Locally Advanced Gastric or Gastroesophageal Junction Adenocarcinoma
Conditions
Keywords
Iparomlimab/Tovonralimab Combination Antibody, Gastric Adenocarcinoma, Gastroesophageal Junction Adenocarcinoma, DOS Regimen
Brief summary
This is an open-label, prospective, interventional study designed to enroll 34 patients with locally advanced gastric or gastroesophageal junction adenocarcinoma, aiming to evaluate and observe the efficacy and safety of QL1706 in combination with DOS for the treatment of locally advanced gastric or gastroesophageal junction adenocarcinoma. Enrolled patients will receive iparomlimab and tuvonralimab in combination with the DOS regimen (docetaxel + oxaliplatin + S-1) administered in 21-day treatment cycles. Subjects who complete 3-4 cycles of treatment and are deemed suitable for surgery will undergo gastrectomy, with the specific interval between neoadjuvant therapy and surgery determined by the investigator based on actual clinical circumstances. Following surgery, clinicians will administer postoperative treatment according to the postoperative pathological assessment results and the clinical practice treatment principles of the study center. The primary endpoint is the pathological complete response rate assessed by postoperative pathological evaluation.
Interventions
5 mg/kg, intravenous infusion, administered once every 21 days (D1), for 3-4 cycles.
DRUGDocetaxel
40 mg/m², intravenous infusion, administered once every 21 days (D1), for 3-4 cycles.
DRUGOxaliplatin
100 mg/m², intravenous infusion, administered once every 21 days (D1), for 3-4 cycles.
40 mg/m², oral, twice daily (BID), D1-14, every 21 days per cycle, for 3-4 cycles.
PROCEDUREGastrectomy
Subjects who complete 3-4 cycles of neoadjuvant therapy and are deemed suitable for surgery will undergo gastrectomy. The specific interval between neoadjuvant therapy and surgery will be determined by the investigator based on actual clinical circumstances.
Sponsors
The First Affiliated Hospital of Zhengzhou University
Qilu Pharmaceutical 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. Aged 18 to 75 years; male or female. 2. Previously untreated, resectable adenocarcinoma of the stomach or gastroesophageal junction (GEJ). 3. Clinical stage cT3-4a/N+ M0. 4. ECOG performance status 0-1. 5. Adequate organ function within 7 days prior to treatment, meeting the following criteria: (1) Complete blood count (CBC) criteria (without blood transfusion within 14 days): Hemoglobin (Hb) ≥ 90 g/L; Absolute neutrophil count (ANC) ≥ 1.5 × 10⁹/L; Platelet count (PLT) ≥ 80 × 10⁹/L; (2) Serum chemistry criteria: Total bilirubin (TBIL) ≤ 1.5 × upper limit of normal (ULN); Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.5 × ULN; Serum creatinine (Cr) ≤ 1.5 × ULN or creatinine clearance (CCr) ≥ 60 mL/min; (3) Doppler echocardiography: left ventricular ejection fraction (LVEF) ≥ lower limit of normal (50%). (4) Thyroid function: thyroid-stimulating hormone (TSH) ≤ upper limit of normal (ULN). 6. Participants of childbearing potential must agree to use effective contraception during the study period and for 6 months after study completion. 7. The participant voluntarily agrees to participate in this study and signs the informed consent form.
Exclusion criteria
1. Known history of hypersensitivity or allergy to QL1706 or its excipients, tegafur/gimeracil/oteracil (S-1), oxaliplatin, docetaxel, or any of their excipients. 2. History of another malignancy within 5 years prior to screening or concurrent malignancy, except for curatively treated carcinoma in situ of the cervix, non-melanoma skin cancer, and superficial bladder tumors. 3. Patients with distant metastasis and/or unresectable disease; 4. Prior treatment with immune checkpoint inhibitors, including anti-PD-1, anti-PD-L1, and anti-CTLA-4 agents. 5. Receipt of any antineoplastic agents within 4 weeks prior to the first dose of study drug. 6. Patients with gastrointestinal disorders such as intestinal obstruction (including partial obstruction), or those with evidence or risk of gastrointestinal bleeding, perforation, or obstruction. 7. Any bleeding event ≥ CTCAE Grade 3 within 4 weeks prior to enrollment, or unhealed wounds, ulcers, or fractures. 8. Concurrent enrollment in another clinical study, unless it is an observational (non-interventional) study or the follow-up phase of an interventional study. 9. Subjects requiring systemic therapy with corticosteroids (\>10 mg/day prednisone or equivalent) or other immunosuppressive agents within 2 weeks prior to the first dose of study drug. 10. Receipt of live or live-attenuated vaccine within 4 weeks prior to the first dose of study drug. 11. Major surgery or significant trauma within 4 weeks prior to the first dose of study drug. 12. Active or history of autoimmune disease, with the exception of vitiligo or resolved childhood asthma/atopy that requires no intervention in adulthood. 13. History of immunodeficiency, including HIV infection, or other acquired or congenital immunodeficiency disorders, or history of organ transplantation or allogeneic bone marrow transplantation. 14. Subjects with inadequately controlled cardiovascular clinical symptoms or diseases. 15. Severe infection (CTCAE Grade \> 2) within 4 weeks prior to the first dose of study drug. 16. Patients with a history of interstitial lung disease (except for radiation pneumonitis not treated with corticosteroids), non-infectious pneumonitis, or active pulmonary tuberculosis; or a history of active pulmonary tuberculosis within 1 year prior to enrollment, or more than 1 year prior to enrollment if not adequately treated. 17. Pregnant or breastfeeding women. 18. Other concomitant diseases that, in the opinion of the Investigator, pose a serious risk to the subject's safety or may interfere with the subject's ability to complete the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pathological Complete Response Rate (pCR Rate) | Perioperative, upon postoperative pathological evaluation | Defined as the proportion of patients with no residual tumor cells in the resected tumor tissue and regional lymph nodes upon pathological evaluation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| R0 Resection Rate | Perioperative, upon postoperative pathological evaluation | The proportion of patients with microscopically margin-negative resection, with no residual tumor cells either macroscopically or microscopically, and complete resection of the lesion. |
| Major Pathological Response Rate (MPR Rate) | Perioperative, upon postoperative pathological evaluation | Defined as the proportion of patients with ≤10% residual viable tumor cells in the postoperative pathological specimen. |
| Objective Response Rate (ORR) | On Day 1 of every 2 cycles (each cycle is 21 days), prior to surgery | The proportion of patients achieving complete response (CR) or partial response (PR) as assessed by RECIST version 1.1 criteria. |
| Disease Control Rate (DCR) | On Day 1 of every 2 cycles (each cycle is 21 days), prior to surgery | The proportion of patients achieving CR, PR, or stable disease (SD) among evaluable patients as assessed by RECIST version 1.1 criteria. |
| Number of Participants with Adverse Events (AEs) and Severity Graded | From signing of ICF through 30 days after the last dose | Defined as all adverse events occurring from enrollment (i.e., signing of the informed consent form) through 30 days after the last dose. AEs will be coded using the MedDRA dictionary, with System Organ Class (SOC) and Preferred Term assigned to each adverse event. The severity of adverse events will be graded according to NCI CTCAE version 5.0. |
| 3-Year Disease-Free Survival Rate (DFS Rate) | 3 years after treatment | Defined as the proportion of patients without recurrence or metastasis within 3 years after treatment. |
Countries
China
Contacts
CONTACTYongxu Jia
Outcome results
None listed