Neoadjuvant Toripalimab Plus Chemotherapy for Resectable Stage II-IIIB Non-squamous Non-small Cell Lung Cancer With EGFR Mutation: a Multicentre, Multi-cohort, Exploratory Study.
Overview
- Phase
- Phase 2
- Intervention
- Toripalimab plus Chemotherapy
- Conditions
- Non Squamous Non Small Cell Lung Cancer
- Sponsor
- Peking University People's Hospital
- Enrollment
- 126
- Primary Endpoint
- Pathologic Complete Response (pCR) Rate
- Status
- Not yet recruiting
- Last Updated
- 2 years ago
Overview
Brief Summary
This study was designed to investigate the efficacy and safety of neoadjuvant Toripalimab (anti-PD1) plus chemotherapy for patients with resectable II-IIIB non-squamous NSCLC harboring EGFR mutation, and to explore the potential predictive and prognostic biomarkers, aiming to provide more abundant evidences for the preoperative treatment decision of non-squamous NSCLC patients.
Detailed Description
Previous studies have confirmed the efficacy of neoadjuvant immunotherapy in NSCLC patients without driver gene mutation, while its efficacy in driver gene mutated patients is still controversial. This study was designed to investigate the efficacy and safety of neoadjuvant Toripalimab (anti-PD1) plus chemotherapy for patients with resectable II-IIIB non-squamous NSCLC harboring EGFR mutation, and to explore the potential predictive and prognostic biomarkers, aiming to provide more abundant evidences for the preoperative treatment decision of non-squamous NSCLC patients.
Investigators
Yang Fan, MD
Professor of Thoracic Surgery
Peking University People's Hospital
Eligibility Criteria
Inclusion Criteria
- •Provision of signed informed consent by the patient or legally acceptable representative;
- •Previously untreated, histologically confirmed resectable stage II-IIIA, IIIB(N2) (AJCC staging 8th edition) non-squamous non-small cell lung cancer;
- •Adequate tissue samples for PD-L1 immunohistochemical testing and gene mutations test by RT-pCR or NGS, or consent for blood RT-PCR or NGS if tissue samples are insufficient;
- •Harboring EGFR mutation (19del or L858R);
- •Aged 18-70 years, regardless of gender;
- •Eastern Cooperative Group (ECOG) Performance Status 0-1;
- •Acceptable cardiac function with a left ventricular ejection fraction \>50%;
- •Acceptable respiratory function (FEV1\>1.5L, DLCO\>50%) and ability to tolerate radical lung cancer surgery;
- •Acceptable bone marrow haematopoiesis with leucocytes ≥ 4 x 10\^9/L, neutrophils ≥ 1.5 x 10\^9/L, haemoglobin ≥ 10g/dL and platelets ≥ 100 x 10\^9/L;
- •Acceptable renal function with a glomerular filtration rate ≥ 60 mL/min;
Exclusion Criteria
- •Pathological histologically confirmed small cell lung cancer, squamous epithelial cell carcinoma and other pathological subtypes cannot be enrolled;
- •Patients with advanced or metastatic lung cancer, or unresectable lung cancer, or who have received previous systemic anti-tumour therapy such as immunotherapy, chemotherapy or targeted therapy cannot be enrolled;
- •Patients with a history of active autoimmune disease or autoimmune disease that is likely to recur cannot be enrolled;
- •Patients with active hepatitis B and C requiring relevant antiviral therapy need to have HBV-DNA \<500 IU/ml and have been on anti-HBV treatment for at least 14 days prior to study entry and continue treatment during the treatment period; HCV RNA-positive patients should be excluded;
- •Patients who are allergic to chemotherapeutic agents such as carboplatin, paclitaxel, albumin paclitaxel, pemetrexed;
- •Patients with a history of allergy to monoclonal antibody drugs;
- •Patients who have previously received an allogeneic stem cell transplant or organ transplant；
- •Patients with mental illness or any other illness that makes it impossible to comply with treatment；
- •Patients who are unable or unwilling to sign the informed consent form；
- •Patients with comorbidities or other conditions that, in the opinion of the investigator, may affect compliance with the protocol or make them unsuitable for participation in this study.
Arms & Interventions
19DEL cohort
Patients who participated in the trial with EGFR 19DEL mutation will be included in this arm.
Intervention: Toripalimab plus Chemotherapy
L858R cohort
Patients who participated in the trial with EGFR L858R mutation will be included in this arm
Intervention: Toripalimab plus Chemotherapy
Outcomes
Primary Outcomes
Pathologic Complete Response (pCR) Rate
Time Frame: Within 1 week after surgery
Pathologic complete response (pCR) rate is defined as the percentage of participants with no residual viable tumor in lung primary or lymph nodes as evaluated by blinded independent pathological review (BIPR).
Secondary Outcomes
- Major Pathologic Response (MPR) Rate(Within 1 week after surgery)
- Event-free Survival (EFS)(Up to 24 months after participation)
- Pathologic Complete Response (pCR) Rate in non-squamous NSCLC with different EGFR mutations status(Within 1 week after surgery)
- Major Pathologic Response (MPR) Rate in non-squamous NSCLC with different EGFR mutations status(Within 1 week after surgery)
- The Safety and Tolerability(Up to 24 months after participation)
- Pathologic Complete Response (pCR) Rate in non-squamous NSCLC with different PD-L1 expression levels(Within 1 week after surgery)
- Major Pathologic Response (MPR) Rate in non-squamous NSCLC with different PD-L1 expression levels(Within 1 week after surgery)