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Colon Cancer MetastaticPhase 2NIMBLENCT07677579

NIMBLE-CRC: NeoImmunoModulation Before Leveraging Excision in Colorectal Rectal Cancer

A Phase 2 study testing Retifanlimab and Zanzalintinib in people with Colon Cancer Metastatic, run by Northwell Health.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
Search all trials

Trial summary

This is a Phase II, single-arm, open-label trial evaluating the feasibility, safety, and preliminary activity of neoadjuvant Zanzalintinib (a VEGFR-targeting TKI) and Retifanlimab (an anti-PD-1 antibody) in patients with resectable stage II-III mismatch repair-proficient (pMMR) colon cancer. Read more about this study

Who is it for?
Ages 18 to 80 years
Conditions the study is for
Colon Cancer Metastatic
What is being tested?
Retifanlimab and Zanzalintinib
Could I receive a placebo?
No, everyone receives an active treatment
How many people
26 participants
Where
No sites listed yet
Study dates
30 Aug 2026to 30 Dec 2028
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 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Capable of giving signed informed consent which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol. A signed informed consent must be obtained prior to conducting any study-specific procedures.
  • Male or female adult 18 to 80 years of age on day of signing informed consent.
  • Histological-confirmed adenocarcinoma of the colon that is amenable to curative intent resection.
  • Only participants with pMMR/MSS CRC are eligible. Microsatellite status should be performed per local standard of practice. (e.g., IHC and/or PCR, next-generation sequencing). Subjects with unknown or indeterminate results for either test at the time of enrollment are not eligible.
  • Adequate organ and marrow function as defined below:
  • Absolute neutrophil count: ≥ 1,500/mcl
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  • Platelets: ≥ 100,000/mcL without transfusion within 2 weeks of screening laboratory sample collection
  • Total bilirubin ≤ 1.5 x the upper limit of normal (ULN). This may be up to 3x ULN if Gilbert's syndrome is documented.
  • AST and ALT ≤ 3 x institutional ULN.
  • Serum creatinine ≤ 1.5 x ULN and EGFR ≥ 40
  • ECOG performance status (PS) 0 or 1.
  • Urine protein-to-creatinine ratio ≤ 1mg/mg creatinine.
  • INR ≤ 1.5 and aPTT ≤ 1.2 x ULN
  • Measurable disease as determined by RECIST v1.1.
  • Sexually active fertile subjects and their partners must agree to use highly effective method of contraception during the course of the study and for the following durations after the last dose of treatment (whichever is later). An additional contraceptive method, such as a barrier method (listed in addendum), is required. In addition, men must agree not to donate sperm and women must agree not to donate eggs (ova, oocyte) for the purpose of reproduction during these same periods.
  • Through 186 days after the last dose of zanzalintinib or 120 days from retifanlimab (whichever is latest) for women of childbearing potential (WOCBP) or through 96 days after the last dose of zanzalintinib or retifanlimab (whichever is latest) for men
  • At least T3 disease or with pathologically enlarged local lymph nodes by pre-surgical imaging.

