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Neoadjuvant of Sintilimab Combined With Chemotherapy for Resectable NSCLC(neoSCORE) (neoSCORE)

Primary Purpose

Non-small Cell Lung Cancer

Status
Unknown status
Phase
Phase 2
Locations
China
Study Type
Interventional
Intervention
sintilimab
pemetrexed
Carboplatin
albumin-bound paclitaxel
Sponsored by
Second Affiliated Hospital, School of Medicine, Zhejiang University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Non-small Cell Lung Cancer focused on measuring sintilimab, resectable NSCLC, neoadjuvant immunochemotherapy

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Sign the informed consent form before starting any trial related procedure.
  • 18-75 years old, male or female.
  • Non-small cell lung cancer confirmed by cytology or histology.
  • There must be at least one evaluable focus judged according to recist1.1 standard.
  • Evaluation by the researchers to confirm resectable stage cⅠb-Ⅲa NSCLC patients without any treatment before.
  • ECOG PS 0-1.
  • Life expectancy > 6 months.
  • Adequate organ function and it should meet the following criteria:

    1. No use of Granulocyte colony stimulating factor within 14 days, absolute neutrophils count(ANC)≥1.5x109/L, platelets count(PLT)>9g/dL, hemoglobin(HB)≥100×109/L;
    2. Total bilirubin(TBIL)≤1.5ULN, ALT、AST≤ 2.5 ULN, serum creatinine(sCr)≤1.5ULN;
    3. good blood coagulation: INR≤1.5 or PT≤1.5 ULN;
    4. normal thyroid function: TSH within normal institutional limits;
  • Women of childbearing age must undergo a serological pregnancy test within 3 days before the first dose(cycle 1 day 1) with negative results. If the result of urine pregnancy test cannot be confirmed as negative, blood pregnancy test is required.

Exclusion Criteria:

  • Malignancies within 5 years prior to the first dose(excluding radical skin basal cell carcinoma, skin squamous cell carcinoma and / or radical resection of carcinoma in situ).
  • Currently participating in the intervention clinical treatment, or receiving other drugs or research instruments within 4 weeks before the first dose.
  • Patients who have had prior treatment with an anti-PD-1, anti-PD-L1, anti-PD-L2, or drugs for another stimulation or synergistic inhibition of T cell receptor (e.g. CTLA-4, OX-40, CD137).
  • Active autoimmune diseases requiring systemic treatment (e.g. using disease improving drugs, corticosteroids or immunosuppressants) occurred within 2 years before the first dose. Alternative therapies (e.g. thyroxine, insulin or corticosteroids in physiological doses for adrenal or pituitary insufficiency) are not considered systemic treatment.
  • Systemic glucocorticoid therapy (excluding local glucocorticoids by nasal spray, inhalation or other routes) or any other form of immunosuppressive therapy is in progress within 7 days before the first dose.

Note: it is allowed to use physiological dose of glucocorticoid (Prednisone≤10 mg/d or equivalent drug).

  • Received allogeneic organ transplantation (except corneal transplantation) or allogeneic hematopoietic stem cell transplantation.
  • Allergic to study drug(sintilimab, pemetrexed, carboplatin, albumin-bound paclitaxel) components excipients.
  • Not fully recovered from toxicity and/or complications caused by any intervention before treatment (≤level 1 or reach baseline, excluding fatigue or hair loss).
  • Has a known history of human immunodeficiency virus (HIV) infection (HIV 1/2 antibody positive).
  • Untreated active Hepatitis B (defined as HBsAg positive and HBV-DNA copies>ULN).
  • Active Hepatitis C (HCV antibody positive and HCV-RNA level higher than the detection limit).
  • Inoculate the live vaccine within 30 days before the first dose (cycle 1 day 1).

Note: it is allowed to receive the injection inactivated virus vaccine for seasonal influenza within 30 days before the first dose; however, it is not allowed to accept the live attenuated influenza vaccine for intranasal medication.

