Gastric CancerPhase 3CIMENCT06346197

Combination of Immune Checkpoint in Locally Advanced or Metastatic MSI/dMMR Esogastric Adenocarcinomas

A Phase 3 study testing Balstilimab, Botensilimab and Folfox Protocol in people with Gastric Cancer and MSI-H, run by Centre Leon Berard at 7 sites in France.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts

Official record

Search all trials

Trial summary

CIME is a multicenter, randomised, comparative, open-label phase III study aiming to compare the survival of patients suffering from MSI-H/dMMR locally advanced or metastatic oeasogastric adenocarcinoma treated by a bi-immunotherapy (experimental arm) versus standard current treatment (FOLFOX/XELOX + nivolumab … Read more about this study

Who is it for?: Ages 18 years and older
Conditions the study is for: Gastric Cancer, MSI-H, Metastatic Cancer
What is being tested?: Balstilimab, Botensilimab and Folfox Protocol
Type of treatment: Pill or oral medicine, Injection or infusion
Could I receive a placebo?: No, everyone receives an active treatment
How many people: 132 participants
Where: 7 sitesFrance
Study dates: 8 Dec 2025to 15 May 2028
Phase: Phase 3
Are there results?: Not yet: the study is under way

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

Male or female patient ≥18 years of age at time of informed consent form signature.
Patient with MSI-H/dMMR, HER2 negativeadvanced or metastatic gastric, gastro-oesophageal junction or oesophageal adenocarcinoma whose tumours express PD-L1 with a combined positive score (CPS) ≥ 5. Note :The claudin 18.2 status must be known and documented before inclusion.
Patient to be treated with a first line therapy for locally advanced/metastatic disease.
No prior treatment with chemotherapy for locally advanced/metastatic disease.
o Note - adjuvant or neoadjuvant chemotherapy is allowed providing that 6 months have relapsed between completion of adjuvant chemotherapy and recurrence.
Measurable disease (outside any previous irradiated field within the past 6 months) defined as at least one unidimensional lesion that can be accurately measured as ≥ 10 mm with CT scan according to RECIST V1.1 (Appendix 01).

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Note: Lesions intended to be biopsied should not be defined as target lesions.
Note: previously irradiated lesions can be selected as target lesion only if recurrence/PD is documented after RT.
Patient with PS ECOG 0 or 1 (Appendix 02).
Adequate hematologic and end-organ function, defined by the following laboratory test results:
Absolute neutrophil count ≥ 1.5 109/L (without growth factor support within 14 d) Platelets ≥ 100 109/L (without transfusion for platelets within 7 d) Hemoglobin ≥ 9 g/dL (without transfusion within 7 d) Creatinine clearance according to CKD-EPI ≥ 30 mL/min/1.73 m2 Serum total bilirubin ≤ 1.5 x ULN (except for patients with Gilbert disease for whom a total serum bilirubin ≤ 3 x ULN is acceptable) ASAT and ALAT ≤ 3 x ULN (or up to 5 x ULN in case of liver metastasis or hepatic infiltration)
Availability of a representative formalin-fixed paraffin-embedded (FFPE) sample of the primary or metastatic tumor tissue (resection or biopsy) with an associated pathology report must be available. This tumor sample must meet the following quality/quantity control criteria: ≥30 % of tumor cells and a tumor surface area ≥ 5mm2 or biopsiable disease (see next inclusion criteria).
Tumor lesion visible by medical imaging and accessible to repeatable percutaneous or endoscopic sampling that permits core needle biopsy without unacceptable risk of a significant procedural complications, and suitable for retrieval of a minimum of 4 cores with a needle minimum diameter :16-gauge.
Note 1: Fine needle aspirates, bone biopsies do not satisfy the requirement for tumor tissue.
Note 2: Tumor lesions used for biopsy should not be lesions used as RECIST 1.1 target lesions unless there are no other lesions suitable for biopsy. If a RECIST target lesion is used for biopsy, the lesion must be ≥ 2 cm in longest diameter.
Women of childbearing potential (WOCBP) must have a negative serum pregnancy test at the Screening Visit (within 72 hours of first dose of study drugs) and must agree to use highly effective contraceptive measures starting with the Screening Visit through
9 months after the end of the treatment with oxaliplatin
6 months after the end of the treatment with fluorouracil
5 months after the end of the treatment with nivolumab or botensilimab or Balstilimab
6 months for capecitabine
Highly effective contraception is defined in Appendix 03.
Note Non-childbearing potential is defined as:
≥ 50 years of age and has not had menses for greater than 1 year.
Amenorrheic for ≥ 2 years without a hysterectomy and bilateral oophorectomy and a follicle-stimulating hormone value in the postmenopausal range upon pre-study (screening) evaluation.
Status is post-hysterectomy, bilateral oophorectomy, or tubal ligation.
Male patients with a female partner(s) of childbearing potential must agree to use highly effective contraceptive measures throughout the study starting with the screening visit through 6 months after the end of the treatment with oxaliplatine or 3 months after the last dose for other study treatments is received. Males with pregnant partners must agree to use a condom; no additional method of contraception is required for the pregnant partner.
Patient should understand, sign, and date the written voluntary informed consent form prior to any protocol-specific procedures performed and should be able and willing to comply with study visits and procedures as per protocol.
Patients must be covered by a medical insurance.

