AzTrials
AzTrials

Colorectal CancerPhase 2NCT07227636

A Study of Botensilimab and Balstilimab for Colorectal Cancer With ctDNA+ After Surgery and Chemotherapy

A Phase 2 study testing Botensilimab and Balstilimab in people with Colorectal Cancer and Rectal Cancer, run by Memorial Sloan Kettering Cancer Center at 7 sites in United States.

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

The researchers are doing this study to find out whether the combination of botensilimab and balstilimab (BOT/BAL), followed by balstilimab alone, is an effective treatment for people with microsatellite stable (MSS) colorectal cancer or colorectal liver metastases (CRLM) who have measurable residual disease (MRD)… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Colorectal Cancer, Rectal Cancer
What is being tested?
Botensilimab and Balstilimab
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
284 participants
Where
7 sitesUnited States
Study dates
7 Nov 2025to Nov 2030
Phase
Phase 2
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

  • Subject or legally authorized representative, is willing and able to provide written informed consent.
  • Histologically- or cytologically- confirmed colorectal cancer.
  • ≥ 18 years of age on day of signing informed consent.
  • Consent for use of archival tissue and blood draws for research purposes.
  • Performance status of ECOG 0 or 1.
  • Known non-MSI-H/pMMR by IHC, PCR or NGS testing. MSKCC confirmation of non-MSI-H/pMMR status is not mandatory prior to enrollment and treatment on the study. For patients with outside testing, if sufficient tissue is available testing may be repeated at MSKCC and will not impact initial eligibility.
Show all 20Show fewer
  • Consent to undergo MSK IMPACT or NGS, if not previously done
  • Disease specific criteria:
  • Cohorts 1a and 2a: Undergone a complete surgical resection (R0) for stage III colon or rectal cancer, followed by adjuvant chemotherapy with FOLFOX or CAPEOX. Post-operative chemotherapy not required if received previous oxaliplatin-based therapy. Total Neoadjuvant Therapy for rectal cancer with complete clinical and radiographic response is allowed.
  • Cohorts 1b and 2b: Undergone a complete surgical resection (R0) for liver metastasis (ablation or stereotactic body radiation therapy [SBRT], but not Y-90, is permitted) and completed standard peri-operative chemotherapy. Peri-operative chemotherapy not required if received previous oxaliplatin-based therapy. Prior floxuridine via Hepatic Arterial Infusion Pump is permitted. Completed definitive treatment for the primary tumor including (R0) resection, or Total Neoadjuvant Therapy for rectal cancer with complete clinical and radiographic response.
  • Positive ctDNA following completion of appropriate standard of care therapy.
  • Patients must sign informed consent within 6 weeks of positive ctDNA result. The 6 weeks is considered from the date that the ctDNA is resulted, and not the date it is drawn.
  • Adequate organ function, defined as:
  • Absolute Neutrophil Count ≥ 1,500/mm3.
  • Platelet count ≥ 75,000/mm3.
  • Hemoglobin ≥ 9.0 g/dL
  • Creatinine clearance (CrCl) ≥60 mL/min.
  • AST and ALT ≤ 2.5 × ULN
  • Bilirubin ≤ 1.5 × ULN or Direct bilirubin ≤ ULN
  • Subjects of childbearing potential (or with partners of childbearing potential) must use effective contraception for the course of the study starting with the screening visit through at least 5 months after the last dose of study treatment. Appropriate methods of birth control include abstinence, oral contraceptives, implantable hormonal contraceptives, or double barrier method (diaphragm plus condom).

