AFP Gastric or Gastroesophageal Junction Adenocarcinoma, Gastric Cancer (GC)
Conditions
Brief summary
Alpha-fetoprotein-producing gastric cancer (AFP-positive gastric cancer, AFP-GC), a rare and highly aggressive subtype of gastric cancer, accounts for 1.3% to 15% of all gastric cancer cases. Its clinical features are significantly different from those of common gastric cancer. Not only does it show abnormally elevated serum AFP levels, but it also has a stronger angiogenic ability, a higher rate of distant metastasis, and a poorer prognosis even after a upfront R0 surgery, making it a challenging problem in the field of gastric cancer treatment. Notably, patients with AFP-positive gastric cancer have a relatively low sensitivity to the traditional standard regimens. There is an urgent need to explore targeted treatment strategies to break through the efficacy bottleneck. Combination of sintilimab, bevacizumab and XELOX/SOX for initially unresectable AFP-positive gastric/esophagogastric junction adenocarcinoma could be a novel therapeutic strategy to increase response rate and therapeutic efficacy. This study is a multi-center, single-arm phase 2 clinical trial to evaluate efficacy, tolerability and safety of perioperative sintilimab in combination with bevacizumab and XELOX/SOX in initially unresectable AFP-positive gastric/esophagogastric junction adenocarcinoma.
Interventions
DRUGSintilimab
Sintilimab, recombinant humanized anti-PD-1 monoclonal antibody for injection; 200mg iv drip，d1, q3w
DRUGBevacizumab
7.5mg/kg，iv drip，d1, q3w
DRUGOxaliplatin
130mg/m2，iv drip for 2h，d1, q3w
DRUGCapecitabine
1000mg/m2 twice daily, d1-14, q3w
DRUGS-1
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 cT3-4N+M0/1 gastric or GEJ adenocarcinoma; (M1 only includes type I liver metastasis of gastric cancer, according to the "Chinese Expert Consensus on Liver Metastasis of Gastric Cancer"); * Serum AFP levels \> 2× upper limit of normal or AFP-positive by IHC staining; * Adequate organ function * ECOG 0-1, no surgery contraindications; * Expected survival ≥3 months;
Exclusion criteria
* HER2-positive status: IHC 3+, or IHC 2+/FISH+ * Prior chemotherapy, radiotherapy, anti-PD-1/PD-L1 therapy, surgery for gastric cancer; * Signs of other distant metastases (e.g., peritoneal, lung, bone, supraclavicular lymph, etc.) * Significant cardiovascular disease --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; * There are active gastric and duodenal ulcers, ulcerative colitis and other gastrointestinal diseases, or active bleeding in unresectable tumors.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Objective response rate(ORR) | From first dose to end of study treatment or last tumor assessment prior to conversion surgery or disease progression.Up to 24 weeks. | Objective response rate(ORR):CR+PR |
Secondary
| Measure | Time frame |
|---|---|
| R0 resection rate | From the initiation date of first cycle (each cycle is 21 days) to the date of operation.Up to 24 weeks. |
| Major pathological response rate | From the initiation date of first cycle (each cycle is 21 days) to the date of operation.Up to 24 weeks. |
| One year progression-free survival (PFS) | 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 1 year. |
| One year overall survival(OS) | The Kaplan-Meier survival from the initiation date of first cycle until death from any cause or the last follow-up date,assessed up to 1 year. |
Outcome results
None listed