A Randomized, Multicenter Phase II Basket Study of Hypofractionated Radiotherapy/Stereotactic Body Radiotherapy Followed by Immunotherapy-Based Systemic Therapy +/- L. Rhamnosus M9 for the First-Line Treatment of Advanced Digestive System Malignancies
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 120
- 试验地点
- 1
- 主要终点
- ORR
研究概览
简要总结
Based on the interaction between radiation therapy and immunotherapy and the potential potentiation of Probio-M9 for the treatment of ICIs, this study is planned to design an integrated treatment protocol for the first-line treatment of advanced gastrointestinal tumors through the use of macrofractionated radiotherapy as a means of immune activation, combined with the synergistic effect of Probio-M9 microbial agents and PD-1 inhibitors.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Double (Participant, Care Provider)
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
- •histopathologically confirmed diagnosis of malignant tumors of the gastrointestinal tract (including Her-2 negative adenocarcinoma of the gastroesophageal junction/gastric adenocarcinoma, hepatocellular carcinoma, malignant tumors of the biliary system, colorectal cancer);
- •advanced patients evaluated as initially non-operable resectable who have not received any antitumor therapy;
- •have at least one measurable or evaluable lesion according to RECIST v1.1 criteria in addition to the primary lesion, with non-operable resectable lymph node metastases to the liver, lung, bone, pelvis, retroperitoneum and/or superficial sites (except for brain metastases), as evaluated by discussion in the framework of the MDT
- •age 18-75 years;
- •ECOG score of 0-1;
- •be able to accept the treatment regimen during the study;
- •sign a written informed consent.
排除标准
- •a history of uncontrolled epilepsy, central nervous system disease, or psychiatric disorder of clinical severity that, in the judgment of the investigator, may preclude the signing of an informed consent form or interfere with the patient's adherence to oral medication;
- •prior immunotherapy for any indication or a history of severe hypersensitivity reactions to other monoclonal antibodies;
- •clinically significant (i.e., active) cardiac disease, such as symptomatic coronary artery disease, New York Heart Association (NYHA) class II or worse congestive heart failure or severe arrhythmias requiring pharmacologic intervention, or history of myocardial infarction within the last 12 months;
- •organ transplantation requiring immunosuppressive therapy;
- •a history of other malignant disease within the last five years;
- •persons with severe uncontrolled recurrent infections, or other severe uncontrolled concomitant diseases;
- •Subjects whose baseline blood routine and biochemical indexes do not meet the following criteria: hemoglobin ≥80g/L; absolute neutrophil count (ANC) ≥1.5×10^9/L; platelets ≥100×10^9/L; ALT, AST ≤2.5 times the upper limit of normal; ALP ≤2.5 times the upper limit of normal; serum total bilirubin <1.5 times the upper limit of normal; serum creatinine <1 times the upper limit of normal; and serum creatinine <1 times the upper limit of normal. times the upper limit of normal;
- •the patient currently has active gastrointestinal diseases such as active gastric and duodenal ulcers, ulcerative colitis, or active bleeding from unresected tumors, or other conditions that may cause gastrointestinal bleeding or perforation as determined by the investigator;
- •persons with active bleeding or bleeding tendencies;
- •women who are pregnant or breastfeeding;
- •allergy to any of the study drug ingredients.
研究组 & 干预措施
ARM D:Colorectal cancer
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Anti-VEGF 7.5mg/kg (Drug)
ARM A:Her-2 negative adenocarcinoma of the gastroesophageal junction/gastric adenocarcinoma
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Hypofractionated radiotherapy/SBRT（5-10Gy/fx，3-5 fx） (Radiation)
ARM A:Her-2 negative adenocarcinoma of the gastroesophageal junction/gastric adenocarcinoma
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Anti-PD-1 monoclonal antibody (Drug)
ARM A:Her-2 negative adenocarcinoma of the gastroesophageal junction/gastric adenocarcinoma
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Oxaliplatin and Capecitabine (Drug)
ARM A*:Her-2 negative adenocarcinoma of the gastroesophageal junction/gastric adenocarcinoma
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Hypofractionated radiotherapy/SBRT（5-10Gy/fx，3-5 fx） (Radiation)
ARM A*:Her-2 negative adenocarcinoma of the gastroesophageal junction/gastric adenocarcinoma
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Anti-PD-1 monoclonal antibody (Drug)
ARM A*:Her-2 negative adenocarcinoma of the gastroesophageal junction/gastric adenocarcinoma
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Oxaliplatin and Capecitabine (Drug)
ARM B: Liver adenocarcinoma
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Hypofractionated radiotherapy/SBRT（5-10Gy/fx，3-5 fx） (Radiation)
ARM B: Liver adenocarcinoma
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Anti-PD-1 monoclonal antibody (Drug)
ARM B: Liver adenocarcinoma
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Anti-VEGF 15mg/kg (Drug)
ARM B*: Liver adenocarcinoma
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Hypofractionated radiotherapy/SBRT（5-10Gy/fx，3-5 fx） (Radiation)
ARM B*: Liver adenocarcinoma
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Anti-PD-1 monoclonal antibody (Drug)
ARM B*: Liver adenocarcinoma
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Anti-VEGF 15mg/kg (Drug)
ARM C: Malignant tumors of the biliary system
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Hypofractionated radiotherapy/SBRT（5-10Gy/fx，3-5 fx） (Radiation)
ARM C: Malignant tumors of the biliary system
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Anti-PD-1 monoclonal antibody (Drug)
ARM C: Malignant tumors of the biliary system
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Gemcitabine and Cisplatin (Drug)
ARM C*: Malignant tumors of the biliary system
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Hypofractionated radiotherapy/SBRT（5-10Gy/fx，3-5 fx） (Radiation)
ARM D:Colorectal cancer
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Oxaliplatin and Capecitabine (Drug)
ARM C*: Malignant tumors of the biliary system
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Anti-PD-1 monoclonal antibody (Drug)
ARM C*: Malignant tumors of the biliary system
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Gemcitabine and Cisplatin (Drug)
ARM D:Colorectal cancer
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Hypofractionated radiotherapy/SBRT（5-10Gy/fx，3-5 fx） (Radiation)
ARM D:Colorectal cancer
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Anti-PD-1 monoclonal antibody (Drug)
ARM D*:Colorectal cancer
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Hypofractionated radiotherapy/SBRT（5-10Gy/fx，3-5 fx） (Radiation)
ARM D*:Colorectal cancer
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Anti-PD-1 monoclonal antibody (Drug)
ARM D*:Colorectal cancer
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Oxaliplatin and Capecitabine (Drug)
ARM D*:Colorectal cancer
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
干预措施: Anti-VEGF 7.5mg/kg (Drug)
结局指标
主要结局
ORR
时间窗: ORR will be assessed 2 months after radiotherapy
for off-target lesions of radiotherapy
次要结局
- adverse effects rate(From date of randomization until the date of death from any cause, assessed up to 5 years ])
- Qol(From date of randomization until the date of death from any cause, assessed up to 10 years])
- OS(From date of randomization until the date of death from any cause, assessed up to 36 months)
- ORR(ORR will be assessed 2 months after radiotherapy)
- PFS(From the date of randomization to the date when progress was first recorded,assessed up to 36 months.)
研究者
Ji Zhu
Professor
Zhejiang Cancer Hospital