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Toripalimab Combined With Anlotinib and SBRT in Patients With Untreated Brain Metastases of Driven Gene-negative NSCLC

Primary Purpose

NSCLC

Status
Recruiting
Phase
Phase 1
Locations
China
Study Type
Interventional
Intervention
Toripalimab
Anlotinib
SBRT 7Gy✖️5 QD
Sponsored by
Hubei Cancer Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for NSCLC focused on measuring Brain metastasis, Toripalimab, Anlotinib, SBRT, Drive gene negative

Eligibility Criteria

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

Inclusion Criteria:

  1. Age ≥ 18 years, no gender limit;
  2. Pathologically or cytologically confirmed NSCLC, stage IV tumor with untreated BMs diagnosed by imaging 2 weeks before enrollment, 1~5 intracranial metastases (The primary tumor disease has not received systemic treatment, or brain metastasis occurs 6 months after the completion of postoperative adjuvant treatment or radical treatment);
  3. Negative driver genes (EGFR, ALK, ROS1, etc.);
  4. ECOG PS score: 0~1;
  5. The expected survival time ≥ 3 months;
  6. Intracranial metastases can be measured and evaluated by MRI;
  7. Intracranial lesions are suitable for stereotactic radiotherapy based on the linear accelerator;
  8. Able to independently complete neurocognitive tests;
  9. Able to complete the QOL questionnaire independently;
  10. Female subjects with fertility should undergo a urine or serum pregnancy test within 72 hours before receiving the first study drug administration, and prove to be negative, and are willing to use effectively during the test period to 3 months after the last administration Methods of contraception. For male subjects whose partners are women of childbearing age, effective methods of contraception should be used during the trial and within 3 months after the last administration;
  11. The functions of important organs meet the following requirements (no blood components and cell growth factors are allowed to be used 2 weeks before the start of the research treatment): Absolute Neutrophil Count (ANC) ≥1.5×10 E+9/L, Hemoglobin (HB) ≥9g/dL, Platelets (PLT)≥90×10 E+9/L, Serum Albumin (ALB)≥2.8g/dL, Total Bilirubin (TBIL) ≤1.5 ULN, ALT、AST≤2.5 UILN(If abnormal liver function is caused by liver metastasis, ≤5 ULN), Serum creatinine sCr≤1.5 ULN, endogenous creatinine clearance ≥50ml/min (Cockcroft-Gault formula) , Normal thyroid function;
  12. The patients joined the study voluntarily and signed an informed consent form (ICF). They had good compliance and cooperated with follow-up.

Exclusion Criteria:

  1. The lesion has received prior radiotherapy and is not suitable for SBRT;
  2. Have leptomeningeal metastasis;
  3. EGFR, ALK or ROS1 genomic tumour alterations;
  4. Patients who cannot undergo MRI examination due to metal implants or claustrophobia;
  5. Currently participating in interventional clinical research and treatment, or receiving other research drugs or treatment with research equipment within 4 weeks before the first administration;
  6. Accept solid organ or blood system transplantation;
  7. Past treatment history of CTLA-4, PD-1 or PD-L1 immune checkpoint inhibitors;
  8. Has received VEGF pathway targeted therapy including anlotinib and bevacizumab.
  9. Suffer from active autoimmune diseases that require hormone or immunomodulatory treatment, such as rheumatoid arthritis, ankylosing spondylitis, type I diabetes, psoriasis, vitiligo, immune-related thyroid dysfunction, etc. (hormone replacement Can be included after treatment is normal);
  10. Suffer from acute or chronic infectious diseases, such as hepatitis B, hepatitis C, tuberculosis, and HIV;
  11. Allergic to research drug ingredients
  12. Active infection or fever of unknown cause occurred during the screening period and before the first administration> 38.5℃ (according to the judgment of the investigator, the subject can be included in the group due to fever caused by the tumor);
  13. Suffer from uncontrolled clinical symptoms or diseases of the heart, such as:(1) Heart failure above NYHA II; (2) Unstable angina pectoris; (3) Myocardial infarction occurred within 1 year; (4) Patients with clinically significant supraventricular or ventricular arrhythmia requiring clinical intervention;
  14. Suffer from high blood pressure and cannot be well controlled by antihypertensive medication (systolic blood pressure ≥150 mmHg or diastolic blood pressure ≥100 mmHg);
  15. Abnormal blood coagulation function (INR>2.0, PT>16s), have a bleeding tendency or are receiving thrombolytic therapy, and allow preventive use of low-dose aspirin and low-molecular-weight heparin;
  16. Obvious coughing up blood or hemoptysis of 10ml or more per day in the 2 months before enrollment;
  17. Have significant clinically significant bleeding symptoms or have a clear bleeding tendency within 3 months before enrollment;
  18. Have received anti-tumor monoclonal antibodies (mAb) within 4 weeks before using the study drug for the first time, or the adverse events caused by the previously received drug have not recovered (ie ≤ grade 1 or reached the baseline level). Note: Except for subjects with ≤ Grade 2 neuropathy or ≤ Grade 2 hair loss, if the subject has undergone major surgery, the toxic reaction and/or complications caused by the surgical intervention must be fully recovered before starting treatment;
  19. Live vaccines have been vaccinated within 4 weeks before the first use of the study drug. Inactivated virus vaccines for seasonal influenza and injections are allowed, but live attenuated influenza vaccines for nasal use are not allowed;
  20. The investigator judged other situations not suitable for inclusion in this study.

