Combined Therapy Using Gemcitabine and Cisplatin Chemotherapy, Lenvatinib and Adebrelimab for Patients With Advanced and Unresectable Intrahepatic Cholangiocarcinoma: a Prospective, Single-arm, Phase II Trial.
Overview
- Phase
- Phase 2
- Intervention
- combined therapy using gemcitabine and cisplatin chemotherapy, Lenvatinib and Adebrelimab
- Conditions
- Intrahepatic Cholangiocarcinoma
- Sponsor
- Nanfang Hospital, Southern Medical University
- Enrollment
- 38
- Locations
- 1
- Primary Endpoint
- Objective response rate (ORR)
- Status
- Recruiting
- Last Updated
- last year
Overview
Brief Summary
In this phase 2 study, the investigators aim to evaluate the efficacy and safety of combined therapy using gemcitabine and cisplatin chemotherapy, Lenvatinib and Adebrelimab for patients with advanced and unresectable intrahepatic cholangiocarcinoma
Detailed Description
Most intrahepatic cholangiocarcinoma (ICC) patients are often accompanied by local or distant metastases and lose the opportunity for surgical resection. For patients with unresectable ICC who have been in stages IIIb and IV (AJCC/UICC, V2, 2018), the survival time is less than 4 months, and there is currently no standard treatment. TheGC chemotherapy (gemcitabine and cisplatin) has been used in the treatment of advanced intrahepatic cholangiocarcinoma, but the efficacy is still unsatisfactory. Lenvatinib is a small molecule multi-kinase inhibitor, the main targets including VEGFR1-3, fibroblast growth factor receptor 1-4, PDGFRα, RET(ret proto-oncogene ), KIT(KIT proto-oncogene, receptor tyrosine kinase), have anti-angiogenic effects, have been proven effective in hepatocellular carcinoma. In recent years, immunological checkpoint inhibitors (ICIs) have shown remarkable therapeutic effects in the treatment of various solid tumors. Combined with other therapies such as chemotherapy and targeted drugs is an important direction to improve the therapeutic effect of immunological checkpoint inhibitors. In this study, the investigators aim to evaluate the efficacy and safety of GC chemotherapy combined with Lenvatinib and immune checkpoint inhibitor PD-L1 antibody Adebrelimab for patients with advanced and unresectable intrahepatic cholangiocarcinoma.
Investigators
Eligibility Criteria
Inclusion Criteria
- •The patient must be required to sign an informed consent form;
- •Age 18-75 years old, male or female;
- •Eastern Cooperative Oncology Group (ECOG) fitness status score (PS score) 0-1;
- •Child-Pugh score A;
- •Histopathologically confirmed intrahepatic cholangiocarcinoma; consent to provide previously stored tumor tissue specimens or fresh biopsy tumor lesions;
- •Advanced and unresectable ICC patients;
- •The expected survival is longer than 12 weeks;
- •At least 1 measurable liver lesion or non-liver lesion (according to RECIST 1.1);
- •Functional indicators of vital organs meet the following requirements a Neutrophils ≥1.5\*109/L; platelets≥100\*109/L; hemoglobin≥9g/dl; serum albumin≥3g/dl; b Thyroid stimulating hormone (TSH) ≤ 1 times the upper limit of normal value(ULN), T3, T4 are in the normal range; c bilirubin ≤ 2 times ULN; Alanine aminotransferase （ALT） and Aspartate aminotransferase （AST） ≤ 2 times ULN; serum creatinine ≤ 1.5 ULN, creatinine clearance rate ≥ 60ml / min;
- •Non-lactating or pregnant women, contraception during or after 3 months of treatment.
Exclusion Criteria
- •Pathological diagnosis of hepatocellular carcinoma, mixed liver cancer and other non-cholangiocarcinoma malignant tumor components;
- •Patients who have received previous treatment with PD1 antibody, programmed death ligand -1 （PD-L1） antibody or cytotoxic T lymphocyte-associated antigen-4 （CTLA4） antibody;
- •With other malignant tumors, except for fully treated non-melanoma skin cancer, cervical carcinoma in situ, and papillary thyroid carcinoma;
- •Active tuberculosis infection. Patients with active tuberculosis infection within 1 year prior to enrollment; had a history of active tuberculosis infection more than 1 year before enrollment, did not receive formal anti-tuberculosis treatment or tuberculosis is still active;
- •Have an active, known or suspected autoimmune disease. Subjects who require only hormone replacement therapy for hypothyroidism and skin diseases that do not require systemic therapy may be enrolled;
- •Previous interstitial lung disease, or (non-infectious) pneumonia and need oral or intravenous steroid therapy;
- •Long-term systemic hormones (dose equivalent to \>10 mg prednisone/day) or any other form of immunosuppressive therapy are required. Subjects using inhaled or topical corticosteroids may be enrolled;
- •Severe cardiopulmonary and renal dysfunction;
- •Suffering from high blood pressure, and can not be well controlled by antihypertensive drugs (systolic blood pressure ≥140mmHg or diastolic blood pressure ≥90mmHg);
- •Abnormal blood coagulation (PT\>14s), with bleeding tendency or receiving thrombolytic or anticoagulant therapy;
Arms & Interventions
Combined therapy using GC, Lenvatinib and Adebrelimab
GC chemotherapy every 3 weeks,with a total of 6 cycles. Lenvatinib 8 mg once daily (QD) oral dosing. Adebrelimab 1200mg intravenously every 3 weeks.
Intervention: combined therapy using gemcitabine and cisplatin chemotherapy, Lenvatinib and Adebrelimab
Outcomes
Primary Outcomes
Objective response rate (ORR)
Time Frame: From date of first dose of study drug until disease progression, development of unacceptable toxicity, withdrawal of consent, or sponsor termination (up to approximately 3 years
ORR is defined as the percentage of participants who have best overall response (BOR) of complete response (CR) or partial response (PR) at the time of data cutoff as assessed by RECIST 1.1
Secondary Outcomes
- The disease control rate (DCR)(From date of first dose of study drug until disease progression, stable disease, development of unacceptable toxicity, withdrawal of consent, or sponsor termination (up to approximately 3 years))
- Duration of response (DOR)(From the first documentation of CR or PR to the first date of documentation of disease progression or death whichever occurs first (up to approximately 3 years))
- The median progression free survival time (mPFS)(From date of first dose of study drug to the date of first documentation of disease progression (up to approximately 3 years))
- The median overall survival time (mOS)(From the start date of the Treatment Phase until date of death from any cause (up to approximately 3 years))
- Number of participants with treatment-related adverse events as assessed by CTCAE v5.0(From the start date of the Treatment Phase until date of death from any cause (up to approximately 3 years))