Who cannot join

  • Presence of metastatic or recurrent disease.
  • Known DNA polymerase epsilon (POLE) or DNA polymerase delta (POLD) activating mutation.
  • R1 (microscopic residual tumor) or R2 resection (macroscopic residual tumor at resection margin).
  • Currently participating and receiving study therapy or has participated in a study of an investigational agent and received study therapy or used an investigational device within 4 weeks of the first dose of treatment.
  • Diagnosis of immunodeficiency or is receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to the first dose of trial treatment.
  • Patients who have received acute, low dose, systemic immunosuppressant medications (e.g., dexamethasone containing antiemetic regimen or steroids as CT scan contrast premedication) may be enrolled.
Show all 24Show fewer
  • The use of inhaled corticosteroids and mineralocorticoids (e.g., fludrocortisone) for patients with orthostatic hypotension or adrenocortical insufficiency is allowed.
  • Hypersensitivity to botensilimab or balstilimab or any of its excipients.
  • Chemotherapy, targeted small molecule therapy, or radiation therapy within 2 weeks prior to study Day 1 or who has not recovered (i.e., ≤ Grade 1 or at baseline) from adverse events due to a previously administered agent
  • Note: If subject received major surgery, they must have recovered adequately from the toxicity and/or complications from the intervention prior to starting therapy.
  • History of, or any evidence of active, non-infectious pneumonitis.
  • Active infection requiring systemic therapy.
  • Current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject's participation for the full duration of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating investigator.
  • Known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.
  • Pregnant or breastfeeding or expecting to conceive or father children within the projected duration of the trial, starting with the pre-screening or screening visit through 90 days after the last dose of trial treatment.
  • Prior therapy with an anti-PD-1, anti-PD-L1, or anti-CTLA-4 agent.
  • 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). The following are exceptions:
  • Subjects with vitiligo or alopecia
  • Subjects with hypothyroidism (e.g., following Hashimoto syndrome) stable on hormone replacement or psoriasis not requiring systemic treatment
  • Known active TB (Bacillus tuberculosis).
  • Uncontrolled infection with human immunodeficiency virus (HIV). Patients on stable highly active antiretroviral therapy with undetectable viral load and normal CD4 counts for at least 6 months prior to study entry are eligible. Serological testing for HIV at screening is not required
  • Known to be positive for hepatitis B virus (HBV) surface antigen, or any other positive test for HBV indicating acute or chronic infection. Patients who are receiving or who have received anti-HBV therapy and have undetectable HBV DNA prior to study entry are eligible. Serological testing for HBV at screening is not required.
  • Known active hepatitis C virus (HCV) as determined by positive serology and confirmed by polymerase chain reaction (PCR). Patients on or who have received antiretroviral therapy are eligible provided they are virus-free by PCR for at least 6 months prior to study entry. Serological testing for HCV at screening is not required.
  • Received a live vaccine within 30 days of planned start of study therapy

Trial locations and contacts

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

Neil Segal, MD, PhD contact

646-888-4187

crc@mskcc.org

Luis Diaz, MD contact

646-888-4641

7 sites in 1 country

United States7 sites, 7 recruiting
  • Memorial Sloan Kettering Basking Ridge (Limited Protocol Activities)

    Basking Ridge, New Jersey, 07920

    Neil Segal, MD, PhD, 646-888-4187

    Recruiting
  • Memorial Sloan Kettering Commack (Limited Protocol Activities)

    Commack, New York, 11725

    Neil Segal, MD, PhD, 646-888-4187

    Recruiting
  • Memorial Sloan Kettering Westchester (All Protocol Activities)

    Harrison, New York, 10604

    Neil Segal, MD, PhD, 646-888-4187

    Recruiting
  • Memorial Sloan Kettering Monmouth (Limited Protocol Activities)

    Middletown, New Jersey, 07748

    Neil Segal, MD, PhD, 646-888-4187

    Recruiting
  • Memorial Sloan Kettering Bergen (Limited Protocol Activities)

    Montvale, New Jersey, 07645

    Neil Segal, MD, PhD, 646-888-4187

    Recruiting
  • Memorial Sloan Kettering Cancer Center (All Protocol Activities)

    New York, New York, 10065

    Neil Segal, MD,PhD, 646-888-4187

    Luis Diaz, MD, 646-888-4641

    Recruiting
  • Memorial Sloan Kettering Nassau (Limited Protocol Activities)

    Rockville Centre, New York, 11553

    Neil Segal, MD, PhD, 646-888-4187

    Recruiting

Other trials in United States

About this study

Official title: Phase II Study of Adjuvant Botensilimab in Combination With Balstilimab in Patients With Colorectal Cancer and Persistent Circulating Tumor DNA Following Surgery and Chemotherapy

The researchers are doing this study to find out whether the combination of botensilimab and balstilimab (BOT/BAL), followed by balstilimab alone, is an effective treatment for people with microsatellite stable (MSS) colorectal cancer or colorectal liver metastases (CRLM) who have measurable residual disease (MRD) after standard treatment with surgery and chemotherapy or total neoadjuvant therapy (TNT).

Read the detailed description

This is a 2-part, 2-cohort each. Part-1 will be a non-randomized study of 54 subjects to assess ctDNA clearance, including 2 cohorts. Cohort 1a includes 27 patients with stage III non-MSI-H/pMMR colorectal cancer following surgery and adjuvant chemotherapy or total neoadjuvant therapy (TNT), with persistent MRD. Cohort 1b includes 27 patients with non-MSI-H/pMMR CRLM following surgery and peri-operative chemotherapy, with persistent MRD.

Part-2 will be a randomized, placebo-controlled, double-blind study of 230 patients with non- MSI-H/pMMR CRC with MRD, to assess RFS. Cohort 2a includes 113 patients with stage III non-MSI-H/pMMR colorectal cancer following surgery and adjuvant chemotherapy or TNT with persistent MRD, randomized 2:1 to treatment versus placebo.

