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Camrelizumab Combined With Apatinib and Capecitabine in Patients With Advanced Unresectable Biliary Tract Cancer.

Primary Purpose

Biliary Tract Cancer, Programmed Cell Death 1 Ligand 1 Gene Mutation, Targeted Molecular Therapy

Status
Unknown status
Phase
Phase 2
Locations
China
Study Type
Interventional
Intervention
Camrelizumab
apatinib
Capecitabine
Sponsored by
Beijing Friendship Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Biliary Tract Cancer focused on measuring Capecitabine, Targeted Molecular Therapy, Biliary Tract Cancer

Eligibility Criteria

18 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Aged 18-70 years old, both genders.
  • Conform to the histological or cytological confirmation of biliary tract carcinoma,including gallbladder cancers and cholangiocarcinomas.
  • Patients have advanced unresectable biliary tract carcinoma, including recurrence or metastasis of BTC after radical resection.
  • Patientss who have not received any prior PD-1 inhibitor and Apatinib therapy.
  • Patients must have at least 1 lesion that is measurable using RECIST v1.1 criteria.
  • Eastern Cooperative Oncology Group Performance Status of 0 or 1within one week before enrollment.
  • Life expectancy greater than 3 months.
  • Patient must have adequate organ function defined by the study-specified laboratory tests.
  • Patient must use acceptable form of birth control while on study.
  • Ability to understand and willingness to sign a written informed consent document.

Exclusion Criteria:

  • Patients with known history of allogeneic organ transplantation or allogeneic hematopoietic stem cell transplantation or planned transplantation.
  • Patients with other malignant tumor in the past 5 years (except cured skin basal cell carcinoma and cervical carcinoma).
  • History of esophageal variceal bleeding, hepatic encephalopathy, massive ascites and abdominal infection.
  • Concurrent medical condition requiring the use of immunosuppressive medications, or immunosuppressive doses of systemic or absorbable topical corticosteroids. Doses > 10 mg/day prednisone or equivalent are prohibited within 14 days before study drug administration.
  • Known history of hypersensitivity to any components of the camrelizumab, apatinib and Capecitabine formulation, or other antibody formulation.
  • Patients who may receive live vaccine during the study, or previous had vaccination within 4 weeks.
  • Known or occurrence of central nervous system (CNS) metastases or hepatic encephalopathy.
  • Peripheral neuropathy> Grade 1.
  • Patients with any active autoimmune disease or history of autoimmune disease.
  • History of immunodeficiency or human immunodeficiency virus (HIV) infection.
  • Clinically significant cardiovascular and cerebrovascular diseases, including but not limited to severe acute myocardial infarction within 6 months before enrollment, unstable or severe angina, or coronary artery bypass surgery, Congestive heart failure (New York heart association (NYHA) class > 2), ventricular arrhythmia which need medical intervention.
  • Hypertension and unable to be controlled within normal level following treatment of anti-hypertension agents (within 3 months): systolic blood pressure > 140 mmHg, diastolic blood pressure > 90 mmHg.
  • Coagulation abnormalities (INR>1.5 or APTT>1.5×ULN), with bleeding tendency or are receiving thrombolytic or anticoagulant therapy.
  • History of hereditary or acquired bleeding and thrombotic tendency, such as hemophilia, coagulopathy, thrombocytopenia, hypersplenism, etc.
  • Patients with obvious cough blood or hemoptysis volume of half teaspoon (2.5 ml) or more within 2 months before entering the study.
  • Have significant clinically significant bleeding symptoms or have a clear bleeding tendency within 3 months before entering the study, such as gastrointestinal bleeding, hemorrhagic gastric ulcer, fecal occult blood++ and above at baseline, or vasculitis, etc.
  • Previous Arterial/venous thrombosis events within 6 months.
  • Required for long-term anticoagulant therapy with warfarin or heparin, or long-term antiplatelet therapy (aspirin ≥300 mg/day or clopidogrel ≥75 mg/day).
  • Severe infection within 4 weeks before the first medication (e.g. need for intravenous antibiotics, antifungal or antiviral drugs), or active infection or an unexplained fever > 38.5°C during screening visits or on the first scheduled day of dosing.
  • Participated in any other drug clinical study within 4 weeks before the first administration, or no more than 5 half lives from the last administration.
  • Known history of psychotropic drug abuse or drug abuse.
  • Pregnant and lactating women. Any other medical, psychiatric, or social condition deemed by the investigator to be likely to interfere with a subject's rights, safety, welfare, or ability to sign informed consent, cooperate, and participate in the study or would interfere with the interpretation of the results.