  • Pregnant or lactating women.
  • There are any serious or uncontrollable systemic diseases, such as:

    1. Resting ECG has significant abnormalities in rhythm, conduction or morphology, and the symptoms are serious and difficult to control,such as complete left bundle branch block, heart block above degree Ⅱ, ventricular arrhythmia or atrial fibrillation;
    2. Unstable angina, congestive heart failure, chronic heart failure with NYHA grade ≥ 2;
    3. Within 6 months before inclusion, there were any arterial thrombosis, embolism or ischemia, such as myocardial infarction, unstable angina, cerebrovascular accident, transient ischemic attack etc;
    4. History of noninfectious pneumonia requiring glucocorticoid treatment within 1 year before the first dose,or having currently clinical active interstitial lung diseases;
    5. Active pulmonary tuberculosis;
    6. Active or uncontrolled infections requiring systemic treatment;
    7. Liver diseases such as cirrhosis, decompensated liver disease, acute or chronic active hepatitis;
    8. poorly controlled diabetes (Fasting blood glucose (FBG)>10mmol/L);
    9. Urine routine test indicates that urine protein≥++, and confirmed that 24 hours proteinuria>1.0 g;
    10. Patients with mental disorders who are unable to cooperate with the treatment;
  • There are medical history, disease, treatment or laboratory abnormal results that may interfere with the test results, prevent the subjects from participating in the whole process of the study, or the researchers think that participating in the study is not in the best interests of the subjects or there are other potential risks that the subjects are not suitable for the study.

Sites / Locations

  • Second Affiliated Hospital, School of Medicine, Zhejiang University

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

sintilimab+chemotherapy(2 cycles of neoadjuvant chemotherapy)

sintilimab+chemotherapy(3 cycles of neoadjuvant chemotherapy)

Arm Description

Patients with nonsquamous NSCLC (including adenocarcinoma, large cell carcinoma and unspecified type) : sintilimab + pemetrexed + carboplatin; Patients with squamous NSCLC : sintilimab + albumin-bound paclitaxel + carboplatin; Followed by surgery within the 4th week after the second dose of sintilimab; Followed by 2 cycles of adjuvant chemotherapy, the researcher will decide whether to radiotherapy or not according to the clinical situation and pathological stage of the patient; Followed by the maintenance treatment of sintilimab for up to 1 year according to the requirements of patients.

Patients with nonsquamous NSCLC (including adenocarcinoma, large cell carcinoma and unspecified type) : sintilimab + pemetrexed + carboplatin; Patients with squamous NSCLC : sintilimab + albumin-bound paclitaxel + carboplatin; Followed by surgery within the 4th week after the third dose of sintilimab; Followed by 1 cycles of adjuvant chemotherapy, the researcher will decide whether to radiotherapy or not according to the clinical situation and pathological stage of the patient; Followed by the maintenance treatment of sintilimab for up to 1 year according to the requirements of patients.

Outcomes

Primary Outcome Measures

Major pathological response rate (MPR)
MPR rate is defined as the percentage of participants having ≤10% viable tumor cells in the pathological examination of resected specimens.

Secondary Outcome Measures

Pathology complete response rate(pCR)
pCR rate is defined as the percentage of participants lacking of evidence of viable tumor cells in the pathological examination of resected specimens.
Objective response rate (ORR)
ORR is defined as the percentage of participants having a complete response or a partial response, measured by RECIST 1.1.
2 years disease-free survival rate (DFS)
2 years DFS rate is defined as the percentage of participants having no recurrence, distant metastasis or death within 2 years after operation.
2 years overall survival rate (OS)
2 years OS rate is defined as the percentage of participants having no death of any cause within 2 years after operation.The Kaplan-Meier estimator will be used to estimate median OS and its 95%CI and the survival curve.

Full Information

First Posted
July 2, 2020
Last Updated
July 11, 2022
Sponsor
Second Affiliated Hospital, School of Medicine, Zhejiang University
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1. Study Identification

Unique Protocol Identification Number
NCT04459611
Brief Title
Neoadjuvant of Sintilimab Combined With Chemotherapy for Resectable NSCLC(neoSCORE)
Acronym
neoSCORE
Official Title
Neoadjuvant of Sintilimab Combined With Chemotherapy for Resectable NSCLC(neoSCORE):A Prospective, Randomized, Open-Label, Single-Center Phase 2 Trial
Study Type
Interventional

2. Study Status

Record Verification Date
September 2021
Overall Recruitment Status
Unknown status
Study Start Date
July 1, 2020 (Actual)
Primary Completion Date
November 1, 2021 (Actual)
Study Completion Date
July 1, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Second Affiliated Hospital, School of Medicine, Zhejiang University

