A Multicenter Randomized Controlled Phase II Trial of Iparomlimab and Tuvonralimab (QL1706) Combined with SOX Chemotherapy Versus Chemotherapy Alone in the Treatment of Locally Advanced Gastric or Gastroesophageal Junction Adenocarcinoma

Phase 2

Not yet recruiting

• Conditions: Locally Advanced Gastric/Gastroesophageal Junction Adenocarcinoma
• Interventions: Drug: Neoadjuvant Therapy(QL1706+SOX Chemotherapy); Drug: Neoadjuvant Therapy(SOX Chemotherapy); Procedure: Radical surgery (D2)

• Registration Number: NCT06829797
• Lead Sponsor: Shandong Provincial Hospital

Brief Summary

To explore the efficacy of Iparomlimab and Tuvonralimab (QL1706) in combination with SOX chemotherapy versus chemotherapy alone for the neoadjuvant treatment of locally-progressed gastric/gastroesophageal union adenocarcinomas by evaluating the complete pathologic remission rate (pCR).

Detailed Description

Not available

Study Timeline

• Status Verified: 2025-01
• Study First Submitted: 2025-02-06
• Study First Submitted QC: 2025-02-11
• Last Update Submitted: 2025-02-11
• Study First Posted: 2025-02-17
• Last Update Posted: 2025-02-17
• Study Start: 2025-02-28
• Primary Completion: 2028-02-29
• Study Completion: 2028-02-29

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: All
• Target Recruitment: 96

Inclusion Criteria

• Voluntary participation in the study and signing of informed consent;
• Age ≥18 years and ≤75 years;
• Pathologically confirmed gastric adenocarcinoma or gastroesophageal junction adenocarcinoma;
• Clinical staging of T3N+ or T4a any N, M0 (according to AJCC 8th edition staging), with potential radical resection confirmed by CT or MRI;
• Have not received any anti-tumor therapy (e.g., surgery, radiotherapy, chemotherapy, targeted therapy and immunotherapy);
• Planned to undergo surgery after completion of neoadjuvant therapy;
• Be able to swallow pills normally;
• ECOG-PS score 0-1;
• Expected survival ≥ 12 months;
• Normal major organ function.

Exclusion Criteria

• Known HER2 positivity;
• Known peritoneal metastases or positive peritoneal cytology (CY1P0) or T4b (according to AJCC 8th edition);
• Presence of unresectable factors including unresectable tumors, contraindications to surgery and refusal of surgery;
• The presence of a pre-existing or concurrent malignancy, with the exception of cured basal cell carcinoma of the skin, carcinoma in situ of the cervix, and carcinoma in situ of the breast
• History of gastrointestinal perforation, history of abdominal abscess or recent (within 3 months) occurrence of intestinal obstruction, or concomitant intestinal obstruction as indicated by imaging or clinical signs;
• Patients with abnormal coagulation (International Normalized Ratio (INR) >2.0 or Prothrombin Time (PT) >16s), a bleeding tendency or currently receiving thrombolytic or anticoagulant therapy (prophylactic use of low-dose aspirin and low-molecular-weight heparin is allowed);
• Clinically significant bleeding symptoms or significant bleeding tendency such as gastrointestinal bleeding, gastric ulcer bleeding, and vasculitis within 3 months prior to randomization into groups. Patients with positive fecal occult blood at baseline may be retested, and if the retest remains positive, gastroscopy will be required (except for patients who have had a gastroscopy within 3 months prior to enrollment to rule out this condition);
• Arterial/venous thrombotic events such as cerebrovascular accidents (including transient ischemic attack, cerebral hemorrhage, and cerebral infarction), deep vein thrombosis, and pulmonary embolism within 6 months prior to randomization to group;
• A known hereditary or acquired predisposition to bleeding and thrombosis (e.g., hemophilia, coagulation disorders, and thrombocytopenia);
• The presence of active ulcers, unhealed wounds or fractures
• Urinalysis showing urinary protein ≥++, confirmed by 24-hour urine protein quantification >1.0 g;
• Active infections requiring antimicrobial therapy (e.g., antibacterial, antiviral, and antifungal medications);
• Active hepatitis (Hepatitis B reference: HBsAg positive and HBV DNA ≥ 500 IU/mL; Hepatitis C reference: HCV antibody positive and HCV viral copy number > upper limit of normal (ULN));
• Congenital or acquired immunodeficiency (e.g., HIV-infected patients);
• Planned or previous organ or allogeneic bone marrow transplant;
• Current interstitial pneumonia or interstitial lung disease, or a history of interstitial pneumonia or interstitial lung disease requiring hormonal therapy, or other conditions that may interfere with the assessment and management of immune-related pulmonary toxicity, such as pulmonary fibrosis, opportunistic pneumonia (e.g., occlusive bronchiectasis), pneumoconiosis, drug-associated pneumonia, and idiopathic pneumonitis, or active pneumonitis or severe pulmonary impairment as demonstrated by CT at screening; Active tuberculosis;
• Any active autoimmune disease or history of autoimmune disease with potential for relapse;
• Treatment with immunosuppressive drugs or systemic corticosteroids (>10 mg/day of prednisone or equivalent) within 7 days prior to randomization to group;
• Use of a strong CYP3A4 inducer within 2 weeks prior to randomization subgroup or use of a strong CYP3A4 inhibitor within 1 week prior to randomization subgroup
• Oral or intravenous administration of therapeutic antibiotics within 4 weeks prior to randomization to subgroups, except for prophylactic antibiotics administered intravenously for no more than 48 hours
• Known allergy to any study drug or excipient;
• Participation in a clinical study of another drug within 4 weeks prior to randomization to group;
• Being a lactating female.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
QL1706+SOX group	Neoadjuvant Therapy(QL1706+SOX Chemotherapy)	-
QL1706+SOX group	Radical surgery (D2)	-
SOX group	Neoadjuvant Therapy(SOX Chemotherapy)	-
SOX group	Radical surgery (D2)	-

