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Efficacy of Neoadjuvant PD-1 Blockade Plus Chemotherapy for Esophageal Squamous Cell Carcinoma

Primary Purpose

Esophageal Squamous Cell Carcinoma, Immunotherapy

Status
Completed
Phase
Phase 2
Locations
China
Study Type
Interventional
Intervention
camrelizumab
Paclitaxel for injection (albumin-bound)
Cisplatin
Sponsored by
Guangzhou Institute of Respiratory Disease
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Esophageal Squamous Cell Carcinoma focused on measuring neoadjuvant immunotherapy, Stage II-IVA, esophageal squamous cell carcinoma, ctDNA, neoadjuvant chemotherapy

Eligibility Criteria

17 Years - 70 Years (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male and female patients aged ≥18 years, ≤70 years.
  • Gastroscope/ultrasound gastroscopy biopsy, Histologically or cytologically confirmed esophageal squamous cell carcinoma. Clinically diagnosed as II-IVA esophageal squamous cell carcinoma (cT2N1-3M0/cT3N0-3M0/cT4N0-3M0).
  • Non-Cervical Esophageal Cancer
  • Previously received no systemic or topical treatment for esophageal cancer, at least one measurable lesion for neoadjuvant treatment imaging evaluation according to RECIST 1.1;
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0-1.
  • Estimated survival time ≥ 12 months;
  • Subjects had no major organ dysfunction, and the investigators assessed thyroid, lung, liver, kidney function, and cardiac function as normal.
  • Women of childbearing age must have taken reliable Contraception or have the negative predictive value of urine/ serum pregnancy test within 7 days prior to enrollment. They are also willing to use appropriate methods of contraception during the trial and 8 weeks after the last administration of the test drugs. For men, They must agree to use contraception or surgical sterilization during the trial and 8 weeks after the last administration of the test drug.
  • Subjects voluntarily joined the study and signed informed consent. patients who accept blood sample collection at multiple time points. Able to comply with the required protocol and follow-up procedures, and able to receive oral medications.

Exclusion Criteria:

  • Have a history of gastrectomy or have surgical contraindications
  • The investigator assessed that the patient had other serious illnesses that may affect follow-up and short-term survival;
  • There are any active autoimmune diseases or a medical history of autoimmune (including, but not limited to: autoimmune hepatitis, interstitial pneumonia, uveitis, enteritis, hepatitis, pituitary inflammation, vasculitis, nephritis, hyperthyroidism, thyroid function Decreased. Subjects with vitiligo or adults who have had childhood asthma but have fully relieved without any intervention may be included. However, subjects who require bronchodilators for medical intervention cannot be included.)
  • Cardiac clinical symptoms or diseases that are not well controlled, such as: a. Heart Failure NYHA > Class Ⅱ, b. unstable angina, c. myocardial infarction within 1 year; d. Clinically significant supraventricular or ventricular arrhythmia requiring treatment or intervention.
  • Subjects with congenital or acquired immunodeficiency (such as HIV-infected), or active hepatitis (hepatitis B reference: HBsAg-positive, HBV DNA ≥ 2000 IU/ml or copy number ≥ 104/ml; hepatitis C reference: HCV antibody-positive.)
  • Uncontrollable history of diabetes;
  • Patients who have used other clinical trial study drugs within 4 weeks prior to the first dose.
  • Severe allergic reactions to monoclonal antibodies or allergy to paclitaxel or human albumin.
  • Peripheral blood neutrophil count is less than 1500/mm3
  • Patients who have received or are undergoing other chemotherapy, radiation therapy or targeted therapy.
  • According to the investigator's assessment, there are other factors that may lead to the termination of the study, such as other serious diseases (including mental illness) requiring combined treatment. Any other condition and social/psychological problems, etc., the investigator judged that the patient was not suitable for participation in the study.

Sites / Locations

  • Jingpei Li

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

camrelizumab plus concurrent chemotherapy

Arm Description

Neoadjuvant immunotherapy, PD-1, plus concurrent chemotherapy(albumin-bound paclitaxel + Cisplatin) will be applied to patients with operable esophageal squamous cell carcinoma before surgery.

Outcomes

Primary Outcome Measures

Pathologic complete remission (PCR)
Primary tumor or lymph node surgery specimen pathological examination without residual tumor cell

Secondary Outcome Measures

Objective Response Rate (ORR)
Objective Response Rate Determine the tumor shrinkage rate, tumor boundary and the adhesion of tumor
2-year progression-free survival (PFS)
From date of surgery until the date of first documented progression or date of death from any cause
Progression-free survival (PFS)
From date of surgery until the date of first documented progression or date of death from any cause
Overall survival (OS)
Defined from date of Signing ICF to date of first documentation of death from any cause or censored at the date of the last follow-up.

