Sponsor: AstraZeneca (industry)
Phase: 2
Start date: Aug. 22, 2024
Planned enrollment: 110
Volrustomig, also known as MEDI5752 or PD-1/CTLA-4 DuetMab, is an investigational bispecific monoclonal antibody targeting both PD-1 and CTLA-4 immune checkpoints. It is designed to fully inhibit PD-1 while preferentially inhibiting CTLA-4 on activated PD-1–positive T cells, aiming to enhance antitumor immune responses. (oncologypro.esmo.org)
Volrustomig's bispecific nature allows it to simultaneously block PD-1 and CTLA-4 pathways. This dual inhibition is intended to restore and amplify T-cell activity against tumor cells, potentially leading to improved therapeutic outcomes compared to targeting either checkpoint alone. (aacrjournals.org)
In a Phase 1 study involving treatment-naïve patients with advanced clear cell renal cell carcinoma (ccRCC), volrustomig demonstrated promising efficacy:
Median progression-free survival (PFS): 12.3 months
500 mg dose cohort (V500):
These results suggest that volrustomig has the potential to improve outcomes in patients with advanced RCC. (onclive.com)
The safety profile of volrustomig is consistent with dual checkpoint inhibition:
46.9% of patients discontinued treatment due to TRAEs.
500 mg dose cohort (V500):
One treatment-related death occurred in the V500 cohort due to bronchopulmonary aspergillosis with immune neutropenia. (onclive.com)
Last updated: Apr 2025
Goal: Evaluate the antitumor activity and safety of the bispecific PD-1/CTLA-4 antibody volrustomig given alone or with chemotherapy across selected advanced/metastatic solid tumors, and characterize pharmacokinetics and immunogenicity.
Patients: Adults (≥18 years) with measurable, advanced or metastatic solid tumors in three cohorts: Sub-study 1 includes recurrent/metastatic cervical cancer (squamous, adeno, or adenosquamous) after 1–2 prior systemic regimens; Sub-study 2 includes recurrent/metastatic head and neck squamous cell carcinoma (oropharynx, oral cavity, hypopharynx, larynx), including PD-L1–positive, systemic-therapy–naive patients for the R/M setting and platinum-refractory patients; Sub-study 3 includes recurrent/metastatic HNSCC untreated in the R/M setting. ECOG 0–1, adequate organ function, life expectancy ≥12 weeks, PD-L1 testing required; key exclusions include active/unstable CNS disease, autoimmune disease, prior immune checkpoint therapy, uncontrolled infections (HBV/HCV/HIV), and contraindications to specified chemotherapies in the combination cohort.
Design: Phase 2, multi-center program with randomized allocation, organized as three parallel sub-studies. Approximately 110 evaluable patients in total. Efficacy assessed per RECIST 1.1 by investigator and/or independent central review, with longitudinal safety monitoring.
Treatments: Sub-study 1: Volrustomig monotherapy. Sub-study 2: Volrustomig monotherapy. Sub-study 3: Volrustomig combined with standard chemotherapy regimens (carboplatin plus paclitaxel, or fluorouracil plus a platinum). Volrustomig (MEDI5752) is a monovalent bispecific checkpoint antibody targeting PD-1 and CTLA-4, designed to fully inhibit PD-1 and preferentially inhibit CTLA-4 on activated PD-1–positive intratumoral T cells, potentially enhancing intratumoral activity and reducing peripheral toxicity versus separate antibodies. The bispecific format can drive PD-1 internalization/degradation, differentiating it from conventional PD-1 plus CTLA-4 combinations. Early-phase studies have shown encouraging responses across solid tumors, notably in first-line RCC with objective response rates around 45–48% at 500–750 mg every 3 weeks, with dose-dependent immune-related toxicity that increases at ≥1500 mg; development focuses on sub-1500 mg dosing and combinations.
Outcomes: Primary endpoints are confirmed objective response rate per RECIST 1.1 and safety/tolerability (AEs, SAEs, labs, vitals, ECGs). Key secondary endpoints include duration of response, progression-free survival, time to response, overall survival, disease control rate, PFS and OS landmark rates, pharmacokinetics of volrustomig, and anti-drug antibodies.
Burden on patient: Moderate. Patients will undergo screening tumor sampling for PD-L1 and require regular imaging for RECIST assessments approximately every 6–12 weeks, along with frequent clinic visits for infusion therapy. Safety monitoring includes serial labs, vitals, ECGs, and immune-related toxicity surveillance. The PK and immunogenicity objectives imply periodic additional blood draws beyond standard-of-care. Combination-therapy participants face higher visit frequency during chemotherapy cycles and potential need for premedications and management of cytotoxic toxicities. Travel demands are typical of multi-center phase 2 immunotherapy studies with combination cohorts, without mandated inpatient stays or intensive biopsy schedules beyond baseline sample submission.
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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Status: Not yet recruiting
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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Status: Not yet recruiting
Shanghai, 200120, China
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Status: Recruiting
Shenyang, 110004, China
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Status: Recruiting
Tianjin, 300060, China
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Status: Active, not recruiting
Wuhan, 430022, China
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Status: Recruiting
Wuhan, 430022, China
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Status: Active, not recruiting
Wuhan, 430040, China
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Status: Not yet recruiting
Wuhan, 430048, China
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Status: Not yet recruiting
Wuhan, 430079, China
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Status: Recruiting
Wuhou District, 610041, China
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Status: Not yet recruiting
Beijing, 100142, China
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Status: Recruiting
Beijing, 100730, China
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Status: Recruiting
Beijing, CN-100730, China
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Status: Recruiting
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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Status: Not yet recruiting
Changsha, 410008, China
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Status: Active, not recruiting
Changsha, 410008, China
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Status: Not yet recruiting
Changsha, 410013, China
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Status: Active, not recruiting
Chengdu, 610041, China
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Status: Active, not recruiting
Chengdu, 610041, China
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Status: Recruiting
Chengdu, 610072, China
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Status: Not yet recruiting
Chongqing, 400030, China
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Status: Recruiting
Dongguan, 523009, China
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Status: Recruiting
Dongguan, 523009, China
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Status: Not yet recruiting
Fuzhou, 350011, China
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Status: Recruiting
Fuzhou, 350014, China
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Status: Not yet recruiting
Hangzhou, 310022, China
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Status: Active, not recruiting
Hangzhou, 310022, China
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Status: Not yet recruiting
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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Status: Recruiting
Nanning, 530021, China
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Status: Active, not recruiting
Nanning, 530021, China
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Status: Not yet recruiting
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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Status: Not yet recruiting
Seoul, 03722, South Korea
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Status: Not yet recruiting
Taipei, 112, Taiwan
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Status: Not yet recruiting
Taichung, Taiwan
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Status: Not yet recruiting
Baltimore, Maryland, 21201, United States
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Status: Not yet recruiting
Stony Brook, New York, 11794, United States
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Status: Not yet recruiting
Columbus, Ohio, 43210, United States
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Status: Not yet recruiting
Ho Chi Minh City, 700000, Vietnam
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Status: Not yet recruiting
Hanoi, 100000, Vietnam
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Status: Not yet recruiting