Primary Outcome Measures

Name	Time	Method
Pathological complete response rate (pCR)	From date of neoadjuvant therapy until the date of postoperative pathological assessment, assessed up to 14-16 weeks.	Pathological complete response was defined as pT0N0M0

Secondary Outcome Measures

Name	Time	Method
Major pathological response rate (MPR)	From date of neoadjuvant therapy until the date of postoperative pathological assessment, assessed up to 14-16 weeks.	The percentage of surviving tumor cells in the tumor bed after neoadjuvant therapy was ≤10%.
R0 resection rate	From date of neoadjuvant therapy until the date of postoperative pathological assessment, assessed up to 14-16 weeks.	The proportion of patients who completed R0 resection in the total enrolled patients.
Event-free survival (EFS)	From date of neoadjuvant therapy until the date of the first occurrence of the above events, assessed up to 60 months.	From the beginning of the study to the time of the first occurrence of any of the following events, disease progression beyond surgical treatment, local or distant recurrence, death from any cause, etc.
Overall survival (OS)	From the date of diagnosis to the date of death, assessed up to 60 months.	From study inception to patient death from any cause.
Disease-free survival (DFS)	From date of neoadjuvant therapy until the date of the disease recurrence or death due to disease progression, assessed up to 60 months.	The time from randomization until disease recurrence or death due to disease progression.
Surgical safety	From date of neoadjuvant therapy until the date of 30 days post-surgery, assessed up to 17-19 weeks.	The occurrence of postoperative complications including surgical site infection, anastomotic leakage, gastrointestinal bleeding, incisional dehiscence, adhesive bowel obstruction, biliary and celiac fistulae, and unexplained fever (≥37.5°C).
Adverse Events	From the date of neoadjuvant therapy to the completion of postoperative adjuvant therapy, up to 24 months.	Based on NCI-CTCAE (version 5.0) adverse events (AEs): including type, incidence, grading, severity, duration, and relevance to the study drug
Drug tolerance	From the date of neoadjuvant therapy to the completion of postoperative adjuvant therapy, up to 24-28 weeks.	The proportion of dose interruptions, dose reductions, and discontinuations due to drug-related toxicity during the study period.
Prognostic Biomarkers	From the date of neoadjuvant therapy initiation until the end of postoperative follow-up, up to 24 months.	Biomarkers of interest include PD-L1 expression (assessed by IHC), microsatellite instability (MSI) status (determined by PCR-based testing), tumor mutation burden (TMB) (evaluated using next-generation sequencing), and circulating tumor DNA (ctDNA) levels (quantified via liquid biopsy). The correlation between these biomarkers and treatment efficacy, including progression-free survival (PFS) and overall survival (OS), will be analyzed.