Who cannot join

Oesogastric cancer eligible to treatment with curative intent
Patients previously treated by anti-PD-1, anti-PD-L1, or anti-CTLA-4 or any other immunotherapy
Patients with surgery or radiotherapy within less than 4 weeks before C1D1
Patients with persistent AE Grade >1 related to previous anti-cancer treatment, except alopecia (all grades), laboratory value according to criteria I7.
Patients with: hypokalemia, hypomagnesemia, hypocalcemia less than normal
Patients with known prolongation QT/QTc interval i.e. QT/QTc interval longer than 450 msec for men and longer than 470 msec for women according to the inclusion ECG.

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Symptomatic, untreated, or actively progressing central nervous system (CNS) metastases.
Note: Asymptomatic patients with treated CNS lesions are eligible, provided that all of the following criteria are met:
Measurable disease, per RECIST v1.1, must be present outside the CNS.
The patient has no history of intracranial hemorrhage or spinal cord hemorrhage.
Metastases are limited to the cerebellum or the supratentorial region (i.e., no metastases to the midbrain, pons, medulla, or spinal cord).
There is no evidence of interim progression between completion of CNS-directed therapy and initiation of study treatment.
The patient has not undergone stereotactic radiotherapy within 7 days prior to initiation of study treatment, whole-brain radiotherapy within 14 days prior to initiation of study treatment, neurosurgical resection within 21 days prior to initiation of study treatment.
The patient has no ongoing requirement for corticosteroids as therapy for CNS disease. Anticonvulsant therapy at a stable dose is permitted. A minimal wash-out period of 10days for corticosteroids is required.
Patients with other malignancy unless this malignancy is not expected to interfere with the evaluation of study endpoints (basal or squamous cell carcinoma of the skin, in-situ carcinoma of the cervix, localized prostate cancer), or with no evidence of disease for ≥ 2 years.
Known allergy or hypersensitivity to any of the study drugs or any of the study drug excipients.
of ILD or non-infectious pneumonitis requiring glucocorticoids.
History of allogeneic organ transplant.
Psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the study.
Patient with peripheral sensory neuropathy with functional impairment.
Patients with clinically significant active heart disease or myocardial infarction within 6 months, history of uncontrolled or symptomatic cardiac disease.
Patient with recent (within 7d before C1D1) or concomitant treatment with brivudine.
Patient with complete absence of dihydropyrimidine dehydrogenase (DPD) activity (blood uracil level ≥ 150 ng/mL) or partial deficit in DPD (i.e. blood uracil level between ≥ 16 ng/ml and < 150 ng/mL)
Patients with a condition requiring systemic treatment with either corticosteroids (> 10 mg daily prednisone equivalent) within 14 days or another immunosuppressive medication within 30 days of the first dose of study treatment. Inhaled or topical steroids, and adrenal replacement steroid doses (≤ 10 mg daily prednisone equivalent) are permitted in the absence of active autoimmune disease.