Who cannot join

  • Symptoms of clinical obstruction or impending clinical obstruction including severe constipation, nausea and vomiting, or other as deemed by the principal investigator.
  • Tumor invading GI-tract from external viscera
  • Active peptic ulcer disease, inflammatory bowel disease, diverticulitis, cholecystitis, symptomatic cholangitis or appendicitis, or acute pancreatitis
  • Systemic therapy with immunosuppressive agents within 7 days or use of any investigational drug within 28 days before the start of trial treatment
  • Prior exposure to any immune checkpoint blockade agent or any other immunomodulatory agent used for antineoplastic therapy within the last two years.
  • Previous malignant disease (other than the target malignancy to be investigated in this trial) within 2 years prior to study treatment initiation unless NED for greater than 2 years or deemed to have no possibility of interference with the current study (such as basal or squamous cell skin cancer, superficial bladder cancer, or carcinoma in situ of the prostate, cervix, or breast).
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  • Receipt of any organ transplantation, including allogeneic stem cell transplantation
  • Active autoimmune disease that might deteriorate when receiving an immunostimulatory agent, such as rheumatoid arthritis, which in the opinion of the Investigator might impair the subject's tolerance or ability to participate in the trial
  • Known severe hypersensitivity reactions to monoclonal antibodies or drug formulation components of retifanlimab or Zanalintinib
  • Subject is pregnant or breast feeding or planning to become pregnant while enrolled in the study, up to the final end of treatment visit
  • Congestive heart failure ≥ New York Heart Association (NYHA) class III.
  • Unstable angina (angina symptoms at rest), new-onset angina (begun within the last 3 months), myocardial infarction less than 6 months before start of study drug.
  • Uncontrolled cardiac arrhythmias.
  • Poorly controlled hypertension, defined as a blood pressure consistently above 140/90 mmHg despite optimal medical management.
  • Persistent proteinuria of NCI-CTCAE Grade 3 or higher. Urine dipstick result of 3+ or abnormal, based on type of urine test strip used, is allowed if protein excretion (estimated by urine protein/creatinine ratio on a random urine sample) is < 3.5 g/24 hr.
  • Non-healing wound, non-healing ulcer, or non-healing bone fracture.
  • Significant acute gastrointestinal disorders with diarrhea as a major symptom e.g., Crohn's disease, malabsorption, or NCI CTCAE Grade ≥ 2 diarrhea of any etiology other then secondary to colon cancer.
  • Participants with an active, known or suspected autoimmune disease. -Participants with type I diabetes mellitus (T1DM), hypothyroidism only requiring hormone replacement, skin disorders (such as vitiligo, psoriasis, or alopecia) not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger are permitted to enroll.
  • Active autoimmune disease requiring systemic immunosuppression in excess of physiologic maintenance doses of corticosteroids (> 10 mg/day of prednisone or equivalent).
  • Physiologic corticosteroid replacement therapy at doses ≤ 10 mg/day of prednisone or equivalent for adrenal or pituitary insufficiency and in the absence of active autoimmune disease is permitted.
  • Participants with asthma that requires intermittent use of bronchodilators, inhaled corticosteroids, or local corticosteroid injections may participate.
  • Participants using topical, ocular, intra-articular, or intranasal corticosteroids (with minimal systemic absorption) may participate.
  • Brief courses of corticosteroids for prophylaxis (eg, contrast dye allergy) or study treatment-related standard premedications are permitted.
  • Active infections requiring systemic antibiotics or antifungal or antiviral treatment within 7 days before first dose of study treatment
  • Has received a live vaccine within 28 days before the planned start of study treatment (mRNA vaccines not considered live vaccines).
  • Note: Examples of live vaccines include but are not limited to measles, mumps, rubella, varicella-zoster (chickenpox), yellow fever, rabies, BCG, and typhoid vaccines. Seasonal influenza vaccines for injection are generally killed-virus vaccines and are allowed; however, intranasal influenza vaccines are live, attenuated vaccines and are not allowed
  • Male participants with reproductive potential must agree to take appropriate precautions to avoid fathering children from screening through 180 days after the last dose of retifanlimab.
  • Participants with laboratory values at screening defined in Table 1.
  • Evidence of interstitial lung disease, history of interstitial lung disease, or active, noninfectious pneumonitis.
  • Corrected QT interval calculated by the Fridericia formula (QTcF) > 480 ms within 14 days per electrocardiogram (ECG) before first dose of study treatment
  • Pulmonary embolism (PE) or deep vein thrombosis (DVT) or prior clinically significant venous events within 3 months before first dose of study treatment.
  • Note: Subjects with a diagnosis of DVT within 6 months are allowed if asymptomatic and stable at screening and are on a stable dose of the anticoagulant for at least 1 week before first dose of study treatment without clinically significant hemorrhagic complications from the anticoagulation regimen.
  • Note: Subjects who don't require prior anticoagulation therapy may be eligible but must be discussed and approved by the Principal Investigator.
  • Concomitant anticoagulation with oral anticoagulants and platelets inhibitors including the following Warfarin, Clopidogrel Acceptable anticoagulants include wow molecular weight heparin, aspirin, rivaroxaban, apixaban, edoxaban
  • Subjects must have discontinued non-accepted anticoagulant within 3 days or 5 half-lives prior to first dose of treatment (whichever is longer)
  • Any medical condition, patient characteristic or past medical history that in the opinion of the principal investigator that would interfere with the patient's safety or compliance while on trial
  • Any prior treatment with zanzalitinib or retifanlimab
  • Stroke or including TIA, MI, or other ischemic event within 6 months before first dose of study treatment
  • Known gastric or esophageal varices
  • Ascites, pleural effusions, or pericardial fluid requiring drainage in the last 4 weeks.
  • Clinically significant hematuria, hematemesis, or hemoptysis of >0.5 tsp (2.5ml) of red blood, or other history of significant bleeding within 12 weeks before first dose of study treatment
  • Symptomatic cavitating pulmonary lesion(s) or endobronchial disease (asymptomatic or radiated lesions allowed)
  • Lesions invading or encasing any major blood vessels
  • Known infection with acute or chronic hepatitis B or C, known human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS)-related illness with the exception of subjects meeting all of the following criteria: (1) on stable anti-retroviral therapy; (2) CD4+ T cell count ≥ 200/µL; and (3) an undetectable viral load. Note: HIV testing will be performed at screening if and as required by local regulation. Note: In order to be eligible, participants taking CYP inhibitors (eg, zidovudine, ritonavir, cobicistat, didanosine) or CYP3 inducers (efavirenz) must change to a different regimen not including these drugs 7 days prior to initiation of study treatment. Anti-retroviral therapies (ART) must have been received for at least 4 weeks prior to the first dose.
  • Requirement for hemodialysis or peritoneal dialysis.
  • Major surgery within 8 weeks, prior laparoscopic nephrectomy within 4 weeks, minor surgery within 5 days. Endoscopy with or without biopsy is not considered minor surgery. Subjects must have complete wound healing before first dose of study treatment.
  • Inability to swallow tablets or ingest a suspension either orally or by a NG or PEG tube.
  • Known positive test for tuberculosis infection if supported by clinical or radiographic evidence of disease.
  • Free T4 outside of the laboratory normal reference range. Asymptomatic subjects with FT4 abnormalities can be eligible after principal investigator approval.

