Clinical Study of Envafolimab Combined With Fruquintinib and Chemotherapy for Neoadjuvant Treatment of Gastric Cancer

Phase 2

Recruiting

• Conditions: Gastric Cancer
• Interventions: Drug: Envafolimab; Drug: Fruquintinib

• Registration Number: NCT06791083
• Lead Sponsor: First Affiliated Hospital of Fujian Medical University

Brief Summary

To observe and evaluate the neoadjuvant treatment of Envafolimab combined with Fruquintinib and chemotherapy for locally advanced gastric/gastroesophageal junction carcinoma

Detailed Description

This study observed and evaluated the major pathological response rate (MPR), pathological complete response rate (pCR), pathological response rate (pRR), objective response rate (ORR), R0 removal rate, disease-free survival (DFS) of Envafolimab combined with Fruquintinib and chemotherapy in neoadjuvant therapy for locally advanced gastric/gastroesophageal junctional cancer. Overall survival (OS) and security. The relationship between tumor angiogenesis and lymphangiogenesis and clinical outcome of patients (including but not limited to immunohistochemical detection of CD31, CD3, CD8, etc.) was also explored.

Study Timeline

• Study Start: 2024-06-20
• Study First Submitted: 2024-06-20
• Status Verified: 2025-01
• Study First Submitted QC: 2025-01-19
• Last Update Submitted: 2025-01-19
• Study First Posted: 2025-01-24
• Last Update Posted: 2025-01-24
• Primary Completion: 2025-12
• Study Completion: 2027-05

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 40

Inclusion Criteria

1. Have fully understood the study and voluntarily signed the informed consent;

2. Aged 18-75 years (including 18 and 75 years);

3. Pathologically confirmed or potentially resectable locally advanced gastric/gastroesophageal junction adenocarcinoma (cT2-T4b, N+M0);

4. If bone metastasis is suspected, a bone scan should be performed. If peritoneal metastasis is suspected, abdominal examination should be performed to rule out distant metastasis.

5. At least 1 measurable lesion according to RECIST v1.1 criteria;

6. United States Eastern Cancer Consortium (ECOG) Physical status score 0-1; BMI≥18;

7. Expected survival ≥12 weeks;

8. The functions of vital organs during the first 14 days of enrollment met the following requirements:

   • Absolute neutrophil count ≥1.5×109/L;
   • Platelet ≥80×109/L;
   • Hemoglobin ≥90g/L;
   • Total bilirubin < 1.5 ULN; ALT and AST < 2.5 ULN (< 5 ULN in patients with liver metastasis);
   • Serum creatinine (Cr) ≤1.5×ULN or creatinine clearance (CCr)≥60ml/min;
   • endogenous creatinine clearance > 50ml/min;

9. Female subjects of childbearing age or male subjects whose sexual partner is a female of childbearing age should take effective contraceptive measures during the whole treatment period and 6 months after the treatment period;

10. Good compliance, cooperate with follow-up.

Exclusion Criteria

1. Known HER2-positive patients;

2. Participated in other drug clinical trials and received at least one drug therapy within 4 weeks prior to enrollment or received other systemic anti-tumor therapy, including chemotherapy, signal transduction inhibitors, immunotherapy, and other investigational drugs within 4 weeks prior to enrollment;

3. Had other malignancies within 5 years prior to admission, except basal cell or squamous cell carcinoma of the skin after radical surgery, or carcinoma in situ of the cervix;

4. Receive live vaccine within 4 weeks prior to enrollment or possibly during the study period;

5. Had active autoimmune disease or history of autoimmune disease within 4 weeks prior to enrollment;

6. Previously received allogeneic bone marrow transplantation or organ transplantation;

7. The patient has a current disease or condition that affects drug absorption, or the patient cannot take Fruquintinib orally;

8. Subjects who are allergic to the investigational drug or any of its adjuncts;

9. The investigator identified clinically significant electrolyte abnormalities;

10. Hypertension that could not be controlled by drugs before enrollment was defined as: systolic blood pressure ≥150 mmHg and/or diastolic blood pressure ≥100 mmHg;

11. Gastrointestinal diseases such as active ulcer of stomach and duodenum, ulcerative colitis, or active bleeding of unresectable tumors, or other conditions that may cause gastrointestinal bleeding or perforation as determined by researchers before enrollment;

12. Patients with significant evidence or history of bleeding tendency within 3 months (bleeding >30 mL within 3 months, accompanied by hematemesis, stool, and blood in the stool), hemoptysis (>5 mL of fresh blood within 4 weeks), or thromboembolic events (including stroke events and/or transient ischemic attacks) within 12 months prior to admission;

13. History of severe cardiovascular and cerebrovascular diseases:

    • Cerebrovascular accident (excluding lacunar infarction, minor cerebral ischemia, or transient ischemic attack), myocardial infarction, unstable angina, and poorly controlled arrhythmias (including QTc interval ≥ 450ms for men and 470 ms for women) within 6 months prior to first administration of the study drug (QTc interval Fridericia) Formula calculation);
    • New York Heart Association (NYHA) heart function Grade > II or left ventricular ejection fraction (LVEF) < 50%;

14. Known human immunodeficiency virus (HIV) infection; A known history of clinically significant liver disease, including viral hepatitis [active HBV infection, i.e., positive HBV DNA (>1×104 copies /mL or >2000 IU/ml) must be excluded for a known hepatitis B virus (HBV) carrier; Known hepatitis C virus infection (HCV) and HCV RNA positive (>1×103 copies /mL), or other hepatitis, cirrhosis];

15. Women who are pregnant (positive pregnancy test before medication) or breastfeeding; 17. Two consecutive routine urine tests indicated urine protein ≥2+, and the urine protein volume >1.0g within 24 hours of reexamination; 18. Patients with ascites or pleural effusion with clinical symptoms; 19. CTCAE V5.0 grade 1 or higher toxicity due to any previous anticancer treatment that is not resolved, excluding oxaliplatin induced alopecia, lymphocytopenia, and neurotoxicity ≤ grade 2; 20.Patients considered inappropriate for inclusion in this study.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Envafolimab combined with Fruquintinib and chemotherapy	Envafolimab	-
Envafolimab combined with Fruquintinib and chemotherapy	Fruquintinib	-

Primary Outcome Measures

Name	Time	Method
Major pathological response rate (MPR)	up to 12 months	MPR is defined as the proportion of neoadjuvant therapy induced tumor regression with pathologically remaining tumor \< 10%

Secondary Outcome Measures

Name	Time	Method
Pathological complete response rate (pCR)	up to 12 months	pCR is defined as the proportion of patients who do not have residual cancer cells on pathological examination after treatment
Pathological response rate (pRR)	up to 12 months	pRR is defined as the proportion of patients whose pathologic examination after treatment found no cancer cells remaining or whose cancer cells remaining within a pre-specified value range
Disease-free survival (DFS)	From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 10 years	DFS is defined as the time between a patient's enrollment and the onset of tumor recurrence or death from any cause
Objective response rate (ORR)	up to 12 months	ORR is defined as the proportion of patients whose best overall assessment is a complete or partial response.
Overall survival (OS)	From date of randomization until the date of death from any cause, assessed up to 10 years	OS is defined as the time until a patient is enrolled and dies from any cause
R0 removal rate	up to 24 weeks	R0 resection rate was defined as the proportion of patients with complete resection of the tumor and a negative submicroscopic margin, i.e. no residual tumor

Trial Locations

Locations (1)

The First Affiliated Hospital of Fujian Medical University; 🇨🇳 FuZhou, Fujian, China