Patient with Live vaccines injection within 4 weeks before C1D1. Examples of live vaccines include, but are not limited to, the following: measles, mumps, rubella, chicken pox, yellow fever and BCG. Seasonal influenza vaccines for injection are generally killed virus vaccines and are allowed; however intranasal influenza vaccines (e.g. Flu-Mist®) are live attenuated vaccines, and are not allowed.
Active autoimmune disease or history of autoimmune disease that required systemic treatment within 2 years of the start of study treatment (i.e., with use of disease-modifying agents or immunosuppressive drugs).
History or current evidence of any condition, co-morbidity, therapy, any active infections, or laboratory abnormality that might confound the results of the study, interfere with the patient's participation for the full duration of the study, or is not in the best interest of the patient to participate, in the opinion of the treating Investigator.
Patients with documented:
Active hepatitis B (chronic or acute; defined as having a positive hepatitis B surface antigen [HBsAg] test at screening) unless their HBV is stably controlled on nucleoside analogs (eg entecavir or tenofovir) which will be continued for the duration of the study. Note: Patients with past hepatitis B virus (HBV) infection or resolved HBV infection (defined as the presence of hepatitis B core antibody [anti-HBc] and absence of HBsAg) are eligible. HBV DNA test must be performed in these patients prior to C1D1.
Active hepatitis C. Patients positive for hepatitis C virus (HCV) antibody are eligible only if PCR is negative for HCV RNA, or
HIV infection
Prior organ or bone marrow transplant.
Pregnant or lactating women.

Trial locations and contacts

7 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Christelle DE LA FOUCHARDIERE, MD contact

04 91 22 35 03

delafouchardierec@ipc.unicancer.fr

City, postcode or hospital

Sites recruiting now only

7 sites in 1 country

France7 sites, 7 recruiting

CHU de Brest
Brest, 29000
Jean-Philippe METGES, Dr, 02 98 22 34 28 ext. +33, jean-philippe.metges@chu-brest.fr
Recruiting
CHU de Clermont-Ferrand
Clermont-Ferrand, 63000
Marine JARY, Dr, 04 73 75 05 08 ext. +33, mjary@chu-clermontferrand.fr
Recruiting
Centre Léon Bérard
Lyon, 69008
Clélia COUTZAC, MD, clelia.coutzac@lyon.unicancer.fr
Recruiting
Hôpital Privé Jean Mermoz
Lyon, 69008
Chloé VERNET, Dr, 04 37 53 87 26 ext. +33, chloe.vernet2@gmail.com
Recruiting
Institut Paoli Calmettes
Marseille, 13000
Christelle DE LA FOUCHARDIERE, MD, 4 91 22 35 03 ext. +33, DELAFOUCHARDIEREC@ipc.unicancer.fr
Recruiting
Institut Mutualiste Montsouris
Paris, 75000
Raphaël COLLE, Dr, 01 56 61 62 41 ext. +33, raphael.colle@imm.fr
Recruiting
CHU de Poitiers
Poitiers, 86000
David TOUGERON, Pr, 5 49 44 42 93 ext. +33, David.TOUGERON@chu-poitiers.fr
Recruiting

Other trials in France

About this study

Official title: A Multicenter, Randomised, Comparative, Open-label Phase III Aiming to Compare the Survival of Patients With Locally Advanced or Metastatic MSI/dMMR Esogastric Adenocarcinomas Treated by a Combination of Immune Checkpoint Inhibitors (Botensilimab + Balstilimab) Versus the Standard of Care (FOLFOX/XELOX + Nivolumab)

