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
About this trial
This is an interventional treatment trial for Nasopharyngeal Carcinoma
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.
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
NCT ID
NCT05340270
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
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
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PD-1 Inhibitor Plus GP as Neoadjuvant Therapy for Locoregionally Advanced Nasopharyngeal Carcinoma
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