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No

5. Study Description

Brief Summary
This is a Phase 2, prospective, randomized, open-Label, single-center international study that assesses the efficacy and safety of neoadjuvant therapy with different cycles of sintilimab combined with chemotherapy for resectable NSCLC. This trial will also explore the biomarkers of neoadjuvant immunochemotherapy.
Detailed Description
This is a Phase 2, prospective, randomized, open-Label, single-center international study that assesses the efficacy and safety of neoadjuvant therapy with different cycles of sintilimab combined with chemotherapy for resectable NSCLC. In this trial, eligible subjects will be randomly assigned to arm A and arm B (1:1). Subjects in arm A will receive 2 cycles of neoadjuvant chemotherapy with sintilimab + chemotherapy and arm B will receive 3 cycles of neoadjuvant chemotherapy with sintilimab + chemotherapy, followed by surgery within the 4th week after the last dose of sintilimab. After operation, subjects in arm A will receive 2 cycles of adjuvant chemotherapy and arm B will receive 1 cycle of adjuvant chemotherapy, followed by the maintenance treatment of sintilimab for up to 1 year according to the requirements of patients. The primary purpose is MPR rate of neoadjuvant chemotherapy of resectable NSCLC with different cycles of sintilimab combined with platinum-based chemotherapy, which is defined as the percentage of participants having ≤10% viable tumor cells in the pathological examination of resected specimens.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Non-small Cell Lung Cancer
Keywords
sintilimab, resectable NSCLC, neoadjuvant immunochemotherapy

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
sintilimab+chemotherapy(2 cycles of neoadjuvant chemotherapy)
Arm Type
Experimental
Arm Description
Patients with nonsquamous NSCLC (including adenocarcinoma, large cell carcinoma and unspecified type) : sintilimab + pemetrexed + carboplatin; Patients with squamous NSCLC : sintilimab + albumin-bound paclitaxel + carboplatin; Followed by surgery within the 4th week after the second dose of sintilimab; Followed by 2 cycles of adjuvant chemotherapy, the researcher will decide whether to radiotherapy or not according to the clinical situation and pathological stage of the patient; Followed by the maintenance treatment of sintilimab for up to 1 year according to the requirements of patients.
Arm Title
sintilimab+chemotherapy(3 cycles of neoadjuvant chemotherapy)
Arm Type
Experimental
Arm Description
Patients with nonsquamous NSCLC (including adenocarcinoma, large cell carcinoma and unspecified type) : sintilimab + pemetrexed + carboplatin; Patients with squamous NSCLC : sintilimab + albumin-bound paclitaxel + carboplatin; Followed by surgery within the 4th week after the third dose of sintilimab; Followed by 1 cycles of adjuvant chemotherapy, the researcher will decide whether to radiotherapy or not according to the clinical situation and pathological stage of the patient; Followed by the maintenance treatment of sintilimab for up to 1 year according to the requirements of patients.
Intervention Type
Biological
Intervention Name(s)
sintilimab
Other Intervention Name(s)
IBI308, PD-1 antibody
Intervention Description
200 mg by IV infusion every 3 weeks (Q3W), given on cycle day 1.
Intervention Type
Drug
Intervention Name(s)
pemetrexed
Intervention Description
500 mg/m^2 by IV infusion Q3W, given on cycle day 1.
Intervention Type
Drug
Intervention Name(s)
Carboplatin
Intervention Description
AUC 5 mg/mL/min by IV infusion Q3W, given on cycle day 1.
Intervention Type
Drug
Intervention Name(s)
albumin-bound paclitaxel
Intervention Description
260 mg/m^2 by IV infusion Q3W, given on cycle day 1.
Primary Outcome Measure Information:
Title
Major pathological response rate (MPR)
Description
MPR rate is defined as the percentage of participants having ≤10% viable tumor cells in the pathological examination of resected specimens.
Time Frame
At time of surgery
Secondary Outcome Measure Information:
Title
Pathology complete response rate(pCR)
Description
pCR rate is defined as the percentage of participants lacking of evidence of viable tumor cells in the pathological examination of resected specimens.
Time Frame
At time of surgery
Title
Objective response rate (ORR)
Description
ORR is defined as the percentage of participants having a complete response or a partial response, measured by RECIST 1.1.
Time Frame
prior to surgery
Title
2 years disease-free survival rate (DFS)
Description
2 years DFS rate is defined as the percentage of participants having no recurrence, distant metastasis or death within 2 years after operation.
Time Frame
2 years postoperatively
Title
2 years overall survival rate (OS)
Description
2 years OS rate is defined as the percentage of participants having no death of any cause within 2 years after operation.The Kaplan-Meier estimator will be used to estimate median OS and its 95%CI and the survival curve.
Time Frame
2 years postoperatively