Conditions: Gastric Cancer, MSI-H, Metastatic Cancer, Advanced Cancer
Being tested: Balstilimab, Botensilimab, Folfox Protocol, XELOX, Nivolumab
Medical subject headings: Stomach Neoplasms, Neoplasm Metastasis

What participants receive

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

BalstilimabDrug
Balstilimab: 240mg, IV, Q2W, until disease progression, unacceptable toxicity, patient or investigator decision or up to 2 years.
BotensilimabDrug
Botensilimab: 75mg, IV for up to 4 doses, Q6W until disease progression, unacceptable toxicity, patient or investigator decision or up to 2 years.
Folfox ProtocolDrug
oxaliplatin 85 mg/m2 , leucovorin 400 mg/m2 , and fluorouracil 400 mg/m2 administered IV on Day 1 of each treatment cycle, and fluorouracil 1200 mg/m2 IV continuous infusion over 24 hours daily or per local standard on Days 1 and 2 of each treatment cycle, every 2 weeks.Treatment is recommended until disease progression, unacceptable toxicity, or up to 24 months in patients without disease progression.
XELOXDrug
Oxaliplatin 130mg/m² IV on Day 1 of each treatment cycle + capecitabine 1000mg/m² orally twice daily on Days 1 to 14 of each treatment cycle, every 3 weeks. Treatment is recommended until disease progression, unacceptable toxicity, or up to 24 months in patients without disease progression.
NivolumabDrug
240mg, IV, Q2. Treatment is recommended until disease progression, unacceptable toxicity, or up to 24 months in patients without disease progression.

Study groups in NCT06346197
Study group	Role	What they receive
Experimental arm	Experimental	Patients treated with Botensilimab + Balstilimab Receives: Drug: Balstilimab; Drug: Botensilimab
Standard arm	Active comparator	o FOLFOX, IV, Q2W + Nivolumab 240mg, IV, Q2. FOLFOX = oxaliplatin 85 mg/m2 , leucovorin 400 mg/m2 , and fluorouracil 400 mg/m2 administered IV on Day 1 of each treatment cycle, and fluorouracil 1200 mg/m2 IV continuous infusion over 24 hours daily or per local standard on Days 1 and 2 of each treatment cycle, every 2 weeks. Premedication is not usually required in the first cycle. For subsequent cycles, adequate premedication may be administrated per local standard. OR * XELOX, IV, Q3W + Nivolumab (360 mg, IV, Q3W). XELOX = Oxaliplatin 130mg/m² IV on Day 1 of each treatment cycle + capecitabine 1000mg/m² orally twice daily on Days 1 to 14 of each treatment cycle, every 3 weeks Treatment is recommended until disease progression, unacceptable toxicity, or up to 24 months in patients without disease progression. Receives: Drug: Folfox Protocol; Drug: XELOX; Drug: Nivolumab

What is being measured

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

Survival of patients
Comparison of survival of patients under Botensilimab + Balstilimab versus the standard of care FOLFOX/XELOX + nivolumab
Measured: at least 2 years

Secondary outcomes (5)

Progression free survival
Measured: At least 2 years
Objective response rate
Measured: After 16 weeks of treatment
Duration of response
Measured: At least 2 years
Adverse Event description as assessed by CTCAE V5.0
Measured: from the date of first intake of study drug until 90 days after study drug discontinuation or at time of initiation of a new anti-cancer treatment
EORTC QLQ C30
Measured: At screening, at Cycle1 Day1 pre dose and every 8 weeks until Week 24 and then every 12 weeks until disease progression (assessed at least 24 months follow up)

Timeline

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

8 Dec 202515 May 2028

First posted3 Apr 2024
Study start8 Dec 2025
Primary completion15 May 2028 (estimated)
Study completion15 May 2028 (estimated)

Resources

Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
Other trials for Gastric CancerStudies of the same condition, open and under way.
More trials run by Centre Leon BerardThe sponsor's other registered studies.
What the trial phases meanHow a treatment moves from first tests in people to approval.

