Colon Cancer, DMMR Cancer, Gastric Cancer, MSI-H
Conditions
Keywords
Organ preservation, immunotherapy, anti-VEGF
Brief summary
This study intends to explore the role of PD1/PDL1 antibody with selective combination of Sintilimab, IBI310 and Lenvatinib in organ preservation in non-metastatic dMMR/MSI-H gastric or colon cancers with mismatch repair deficiency or high microsatellite instability
Interventions
DRUGPD1/PDL1 antibody monotherapy, up to 24 weeks
non-specific, according to Drug Instructions
COMBINATION_PRODUCTIntensive immunotherapy plus anti-VEGF treatment, up to 24 weeks
Sintilimab 200mg, ivgtt, q21d; IBI310 1mg/kg, ivgtt, q42d; Lenvatinib 8mg (starting from 4mg), po, qd
PROCEDURERadical surgery
Radical surgery will be recommended per local treatment standards.
Sponsors
Peking University
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Subjects are able to comprehend the informed consent form, and voluntarily sign the informed consent form. * Subjects are ≥18 years old on the day of signing the informed consent form, with no gender restrictions. * Histologically confirmed gastric cancer or colon cancer, without distant metastasis based on CR or MR. * ECOG performance status of 0-2. * dMMR confirmed by immunohistochemistry or MSI-H confirmed by PCR and NGS. If MSI status and MMR status were not consistent, whether to enroll this patient should be determine by investigators. Patients with MMR heterogeneity in tumors could not be included. * Patients who are about to receive or are receiving 24 weeks of PD1/PDL1 antibody monothearpy and have not had the first efficacy assessment. * Archived tumor tissue samples or freshly obtained tumor tissue samples are available. * Female subjects of childbearing potential or male subjects with partners of childbearing potential agree to use highly effective contraception from 7 days before the first dose until 120 days after the last dose. Female subjects of childbearing potential must have a negative serum pregnancy test within 7 days before the first dose. * Subjects have the ability and willingness to comply with the study protocol's visits, treatment plan, laboratory tests, and other study-related procedures. * For patients who are about to receive combination of Sintilimab, IBI310 and Lenvatinib. subjects should have good organ function within the first 7 days of initial dosing: HGB ≥ 80g/L, NEU ≥ 1.0\*10\^9/L, PLT ≥ 75\*10\^9/L, Cr≤1.5×ULN or CrCl≥50mL/min（Cockcroft-Gault method), TBiL ≤ 1.5×ULN, ALT and AST ≤3 ×ULN; urine protein \<2+; if urine protein ≥ 2+, 24 hour urinary protein quantity \<2g; INR, APTT, PT ≤ 1.5 ×ULN
Exclusion criteria
* Distant metastasis; * Previous treatment including CTLA4 blockade; * Subjects with interstitial lung disease or a history of non-infectious pneumonia requiring oral or intravenous corticosteroid treatment. * Subjects with active autoimmune diseases requiring systemic treatment before the start of the study or those considered at risk of recurrence or planned treatment for autoimmune diseases as judged by the investigator. Except for these conditions: a) skin diseases that do not require systemic treatment (e.g., vitiligo, alopecia, psoriasis, or eczema); b) hypothyroidism caused by autoimmune thyroiditis, requiring stable doses of hormone replacement therapy; c) type 1 diabetes requiring stable doses of insulin replacement therapy; d) childhood asthma fully resolved with no need for intervention in adulthood; e) the investigator judges that the disease will not relapse without external triggering factors. * Subjects with a history of other malignant tumors within 5 years, excluding cured skin squamous cell carcinoma, basal cell carcinoma, non-invasive bladder carcinoma, localized low-risk prostate cancer (defined as stage ≤T2a, Gleason score ≤6, and prostate-specific antigen (PSA) ≤10 ng/mL (if measured) in patients who have undergone curative treatment and have no biochemical recurrence of prostate-specific antigen (PSA)), in situ cervical/breast carcinoma, or Lynch syndrome. * Subjects with uncontrolled comorbidities, including but not limited to: a) active HBV or HCV infection; b) subjects who are HBsAg positive and/or HCV antibody positive during screening must undergo HBV DNA and/or HCV RNA testing. Only subjects with HBV DNA ≤500 IU/mL (or ≤2000 copies/mL) and/or HCV RNA negative can be enrolled; HBV DNA monitoring will be at the discretion of the investigator based on the subject's condition during the trial; c) known HIV infection or AIDS history; d) active tuberculosis; e) uncontrolled hypertension (resting blood pressure ≥160/100 mmHg), symptomatic congestive heart failure (NYHA II-IV), unstable angina or myocardial infarction within 6 months, or the presence of QTc prolongation or the risk of arrhythmia (baseline QTc \>470 msec \<Fridericia method correction\>, refractory hypokalemia, long QT syndrome, atrial fibrillation with resting heart rate \>100 bpm, or severe valvular heart disease); f) active bleeding that cannot be controlled after medical treatment. * History of allogeneic bone marrow or organ transplantation. * Previous history of allergic reactions, hypersensitivity reactions, or intolerance to antibody drugs (e.g., severe allergic reactions, immune-mediated hepatotoxicity, immune-mediated thrombocytopenia, or anemia). * Pregnant and/or lactating females. * For patients who are about to receive combination of Sintilimab, IBI310 and Lenvatinib: a) Subjects with a history of gastrointestinal perforation or fistula within 6 months before the first dose. If the perforation or fistula has been treated with resection or repair, and the disease is judged to be recovered or improved by the investigator, then enrollment is allowed. b) Subjects who have undergone major surgery within 28 days before the first dose (e.g., major abdominal or thoracic surgery; excluding drainage, diagnostic puncture, or peripheral vascular access replacement). c) Subjects who require systemic corticosteroids (≥10 mg/day prednisone or equivalent) or immunosuppressive therapy for a continuous 7-day period within 14 days before the first dose. Inhaled or locally applied steroids and physiological replacement doses of steroids due to adrenal insufficiency are allowed. Short-term (≤7 days) corticosteroids for prophylaxis (e.g., contrast dye allergy) or treatment of non-autoimmune diseases (e.g., delayed hypersensitivity reaction caused by exposure to allergens) are allowed. d) Toxicity from previous antitumor treatments has not recovered to Grade ≤2 (NCI-CTCAE v5.0) or baseline, except for alopecia, skin pigmentation (allowed at any level), and immune-related adverse reactions requiring physiological replacement (e.g., hypothyroidism, hypopituitarism, type 1 diabetes).