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
Overview
- Phase
- N/A
- Intervention
- Anti-VEGF 7.5mg/kg
- Conditions
- Her-2 Negative Adenocarcinoma of the Gastro-oesophageal Junction/Gastric Adenocarcinoma
- Sponsor
- Zhejiang Cancer Hospital
- Enrollment
- 120
- Locations
- 1
- Primary Endpoint
- ORR
- Status
- Recruiting
- Last Updated
- last year
Overview
Brief Summary
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.
Investigators
Ji Zhu
Professor
Zhejiang Cancer Hospital
Eligibility Criteria
Inclusion Criteria
- •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.
Exclusion Criteria
- •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;
Arms & Interventions
ARM D:Colorectal cancer
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Anti-VEGF 7.5mg/kg
ARM A:Her-2 negative adenocarcinoma of the gastroesophageal junction/gastric adenocarcinoma
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Hypofractionated radiotherapy/SBRT（5-10Gy/fx，3-5 fx）
ARM A:Her-2 negative adenocarcinoma of the gastroesophageal junction/gastric adenocarcinoma
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Anti-PD-1 monoclonal antibody
ARM A:Her-2 negative adenocarcinoma of the gastroesophageal junction/gastric adenocarcinoma
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Oxaliplatin and Capecitabine
ARM A*:Her-2 negative adenocarcinoma of the gastroesophageal junction/gastric adenocarcinoma
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Hypofractionated radiotherapy/SBRT（5-10Gy/fx，3-5 fx）
ARM A*:Her-2 negative adenocarcinoma of the gastroesophageal junction/gastric adenocarcinoma
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Anti-PD-1 monoclonal antibody
ARM A*:Her-2 negative adenocarcinoma of the gastroesophageal junction/gastric adenocarcinoma
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Oxaliplatin and Capecitabine
ARM B: Liver adenocarcinoma
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Hypofractionated radiotherapy/SBRT（5-10Gy/fx，3-5 fx）
ARM B: Liver adenocarcinoma
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Anti-PD-1 monoclonal antibody
ARM B: Liver adenocarcinoma
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Anti-VEGF 15mg/kg
ARM B*: Liver adenocarcinoma
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Hypofractionated radiotherapy/SBRT（5-10Gy/fx，3-5 fx）
ARM B*: Liver adenocarcinoma
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Anti-PD-1 monoclonal antibody
ARM B*: Liver adenocarcinoma
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Anti-VEGF 15mg/kg
ARM C: Malignant tumors of the biliary system
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Hypofractionated radiotherapy/SBRT（5-10Gy/fx，3-5 fx）
ARM C: Malignant tumors of the biliary system
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Anti-PD-1 monoclonal antibody
ARM C: Malignant tumors of the biliary system
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Gemcitabine and Cisplatin
ARM C*: Malignant tumors of the biliary system
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Hypofractionated radiotherapy/SBRT（5-10Gy/fx，3-5 fx）
ARM D:Colorectal cancer
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Oxaliplatin and Capecitabine
ARM C*: Malignant tumors of the biliary system
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Anti-PD-1 monoclonal antibody
ARM C*: Malignant tumors of the biliary system
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Gemcitabine and Cisplatin
ARM D:Colorectal cancer
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Hypofractionated radiotherapy/SBRT（5-10Gy/fx，3-5 fx）
ARM D:Colorectal cancer
patients will receive Probio-M9 ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Anti-PD-1 monoclonal antibody
ARM D*:Colorectal cancer
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Hypofractionated radiotherapy/SBRT（5-10Gy/fx，3-5 fx）
ARM D*:Colorectal cancer
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Anti-PD-1 monoclonal antibody
ARM D*:Colorectal cancer
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Oxaliplatin and Capecitabine
ARM D*:Colorectal cancer
patients will receive placebo ,RT followed by Immunotherapy-Based Systemic Therapy
Intervention: Anti-VEGF 7.5mg/kg
Outcomes
Primary Outcomes
ORR
Time Frame: ORR will be assessed 2 months after radiotherapy
for off-target lesions of radiotherapy
Secondary Outcomes
- 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.)