Toripalimab Plus FLOT in Locally Advanced Gastric Cancer
Primary Purpose
Chemotherapy, Immune Checkpoint Inhibitor, Locally Advanced Gastric Carcinoma
Status
Recruiting
Phase
Phase 2
Locations
China
Study Type
Interventional
Intervention
delayed toripalimab
control
Sponsored by
About this trial
This is an interventional treatment trial for Chemotherapy
Eligibility Criteria
Inclusion Criteria:
- 70 ≥ Age ≥ 18 years regardless of gender
- Gastric adenocarcinoma confirmed by pathology
- no distant metastasis and resectable or potentially resectable evaluated by general surgery experts
- ECOG PS 0-1
- clinical stage III by AJCC 8.0
- expected lifespan over 3 months
- Adequate organ function: 1) without growth factor and blood component support in the first 2 weeks of enrollment; 2) Cardiac function: no heart disease or coronary heart disease, grade 1-2; 3) liver function: TBIL ≤ 2ULN, AST ≤ 2.5 ULN, alt ≤ 2.5 ULNX 4 Renal function: cr ≤ 1.25ULN, liver function: TBIL ≤ 2ULN, TBIL ≤ 2.5ULN, alt ≤ 2.5ULN, 4)renal function: cr ≤ 1.25ULN.
- blood pressure normal or controlled within the normal range by antihypertensive drugs
- Diabetic patients were treated with hypoglycemic drugs to control fasting blood glucose ≤ 8mmol/L
- Patients with positive hepatitis B surface antigen need to be tested for quantitative detection of hepatitis B DNA virus. HBV DNA should be less than the upper limit of the normal test value for patients with HBV infection.
- no other serious diseases conflicting with this study
- No history of other malignant tumors
- Women of childbearing age must be tested negative for blood pregnancy test within 7 days before enrollment, and subjects of childbearing age must use appropriate contraceptive measures during the trial and within 6 months after the trial
- agreement to participate in this study and signed the informed consent form
Exclusion Criteria:
- Pregnant or lactating women
- Suffered from severe infectious diseases within 4 weeks before entering the group
- Bronchial asthma requires intermittent use of bronchodilators or medical intervention
- Due to the use of immunosuppressants before coexisting diseases and the dosage of immunosuppressants ≥ 10mg/, the oral dose of prednisone lasted for more than 2 weeks
- Clinically obvious cardio-cerebrovascular diseases, including, but not limited to, severe acute myocardial infarction, instability or severe angina pectoris, coronary artery bypass surgery, congestive heart failure, ventricular arrhythmias requiring medical intervention, left ventricular ejection fraction < 50%, stroke within 6 months
- Allergic to any experimental drug and its excipients, or have a history of severe allergy, or are contraindications to experimental drugs
- Severe mental disorders
- Abnormal coagulation function (PT > 16s, APTT > 53s, TT > 21s Fib < 1.5g/L), bleeding tendency or undergoing thrombolysis or anticoagulation therapy
- Past or present pulmonary fibrosis, interstitial pneumonia, pneumoconiosis, radiation pneumonia, severe impairment of lung function, etc.
- Unable to swallow research drugs, chronic diarrhea (including but not limited to irritable bowel syndrome, Crohn's disease, ulcerative colitis) and intestinal obstruction affect drug use and absorption
- Have a history of immunodeficiency, including positive for HIV, or suffer from other acquired, congenital immunodeficiency diseases, or have a history of organ transplant
- Other researchers evaluate those who do not meet the criteria for admission
Sites / Locations
- Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Other
Arm Label
experimental group
control group
Arm Description
patients received FLOT regimen on day 1 and toripalimab on day 3.
patients received FLOT regimen and toripalimab on day 1.
Outcomes
Primary Outcome Measures
pathological complete response rate
the proportion of patients with no tumor cells in the postoperative specimens
Secondary Outcome Measures
rate of adverse events
rate of adverse events
disease-free survival
the rate of patients who keep from disease at three years
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT04891016
Brief Title
Toripalimab Plus FLOT in Locally Advanced Gastric Cancer
Official Title
Toripalimab Combined With FLOT Regimen in Locally Advanced Gastric cancer-a Prospective, Open, Single-center, Phase Ⅱ Clinical Study
Study Type
Interventional
2. Study Status
Record Verification Date
February 2022
Overall Recruitment Status
Recruiting
Study Start Date
June 25, 2021 (Actual)
Primary Completion Date
June 11, 2022 (Anticipated)
Study Completion Date
May 11, 2025 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Henan Cancer 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
Neoadjuvant therapy for locally advanced gastric cancer is still in the exploratory stage. With the emergence of immune checkpoint inhibitors, neoadjuvant chemoimmunotherapy is also in the exploratory stage in locally advanced gastric cancer. At present, chemotherapy combined with immunotherapy is usually a simple combination of chemotherapeutic drugs and immune drugs, without taking into account of the influenece of applied sequence. The purpose of this study is to explore whether the sequence of chemotherapy and immunotherapy influence the complete pathological response rate in locally advanced gastric cancer.