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Organ preservation rate | The status of cCR or near-cCR and the possibility of organ preservation will be evaluated after completion of PD1/PDL1 antibody monotherapy, 12 weeks after Sintilimab, IBI310 and Lenvatinib, and 24 weeks after Sintilimab, IBI310 and Lenvatinib | The rate of patients who achieved cCR or near-cCR and did not undergo surgery after completion of established therapy, assessed among all patients who completed established therapy. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Organ preservation rate after completion of PD1/PDL1 antibody monotherapy | The status of cCR or near-cCR and the possibility of organ preservation will be evaluated after completion of PD1/PDL1 antibody monotherapy, an average of 24 weeks | The rate of patients who achieve cCR or near-cCR and do not undergo surgery after completion of PD1/PDL1 antibody monotherapy, assessed among all patients who completed PD1/PDL1 antibody monotherapy |
| Organ preservation rate after completion of selective combination of Sintilimab, IBI310 and Lenvatinib | The status of cCR or near-cCR and the possibility of organ preservation will be evaluated 12 weeks and 24 weeks after Sintilimab, IBI310 and Lenvatinib | The rate of patients who achieved cCR or near-cCR and did not undergo surgery after completion of selective combination of Sintilimab, IBI310 and Lenvatinib, assessed among all patients who do not achieve cCR or near-cCR after PD1/PDL1 antibody monotherapy, and all patients who achieve cCR or near-cCR after PD1/PDL1 antibody monotherapy but have disease progression during follow-up |
| Objective response rate of selective combination of Sintilimab, IBI310 and Lenvatinib | Baseline up to withdrawal of consent, progressive disease, unacceptable toxicity, or surgery (whichever occurs first), up to 8 years | Objective response rate (defined as CR+PR) will be reported based on investigator's evaluation according to RECIST 1.1 |
| Disease control rate of selective combination of Sintilimab, IBI310 and Lenvatinib | Baseline up to withdrawal of consent, progressive disease, unacceptable toxicity, or surgery (whichever occurs first), up to 8 years | Disease control rate (defined as CR+PR+SD) will be reported based on investigator's evaluation according to RECIST 1.1 |
| 3 year organ preservation rate | From first dose of PD1/PDL1 antibody until the date of surgery, assessed up to 3 years | Rate of 3 year surgery-free survival |
| 3 year disease free survival rate | From first dose of PD1/PDL1 antibody until disease progression (local or distant), secondary tumor or death (whichever occurs first), assessed up to 3 years | Rate of 3 year disease free survival |
| 3 year overall survival rate | From first dose of PD1/PDL1 antibody until death, assessed up to 3 years | Rate of 3 year overall survival |
| 5 year overall survival rate | From first dose of PD1/PDL1 antibody until death, assessed up to 5 years | Rate of 5 year overall survival |
| 3 year local recurrence free survival rate | From first dose of PD1/PDL1 antibody until first local failure or death (whichever occurs first), assessed up to 3 years | Rate of 3 year local recurrence free survival |
| 3 year distant metastasis free survival rate | From first dose of PD1/PDL1 antibody until distant metastasis or death (whichever occurs first), assessed up to 3 years | Rate of 3 year distant metastasis free survival |
| 3 year surgery free survival rate | From first dose of PD1/PDL1 antibody until radical surgery or death (whichever occurs first), assessed up to 3 years | Rate of 3 year surgery free survival |
| Treatment-related adverse event of combination of Sintilimab, IBI310 and Lenvatinib | From first dose of Sintilimab, IBI310 and Lenvatinib to 30 days after last dose of treatment. | A treatment-related adverse event (TRAE) is defined as any adverse event not present prior to the initiation of drug treatment or any adverse event already present that worsens in intensity or frequency following exposure to the drug treatment. TRAEs were graded using National Cancer Institute (NCI)-CTCAE version 5.0. |
| Quality of life of combination of Sintilimab, IBI310 and Lenvatinib for gastric cancer patients | From first dose of PD1/PDL1 antibody until death, assessed up to 8 years | Quality of life will be evaluated using EORTC QLQ-C30 and QLQ-STO22. |
| Quality of life of combination of Sintilimab, IBI310 and Lenvatinib for colon cancer patients | From first dose of PD1/PDL1 antibody until death, assessed up to 8 years | Quality of life will be evaluated using EORTC QLQ-C30 and EORTC QLQ-CR29. |
| Rate of complications | From 7 days before surgery to 12 days after surgey | Rate of complications in perioperative period |
| Rate of mortality | From 7 days before surgery to 12 days after surgey | Rate of mortality in perioperative period |
Countries
China
Contacts
CONTACTLin Shen
CONTACTZhenghang Wang
PRINCIPAL_INVESTIGATORLin Shen
Peking University Cancer Hospital & Institute
Outcome results
None listed