Sites / Locations

  • Hubei Cancer HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Anlotinib combined with SBRT

Anlotinib combined with SBRT and Toripalimab

Arm Description

Induction therapy (D1-D21): SBRT 7Gy✖️5 QD, D1-D5 + Toripalimab 240mg iv drip D1 + Anlotinib 12mg, QD, PO, D1-D14; Maintenance (D22~1year): Toripalimab 240mg iv drip D1 Q3W + Anlotinib 12mg, QD, PO, D1-D14, Q3W, until progression (up to approximately 1 year)

Induction therapy (D1-D21): SBRT 7Gy✖️5 QD, D1-D5 + Anlotinib 12mg, QD, PO, D1-D14; Maintenance (D22~1year): Toripalimab 240mg iv drip D1 Q3W + Anlotinib 12mg, QD, PO, D1-D14, Q3W, until progression (up to approximately 1 year)

Outcomes

Primary Outcome Measures

Treatment-related adverse events
AEs per Common Terminology Criteria for Adverse Events (CTCAE V5.0)
Intracranial response rate (iORR)
Proportion of patients with a complete or partial response in intracranial metastases as measured using RECIST 1.1 criteria (modified for brain metastases - bm RECIST).

Secondary Outcome Measures

Intracranial progression-free survival (iPFS)
Defined as the time from randomisation to progression of intracranial disease or death from any cause.
Local Control Rate (LCR)
Local recurrence is defined as the onset or progression of nodular contrast grafting within the resection cavity according to the Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) criteria.
Overall survival (OS)
Defined as the time from randomisation to death from any cause

Full Information

First Posted
August 20, 2021
Last Updated
July 4, 2023
Sponsor
Hubei Cancer Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT05021328
Brief Title
Toripalimab Combined With Anlotinib and SBRT in Patients With Untreated Brain Metastases of Driven Gene-negative NSCLC
Official Title
A Phase Ib Study on Toripalimab Combined With Anlotinib and SBRT for Patients With Untreated Brain Metastases of Driven Gene-negative Non-small Cell Lung Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Recruiting
Study Start Date
October 1, 2021 (Actual)
Primary Completion Date
June 1, 2024 (Anticipated)
Study Completion Date
June 1, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Hubei Cancer Hospital

4. Oversight

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

5. Study Description

Brief Summary
The purpose of this study is to explore the efficacy and safety of toripalimab combined with anlotinib and SBRT for non-driver gene mutation untreated brain metastases non-small Cell Lung Cancer.
Detailed Description
Brain metastases (BM) develop in 22-54% of NSCLC patients during the disease course. NSCLC patients with BM with a median overall survival (OS) of 2-3 months when treated with systemic corticosteroid alone, and a median OS of 10-12 months when treated with brain radiation therapy. Recently, several studies have reported the benefits of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) for EGFR mutation NSCLC patients with BM. The median OS of EGFR mutation patients with BM significantly improved with TKIs treatment, which ranged from 11.8 to 18.8 months. However, for the EGFR wide-type NSCLC patients with BM, the prognosis remains poor. JS-001 is the first monoclonal antibody (mAb) against programmed cell death protein-1 (PD-1) approved by the China Food and Drug Administration (CFDA) into the clinical trails. Anlotinib hydrochloride is a multi-target receptor tyrosine kinase inhibitor that has significant inhibitory activity against angiogenesis related kinases such as VEGFR1/2/3, FGFR1/2/3, and other tumor related kinases such as PDGFR /, C-Kit, Ret, etc. (e.g., Met, FGFR1/2/3). The previously study (2021 EMSO congress abstract) found that Apatinib, another kind of tyrosine kinase inhibitor that selectively inhibits the VEGFR-2, combined with brain radiation therapy could improve mOS time to 17 months in lung cancer patients with BMs. Therefore, the investigators initiated this study to evaluate the efficacy and safety of toripalimab combined with anlotinib and SBRT for non-driver gene mutation untreated brain metastases non-small Cell Lung Cancer.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
NSCLC
Keywords
Brain metastasis, Toripalimab, Anlotinib, SBRT, Drive gene negative