Sites / Locations

  • Beijing Friendship Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Camrelizumab combined with Apatinib and Capecitabine

Arm Description

Camrelizumab was administered 200mg iv every 3 weeks. Capecitabine was administered 1000mg/m2 orally, b.i.d. every 3 weeks (Day 1-14 of a treatment cycle) Apatinib:A safety-run-in was conducted in the first cycle to identify the recommended dose of Apatinib, the initial dose was administered 250mg orally daily every 3 weeks (Day 1-14 of a treatment cycle). The dose of Apatinib increase and reduction was 250 mg orally q.d. and 250 mg orally q.o.d. every 3 weeks respectively according to the number of doses limiting toxicity events (DLTs) in the initial group. The final dose of Apatinib for the extension stage was detemained by the result of safety-run-in stage.

Outcomes

Primary Outcome Measures

Objective response rate
The proportion of patients with measurable disease who achieved complete response (CR) or partial response (PR)

Secondary Outcome Measures

Disease Control Rates (DCR)
The proportion of patients achieving CR or PR or stable disease (SD)
Progression-Free Survival
The duration from the beginning of the treatment to the disease progression, or death from any cause, or last progression-free survival assessment for patients alive without progression
Overall Survival
The duration from the enrollment to death from any cause
Safety
The incidence of any grade treatment-related adverse events.

Full Information

First Posted
January 20, 2021
Last Updated
January 20, 2021
Sponsor
Beijing Friendship Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT04720131
Brief Title
Camrelizumab Combined With Apatinib and Capecitabine in Patients With Advanced Unresectable Biliary Tract Cancer.
Official Title
Camrelizumab Combined With Apatinib and Capecitabine for Patients With Advanced Unresectable Biliary Tract Cancer: a Phase 2, Single-arm, Prospective Study.
Study Type
Interventional

2. Study Status

Record Verification Date
January 2021
Overall Recruitment Status
Unknown status
Study Start Date
February 1, 2021 (Anticipated)
Primary Completion Date
June 1, 2023 (Anticipated)
Study Completion Date
August 1, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Beijing Friendship Hospital