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 3
Primary purpose: Treatment
Allocation: Randomised
Intervention model: Parallel groups
Masking: None (open label)
Enrolment: 132 participants (estimated)

IDs, dates and publications

ClinicalTrials.gov ID: NCT06346197
Sponsor's protocol ID: ET23-185
Acronym: CIME
Status last verified: Jun 2026
First submitted: 8 Mar 2024
Last updated: 25 Jun 2026
Results posted: No
Data monitoring committee: Yes
FDA-regulated drug: No
FDA-regulated device: No

Study at a glance

From the registry record, last updated by the sponsor on 25 Jun 2026. Recruitment status is as the sponsor reported it: confirm with the study team.

Official title: A Multicenter, Randomised, Comparative, Open-label Phase III Aiming to Compare the Survival of Patients With Locally Advanced or Metastatic MSI/dMMR Esogastric Adenocarcinomas Treated by a Combination of Immune Checkpoint Inhibitors (Botensilimab + Balstilimab) Versus the Standard of Care (FOLFOX/XELOX + Nivolumab)
ClinicalTrials.gov ID: NCT06346197
Acronym / sponsor ID: CIME / ET23-185
Conditions: Gastric Cancer, MSI-H, Metastatic Cancer, Advanced Cancer
Phase: Phase 3
Study type: Interventional
Recruitment status: Recruiting
Enrolment: 132 participants (estimated)
Lead sponsor: Centre Leon BerardUniversity, hospital or other
Collaborators: Agenus Inc.
Study start: 8 Dec 2025 (actual)
Primary completion: 15 May 2028 (estimated)
Study completion: 15 May 2028 (estimated)
First posted: 3 Apr 2024 (actual)
Results: Not posted in the source record

Clinical summary

The research question as the sponsor registered it. This describes what the study plans to test, not what it found.

Study design

Primary purpose: Treatment
Allocation: Randomised
Intervention model: Parallel groups
Masking: None (open label)
Number of arms: 2

Arm	Type	Receives
Experimental arm	Experimental	Drug: Balstilimab, Drug: BotensilimabPatients treated with Botensilimab + Balstilimab
Standard arm	Active comparator	Drug: Folfox Protocol, Drug: XELOX, Drug: Nivolumabo FOLFOX, IV, Q2W + Nivolumab 240mg, IV, Q2. FOLFOX = oxaliplatin 85 mg/m2 , leucovorin 400 mg/m2 , and fluorouracil 400 mg/m2 administered IV on Day 1 of each treatment cycle, and fluorouracil 1200 mg/m2 IV continuous infusion over 24 hours daily or per local standard on Days 1 and 2 of each treatment cycle, every 2 weeks. Premedication is not usually required in the first cycle. For subsequent cycles, adequate premedication may be administrated per local standard. OR * XELOX, IV, Q3W + Nivolumab (360 mg, IV, Q3W). XELOX = Oxaliplatin 130mg/m² IV on Day 1 of each treatment cycle + capecitabine 1000mg/m² orally twice daily on Days 1 to 14 of each treatment cycle, every 3 weeks Treatment is recommended until disease progression, unacceptable toxicity, or up to 24 months in patients without disease progression.

Who may qualify

Ages: 18 years and older
Sex: All
Healthy volunteers: Not accepted
Age groups: Adult, Older adult

Key inclusion criteria (28 listed)

Male or female patient ≥18 years of age at time of informed consent form signature.
Patient with MSI-H/dMMR, HER2 negativeadvanced or metastatic gastric, gastro-oesophageal junction or oesophageal adenocarcinoma whose tumours express PD-L1 with a combined positive score (CPS) ≥ 5. Note :The claudin 18.2 status must be known and documented before inclusion.
Patient to be treated with a first line therapy for locally advanced/metastatic disease.
No prior treatment with chemotherapy for locally advanced/metastatic disease.
o Note - adjuvant or neoadjuvant chemotherapy is allowed providing that 6 months have relapsed between completion of adjuvant chemotherapy and recurrence.