Being tested
Botensilimab, Balstilimab, Placebo
Keywords
Persistent Circulating Tumor DNA, Botensilimab, Balstilimab, ctDNA, ctDNA+, immunotherapy, checkpoint inhibitor, dual checkpoint blockade, AGEN1181, AGEN2034, CTLA-4 inhibitor, PD-1 inhibitor
Medical subject headings
Colorectal Neoplasms, Rectal Neoplasms

What participants receive

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

  • BotensilimabDrug

    Also called AGEN1181

    All patients will receive botensilimab IV on day 1 of the 42 day cycle for 4 doses

  • BalstilimabDrug

    Also called AGEN2034

    All patients will receive balstilimab IV on days 1, 15, and 29 of the 42 day cyclePatient then continues balstilimab alone for an additional two cycles IV on days 1, 15, and 29 of the 42 day cycle.

  • PlaceboOther

    Placebo

Study groups in NCT07227636
Study groupRoleWhat they receive
Cohort 1a: Stage III MSS Colorectal Cancer (Botensilimab and Balstilimab)ExperimentalAll patients will receive botensilimab IV on day 1 of the 42 day cycle for 4 doses, balstilimab IV on days 1, 15, and 29 of the 42 day cycle. Patient then continues balstilimab alone for an additional two cycles IV on days 1, 15, and 29 of the 42 day cycle.
Receives: Drug: Botensilimab; Drug: Balstilimab
Cohort 1b: MSS CRLM (Botensilimab and Balstilimab)ExperimentalAll patients will receive botensilimab IV on day 1 of the 42 day cycle for 4 doses, balstilimab IV on days 1, 15, and 29 of the 42 day cycle. Patient then continues balstilimab alone for an additional two cycles IV on days 1, 15, and 29 of the 42 day cycle.
Receives: Drug: Botensilimab; Drug: Balstilimab
Cohort 2a: Stage 3 MSS Colorectal Cancer (Botensilimab and Balstilimab vs. Placebo) RandomizedExperimentalAll patients will receive botensilimab IV on day 1 of the 42 day cycle for 4 doses, balstilimab IV on days 1, 15, and 29 of the 42 day cycle. Patient then continues balstilimab alone for an additional two cycles IV on days 1, 15, and 29 of the 42 day cycle OR Placebo
Receives: Drug: Botensilimab; Drug: Balstilimab; Other: Placebo
Cohort 2b: MSS CRLM (Botensilimab and Balstilimab vs. Placebo) RandomizedExperimentalAll patients will receive botensilimab IV on day 1 of the 42 day cycle for 4 doses, balstilimab IV on days 1, 15, and 29 of the 42 day cycle. Patient then continues balstilimab alone for an additional two cycles IV on days 1, 15, and 29 of the 42 day cycle OR Placebo
Receives: Drug: Botensilimab; Drug: Balstilimab; Other: Placebo

What is being measured

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

  1. Rate of ctDNA clearance (Cohort 1a)

    The 6 months ctDNA clearance will be estimated using the binomial distribution along with exact 95% confidence intervals separately in each cohort.

    Measured: 6 months

  2. Rate of ctDNA clearance (Cohort 1b)

    The 6 months ctDNA clearance will be estimated using the binomial distribution along with exact 95% confidence intervals separately in each cohort.

    Measured: 6 months

  3. Recurrence-free survival (RFS) (Cohort 2a)

    Measured: 1 year

  4. Recurrence-free survival (RFS) (Cohort 2b)

    Measured: 1 year

Timeline

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

  1. First posted13 Nov 2025
  2. Study start7 Nov 2025
  3. Primary completionNov 2030 (estimated)
  4. Study completionNov 2030 (estimated)

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
Parallel groups
Model description
This is a 2-part, 2-cohort each, phase II study. Part 2 is randomized.
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
284 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07227636
Sponsor's protocol ID
25-132
Status last verified
Sep 2026
First submitted
10 Nov 2025
Last updated
22 Sep 2026
Results posted
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
Yes: Memorial Sloan Kettering Cancer Center supports the international committee of medical journal editors (ICMJE) and the ethical obligation of responsible sharing of data from clinical trials. The protocol summary, a statistical summary, and informed consent form will be made available on clinicaltrials.gov when required as a condition of Federal awards, other agreements supporting the research and/or as otherwise required. Requests for deidentified individual participant data can be made beginning 12 months after publication and for up to 36 months post publication. Deidentified individual participant data reported in the manuscript will be shared under the terms of a Data Use Agreement and may only be used for approved proposals. Requests may be made to: crdatashare@mskcc.org.

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Botensilimab and Balstilimab in people with Colorectal Cancer and Rectal Cancer, run by Memorial Sloan Kettering Cancer Center at 7 sites in United States.

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 20 inclusion and 24 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 22 Sep 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 United States. 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?

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 Neil Segal, MD, PhD (646-888-4187, crc@mskcc.org), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Rate of ctDNA clearance (Cohort 1a) (time frame: 6 months). The study lists 4 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 22 Sep 2026.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in