Intra-tumor Delivery of Double Checkpoint Inhibitors, Chemodrug, and/or Bevacizumab Therapy as First Line for Hepatocellular Carcinoma
试验速览
- 阶段
- 2 期
- 状态
- 招募中
- 发起方
- 入组人数
- 90
- 试验地点
- 1
- 主要终点
- Disease control rate
研究概览
简要总结
This trial is designed to investigate the safety, response rates and survival outcomes of patients with hepatocellular carcinoma by infusion of CTLA4, PD1 and PDL1 antibodies combination with chemodrug or/and bevacizumab through intra-tumor (IT).
详细描述
Antibodies against CTLA4, PD1 and PDL1 are representative drugs for the check-points inhibitory agents, and their clinical indications have been approved in various types of tumors, including advanced melanoma, non-small cell lung cancer, renal cell carcinoma, and classical Hodgkin's lymphoma and late recurrent head and neck squamous cell carcinoma patients, et al. Those drugs are regularly systemically administrated by vein infusion, however, local delivery of those drugs via interventional radiology technique including trans-artery or intra-tumor injection may increase the local drug concentration of the tumor, improve the efficacy, and reduce systemic adverse reactions. CTLA4 antibody ipilimumab has been widely effectively using to combine with PD1 or PDL1 antibody and this study is to combine ipilimumab and PD1 antibody or PDL1 antibody, so called double checkpoint inhibitors combination therapy, as first line for hepatocellular carcinoma (HCC) via intra-tumor admistration. To the investigator's knowledge, no studies have been developed on the safety, efficacy and survival benefit of the double checkpoint inhibitors combination therapy for cancer patients as first line via intra-tumor delivery. This phase II clinical trial is designed to assess the safety and survival benefit of ipilimumab and pembrolizumab or durvalumab combination with or without chemodrug or bevacizumab as first line therapy on patients with HCC, including PFS, ORR, DCR, and median survival time.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 75 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Cytohistological confirmation is required for diagnosis of cancer.
- •Signed informed consent before recruiting.
- •Age above 18 years with estimated survival over 3 months.
- •Child-Pugh class A or B/Child score > 7; ECOG score < 2
- •Tolerable coagulation function or reversible coagulation disorders
- •Laboratory examination test within 7 days prior to procedure: WBC≥3.0×10E9/L; Hb≥90g/L； PLT ≥50×10E9/L；INR < 2.3 or PT < 6 seconds above control；Cr ≤ 145.5 umul/L；Albumin > 28 g/L；Total bilirubin < 51 μmol/L
- •At least one tumor lesion meeting measurable disease criteria as determined by RECIST v1.
- •Birth control.
- •Willing and able to comply with scheduled visits, treatment plan and laboratory tests.
排除标准
- •Patients participated in clinical trials of equipment or drugs (signed informed consent) within 4 weeks;
- •Patients accompany by ascites, hepatic encephalopathy and esophageal and gastric varices bleeding;
- •Any serious accompanying disease, which is expected to have an unknown, impact on the prognosis, include heart disease, inadequately controlled diabetes and psychiatric disorders;
- •Patients accompanied with other tumors or past medical history of malignancy;
- •Pregnant or lactating patients, all patients participating in this trial must adopt appropriate birth control measures during treatment;
- •Patients have poor compliance.
- •Any contraindications for hepatic arterial infusion procedure:
- •A.Impaired clotting test (platelet count < 60000/mm3, prothrombin activity < 50%).
- •B.Renal failure / insufficiency requiring hemo-or peritoneal dialysis. C.Known severe atheromatosis. D.Known uncontrolled blood hypertension (> 160/100 mm/Hg).
- •Allergic to contrast agent;
- •Any agents which could affect the absorption or pharmacokinetics of the study drugs
- •Other conditions that investigator decides not suitable for the trial.
研究组 & 干预措施
IT injection of double ICI
Arm 1: intra-tumor injection of double ICIs only.
干预措施: ipilimumab+pembrolizumab or ipilimumab+durvalumab, idarubicin, bevacizumab (Drug)
IT injection of double ICI and chemodrug
Arm 2: intra-tumor injection of double ICIs and a chemodrug.
干预措施: ipilimumab+pembrolizumab or ipilimumab+durvalumab, idarubicin, bevacizumab (Drug)
IT injection of double ICI and chemodrug plus bevacizumab
Arm 3: intra-tumor injection of double ICIs, a chemodrug, and bevacizumab.
干预措施: ipilimumab+pembrolizumab or ipilimumab+durvalumab, idarubicin, bevacizumab (Drug)
结局指标
主要结局
Disease control rate
时间窗: 5 years
Disease control rate will be defined as objective response rate + steady disease rate.
Safety of IT delivery of drugs combination treatment
时间窗: 5 years
Safety will be assessed by recording all types of advise effects upon and after the treatment.
Progression-free survival
时间窗: 5 years
Progression-free survival (PFS) will be defined as the elapsed time from the first date of study treatment until documented disease progression (as per RECIST 1.1) or death from any cause, whichever is earlier. For patients who remain alive without progression, follow-up time will be censored at the date of last disease assessment.
Duration of remission (DOR)
时间窗: 5 years
DOR will be defined as the duration of the cancer remission.
次要结局
- Overall survival(5 years)