histologies not mentioned as part of the inclusion criteria.
4. Have not recovered (ie, ≤ Grade 1 or at baseline) from an AE due to a previously administered anti-cancer therapy.
5. For sub-study 2, have had radiotherapy within 2 weeks prior to enrollment.
6. For sub-study 3, Participants have contraindications to any of the following drugs: 5-FU, paclitaxel and carboplatin
7. History of another primary malignancy except for a) Malignancy treated with curative intent with no known active disease ≥2 years before the first dose of study intervention and of low potential risk for recurrence; b) Adequately treated nonmelanoma skin cancer or lentigo maligna, or carcinoma in situ without evidence of disease.
8. Any evidence of diseases, and/or history of organ transplant or allogenic stem cell transplant, which makes it undesirable for the participant to participate in the study or that would jeopardize compliance with the protocol.
9. Evidence of the following infections: active infection including tuberculosis; known HIV infection. that is not well controlled; active or uncontrolled HBV or HCV; or active hepatitis A.
10. Active or prior documented autoimmune or inflammatory disorders.
11. Participants who are candidates for curative therapy.
12. Prior exposure to any immune-mediated therapy.
13. Current or prior use of immunosuppressive medication within 14 days before the first dose of the study intervention is excluded. The following are exceptions to this criterion: a) Intranasal, inhaled, topical steroids, or local steroid injections (eg, intraarticular injection); b) Steroids as premedication for hypersensitivity reactions (eg, CT scan premedication or chemotherapy premedication) or a single dose for palliative purpose (eg, pain control).
14. Participants are ineligible if they have received any anti-cancer therapy within 28 days prior to the first dose of study intervention or within 5 half-lives of the respective agent, whichever is longer..
15. Any concurrent chemotherapy except study intervention, radiotherapy, investigational, biologic, or hormonal therapy for cancer treatment.
16. Radiotherapy treatment with a wide field of radiation or to more than 30% of the bone marrow within 4 weeks, prior to the first dose of study intervention.
17. Major surgical procedures within 4 weeks prior to the first dose of the study intervention or still recovering from prior surgery.
18. Receipt of live attenuated vaccine within 30 days prior to the first dose of the study intervention.
19. Participants with a known allergy or hypersensitivity to any study intervention, on any excipients of any study intervention.
Londrina, 86015-520, Brazil
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Vitória, 29043-260, Brazil
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São Caetano do Sul, 09541-270, Brazil
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Ijuí, 98700-000, Brazil
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Tianjin, 300060, China
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Shanghai, 200120, China
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Shenyang, 110004, China
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Tianjin, 300060, China
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Wuhan, 430022, China
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Wuhan, 430022, China
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Wuhan, 430040, China
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Wuhan, 430048, China
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Wuhan, 430079, China
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Wuhou District, 610041, China
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Beijing, 100142, China
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Beijing, 100730, China
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Beijing, CN-100730, China
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Bengbu, 233004, China
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Status: Recruiting
Changchun, 130021, China
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Status: Withdrawn
Changsha, 410003, China
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Changsha, 410008, China
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Changsha, 410008, China
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Changsha, 410013, China
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Chengdu, 610041, China
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Chengdu, 610041, China
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Status: Recruiting
Chengdu, 610072, China
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Chongqing, 400030, China
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Dongguan, 523009, China
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Dongguan, 523009, China
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Fuzhou, 350011, China
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Fuzhou, 350014, China
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Hangzhou, 310022, China
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Hangzhou, 310022, China
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Jining, 272029, China
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Status: Recruiting
Kunming, 650118, China
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Status: Recruiting
Nanchang, 330006, China
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Nanning, 530021, China
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Nanning, 530021, China
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Shandong, China
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Status: Recruiting
Shandong, China
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Status: Active, not recruiting
Shanghai, 200120, China
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Status: Active, not recruiting
Namdong-gu, 21565, South Korea
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Seoul, 03722, South Korea
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Taipei, 112, Taiwan
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Taichung, Taiwan
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Baltimore, Maryland, 21201, United States
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Stony Brook, New York, 11794, United States
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Columbus, Ohio, 43210, United States
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Ho Chi Minh City, 700000, Vietnam
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Hanoi, 100000, Vietnam
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