Neoadjuvant Transcatheter Arterial Chemoembolization Combined With Lenvatinib Plus Cadonilimab for Resectable Hepatocellular Carcinoma: A Single-Arm Phase II Clinical Trial
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Resectable Hepatocellular Carcinoma
- Sponsor
- Fujian Provincial Hospital
- Enrollment
- 20
- Locations
- 6
- Primary Endpoint
- MPR rate
- Status
- Recruiting
- Last Updated
- last year
Overview
Brief Summary
This study is a single-arm, multi-center, prospective phase II trial aimed at evaluating the efficacy and safety of neoadjuvant therapy with transarterial chemoembolization (TACE) combined with lenvatinib and camrelizumab (triple therapy) in patients with resectable hepatocellular carcinoma (HCC). The study plans to enroll 20 patients. The primary endpoints are major pathological response (MPR) rate and safety, while the secondary endpoints are recurrence-free survival (RFS), objective response rate (ORR), R0 resection rate, and overall survival (OS).
Investigators
Mao-Lin Yan
Department of Hepatobiliary Pancreatic Surgery
Fujian Provincial Hospital
Eligibility Criteria
Inclusion Criteria
- •Voluntarily join the study and sign the informed consent form.
- •Male or female patients aged between 18 and 75 years.
- •Child-Pugh class A.
- •Indocyanine green 15-minute retention rate (ICGR-15) \< 15%.
- •ECOG performance status 0-
- •Diagnosed with hepatocellular carcinoma (HCC) according to the "Guidelines for Diagnosis and Treatment of Primary Liver Cancer (2022 Edition)."
- •BCLC stage A or B, with a single tumor larger than 5 cm or multiple tumors, and considered surgically resectable after multidisciplinary discussion.
- •According to RECIST 1.1 criteria, the patient has at least one measurable lesion (a measurable lesion with a long diameter ≥ 10 mm on CT/MRI scan, and the measurable lesion has not received local treatments such as radiotherapy or cryotherapy).
- •Blood routine: absolute neutrophil count ≥ 1.5 × 10\^9/L, Hb ≥ 8.5 g/L, PLT ≥ 75 × 10\^9/L.
- •No history of severe arrhythmia, heart failure, severe pulmonary ventilation disorders, or severe lung infections; no acute or chronic renal failure, and creatinine clearance rate \> 40 mL/min.
Exclusion Criteria
- •Tumor rupture with bleeding or suspected abdominal cavity metastasis.
- •Previous treatment with any antitumor therapies before enrollment, such as targeted drugs, PD-1/PD-L1/CTLA-4 monoclonal antibodies, surgery, TACE, FOLFOX systemic chemotherapy, radiotherapy, and Huaier granules.
- •History of allergy to lenvatinib, cadonilimab, or their components.
- •Presence of any active autoimmune disease or a history of autoimmune disease with expected recurrence (e.g., interstitial pneumonia, colitis, hepatitis, hypophysitis, vasculitis, nephritis, hyperthyroidism, hypothyroidism, including but not limited to these diseases and syndromes); hypothyroidism treated with stable doses of thyroid replacement hormone; type 1 diabetes mellitus treated with stable doses of insulin; excluding patients with vitiligo or childhood asthma/allergies that have resolved and require no intervention in adulthood.
- •History of immunodeficiency; patients using immunosuppressive drugs or systemic corticosteroids for immunosuppressive purposes and who have continued using them within 2 weeks before signing the informed consent form.
- •Known hereditary or acquired bleeding (e.g., coagulopathy) or thrombotic tendency, such as hemophilia; currently receiving or recently (within 10 days before the start of study treatment) receiving full-dose oral or injectable anticoagulants or thrombolytics for therapeutic purposes (prophylactic use of low-dose aspirin and low-molecular-weight heparin is allowed).
- •Severe infection within 4 weeks before the first use of the study drug (CTC AE grade \> 2), such as severe pneumonia requiring hospitalization, bacteremia, or infection complications; baseline chest imaging indicating active lung inflammation; symptoms and signs of infection within 2 weeks before the first use of the study drug or requiring oral or intravenous antibiotic treatment (excluding prophylactic antibiotic use).
- •Urinalysis indicating proteinuria ≥ 1+; if so, a 24-hour urine protein test is required; patients with 24-hour urine protein ≥ 1 g.
- •History of other malignancies within the past 5 years or concurrently, except for cured basal cell carcinoma of the skin, cervical carcinoma in situ, and papillary thyroid carcinoma.
- •Patients with concomitant psychiatric disorders; history of substance abuse, alcohol, or drug addiction.
Outcomes
Primary Outcomes
MPR rate
Time Frame: Immediately after surgery
The proportion of residual viable tumor cells in the tumor bed of the surgically resected specimen ≤10%.
Reoperation rate
Time Frame: From date of surgery, assessed up to 12 months.
Defined as the percentage of postoperative complications that were resolved by surgical treatment.
Adverse events
Time Frame: From the initiation of medication, with recordings made whenever an adverse reaction occurs, assessed up to 12 months.
Refer to the adverse events related to study medication, including type, incidence, and severity; severity was graded according to NCI CTCAE Version 5.0.
Operative mortality
Time Frame: From date of surgery, assessed up to 1 month.
Defined as the rate of death occurring in the hospital or within 30 days of surgery.
Operative complications
Time Frame: From date of surgery, assessed up to 12 months.
Defined as complications directly related to surgery and graded according to the Clavien-Dindo classification.
Secondary Outcomes
- ORR(Four weeks after the initiation of medication until the day before surgery)
- R0 resection rate(Immediately after surgery)
- RFS(From date of surgery until the date of first documented recurrence or date of death from any cause, whichever came first, assessed up to 60 months.)
- OS(From date of surgery until the date of death from any cause, assessed up to 60 months.)