Esophageal Squamous Cell Carcinoma (ESCC)
Conditions
Keywords
chemotherapy, radiotherapy, immune checkpoint inhibitors, adebrelimab
Brief summary
This study aims to systematically evaluate the safety and efficacy of adalimumab combined with paclitaxel, carboplatin, and short-course radiotherapy in the neoadjuvant treatment of esophageal squamous cell carcinoma.
Detailed description
CROSS Study showed that the pathological complete response (pCR) rate of patients with esophageal cancer (23% of whom were esophageal squamous cell carcinoma, ESCC) after neoadjuvant radiotherapy and chemotherapy was 29%. NEOCRTEC5010 Study showed that the pCR rate was 43.2% in locally advanced esophageal squamous cell carcinoma, which means that more than half of patients still cannot achieve ideal therapeutic effects from existing treatment options. In addition, the recurrence rate after surgical resection compromises the long-term survival rate of patients. Therefore, exploring new treatment strategies to improve the treatment efficacy and survival rate of esophageal cancer patients has important clinical significance. Currently, the significance of immunotherapy combined with chemoradiotherapy in terms of pathological complete response (pCR) rates and postoperative survival quality for locally advanced esophageal squamous cell carcinoma remains unclear. Therefore, this study aims to systematically evaluate the safety and efficacy of adebrelimab in combination with paclitaxel, carboplatin, and short-course radiotherapy as neoadjuvant therapy for ESCC. By integrating immunotherapy with existing standard treatment regimens, this study seeks to significantly improve pCR rates, optimize surgical resection outcomes, ultimately prolong disease-free survival (DFS), and enhance overall survival (OS). The implementation of this study is expected to provide innovative approaches and methods for the clinical treatment of ESCC, holding important clinical application value and significance.
Interventions
DRUG• Adebrelimab and nab-paclitaxel, carboplatin in Combination With radiotherapy
Patients would receive Adebrelimab (IV 1200mg d1) and nab-paclitaxel (IV 220 mg/m²d1) plus carboplatin (AUC = 5, d1) for two 21-day cycles, followed by one week off for radiotherapy (2.5 ⨉12 Gy). After radiotherapy, another cycle of Adebrelimab (IV 1200mg d1) would be given. 4 to 6 weeks after completing the neoadjuvant therapy, patients would undergo esophagectomy.
Sponsors
Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University
Jiangsu HengRui Medicine Co., Ltd.
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
* \- 1. Provided informed consent and sign the informed consent form; * 2\. Male or female, Aged 18-75 years (counted on the date of signing informed consent); * 3\. Pathological confirmed ESCC; * 4\. Patients assessed by thoracic oncologists as resectable without distant metastasis * 5\. Patients evaluate with clinical staging of T1-4aN1-3M0 or T3-4aN0M0(AJCC 9.0) based on imaging and pathological examination results; * 6\. Have at least one assessable lesion according to the RECIST V1.1 * 7\. ECOG-PS score: 0-1; * 8\. Patients with normal function of organs such as heart, brain, lungs, and kidneys who can tolerate surgery; * 9\. With a life expectancy of ≥ 6 weeks; * 10\. Adequate major organ function without severe hematologic, cardiac, pulmonary, hepatic, renal, or bone marrow dysfunction, and no immunodeficiency disease;
Exclusion criteria
* 1\. Patients who have received or are currently receiving chemotherapy, radiotherapy, immunotherapy, or targeted therapy * 2\. Patients with distant metastasis or inability to undergo resection after evaluation by thoracic surgeons * 3\. Simultaneously developing tumors in other parts of the body * 4\. Severe impairment of heart, liver, and kidney function (heart function grade 3-4, ALT and/or AST exceeding the upper limit of normal by more than 1.5 times, Cr (serum creatinine) exceeding the upper limit of normal by more than 1.5 times) * 5\. Patients with a history of autoimmune diseases who were receiving immunosuppressive therapy prior to enrollment, with immunosuppressive doses\>10 mg/day or oral prednisone for more than 2 weeks * 6\. Severe allergy to immune preparations * 7\. Abnormal coagulation function: (PT\>16s, APTT\>53s, TT\>21s, Fib\<1.5 g/L), bleeding tendency or during thrombolytic or anticoagulant therapy * 8\. Pregnancy or lactation period * 9\. Other situations as judged by investigators not suitable for inclusion.;
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pathological complete response (pCR) | From patient enrollment to the end of surgery | The proportion of subjects with no residual viable tumor cells(ypT0N0) in the primary tumor and lymph nodes; that is, the proportion of patients who have achieved complete remission among PPS(Per-Protocol Set). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| R0 resection rate | From patient enrollment to the end of surgery | The proportion of patients with tumor margins showing no residual cancer cells under the microscope after surgical resection. That is, the proportion of patients in PPS achieving R0 resection. |
| Disease free survival (DFS) | up to 24 months post-surgery | Disease free survival (DFS) refers to the time from the start of treatment until disease recurrence or death from any cause, whichever occurs first. |
| Overall survival (OS) | up to 24 months after surgery | OS is the time interval from the start of treatment to death due to any reason or loss of follow-up |
| Major pathological remission (MPR) | From patient enrollment to the end of surgery | Major pathological remission (MPR) refers to the percentage of residual tumor cells in the tumor bed after neoadjuvant therapy being ≤ 10%, regardless of whether there are residual tumor cells in the lymph nodes. |
| Progression free survival (PFS) | Up to 24 months post-surgery | PFS is defined as the time from the start of treatment to the date of first documentation of disease progression, or date of death, whichever occurred first. |
| Event free survival (EFS) | From patient enrollment to the end of surgery | EFS refers to the time from the start of treatment to the occurrence of any event, including disease progression, cessation of treatment for any reason, or death. |
| Adverse Events | from the first drug administration to within 30 days for the last Adebrelimab dose | Number of adverse events. The evaluation criteria for adverse reactions are based on the American Cancer Institute Common Adverse Event Terminology 4.0 (CTCAE 5.0) and the Acute Radiation Injury Grading Standards of the American Oncology Radiotherapy Collaboration Group (RTOG). |
Countries
China
Contacts
CONTACTBaisheng Chen, M.D, PhD
Outcome results
None listed