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PD-1 Inhibitor Plus GP as Neoadjuvant Therapy for Locoregionally Advanced Nasopharyngeal Carcinoma

Primary Purpose

Nasopharyngeal Carcinoma, Neoadjuvant Therapy, PD-1 Inhibitor

Status
Not yet recruiting
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
PD-1 inhibitor+GP
GP
Sponsored by
Guangxi Medical University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Nasopharyngeal Carcinoma

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Histologically confirmed non-keratinizing nasopharyngeal carcinoma(WHO II/III).
  2. Original clinical staged as T4NanyM0 or TanyN2-3M0 (according to AJCC 8th edition), with no evidence of distant metastasis.
  3. Eastern Cooperative Oncology Group performance status ≤1.
  4. Adequate marrow function: neutrocyte count≥1.5×10e9/L, hemoglobin ≥90g/L, and platelet count ≥100×10e9/L.
  5. Alanine Aminotransferase (ALT)/Aspartate Aminotransferase (AST) ≤1.5×upper limit of normal (ULN), and bilirubin ≤ 1.5×ULN.
  6. Adequate renal function: creatinine clearance rate ≥ 60 ml/min (Cockcroft-Gault formula).
  7. Patients must be informed of the investigational nature of this study and give written informed consent.
  8. Women of childbearing potential (WOCBP) who are sexually active must be willing to adhere to effective contraception during treatment and for 1 year after the last dose of the study drug. Men who are sexually active with WOCBP must be willing to adhere to effective contraception during treatment and for 1 year after the last dose of the study drug.

Exclusion Criteria:

  1. Age > 65 or < 18.
  2. Receiving radiotherapy or chemotherapy or targeted therapy or immunotherapy previously.
  3. Severe cerebrovascular disease/canker/psychosis.
  4. Has active autoimmune disease, except type I diabetes, hypothyroidism treated with replacement therapy, and skin disease that doesn't require systemic treatment (e.g., vitiligo, psoriasis, or alopecia).
  5. Has any condition that required systemic corticosteroid (equivalent to prednisone >10mg/d) or other immunosuppressive therapy within 28 days before informed consent. Patients who received systemic corticosteroid equivalent to prednisone ≤10mg/d, inhale or topical corticosteroid will be allowed.
  6. Has a known history of active TB (bacillus tuberculosis) within 1 year; patients with adequately treated active TB over 1 year ago will be allowed.
  7. Suffering from active infection diseases and in need of treatment.
  8. Has received a live vaccine within 30 days before informed consent or will receive a live vaccine in the near future.
  9. Pregnant or breastfeeding.
  10. Prior malignancy within 5 years, except in situ cancer, adequately treated non-melanoma skin cancer and papillary thyroid carcinoma.
  11. Has known allergy to large molecule protein products or any compound of PD-1 antibody.
  12. Has a known history of the human immunodeficiency virus (HIV) infection.
  13. Any other condition, including symptomatic heart failure, unstable angina, myocardial infarction, active infection requiring systemic therapy, mental illness or domestic/social factors, deemed by the investigator to be likely to interfere with a patient's ability to sign informed consent, cooperate and participate in the study, or interferes with the interpretation of the results.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Active Comparator

    Arm Label

    PD-1 inhibitor + GP Group

    GP Group

    Arm Description

    PD-1 inhibitor plus GP chemotherapy as Neoadjuvant Therapy followed by IMRT combined with cisplatin concurrent chemotherapy

    GP chemotherapy as Neoadjuvant Therapy chemotherapy followed by IMRT combined with cisplatin concurrent chemotherapy

    Outcomes

    Primary Outcome Measures

    Failure-free survival
    the time from registration to treatment failure or death from any cause, whichever is first.

    Secondary Outcome Measures

    Complete Response (CR)
    the complete disappearance of the target and non-target lesion identified at baseline after radiological evaluation by MRI. Disease response was evaluated after the completion of the neoadjuvant therapy, according to RECIST 1.1.
    Overall survival
    the time from registration to death due to any cause, or censored at date last known alive.
    Locoregional failure-free survival(LRRFS)
    the time from registration to the first locoregional relapse or death from any cause.
    Distant metastasis-free survival(DMFS)
    the time from registration to the first distant metastasis or death from any cause.
    Adverse events (AEs)
    Analysis of adverse events (AEs) are based on treatment-related AEs (trAEs) and immune-related AEs (irAEs), and all-grade AEs and grade 3-4 AEs. AEs are evaluated by investigators according to the Common Terminology Criteria for Adverse Events, version 5.0
    Quality of life(QOL)
    Assessed by European Organization for Research and Treatment of Cancer's quality of life questionnaire(QLQ)-C30

