Cemiplimab With or Without Fianlimab to Treat Older Patients With Localized or Locally Advanced MSI-H Colorectal Cancer

Inclusion criteria

• for Cohort A and B:
• Age ≥70 years.
• Eastern Cooperative Oncology Group (ECOG) performance status 0 -2
• Have histologically proven localized or locally advanced mismatch repair deficient (dMMR) or microsatellite unstable (MSI-H) colorectal cancer.
• Must not have received any prior systemic treatment or radiation.
• Must be agreeable to endoscopic, and CT surveillance for a total of 24 months.
• Patient's acceptance to have a tumor biopsy.
• Patients must have adequate organ and marrow function defined by study-specified laboratory tests and procedures.
• LVEF assessment with documented LVEF ≥ 45% by either TTE or MUGA (TTE preferred) within 6 months from first study drug administration.
• For both Women and Men, must use acceptable form of birth control while on study.
• Ability to understand and willingness to sign a written informed consent document. Inclusion Criteria for Cohort C and D:
• Age ≥18 years.
• Eastern Cooperative Oncology Group (ECOG) performance status 0 -3.
• Have histologically proven localized or locally advanced mismatch repair deficient (dMMR) or microsatellite unstable (MSI-H) colorectal cancer.
• Patient deemed a poor surgical candidate after evaluation by a surgeon or unwilling to undergo surgery.
• Must not have received any prior systemic treatment or radiation.
• Must be agreeable to endoscopic, and CT surveillance for a total of 24 months.
• Patient's acceptance to have a tumor biopsy.
• Patients must have adequate organ and marrow function defined by study-specified laboratory tests and procedures.
• For both Women and Men, must use acceptable form of birth control while on study.
• Ability to understand and willingness to sign a written informed consent document.

Exclusion criteria

• for Cohorts A and B:
• Have received an investigational agent or used an investigational device within 28 days of the first dose of study drug.
• Have expected to require any other form of systemic or localized antineoplastic therapy while on study.
• Have had surgery within 28 days of dosing of investigational agent, excluding minor procedures (dental work, skin biopsy, etc.).
• History of prior treatment with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CTLA4, or anti-Lag-3 antibodies for any reason in the 5 years proceeding their colorectal cancer diagnosis.
• Currently using any chronic systemic steroids.
• Patient has received a live vaccine within 30 days of the first dose of study drug.
• History of severe hypersensitivity reaction to any monoclonal antibody.
• Uncontrolled intercurrent illness including, but not limited to, uncontrolled infection, symptomatic congestive heart failure, unstable angina, cardiac arrhythmia, metastatic cancer, or psychiatric illness/social situations that would limit compliance with study requirements.
• Active autoimmune disease.
• Any tissue or organ allograft, regardless of need for immunosuppression, including corneal allograft.
• Patient has a pulse oximetry of \<92% on room air.
• Patient is on supplemental home oxygen.
• Has clinically significant heart disease.
• Cohort B Only: Troponin T (TnT) or troponin I (TnI) \> 2x institutional ULN at baseline.
• Conditions, including alcohol or drug dependence, intercurrent illness, or lack of sufficient peripheral venous access, that would affect the patient's ability to comply with study visits and procedures.
• Unwilling or unable to follow the study schedule for any reason Exclusion for Cohort C and D:
• Have received an investigational agent or used an investigational device within 28 days of the first dose of study drug.
• Have expected to require any other form of systemic or localized antineoplastic therapy while on study.
• Currently using any chronic systemic steroids.
• Patient has received a live vaccine within 30 days of the first dose of study drug.
• History of severe hypersensitivity reaction to any monoclonal antibody.
• Any tissue or organ allograft, regardless of need for immunosuppression, including corneal allograft.
• Patient is pregnant or breastfeeding.
• Cohort D Only: Troponin T (TnT) or troponin I (TnI) \> 2x institutional ULN at baseline.
• Conditions, including alcohol or drug dependence, intercurrent illness, or lack of sufficient peripheral venous access, that would affect the patient's ability to comply with study visits and procedures.
• Participation deemed not in the best interest of the patient.
• Unwilling or unable to follow the study schedule for any reason.