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Biliary tract cancer (BTC) is a series of rare malignancies with poor overall prognosis. Radical surgery the preferred treatment option, but most patients have lost the opportunity of surgery at the time of diagnosis. At present, there are limited systematical treatment options for biliary tract cancer, with poor efficacy and short duration of responses. In the past few years, immune checkpoint inhibitors (ICIs) therapy has gradually been added to the advanced biliary comprehensive treatment. However, in view of the low incidence and high heterogeneity of BTC, more large number of clinical trials and practices need to be carried out, and the effective combination regimens and predictive biomarkers need to be explored. This study is a single-arm, open-label, prospective cohort study, combining Camrelizumab with apatinib and capecitabine as the first-line or second-line treatment for patients with advanced biliary tract cancer. The study aims to explore the efficacy and safety of the combination regimen, and try to find biomarkers that can guild treatment. In this study, 34 patients were enrolled by the Simon's two-stage design, with the objective response rate as the primary endpoint and the disease control rate, progression-free survival, overall survival and safety as secondary endpoints. It is expected that the three-drug combination regimen will have significant efficacy and manageable adverse reactions, and predictive biomarkers can be found.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Biliary Tract Cancer, Programmed Cell Death 1 Ligand 1 Gene Mutation, Targeted Molecular Therapy, Capecitabine
Keywords
Capecitabine, Targeted Molecular Therapy, Biliary Tract Cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
39 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Camrelizumab combined with Apatinib and Capecitabine
Arm Type
Experimental
Arm Description
Camrelizumab was administered 200mg iv every 3 weeks. Capecitabine was administered 1000mg/m2 orally, b.i.d. every 3 weeks (Day 1-14 of a treatment cycle) Apatinib:A safety-run-in was conducted in the first cycle to identify the recommended dose of Apatinib, the initial dose was administered 250mg orally daily every 3 weeks (Day 1-14 of a treatment cycle). The dose of Apatinib increase and reduction was 250 mg orally q.d. and 250 mg orally q.o.d. every 3 weeks respectively according to the number of doses limiting toxicity events (DLTs) in the initial group. The final dose of Apatinib for the extension stage was detemained by the result of safety-run-in stage.
Intervention Type
Drug
Intervention Name(s)
Camrelizumab
Intervention Description
Camrelizumab was administered 200mg iv every 3 weeks.
Intervention Type
Drug
Intervention Name(s)
apatinib
Intervention Description
Apatinib A safety-run-in was conducted in the first cycle to identify the recommended dose of Apatinib, the initial dose was administered 250mg orally daily every 3 weeks (Day 1-14 of a treatment cycle) The dose of Apatinib increase and reduction was 250 mg orally q.d. and 250 mg orally q.o.d. every 3 weeks respectively according to the number of doses limiting toxicity events (DLTs) in the initial group. The final dose of Apatinib for the extension stage was detemained by the result of safety-run-in stage.
Intervention Type
Drug
Intervention Name(s)
Capecitabine
Intervention Description
Capecitabine was administered 1000mg/m2 orally, b.i.d. every 3 weeks (Day 1-14 of a treatment cycle)
Primary Outcome Measure Information:
Title
Objective response rate
Description
The proportion of patients with measurable disease who achieved complete response (CR) or partial response (PR)
Time Frame
30 months
Secondary Outcome Measure Information:
Title
Disease Control Rates (DCR)
Description
The proportion of patients achieving CR or PR or stable disease (SD)
Time Frame
30 months
Title
Progression-Free Survival
Description
The duration from the beginning of the treatment to the disease progression, or death from any cause, or last progression-free survival assessment for patients alive without progression
Time Frame
30 months
Title
Overall Survival
Description
The duration from the enrollment to death from any cause
Time Frame
30 months
Title
Safety
Description
The incidence of any grade treatment-related adverse events.
Time Frame
30 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Aged 18-70 years old, both genders. Conform to the histological or cytological confirmation of biliary tract carcinoma,including gallbladder cancers and cholangiocarcinomas. Patients have advanced unresectable biliary tract carcinoma, including recurrence or metastasis of BTC after radical resection. Patientss who have not received any prior PD-1 inhibitor and Apatinib therapy. Patients must have at least 1 lesion that is measurable using RECIST v1.1 criteria. Eastern Cooperative Oncology Group Performance Status of 0 or 1within one week before enrollment. Life expectancy greater than 3 months. Patient must have adequate organ function defined by the study-specified laboratory tests. Patient must use acceptable form of birth control while on study. Ability to understand and willingness to sign a written informed consent document. Exclusion Criteria: Patients with known history of allogeneic organ transplantation or allogeneic hematopoietic stem cell transplantation or planned transplantation. Patients with other malignant tumor in the past 5 years (except cured skin basal cell carcinoma and cervical carcinoma). History of esophageal variceal bleeding, hepatic encephalopathy, massive ascites and abdominal infection. Concurrent medical condition requiring the use of immunosuppressive medications, or immunosuppressive doses of systemic or absorbable topical corticosteroids. Doses > 10 mg/day prednisone or equivalent are prohibited within 14 days before study drug administration. Known history of hypersensitivity to any components of the camrelizumab, apatinib and Capecitabine formulation, or other antibody formulation. Patients who may receive live vaccine during the study, or previous had vaccination within 4 weeks. Known or occurrence of central nervous system (CNS) metastases or hepatic encephalopathy. Peripheral neuropathy> Grade 1. Patients with any active autoimmune disease or history of autoimmune disease. History of immunodeficiency or human immunodeficiency virus (HIV) infection. Clinically significant cardiovascular and cerebrovascular diseases, including but not limited to severe acute myocardial infarction within 6 months before enrollment, unstable or severe angina, or coronary artery bypass surgery, Congestive heart failure (New York heart association (NYHA) class > 2), ventricular arrhythmia which need medical intervention. Hypertension and unable to be controlled within normal level following treatment of anti-hypertension agents (within 3 months): systolic blood pressure > 140 mmHg, diastolic blood pressure > 90 mmHg. Coagulation abnormalities (INR>1.5 or APTT>1.5×ULN), with bleeding tendency or are receiving thrombolytic or anticoagulant therapy. History of hereditary or acquired bleeding and thrombotic tendency, such as hemophilia, coagulopathy, thrombocytopenia, hypersplenism, etc. Patients with obvious cough blood or hemoptysis volume of half teaspoon (2.5 ml) or more within 2 months before entering the study. Have significant clinically significant bleeding symptoms or have a clear bleeding tendency within 3 months before entering the study, such as gastrointestinal bleeding, hemorrhagic gastric ulcer, fecal occult blood++ and above at baseline, or vasculitis, etc. Previous Arterial/venous thrombosis events within 6 months. Required for long-term anticoagulant therapy with warfarin or heparin, or long-term antiplatelet therapy (aspirin ≥300 mg/day or clopidogrel ≥75 mg/day). Severe infection within 4 weeks before the first medication (e.g. need for intravenous antibiotics, antifungal or antiviral drugs), or active infection or an unexplained fever > 38.5°C during screening visits or on the first scheduled day of dosing. Participated in any other drug clinical study within 4 weeks before the first administration, or no more than 5 half lives from the last administration. Known history of psychotropic drug abuse or drug abuse. Pregnant and lactating women. Any other medical, psychiatric, or social condition deemed by the investigator to be likely to interfere with a subject's rights, safety, welfare, or ability to sign informed consent, cooperate, and participate in the study or would interfere with the interpretation of the results.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Wei Deng
Phone
8610-63138712
Email
Dengweiwei@126.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Wei Deng
Organizational Affiliation
Department of General Surgery, Beijing Friendship Hospital, Capital Medical University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Beijing Friendship Hospital
City
Beijing
State/Province
Beijing
ZIP/Postal Code
100050
Country
China

12. IPD Sharing Statement

Plan to Share IPD
Undecided
IPD Sharing Plan Description
IPD can be obtained with the consent of the principal investigator
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Camrelizumab Combined With Apatinib and Capecitabine in Patients With Advanced Unresectable Biliary Tract Cancer.

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