    Full Information

    First Posted
    March 19, 2020
    Last Updated
    July 1, 2022
    Sponsor
    Guangxi Medical University
    Collaborators
    Affiliated Hospital of North Sichuan Medical College, Hainan People's Hospital, Wuzhou Red Cross Hospital, First People's Hospital of Yulin, Fourth Affiliated Hospital of Guangxi Medical University, Guigang People's Hospital, Wuhan Union Hospital, China, Yunnan Cancer Hospital, LiuZhou People's Hospital
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05340270
    Brief Title
    PD-1 Inhibitor Plus GP as Neoadjuvant Therapy for Locoregionally Advanced Nasopharyngeal Carcinoma
    Official Title
    PD-1 Inhibitor Plus GP Chemotherapy as Neoadjuvant Therapy for Locoregionally Advanced Nasopharyngeal Carcinoma: A Phase II, Multicenter, Randomized Controlled Clinical Trial
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    July 2022
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    August 1, 2022 (Anticipated)
    Primary Completion Date
    July 31, 2023 (Anticipated)
    Study Completion Date
    July 31, 2026 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Guangxi Medical University
    Collaborators
    Affiliated Hospital of North Sichuan Medical College, Hainan People's Hospital, Wuzhou Red Cross Hospital, First People's Hospital of Yulin, Fourth Affiliated Hospital of Guangxi Medical University, Guigang People's Hospital, Wuhan Union Hospital, China, Yunnan Cancer Hospital, LiuZhou People's 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 Phase II, Multicenter, Randomized Controlled Clinical Trial is to evaluate the efficacy and safety of PD-1 inhibitor Plus GP chemotherapy as Neoadjuvant Therapy in the Treatment of Locoregionally Advanced Nasopharyngeal Carcinoma.
    Detailed Description
    Induction chemotherapy plus concurrent chemoradiotherapy has the IIA evidence and the gemcitabine plus cisplatin (GP) regimen has the I evidence in the National Comprehensive Cancer Network (NCCN) guidelines for the treatment of locoregionally advanced nasopharyngeal carcinoma (NPC). More and more evidence shows that immunotherapy combined with chemotherapy has a synergistic effect in treating tumors. GP chemotherapy combined with PD-1 inhibitor has achieved the initial effect in NPC. With the development of radiotherapeutic techniques and equipment as well as advances in treatment modalities, the 5-year overall survival of patients with non-disseminated NPC has exceeded 80%. But there are still about 20-30% of NPC patients who experienced recurrence or metastasis after radical chemoradiotherapy, especially locoregionally advanced patients. In order to improve their survival, we conduct this clinical trial to determine whether GP chemotherapy combined with PD-1 inhibitor as neoadjuvant therapy can improve the failure-free survival rate of locoregionally advanced NPC patients and provide new evidence for their neoadjuvant therapy of them.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Nasopharyngeal Carcinoma, Neoadjuvant Therapy, PD-1 Inhibitor