Trial locations and contacts

No sites are listed yet. Contact the study team or a site near you to ask about taking part.

GI Referral GI Trial Referral Team contact

(516) 734-8900

gitrialreferral@northwell.edu

About this study

This is a Phase II, single-arm, open-label trial evaluating the feasibility, safety, and preliminary activity of neoadjuvant Zanzalintinib (a VEGFR-targeting TKI) and Retifanlimab (an anti-PD-1 antibody) in patients with resectable stage II-III mismatch repair-proficient (pMMR) colon cancer. The study's primary objective is to determine the proportion of patients able to undergo curative-intent surgery within 14-35 days after completing two cycles (6 weeks) of neoadjuvant therapy. Secondary objectives include assessment of safety/tolerability and rates of pathologic response, including tumor regression grade (TRG). Two-year relapse-free survival (RFS) will also be evaluated.

This trial builds on emerging evidence from neoadjuvant immunotherapy studies-including in pMMR tumors-and the recently positive readout of STELLAR-303, which evaluated Zanzalintinib plus a PD-(L)1 inhibitor in refractory metastatic colorectal cancer. With a favorable safety profile, short treatment window, and rapid post-treatment pathologic readout, this study provides a low-risk opportunity to test whether immunotherapy-based neoadjuvant strategies can improve outcomes and potentially redefine management in early-stage, pMMR colon cancer.

Being tested
Retifanlimab, Zanzalintinib

What participants receive

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

  • RetifanlimabDrug

    Retifanlimab-dlwr is a programmed death receptor-1 (PD-1)-blocking antibody. Retifanlimab-dlwr is a humanized IgG4 kappa monoclonal antibody produced in Chinese hamster ovary cells. Retifanlimab-dlwr has an approximate molecular weight of 148 kDa.