Full Information

First Posted
December 23, 2019
Last Updated
January 31, 2021
Sponsor
Guangzhou Institute of Respiratory Disease
Collaborators
BGI-Shenzhen, Jiangsu HengRui Medicine Co., Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT04225364
Brief Title
Efficacy of Neoadjuvant PD-1 Blockade Plus Chemotherapy for Esophageal Squamous Cell Carcinoma
Official Title
The Efficacy of Neoadjuvant PD-1 Plus Concurrent Chemotherapy for Stage II-IVA Operable Esophageal Squamous Cell Carcinoma:A Single Armed, Open-label, Multicentre, Clinical Trial
Study Type
Interventional

2. Study Status

Record Verification Date
January 2021
Overall Recruitment Status
Completed
Study Start Date
January 17, 2020 (Actual)
Primary Completion Date
January 15, 2021 (Actual)
Study Completion Date
January 31, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Guangzhou Institute of Respiratory Disease
Collaborators
BGI-Shenzhen, Jiangsu HengRui Medicine Co., Ltd.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study aims to evaluate the efficacy of Camrelizumab plus concurrent chemotherapy as neoadjuvant approach for patients with opearble esophageal squamous cell carcinoma. In addition, potential clinical utility of ctDNA in monitoring tumor burden and dynamics of tumor clonality during neoadjuvant immunotherapy will be assessed as well. At the same time, CD8 and PD-L1 will also be used as monitoring indicators.
Detailed Description
Immunotherapy improves clinical outcome of patients with advanced stage or metastatic esophageal squamous cell carcinoma (ESCC). In addition, superior effect of immunotherapy for esophageal squamous cell carcinoma was also reported recently. While, clinical application of ctDNA, PD-L1 and CD8 T cell monitoring in neoadjuvant immunotherapy for patients with esophageal squamous cell carcinoma is largely unknown. This trial will evaluate firstly the efficacy and the safety of Camrelizumab plus chemotherapy (albumin-bound paclitaxel plus cisplatin)as neoadjuvant approach. The evaluation indicators include pathological complete response rate (pCR) and objective imaging response rate after neoadjuvant therapy (ORR). ), 2-year progression-free survival (2y-PFS), postoperative progression-free survival (PFS), and overall survival (OS) after treatment. Objective response rate (ORR) based upon immune-Response Evaluation Criteria in Solid Tumors Version (RECIST v1.1). Major pathological response assessed by post-operational pathological review ctDNA efficacy will also be evaluated along with clinical management. Monitoring tumor burden, clonality as well as tumor heterogeneity evaluation will be correlated to radiological assessment and pathological findings.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Esophageal Squamous Cell Carcinoma, Immunotherapy
Keywords
neoadjuvant immunotherapy, Stage II-IVA, esophageal squamous cell carcinoma, ctDNA, neoadjuvant chemotherapy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Model Description
Patients with II-IVA stage with pathologically diagnosed squamous cell lung carcinoma will be enrolled in this study. Camrelizumab plus chemotherapy will be administrated intravenously per 3 weeks at the dosage of 200mg. Contrast-CT evaluation and peripheral blood collected will be performed at pre-neoadjuvant therapy and pre-operation. 6 weeks after neoadjuvant therapy, participants who meet the indication will be assigned to operation. Another peripheral blood sample will be harvested 3-4 weeks after operation.
Masking
None (Open Label)
Allocation
N/A
Enrollment
56 (Actual)