Detailed Description
Neoadjuvant therapy for locally advanced gastric cancer is still in the exploratory stage. With the emergence of immune checkpoint inhibitors, neoadjuvant chemoimmunotherapy is also in the exploratory stage in locally advanced gastric cancer. At present, chemotherapy combined with immunotherapy is usually a simple combination of chemotherapeutic drugs and immune drugs, without taking into account of the influenece of applied sequence. The purpose of this study is to explore whether the sequence of chemotherapy and immunotherapy influence the complete pathological response rate in locally advanced gastric cancer. All patients received toripalimab plus FLOT regimen. If pCR was achieved, the patients received two cycles of toripalimab plus FLOT, then toripalimab maintenance until one year, if pCR was not achieved, the patients received 8 cycles of perioperative toripalimab plus FLOT, then toripalimab maintenance until one year.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chemotherapy, Immune Checkpoint Inhibitor, Locally Advanced Gastric Carcinoma
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
patients were randomized at 1:1 into experiment group and control group. In control group patients received chemotherapy and toripalimab on same day, in experiment group patients received chemotherapy on day 1 and toripalimab on day 3.
Masking
None (Open Label)
Allocation
Randomized
Enrollment
70 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
experimental group
Arm Type
Experimental
Arm Description
patients received FLOT regimen on day 1 and toripalimab on day 3.
Arm Title
control group
Arm Type
Other
Arm Description
patients received FLOT regimen and toripalimab on day 1.
Intervention Type
Drug
Intervention Name(s)
delayed toripalimab
Other Intervention Name(s)
experiment group
Intervention Description
chemotherapy plus toripalimab and toripalimab was delayed on day 3. If the pCR was not achieved after surgery, then the patients received five cycles of FLOT plus toripalimab every two weeks, then toripalimab maintenance until one year. If pCR was achieved, then then the patients received two cycles of original regimen and then toripalimab maintenance until one year.
Intervention Type
Drug
Intervention Name(s)
control
Other Intervention Name(s)
control group
Intervention Description
chemotherapy and toripalimab were given on same day. If the pCR was not achieved after surgery, then the patients received four cycles of FLOT plus toripalimab every two weeks, then toripalimab maintenance until one year. If pCR was achieved, then then the patients received two cycles of original regimen and then toripalimab maintenance until one year.
Primary Outcome Measure Information:
Title
pathological complete response rate
Description
the proportion of patients with no tumor cells in the postoperative specimens
Time Frame
6 months
Secondary Outcome Measure Information:
Title
rate of adverse events
Description
rate of adverse events
Time Frame
3 months
Title
disease-free survival
Description
the rate of patients who keep from disease at three years
Time Frame
3 years
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
70 ≥ Age ≥ 18 years regardless of gender
Gastric adenocarcinoma confirmed by pathology
no distant metastasis and resectable or potentially resectable evaluated by general surgery experts
ECOG PS 0-1
clinical stage III by AJCC 8.0
expected lifespan over 3 months
Adequate organ function: 1) without growth factor and blood component support in the first 2 weeks of enrollment; 2) Cardiac function: no heart disease or coronary heart disease, grade 1-2; 3) liver function: TBIL ≤ 2ULN, AST ≤ 2.5 ULN, alt ≤ 2.5 ULNX 4 Renal function: cr ≤ 1.25ULN, liver function: TBIL ≤ 2ULN, TBIL ≤ 2.5ULN, alt ≤ 2.5ULN, 4)renal function: cr ≤ 1.25ULN.
blood pressure normal or controlled within the normal range by antihypertensive drugs
Diabetic patients were treated with hypoglycemic drugs to control fasting blood glucose ≤ 8mmol/L
Patients with positive hepatitis B surface antigen need to be tested for quantitative detection of hepatitis B DNA virus. HBV DNA should be less than the upper limit of the normal test value for patients with HBV infection.