    ZYNYZ (retifanlimab-dlwr) injection is a sterile, preservative-free, clear to slightly opalescent, colorless to pale yellow solution for intravenous use. The solution is free from visible particles.

    Each single-dose vial contains 500 mg of retifanlimab-dlwr in 20 mL of solution. Each mL contains 25 mg of retifanlimab-dlwr, glacial acetic acid (0.18 mg), polysorbate 80 (0.1 mg), sodium acetate (0.57 mg), sucrose (90 mg), and Water for Injection, USP. The pH is 5.1

  • ZanzalintinibDrug

    Chemical Name: N-(4-fluorophenyl)-N-(4-((7-methoxy-6-(methylcarbamoyl)quinoline-4-yl)oxy)phenyl)cyclopropane-1,1-dicarboxamide hemi-fumarate.

    Zanzalintinib doses administered reflect salt weight-converted free base equivalent (FBE) doses.

    Exelixis will provide each Investigator with adequate supplies of zanzalintinib, which will be supplied as 60mg, 40 mg or 20mg film-coated tablets.

    Tablets should be stored at room temperature.

Study groups in NCT07677579
Study groupRoleWhat they receive
Single ArmExperimentalPhase II, single arm, open-label study of the feasibility, safety and efficacy of neoadjuvant treatment of colon cancer with Zanzalitinib and Retifanlimab. Zanzalitinib 60mg daily for 21 days for 2 cycles. VEGF TKI. Retifanlimab 375mg once every 21 days for 2 cycles. Anti-PD1 agent
Receives: Drug: Retifanlimab; Drug: Zanzalintinib

What is being measured

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

  1. Intent for Curative Surgery Post-Treatment

    To determine the proportion of patients treated with two cycles of neoadjuvant Zanzalintinib and Retifanlimab to proceed to curative intent surgery within 14-35 days of completion of treatment.

    Measured: Within 14-35 days after completion of two cycles of neoadjuvant therapy

Secondary outcomes (3)
  1. Safety And Tolerability of Neoadjuvant Therapy

    To evaluate the tolerability and safety (incidence and severity of treatment-emergent adverse events [TEAEs]) of neoadjuvant treatment with Zanzalintinib and Retifanlimab

    Measured: From first dose of neoadjuvant therapy through 30 days post-curative intent surgery

  2. Pathologic Disease Response Following Neoadjuvant Therapy

    To measure the rate of pathologic response in resected colon cancer tissue specimen following neoadjuvant (Zanzalinitinib and Retifanlimab) treatment.

    Tumor Regression Grade (TRG) and pathologic Complete Response (pCR) will be used to describe the disease response to neoadjuvant therapy following collection of resected colon cancer tissue specimen during curative-intent surgery. Pathological downstaging will be evaluated through comparison of pre-treatment radiographic (imaging) TNM classification stage versus post-surgical pathologic TNM stage.

    Measured: At the time of curative-intent surgery

  3. Disease-Free Survival (DFS) at Two Years

    To determine two-year relapse free survival (RFS) rate

    Measured: 2 years following curative-intent surgery

Timeline

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

  1. First posted1 Jul 2026
  2. Study start30 Aug 2026 (estimated)
  3. Primary completion30 Aug 2028 (estimated)
  4. Study completion30 Dec 2028 (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
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
26 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07677579
Sponsor's protocol ID
NHCI25-005
Acronym
NIMBLE
Status last verified
Jun 2026
First submitted
6 May 2026
Last updated
1 Jul 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Retifanlimab and Zanzalintinib in people with Colon Cancer Metastatic, run by Northwell Health.

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 17 inclusion and 49 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: opening soon, as of the sponsor's last update on 1 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.

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 GI Referral GI Trial Referral Team ((516) 734-8900, gitrialreferral@northwell.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Intent for Curative Surgery Post-Treatment (time frame: Within 14-35 days after completion of two cycles of neoadjuvant therapy). 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 1 Jul 2026.

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