8. Arms, Groups, and Interventions

Arm Title
camrelizumab plus concurrent chemotherapy
Arm Type
Experimental
Arm Description
Neoadjuvant immunotherapy, PD-1, plus concurrent chemotherapy(albumin-bound paclitaxel + Cisplatin) will be applied to patients with operable esophageal squamous cell carcinoma before surgery.
Intervention Type
Drug
Intervention Name(s)
camrelizumab
Other Intervention Name(s)
SHR-1210
Intervention Description
Participants will receive camrelizumab, 200mg, intravenously over 30 - 60 minutes, day 1 of every 3 weeks for 6 weeks. Discontinuation will be considered due to toxicity, withdrawal of consent, or end of study. Every 3-week treatment period was considered to be a cycle.
Intervention Type
Drug
Intervention Name(s)
Paclitaxel for injection (albumin-bound)
Other Intervention Name(s)
paclitaxel
Intervention Description
Paclitaxel for injection (albumin-bound): 260mg/m2(in total), ivgtt d1, d8, q3w,for 2 cycle
Intervention Type
Drug
Intervention Name(s)
Cisplatin
Other Intervention Name(s)
CDDP
Intervention Description
75mg/m2(in total), ivgtt d1-d3, q3w, for 2 cycles
Primary Outcome Measure Information:
Title
Pathologic complete remission (PCR)
Description
Primary tumor or lymph node surgery specimen pathological examination without residual tumor cell
Time Frame
4 weeks after surgery
Secondary Outcome Measure Information:
Title
Objective Response Rate (ORR)
Description
Objective Response Rate Determine the tumor shrinkage rate, tumor boundary and the adhesion of tumor
Time Frame
At the end of Cycle 2 (each cycle is 21 days)
Title
2-year progression-free survival (PFS)
Description
From date of surgery until the date of first documented progression or date of death from any cause
Time Frame
every 2 months (up to 24 months)
Title
Progression-free survival (PFS)
Description
From date of surgery until the date of first documented progression or date of death from any cause
Time Frame
every 2 months (up to 24 months)
Title
Overall survival (OS)
Description
Defined from date of Signing ICF to date of first documentation of death from any cause or censored at the date of the last follow-up.
Time Frame
every 2 months (up to 24 months)
Other Pre-specified Outcome Measures:
Title
safety of neoadjuvant PD-1 Blockade Plus Chemotherapy
Description
Incidence of grade 3-5 adverse events [Safety and Tolerability]
Time Frame
Every 3 weeks (up to 3 months after surgery)
Title
Evaluation of molecular features and ctDNA changing in pre, per and post-treatment plasma
Description
All DNA samples were tested to calculate single nucleotide variants (SNV's), small insertions or deletions (Indels), copy number variations (CNV's), splice variations (SV's), gene fusions (GF's), tumor mutation burden (TMB) and micro-satellite instability (MSI) and others value by all enrolled. NGS (Next generation sequencing)-panel (688 genes) for monitoring on post-treatment residual disease in order to identify mechanisms of response. Measurement of different baseline ctDNA for their prognostic value.
Time Frame
every 2 months (up to 12 months)
Title
Evaluation of Immunomicroenvironment changing in pre, per and post-treatment plasma
Description
the tumor immune microenvironment evaluated with multiplexed immunohistochemistry (mIHC), The evaluation of immune microenvironment uses the method of multiple immunofluorescence, through the detection of CD8, CD163, CD68, PD-1 and PD-L1 four bio-markers, determine the situation of related immune cells in the process and efficacy.
Time Frame
every 2 months (up to 12 months)
Title
perioperative adverse events
Description
The participants were followed up daily and perioperative adverse events as defined by the American College of Surgeons National Quality Improvement Program. The participants were followed up until discharge or 30 days of in hospital stay and the secondary outcome measures entered into a questionnaire.
Time Frame
Time to discharge or 30 days of in hospital stay whichever came first