Key exclusion criteria (33 listed)

Oesogastric cancer eligible to treatment with curative intent
Patients previously treated by anti-PD-1, anti-PD-L1, or anti-CTLA-4 or any other immunotherapy
Patients with surgery or radiotherapy within less than 4 weeks before C1D1
Patients with persistent AE Grade >1 related to previous anti-cancer treatment, except alopecia (all grades), laboratory value according to criteria I7.
Patients with: hypokalemia, hypomagnesemia, hypocalcemia less than normal

Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.

Interventions

Intervention	Type	Arms
BalstilimabBalstilimab: 240mg, IV, Q2W, until disease progression, unacceptable toxicity, patient or investigator decision or up to 2 years.	Drug	Experimental arm
BotensilimabBotensilimab: 75mg, IV for up to 4 doses, Q6W until disease progression, unacceptable toxicity, patient or investigator decision or up to 2 years.	Drug	Experimental arm
Folfox Protocoloxaliplatin 85 mg/m2 , leucovorin 400 mg/m2 , and fluorouracil 400 mg/m2 administered IV on Day 1 of each treatment cycle, and fluorouracil 1200 mg/m2 IV continuous infusion over 24 hours daily or per local standard on Days 1 and 2 of each treatment cycle, every 2 weeks.Treatment is recommended until disease progression, unacceptable toxicity, or up to 24 months in patients without disease progression.	Drug	Standard arm
XELOXOxaliplatin 130mg/m² IV on Day 1 of each treatment cycle + capecitabine 1000mg/m² orally twice daily on Days 1 to 14 of each treatment cycle, every 3 weeks. Treatment is recommended until disease progression, unacceptable toxicity, or up to 24 months in patients without disease progression.	Drug	Standard arm
Nivolumab240mg, IV, Q2. Treatment is recommended until disease progression, unacceptable toxicity, or up to 24 months in patients without disease progression.	Drug	Standard arm

Primary outcome

Survival of patients
Time frame: at least 2 years
Comparison of survival of patients under Botensilimab + Balstilimab versus the standard of care FOLFOX/XELOX + nivolumab

5 secondary outcomes

Progression free survival
Time frame: At least 2 years
Objective response rate
Time frame: After 16 weeks of treatment
Duration of response
Time frame: At least 2 years
Adverse Event description as assessed by CTCAE V5.0
Time frame: from the date of first intake of study drug until 90 days after study drug discontinuation or at time of initiation of a new anti-cancer treatment
EORTC QLQ C30
Time frame: At screening, at Cycle1 Day1 pre dose and every 8 weeks until Week 24 and then every 12 weeks until disease progression (assessed at least 24 months follow up)

Results and safety

This study is still under way. Results are not available in the source record yet.

Research links

Official record on ClinicalTrials.govLast updated by the sponsor 25 Jun 2026.

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Referral and contact

AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.

Christelle DE LA FOUCHARDIERE, MD contact

04 91 22 35 03

delafouchardierec@ipc.unicancer.fr

7 sites in 1 country: see every site and its status.

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Balstilimab, Botensilimab and Folfox Protocol in people with Gastric Cancer and MSI-H, run by Centre Leon Berard at 7 sites in France.

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 28 inclusion and 33 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: looking for participants now, as of the sponsor's last update on 25 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 7 sites in France. 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 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

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

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

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

Contact Christelle DE LA FOUCHARDIERE, MD (04 91 22 35 03, delafouchardierec@ipc.unicancer.fr), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Survival of patients (time frame: at least 2 years). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06346197.

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 25 Jun 2026.