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Sign the informed consent form before starting any trial related procedure. 18-75 years old, male or female. Non-small cell lung cancer confirmed by cytology or histology. There must be at least one evaluable focus judged according to recist1.1 standard. Evaluation by the researchers to confirm resectable stage cⅠb-Ⅲa NSCLC patients without any treatment before. ECOG PS 0-1. Life expectancy > 6 months. Adequate organ function and it should meet the following criteria: No use of Granulocyte colony stimulating factor within 14 days, absolute neutrophils count(ANC)≥1.5x109/L, platelets count(PLT)>9g/dL, hemoglobin(HB)≥100×109/L; Total bilirubin(TBIL)≤1.5ULN, ALT、AST≤ 2.5 ULN, serum creatinine(sCr)≤1.5ULN; good blood coagulation: INR≤1.5 or PT≤1.5 ULN; normal thyroid function: TSH within normal institutional limits; Women of childbearing age must undergo a serological pregnancy test within 3 days before the first dose(cycle 1 day 1) with negative results. If the result of urine pregnancy test cannot be confirmed as negative, blood pregnancy test is required. Exclusion Criteria: Malignancies within 5 years prior to the first dose(excluding radical skin basal cell carcinoma, skin squamous cell carcinoma and / or radical resection of carcinoma in situ). Currently participating in the intervention clinical treatment, or receiving other drugs or research instruments within 4 weeks before the first dose. Patients who have had prior treatment with an anti-PD-1, anti-PD-L1, anti-PD-L2, or drugs for another stimulation or synergistic inhibition of T cell receptor (e.g. CTLA-4, OX-40, CD137). Active autoimmune diseases requiring systemic treatment (e.g. using disease improving drugs, corticosteroids or immunosuppressants) occurred within 2 years before the first dose. Alternative therapies (e.g. thyroxine, insulin or corticosteroids in physiological doses for adrenal or pituitary insufficiency) are not considered systemic treatment. Systemic glucocorticoid therapy (excluding local glucocorticoids by nasal spray, inhalation or other routes) or any other form of immunosuppressive therapy is in progress within 7 days before the first dose. Note: it is allowed to use physiological dose of glucocorticoid (Prednisone≤10 mg/d or equivalent drug). Received allogeneic organ transplantation (except corneal transplantation) or allogeneic hematopoietic stem cell transplantation. Allergic to study drug(sintilimab, pemetrexed, carboplatin, albumin-bound paclitaxel) components excipients. Not fully recovered from toxicity and/or complications caused by any intervention before treatment (≤level 1 or reach baseline, excluding fatigue or hair loss). Has a known history of human immunodeficiency virus (HIV) infection (HIV 1/2 antibody positive). Untreated active Hepatitis B (defined as HBsAg positive and HBV-DNA copies>ULN). Active Hepatitis C (HCV antibody positive and HCV-RNA level higher than the detection limit). Inoculate the live vaccine within 30 days before the first dose (cycle 1 day 1). Note: it is allowed to receive the injection inactivated virus vaccine for seasonal influenza within 30 days before the first dose; however, it is not allowed to accept the live attenuated influenza vaccine for intranasal medication. Pregnant or lactating women. There are any serious or uncontrollable systemic diseases, such as: Resting ECG has significant abnormalities in rhythm, conduction or morphology, and the symptoms are serious and difficult to control,such as complete left bundle branch block, heart block above degree Ⅱ, ventricular arrhythmia or atrial fibrillation; Unstable angina, congestive heart failure, chronic heart failure with NYHA grade ≥ 2; Within 6 months before inclusion, there were any arterial thrombosis, embolism or ischemia, such as myocardial infarction, unstable angina, cerebrovascular accident, transient ischemic attack etc; History of noninfectious pneumonia requiring glucocorticoid treatment within 1 year before the first dose,or having currently clinical active interstitial lung diseases; Active pulmonary tuberculosis; Active or uncontrolled infections requiring systemic treatment; Liver diseases such as cirrhosis, decompensated liver disease, acute or chronic active hepatitis; poorly controlled diabetes (Fasting blood glucose (FBG)>10mmol/L); Urine routine test indicates that urine protein≥++, and confirmed that 24 hours proteinuria>1.0 g; Patients with mental disorders who are unable to cooperate with the treatment; There are medical history, disease, treatment or laboratory abnormal results that may interfere with the test results, prevent the subjects from participating in the whole process of the study, or the researchers think that participating in the study is not in the best interests of the subjects or there are other potential risks that the subjects are not suitable for the study.
Facility Information:
Facility Name
Second Affiliated Hospital, School of Medicine, Zhejiang University
City
Hangzhou
State/Province
Zhejiang
ZIP/Postal Code
310009
Country
China

12. IPD Sharing Statement

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Neoadjuvant of Sintilimab Combined With Chemotherapy for Resectable NSCLC(neoSCORE)

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