no other serious diseases conflicting with this study
No history of other malignant tumors
Women of childbearing age must be tested negative for blood pregnancy test within 7 days before enrollment, and subjects of childbearing age must use appropriate contraceptive measures during the trial and within 6 months after the trial
agreement to participate in this study and signed the informed consent form
Exclusion Criteria:
Pregnant or lactating women
Suffered from severe infectious diseases within 4 weeks before entering the group
Bronchial asthma requires intermittent use of bronchodilators or medical intervention
Due to the use of immunosuppressants before coexisting diseases and the dosage of immunosuppressants ≥ 10mg/, the oral dose of prednisone lasted for more than 2 weeks
Clinically obvious cardio-cerebrovascular diseases, including, but not limited to, severe acute myocardial infarction, instability or severe angina pectoris, coronary artery bypass surgery, congestive heart failure, ventricular arrhythmias requiring medical intervention, left ventricular ejection fraction < 50%, stroke within 6 months
Allergic to any experimental drug and its excipients, or have a history of severe allergy, or are contraindications to experimental drugs
Severe mental disorders
Abnormal coagulation function (PT > 16s, APTT > 53s, TT > 21s Fib < 1.5g/L), bleeding tendency or undergoing thrombolysis or anticoagulation therapy
Past or present pulmonary fibrosis, interstitial pneumonia, pneumoconiosis, radiation pneumonia, severe impairment of lung function, etc.
Unable to swallow research drugs, chronic diarrhea (including but not limited to irritable bowel syndrome, Crohn's disease, ulcerative colitis) and intestinal obstruction affect drug use and absorption
Have a history of immunodeficiency, including positive for HIV, or suffer from other acquired, congenital immunodeficiency diseases, or have a history of organ transplant
Other researchers evaluate those who do not meet the criteria for admission
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Quanli Gao, M.D
Phone
+8637165587483
Email
gaoquanli2015@126.com
First Name & Middle Initial & Last Name or Official Title & Degree
Lingdi Zhao, M.D
Phone
+8637165587483
Email
lingdizhao@126.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Quanli Gao, M.D
Organizational Affiliation
Department of Immunotherapy, Henan Provincial Cancer Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital
City
Zhengzhou
State/Province
Henan
ZIP/Postal Code
450008
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Quanli Gao, M.D
Phone
+86-371-65587795
Email
gaoquanli2015@126.com
First Name & Middle Initial & Last Name & Degree
Lingdi Zhao, M.D
Phone
+86-371-65587483
Email
lingdizhao@126.com
12. IPD Sharing Statement
Plan to Share IPD
Yes
IPD Sharing Plan Description
Demographic characteristics, adverse reactions, postoperative pathology
IPD Sharing Time Frame
every 6 months
IPD Sharing Access Criteria
under suitable requirement
Citations:
PubMed Identifier
31086347
Citation
Voorwerk L, Slagter M, Horlings HM, Sikorska K, van de Vijver KK, de Maaker M, Nederlof I, Kluin RJC, Warren S, Ong S, Wiersma TG, Russell NS, Lalezari F, Schouten PC, Bakker NAM, Ketelaars SLC, Peters D, Lange CAH, van Werkhoven E, van Tinteren H, Mandjes IAM, Kemper I, Onderwater S, Chalabi M, Wilgenhof S, Haanen JBAG, Salgado R, de Visser KE, Sonke GS, Wessels LFA, Linn SC, Schumacher TN, Blank CU, Kok M. Immune induction strategies in metastatic triple-negative breast cancer to enhance the sensitivity to PD-1 blockade: the TONIC trial. Nat Med. 2019 Jun;25(6):920-928. doi: 10.1038/s41591-019-0432-4. Epub 2019 May 13. Erratum In: Nat Med. 2019 Jun 17;:
Results Reference
background
PubMed Identifier
31095287
Citation
Loibl S, Untch M, Burchardi N, Huober J, Sinn BV, Blohmer JU, Grischke EM, Furlanetto J, Tesch H, Hanusch C, Engels K, Rezai M, Jackisch C, Schmitt WD, von Minckwitz G, Thomalla J, Kummel S, Rautenberg B, Fasching PA, Weber K, Rhiem K, Denkert C, Schneeweiss A. A randomised phase II study investigating durvalumab in addition to an anthracycline taxane-based neoadjuvant therapy in early triple-negative breast cancer: clinical results and biomarker analysis of GeparNuevo study. Ann Oncol. 2019 Aug 1;30(8):1279-1288. doi: 10.1093/annonc/mdz158. Erratum In: Ann Oncol. 2022 Jul;33(7):743-744.
Results Reference
background
PubMed Identifier
33115941
Citation
He X, Du Y, Wang Z, Wang X, Duan J, Wan R, Xu J, Zhang P, Wang D, Tian Y, Han J, Fei K, Bai H, Tian J, Wang J. Upfront dose-reduced chemotherapy synergizes with immunotherapy to optimize chemoimmunotherapy in squamous cell lung carcinoma. J Immunother Cancer. 2020 Oct;8(2):e000807. doi: 10.1136/jitc-2020-000807.
Results Reference
background
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Toripalimab Plus FLOT in Locally Advanced Gastric Cancer
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