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
20 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Anlotinib combined with SBRT
Arm Type
Experimental
Arm Description
Induction therapy (D1-D21): SBRT 7Gy✖️5 QD, D1-D5 + Toripalimab 240mg iv drip D1 + Anlotinib 12mg, QD, PO, D1-D14; Maintenance (D22~1year): Toripalimab 240mg iv drip D1 Q3W + Anlotinib 12mg, QD, PO, D1-D14, Q3W, until progression (up to approximately 1 year)
Arm Title
Anlotinib combined with SBRT and Toripalimab
Arm Type
Experimental
Arm Description
Induction therapy (D1-D21): SBRT 7Gy✖️5 QD, D1-D5 + Anlotinib 12mg, QD, PO, D1-D14; Maintenance (D22~1year): Toripalimab 240mg iv drip D1 Q3W + Anlotinib 12mg, QD, PO, D1-D14, Q3W, until progression (up to approximately 1 year)
Intervention Type
Drug
Intervention Name(s)
Toripalimab
Other Intervention Name(s)
JS001, Toripalimab Injection, Teruipuli dankang Zhusheye, TuoYI
Intervention Description
Toripalimab 240mg, ivgtt, d1, q3w.
Intervention Type
Drug
Intervention Name(s)
Anlotinib
Other Intervention Name(s)
AL3818, Anlotinib Hydrochloride Capsules, FuKeWei
Intervention Description
Anlotinib 12 mg/d, d1-14, q3w.
Intervention Type
Drug
Intervention Name(s)
SBRT 7Gy✖️5 QD
Intervention Description
SBRT 7Gy✖️5 QD
Primary Outcome Measure Information:
Title
Treatment-related adverse events
Description
AEs per Common Terminology Criteria for Adverse Events (CTCAE V5.0)
Time Frame
up to 24 month
Title
Intracranial response rate (iORR)
Description
Proportion of patients with a complete or partial response in intracranial metastases as measured using RECIST 1.1 criteria (modified for brain metastases - bm RECIST).
Time Frame
4 weeks after Radiotherapy.
Secondary Outcome Measure Information:
Title
Intracranial progression-free survival (iPFS)
Description
Defined as the time from randomisation to progression of intracranial disease or death from any cause.
Time Frame
Tumor assesment at 4 weeks and 12 weeks after radiotherapy, and then every 12 weeks, up to 24 months
Title
Local Control Rate (LCR)
Description
Local recurrence is defined as the onset or progression of nodular contrast grafting within the resection cavity according to the Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) criteria.
Time Frame
Tumor assesment at 4 weeks and 12 weeks after radiotherapy, and then every 12 weeks, up to 24 months
Title
Overall survival (OS)
Description
Defined as the time from randomisation to death from any cause
Time Frame
Tumor assesment at 4 weeks and 12 weeks after radiotherapy, and then every 12 weeks, up to 24 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age ≥ 18 years, no gender limit; Pathologically or cytologically confirmed NSCLC, stage IV tumor with untreated BMs diagnosed by imaging 2 weeks before enrollment, 1~5 intracranial metastases (The primary tumor disease has not received systemic treatment, or brain metastasis occurs 6 months after the completion of postoperative adjuvant treatment or radical treatment); Negative driver genes (EGFR, ALK, ROS1, etc.); ECOG PS score: 0~1; The expected survival time ≥ 3 months; Intracranial metastases can be measured and evaluated by MRI; Intracranial lesions are suitable for stereotactic radiotherapy based on the linear accelerator; Able to independently complete neurocognitive tests; Able to complete the QOL questionnaire independently; Female subjects with fertility should undergo a urine or serum pregnancy test within 72 hours before receiving the first study drug administration, and prove to be negative, and are willing to use effectively during the test period to 3 months after the last administration Methods of contraception. For male subjects whose partners are women of childbearing age, effective methods of contraception should be used during the trial and within 3 months after the last administration; The functions of important organs meet the following requirements (no blood components and cell growth factors are allowed to be used 2 weeks before the start of the research treatment): Absolute Neutrophil Count (ANC) ≥1.5×10 E+9/L, Hemoglobin (HB) ≥9g/dL, Platelets (PLT)≥90×10 E+9/L, Serum Albumin (ALB)≥2.8g/dL, Total Bilirubin (TBIL) ≤1.5 ULN, ALT、AST≤2.5 UILN(If abnormal liver function is caused by liver metastasis, ≤5 ULN), Serum creatinine sCr≤1.5 ULN, endogenous creatinine clearance ≥50ml/min (Cockcroft-Gault formula) , Normal thyroid function; The patients joined the study voluntarily and signed an informed consent form (ICF). They had good compliance and cooperated with follow-up. Exclusion Criteria: The lesion has received prior radiotherapy and is not suitable for SBRT; Have leptomeningeal metastasis; EGFR, ALK or ROS1 genomic tumour alterations; Patients who cannot undergo MRI examination due to metal implants or claustrophobia; Currently participating in interventional clinical research and treatment, or receiving other research drugs or treatment with research equipment within 4 weeks before the first administration; Accept solid organ or blood system transplantation; Past treatment history of CTLA-4, PD-1 or PD-L1 immune checkpoint inhibitors; Has received VEGF pathway targeted therapy including anlotinib and bevacizumab. Suffer from active autoimmune diseases that require hormone or immunomodulatory treatment, such as rheumatoid arthritis, ankylosing spondylitis, type I diabetes, psoriasis, vitiligo, immune-related thyroid dysfunction, etc. (hormone replacement Can be included after treatment is normal); Suffer from acute or chronic infectious diseases, such as hepatitis B, hepatitis C, tuberculosis, and HIV; Allergic to research drug ingredients Active infection or fever of unknown cause occurred during the screening period and before the first administration> 38.5℃ (according to the judgment of the investigator, the subject can be included in the group due to fever caused by the tumor); Suffer from uncontrolled clinical symptoms or diseases of the heart, such as:(1) Heart failure above NYHA II; (2) Unstable angina pectoris; (3) Myocardial infarction occurred within 1 year; (4) Patients with clinically significant supraventricular or ventricular arrhythmia requiring clinical intervention; Suffer from high blood pressure and cannot be well controlled by antihypertensive medication (systolic blood pressure ≥150 mmHg or diastolic blood pressure ≥100 mmHg); Abnormal blood coagulation function (INR>2.0, PT>16s), have a bleeding tendency or are receiving thrombolytic therapy, and allow preventive use of low-dose aspirin and low-molecular-weight heparin; Obvious coughing up blood or hemoptysis of 10ml or more per day in the 2 months before enrollment; Have significant clinically significant bleeding symptoms or have a clear bleeding tendency within 3 months before enrollment; Have received anti-tumor monoclonal antibodies (mAb) within 4 weeks before using the study drug for the first time, or the adverse events caused by the previously received drug have not recovered (ie ≤ grade 1 or reached the baseline level). Note: Except for subjects with ≤ Grade 2 neuropathy or ≤ Grade 2 hair loss, if the subject has undergone major surgery, the toxic reaction and/or complications caused by the surgical intervention must be fully recovered before starting treatment; Live vaccines have been vaccinated within 4 weeks before the first use of the study drug. Inactivated virus vaccines for seasonal influenza and injections are allowed, but live attenuated influenza vaccines for nasal use are not allowed; The investigator judged other situations not suitable for inclusion in this study.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Guang Han, MD
Phone
13886048178
Email
hg7913@hotmail.com
Facility Information:
Facility Name
Hubei Cancer Hospital
City
Wuhan
State/Province
Hubei
ZIP/Postal Code
430079
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Han Guang, MD
First Name & Middle Initial & Last Name & Degree
Han Guang, MD

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Toripalimab Combined With Anlotinib and SBRT in Patients With Untreated Brain Metastases of Driven Gene-negative NSCLC

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