A Phase II Study of Neoadjuvant Toripalimab Plus Platinum-based Doublet for Potentially Resectable Stage III Non-small Cell Lung Cancer
试验速览
- 阶段
- 2 期
- 状态
- 进行中（未招募）
- 发起方
- 入组人数
- 30
- 试验地点
- 1
- 主要终点
- Evaluation of the major pathologic response (MPR)
研究概览
简要总结
This is an open-label, single-arm, phase II, multi-center clinical trial. Thirty patients will be enrolled in this trial to investigate the pathological complete response rate defined as the absence of residual tumor in lung and lymph nodes treated by chemo-immunotherapy.
详细描述
This is an open-label, single-arm, phase II, multi-center clinical trial. Eligible patients will receive Toripalimab 240mg + Albumin-bound paclitaxel 260mg/m2 + Carboplatin AUC5 for 3 cycles every 21 days (+/-3 days) as neoadjuvant treatment followed by surgery 3-4 weeks after the last dose of chemo-immunotherapy.
The primary objective is major pathologic response (MPR), defined as less than 10% tumor cells in the pathologically resected specimen. Patient accrual is expected to be completed within 18 months excluding a run-in-phase of 3 months. Patients will be followed 3 years after surgery. The study will end once survival follow-up has concluded.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Previously untreated patients with histologically- or cytologically- documented NSCLC who present stage IIIA disease (according to 8th version of the International Association for the Study of Lung Cancer Staging Manual in Thoracic Oncology) and also, potentially resectable locally advanced NSCLC patients' stage IIIB with T3N2 disease according to 8th edition can be included.
- •PET/CT including IV contrast (CT of diagnostic quality) will be performed at baseline (28 days +10 before randomization);
- •Tumor should be EGFR wild-type or EML4-ALK negative;
- •Tumor should be considered resectable before study entry by a multidisciplinary team;
- •ECOG (Performance status) 0-1;
- •Screening laboratory values must meet the following criteria and should be obtained within 14 days prior to randomization.
- •i. Neutrophils ≥ 1500×109/L ii. Platelets ≥ 100 x×109/L iii. Hemoglobin > 9.0 g/dL iv. Serum creatinine ≤ 1.5 x ULN or creatinine clearance (CrCl) ≥ 40 mL/min v. AST/ALT ≤ 3 x ULN vi. Total Bilirubin ≤ 1.5 x ULN (except subjects with Gilbert Syndrome, who can have total bilirubin < 3.0 mg/dL) vii. The patients need to have a forced expiratory volume (FEV1) ≥ 1.2 liters or >40% predicted value viii. INR/APTT within normal limits;
- •All patients are notified of the investigational nature of this study and signed a written informed consent in accordance with institutional and national guidelines, including the Declaration of Helsinki prior to any trial-related intervention;
- •Patients aged > 18 years;
- •Women of childbearing potential, including women who had their last menstrual period in the last 2 years, must have a negative serum or urine pregnancy test within 7 days before randomization.
- •All sexually active men and women of childbearing potential must use an effective contraceptive method (two barrier methods or a barrier method plus a hormonal method) during the study treatment and for a period of at least 12 months following the last administration of trial drugs;
- •Patient capable of proper therapeutic compliance and accessible for correct follow-up;
- •Measurable or evaluable disease (according to RECIST 1.1 criteria).
排除标准
- •All patients carrying activating mutations in the TK domain of EGFR or any variety of alterations in the ALK gene.
- •Patients with active, known or suspected autoimmune disease. Subjects with vitiligo, type I diabetes mellitus, residual hypothyroidism due to autoimmune thyroiditis only requiring hormone replacement or unexpected conditions of recurrence in the absence of an external trigger are allowed to be included.
- •Patients with a condition requiring systemic treatment with either corticosteroids (>10 mg daily prednisone equivalent) or other immunosuppressive medications within 14 days of randomization. Inhaled or topical steroids, and adrenal replacement steroid doses > 10 mg daily prednisone equivalent, are permitted in the absence of active autoimmune disease.
- •Patients with a history of interstitial lung disease cannot be included if they have symptomatic ILD (Grade 3-4) and/or poor lung function. In case of doubt please contact trial team.
- •Patients with other active malignancy requiring concurrent intervention and/or concurrent treatment with other investigational drugs or anti-cancer therapy
- •Patients with previous malignancies (except non-melanoma skin cancers, and the following in situ cancers: bladder, gastric, colon, endometrial, cervical/dysplasia, melanoma, or breast) are excluded unless a complete remission was achieved at least 2 years prior to study entry AND no additional therapy is required during the study period.
- •Any medical, mental or psychological condition which in the opinion of the investigator would not permit the patient to complete the study or understand the patient information
- •Patients who have had prior treatment with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CTLA-4 antibody, or any other antibody or drug specifically targeting T-cell costimulation or immune checkpoint pathways
- •Patients with positive test for hepatitis B virus surface antigen (HBV sAg) or hepatitis C virus ribonucleic acid (HCV antibody) indicating acute or chronic infection
- •Patients with known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS)
- •Patients with history of allergy to study drug components excipients
- •Women who are pregnant or in the period of breastfeeding
- •Sexually active men and women of childbearing potential who are not willing to use an effective contraceptive method during the study
研究组 & 干预措施
Neoadjuvant chemo-immunotherapy
Neoadjuvant treatment (Albumin-bound paclitaxel + carboplatin + toripalimab) will start within 1-3 days from enrollment at 21-day (+/-3 days) intervals (Q3W) prior to surgery. Before surgery a tumor assessment will be done to exclude evidence of progression. Patients with radiographically stable disease or partial response may be considered for operation.
Surgery: Surgery must be done within the 3rd to 4th week (+7 days) from day 21 cycle 3 of neoadjuvant treatment.
干预措施: Albumin-bound paclitaxel, Carboplatin, Toripalimab (Drug)
结局指标
主要结局
Evaluation of the major pathologic response (MPR)
时间窗: From date of enrollment until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 45 months
The major pathologic response is defined as less than 10% tumor cells in the pathologically resected specimen
次要结局
- Resectable rate(From date of enrollment until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 45 months)
- pathologic complete response(From date of enrollment until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 45 months)
- Disease-free survival(From date of enrollment until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 45 months)
研究者
Hao Long
Prof.
Sun Yat-sen University