10. Eligibility

Sex
All
Minimum Age & Unit of Time
17 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male and female patients aged ≥18 years, ≤70 years. Gastroscope/ultrasound gastroscopy biopsy, Histologically or cytologically confirmed esophageal squamous cell carcinoma. Clinically diagnosed as II-IVA esophageal squamous cell carcinoma (cT2N1-3M0/cT3N0-3M0/cT4N0-3M0). Non-Cervical Esophageal Cancer Previously received no systemic or topical treatment for esophageal cancer, at least one measurable lesion for neoadjuvant treatment imaging evaluation according to RECIST 1.1; Eastern Cooperative Oncology Group (ECOG) performance status of 0-1. Estimated survival time ≥ 12 months; Subjects had no major organ dysfunction, and the investigators assessed thyroid, lung, liver, kidney function, and cardiac function as normal. Women of childbearing age must have taken reliable Contraception or have the negative predictive value of urine/ serum pregnancy test within 7 days prior to enrollment. They are also willing to use appropriate methods of contraception during the trial and 8 weeks after the last administration of the test drugs. For men, They must agree to use contraception or surgical sterilization during the trial and 8 weeks after the last administration of the test drug. Subjects voluntarily joined the study and signed informed consent. patients who accept blood sample collection at multiple time points. Able to comply with the required protocol and follow-up procedures, and able to receive oral medications. Exclusion Criteria: Have a history of gastrectomy or have surgical contraindications The investigator assessed that the patient had other serious illnesses that may affect follow-up and short-term survival; There are any active autoimmune diseases or a medical history of autoimmune (including, but not limited to: autoimmune hepatitis, interstitial pneumonia, uveitis, enteritis, hepatitis, pituitary inflammation, vasculitis, nephritis, hyperthyroidism, thyroid function Decreased. Subjects with vitiligo or adults who have had childhood asthma but have fully relieved without any intervention may be included. However, subjects who require bronchodilators for medical intervention cannot be included.) Cardiac clinical symptoms or diseases that are not well controlled, such as: a. Heart Failure NYHA > Class Ⅱ, b. unstable angina, c. myocardial infarction within 1 year; d. Clinically significant supraventricular or ventricular arrhythmia requiring treatment or intervention. Subjects with congenital or acquired immunodeficiency (such as HIV-infected), or active hepatitis (hepatitis B reference: HBsAg-positive, HBV DNA ≥ 2000 IU/ml or copy number ≥ 104/ml; hepatitis C reference: HCV antibody-positive.) Uncontrollable history of diabetes; Patients who have used other clinical trial study drugs within 4 weeks prior to the first dose. Severe allergic reactions to monoclonal antibodies or allergy to paclitaxel or human albumin. Peripheral blood neutrophil count is less than 1500/mm3 Patients who have received or are undergoing other chemotherapy, radiation therapy or targeted therapy. According to the investigator's assessment, there are other factors that may lead to the termination of the study, such as other serious diseases (including mental illness) requiring combined treatment. Any other condition and social/psychological problems, etc., the investigator judged that the patient was not suitable for participation in the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jun liu, Ph.D, M.D
Organizational Affiliation
The First Affiliated Hospital of Guangzhou Medical University
Official's Role
Study Chair
Facility Information:
Facility Name
Jingpei Li
City
Guangzhou
State/Province
Guangdong
Country
China

12. IPD Sharing Statement

Citations:
PubMed Identifier
28993052
Citation
Kang YK, Boku N, Satoh T, Ryu MH, Chao Y, Kato K, Chung HC, Chen JS, Muro K, Kang WK, Yeh KH, Yoshikawa T, Oh SC, Bai LY, Tamura T, Lee KW, Hamamoto Y, Kim JG, Chin K, Oh DY, Minashi K, Cho JY, Tsuda M, Chen LT. Nivolumab in patients with advanced gastric or gastro-oesophageal junction cancer refractory to, or intolerant of, at least two previous chemotherapy regimens (ONO-4538-12, ATTRACTION-2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2017 Dec 2;390(10111):2461-2471. doi: 10.1016/S0140-6736(17)31827-5. Epub 2017 Oct 6.
Results Reference
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PubMed Identifier
26254683
Citation
Shapiro J, van Lanschot JJB, Hulshof MCCM, van Hagen P, van Berge Henegouwen MI, Wijnhoven BPL, van Laarhoven HWM, Nieuwenhuijzen GAP, Hospers GAP, Bonenkamp JJ, Cuesta MA, Blaisse RJB, Busch ORC, Ten Kate FJW, Creemers GM, Punt CJA, Plukker JTM, Verheul HMW, Bilgen EJS, van Dekken H, van der Sangen MJC, Rozema T, Biermann K, Beukema JC, Piet AHM, van Rij CM, Reinders JG, Tilanus HW, Steyerberg EW, van der Gaast A; CROSS study group. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol. 2015 Sep;16(9):1090-1098. doi: 10.1016/S1470-2045(15)00040-6. Epub 2015 Aug 5.
Results Reference
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PubMed Identifier
30089078
Citation
Yang H, Liu H, Chen Y, Zhu C, Fang W, Yu Z, Mao W, Xiang J, Han Y, Chen Z, Yang H, Wang J, Pang Q, Zheng X, Yang H, Li T, Lordick F, D'Journo XB, Cerfolio RJ, Korst RJ, Novoa NM, Swanson SJ, Brunelli A, Ismail M, Fernando HC, Zhang X, Li Q, Wang G, Chen B, Mao T, Kong M, Guo X, Lin T, Liu M, Fu J; AME Thoracic Surgery Collaborative Group. Neoadjuvant Chemoradiotherapy Followed by Surgery Versus Surgery Alone for Locally Advanced Squamous Cell Carcinoma of the Esophagus (NEOCRTEC5010): A Phase III Multicenter, Randomized, Open-Label Clinical Trial. J Clin Oncol. 2018 Sep 20;36(27):2796-2803. doi: 10.1200/JCO.2018.79.1483. Epub 2018 Aug 8.
Results Reference
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Efficacy of Neoadjuvant PD-1 Blockade Plus Chemotherapy for Esophageal Squamous Cell Carcinoma

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