Gastric Cancer, Gastro Esophageal Junction Cancer
Conditions
Brief summary
For locally advanced gastric and gastroesophageal junction adenocarcinoma (cT3-4bNanyM0), perioperative PD-1 antibody combined with chemotherapy can downstage tumor stage, increase the R0 resection rate, and may improve the long-term survival. Combination of perioperative surufatinib, sintilimab and chemotherapy for locally advanced gastric and gastroesophageal junction adenocarcinoma could be a novel therapeutic strategy to increase response rate and therapeutic efficacy. Surufatinib, as the oral drug in this study is a small molecule kinase inhibitor that mainly acts on vascular growth factor receptor (VEGFR1, 2,3), fibroblast growth factor receptor 1(FGFR1) and colony stimulating factor 1 receptor (CSF1R). It is a proprietary product developed by Hutchison Whampoa Pharmaceutical (Shanghai, China) Co., LTD. Surufatinib has been approved for neuroendocrine tumor. This study is a monocenter, single-arm phase 2 clinical trial to evaluate tolerability, safety and efficacy of perioperative surufatinib in combination with sintilimab and chemotherapy in locally advanced gastric and gastroesophageal junction adenocarcinoma.
Detailed description
The incidence of gastric and gastroesophageal junction adenocarcinoma is increasing in China, and it is one of the most common malignant tumors in China. Surgery is the only possible way to cure gastric and gastroesophageal junction adenocarcinoma, however, over 70-80% of gastric/gastroesophageal junction adenocarcinoma patients in China are in advanced stage. Locally gastric/gastroesophageal junction adenocarcinoma (cT3-4bNanyM0) could be cured by multi-disciplinary therapies including surgery, immunotherapy and chemotherapy. Perioperative immunotherapy plus chemotherapy can downstage tumor T and N stage, increase the R0 resection rate, and may improve the long-term survival. However, the therapeutic effects still not satisfactory to date. Surufatinib, as the novel oral antivascular targeting drug, has been proved to be effective in neuroendocrine tumor. Combination of perioperative surufatinib and immunotherapy plus chemotherapy for locally advanced gastric/gastroesophageal junction adenocarcinoma could be a novel therapeutic strategy to increase response rate and therapeutic efficacy. This study is a monocenter, single-arm phase 2 clinical trial to evaluate tolerability, safety and efficacy of perioperative surufatinib in combination with sintilimab and chemotherapy in locally advanced gastric and gastroesophageal junction adenocarcinoma.
Interventions
DRUGSurufatinib
Surufatinib: 250mg qd，d1-21, q3w
DRUGSintilimab
Sintilimab：200mg ivdrip, d1, q3w
DRUGOxaliplatin
130mg/m2，iv drip for 2h，d1, q3w
DRUGS1
S1：40\~60mg Bid，d1\~14, q3w
Sponsors
Fudan University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* signed informed consent * patients age 18-75 years; * Histologically CT/MRI confirmed cT3-4bNanyM0 gastric or GEJ adenocarcinoma; * ECOG 0-1, no surgery contraindications; * Expected survival ≥3 months;
Exclusion criteria
* signs of distant metastases * Prior chemotherapy, radiotherapy, surgery for gastric cancer; * Significant cardiovascular disease * major surgical procedure within 4 weeks prior to initiation of study treatment * current treatment with anti-viral therapy or HBV * pregnancy or breastfeeding * history of malignancy within 5 years prior to screening * Present or history of any autoimmune disease or immune deficiency; * Prior therapy with a PD-1, anti-PD-Ligand 1 (PD-L1) or CTLA-4 agent; * There are active gastric and duodenal ulcers, ulcerative colitis and other gastrointestinal diseases, or active bleeding in unresectable tumors. * Poorly controlled hypertension or diabetes;
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Pathological complete response（pCR）rate | From the initiation date of first cycle (each cycle is 21 days) to the date of operation, an average of 12 weeks |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| R0 resection rate | From the initiation date of first cycle (each cycle is 21 days) to the date of operation, an average of 12 weeks. | — |
| Event free survival (EFS) | From the initiation date of first cycle (each cycle is 21 days) to the date of first documented progression or date of death from any cause, whichever came first, assessed up to 3 years. | EFS is defined as the time from enrollment to disease progression, recurrence, or death from any cause, whichever occurs first. |
| Overall survival (OS) | From the initiation date of first cycle (each cycle is 21 days) to the date of first documented date of death from any cause, assessed up to 3 years. | OS is defined as the time from enrollment to death from any cause. |
Countries
China
Outcome results
None listed