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 2
    Interventional Study Model
    Parallel Assignment
    Masking
    None (Open Label)
    Allocation
    Randomized
    Enrollment
    146 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    PD-1 inhibitor + GP Group
    Arm Type
    Experimental
    Arm Description
    PD-1 inhibitor plus GP chemotherapy as Neoadjuvant Therapy followed by IMRT combined with cisplatin concurrent chemotherapy
    Arm Title
    GP Group
    Arm Type
    Active Comparator
    Arm Description
    GP chemotherapy as Neoadjuvant Therapy chemotherapy followed by IMRT combined with cisplatin concurrent chemotherapy
    Intervention Type
    Drug
    Intervention Name(s)
    PD-1 inhibitor+GP
    Intervention Description
    PD-1 inhibitor (200-240mg), gemcitabine (1000mg/m2 on day 1,8) and cisplatin (80mg/m2 on day 1) every three weeks for three cycles as neoadjuvant therapy, then followed by IMRT and cisplatin (100mg/m2, d1, 22, 43 of RT) during concurrent chemoradiotherapy.
    Intervention Type
    Drug
    Intervention Name(s)
    GP
    Intervention Description
    Gemcitabine (1000mg/m2 on day 1,8) and cisplatin (80mg/m2 on day 1) every three weeks for three cycles as neoadjuvant therapy, then followed by IMRT and cisplatin (100mg/m2, d1, 22, 43 of RT) during concurrent chemoradiotherapy.
    Primary Outcome Measure Information:
    Title
    Failure-free survival
    Description
    the time from registration to treatment failure or death from any cause, whichever is first.
    Time Frame
    up to 24 months
    Secondary Outcome Measure Information:
    Title
    Complete Response (CR)
    Description
    the complete disappearance of the target and non-target lesion identified at baseline after radiological evaluation by MRI. Disease response was evaluated after the completion of the neoadjuvant therapy, according to RECIST 1.1.
    Time Frame
    up to 9 weeks
    Title
    Overall survival
    Description
    the time from registration to death due to any cause, or censored at date last known alive.
    Time Frame
    up to 24 months
    Title
    Locoregional failure-free survival(LRRFS)
    Description
    the time from registration to the first locoregional relapse or death from any cause.
    Time Frame
    up to 24 months
    Title
    Distant metastasis-free survival(DMFS)
    Description
    the time from registration to the first distant metastasis or death from any cause.
    Time Frame
    up to 24 months
    Title
    Adverse events (AEs)
    Description
    Analysis of adverse events (AEs) are based on treatment-related AEs (trAEs) and immune-related AEs (irAEs), and all-grade AEs and grade 3-4 AEs. AEs are evaluated by investigators according to the Common Terminology Criteria for Adverse Events, version 5.0
    Time Frame
    up to 24 months
    Title
    Quality of life(QOL)
    Description
    Assessed by European Organization for Research and Treatment of Cancer's quality of life questionnaire(QLQ)-C30
    Time Frame
    up to 24 months

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    65 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Histologically confirmed non-keratinizing nasopharyngeal carcinoma(WHO II/III). Original clinical staged as T4NanyM0 or TanyN2-3M0 (according to AJCC 8th edition), with no evidence of distant metastasis. Eastern Cooperative Oncology Group performance status ≤1. Adequate marrow function: neutrocyte count≥1.5×10e9/L, hemoglobin ≥90g/L, and platelet count ≥100×10e9/L. Alanine Aminotransferase (ALT)/Aspartate Aminotransferase (AST) ≤1.5×upper limit of normal (ULN), and bilirubin ≤ 1.5×ULN. Adequate renal function: creatinine clearance rate ≥ 60 ml/min (Cockcroft-Gault formula). Patients must be informed of the investigational nature of this study and give written informed consent. Women of childbearing potential (WOCBP) who are sexually active must be willing to adhere to effective contraception during treatment and for 1 year after the last dose of the study drug. Men who are sexually active with WOCBP must be willing to adhere to effective contraception during treatment and for 1 year after the last dose of the study drug. Exclusion Criteria: Age > 65 or < 18. Receiving radiotherapy or chemotherapy or targeted therapy or immunotherapy previously. Severe cerebrovascular disease/canker/psychosis. Has active autoimmune disease, except type I diabetes, hypothyroidism treated with replacement therapy, and skin disease that doesn't require systemic treatment (e.g., vitiligo, psoriasis, or alopecia). Has any condition that required systemic corticosteroid (equivalent to prednisone >10mg/d) or other immunosuppressive therapy within 28 days before informed consent. Patients who received systemic corticosteroid equivalent to prednisone ≤10mg/d, inhale or topical corticosteroid will be allowed. Has a known history of active TB (bacillus tuberculosis) within 1 year; patients with adequately treated active TB over 1 year ago will be allowed. Suffering from active infection diseases and in need of treatment. Has received a live vaccine within 30 days before informed consent or will receive a live vaccine in the near future. Pregnant or breastfeeding. Prior malignancy within 5 years, except in situ cancer, adequately treated non-melanoma skin cancer and papillary thyroid carcinoma. Has known allergy to large molecule protein products or any compound of PD-1 antibody. Has a known history of the human immunodeficiency virus (HIV) infection. Any other condition, including symptomatic heart failure, unstable angina, myocardial infarction, active infection requiring systemic therapy, mental illness or domestic/social factors, deemed by the investigator to be likely to interfere with a patient's ability to sign informed consent, cooperate and participate in the study, or interferes with the interpretation of the results.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    KAI HU, MD
    Phone
    +8613907710887
    Email
    gxhukai@hotmail.com
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    RENSHENG WANG, MD
    Organizational Affiliation
    First Affiliated Hospital of Guangxi Medical University
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    Undecided

    Learn more about this trial

    PD-1 Inhibitor Plus GP as Neoadjuvant Therapy for Locoregionally Advanced Nasopharyngeal Carcinoma

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