Description:
Our aim in this study was to evaluate the efficacy and safety of etoposide combined with
cisplatin or carboplatin (EC/EP) chemotherapy regimens followed by toripalimab combined with
anlotinib for maintenance in extensive small cell lung cancer(ES-SCLC).
Title
- Brief Title: First-line Chemotherapy Followed by Toripalimab Combined With Anlotinib for Maintenance in ES-SCLC
- Official Title: Efficacy and Safety of First-line Etoposide/Platinum-based Chemotherapy Followed by Toripalimab Combined With Anlotinib for Maintenance in Extensive Small Cell Lung Cancer: A Single-arm, Multicentral Phase II Study
Clinical Trial IDs
- ORG STUDY ID:
LDQ-202004
- NCT ID:
NCT04363255
Conditions
- Small Cell Lung Carcinoma
Interventions
Drug | Synonyms | Arms |
---|
Etoposide Injection | Etoposide | Maintenance group |
Carboplatin Injection | Carboplatin | Maintenance group |
Cisplatin injection | Cisplatin | Maintenance group |
Toripalimab | JS001 | Maintenance group |
Anlotinib hydrochloride | Anlotinib | Maintenance group |
Purpose
Our aim in this study was to evaluate the efficacy and safety of etoposide combined with
cisplatin or carboplatin (EC/EP) chemotherapy regimens followed by toripalimab combined with
anlotinib for maintenance in extensive small cell lung cancer(ES-SCLC).
Detailed Description
Lung cancer is the most leading malignant tumor, among which small cell lung cancer accounts
for about 15%. Approximately 65% of new patients were diagnosed with ES-SCLC at the first
visit with less than 6 months of median PFS (mPFS) and 8-13 months of median OS (mOS).
Platinum combined with etoposide or irinotecan chemotherapy is the first-line standard
chemotherapy treatment. Despite high objective response of initial treatment, it is evitable
to develop chemotherapy resistance and the effects of follow-up line treatment is
dissatisfying. Therefore, combination therapy may be promising and efficient.
Anlotinib, the brand new multi-target protein tyrosine kinase (PTK) blockers, could normalize
distribution of blood vessels in the tumor, gather T cells and enhance effect of immune drugs
via vascular endothelial growth factor receptor (VEGFR), platelet-derived growth factor
receptor (PDGFR), fibroblast growth factor receptor (FGFR), type Ⅲ tyrosine kinase and others
signal pathways, and then inhibit the growth, proliferation and differentiation of lung
cancer cells. According to ALTER1202 study, anlotinib played a promising role in local tumor
control and effectively prolonged PFS in third line or more for ES-SCLC patients. Meanwhile,
immunocheckpoint inhibitors can improve tumor immune microenvironment, relieve VEGF-mediated
immunosuppression, reduce Treg activity, promote tumor antigen presenting ability and better
infiltrate T cell into the tumor to play an anti-tumor effect. Emerging studies have shown
that immunocheckpoint inhibitors, such as Atezolizumab, Pembrolizumab and Nivolumab, can
effectively improve ORR, DoR and survival in SCLC patients. In terms of molecular mechanisms,
immunocheckpoint inhibitors and vascular targeting drugs complemented and the combination of
two drugs has superior efficacy in non-small cell lung cancer (NSCLC), just as it shown in
IMpower150 and other studies. However, the role of immunocheckpoint inhibitors in maintenance
therapy in SCLC were disappointing in CheckMate451 and a study of pembrolizumab, although it
obtained some victories in first line or more for SCLC.
In summary, the investigators proposed that first-line etoposide/platinum-based chemotherapy
followed by toripalimab combined with anlotinib for maintenance may prolong chemo-resistance
in extensive small cell lung cancer.
Trial Arms
Name | Type | Description | Interventions |
---|
Maintenance group | Experimental | After 4-6 cycles of EP/EC chemotherapy regiment, maintenance therapy with toripalimab and anlotinib was followed and continued until disease progression. | - Etoposide Injection
- Carboplatin Injection
- Cisplatin injection
- Toripalimab
- Anlotinib hydrochloride
|
Eligibility Criteria
Inclusion Criteria:
- 1. Patients must sign a specific informed consent form prior to clinical trial; 2.
Extensive stage small cell lung cancer confirmed by histology or cytology; 3. Patients
did not receive any system treatment before or only received EP/EC chemotherapy (time
from the last medication of chemotherapy to the beginning of maintenance treatment
must be ≤21 days); 4. Eastern Cooperative Oncology Group (ECOG) performance status
0-1; 5. An estimated survival duration of >5 months from the beginning of
chemotherapy; 6. Age no less than 18; 7. A measurable lesion on image; 8. Patients
with asymptomatic brain metastases or symptomatic brain metastases which were stable
after treatment; 9. Before the first dose of drugs for study, patients should have
appropriate organ function and the laboratory results must meet conditions as
following: Blood routine examination: neutrophil absolute value (ANC) ≥1.5×109/L,
platelet (PLT) ≥100×109/L, hemoglobin content (HGB) ≥9g/dl; Adequate hepatic function:
bilirubin ≤1.5×ULN mg/dl, creatinine clearance ≥ 50 ml/min; Adequate hepatic function:
Aspartate aminotransferase (AST) /alanine aminotransferase (ALT)> 2.5 × upper limit of
normal (ULN) or > 5 × ULN (patients with liver metastasis), alkaline phosphatase (ALP)
≤2.5×ULN or ≤5×ULN (patients with bone metastasis), Total bilirubin (TB) ≤1.5×ULN,
albumin (ALB)>30g/dl; Coagulation function: international normalized ratio (INR)
≤1.5×ULN, activated partial thromboplastin time (APTT) ≤1.5×ULN; Urine routine:
24-hour urine protein<1g (if urine protein ≥2+, additional 24-hour urine protein is
required); Others: serum lipase or amylase ≤1.5×ULN or >1.5×ULN (subjects clinically
or radiologically diagnosed with pancreatitis).
Exclusion Criteria:
- 1. Patients received EP/EC regiment received the last medication ≥21 days before
maintenance treatment, or received other systematic anti-tumor treatment for ES-SCLC;
2. Patients with epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase
(ALK) mutation; 3. Patients received any other experimental drugs or participated in
another interventional clinical study within 4 weeks prior to signing the informed
consent; 4. Patients received other systemic or local antitumor therapy (including but
not limited to the use of other drugs for SCLC maintenance therapy or radiotherapy,
but CR/PR subjects are allowed to use prophylactic cranial irradiation (PCI) after
induction period treatment); 5. Patients with active and untreated brain metastases or
carcinoma meningitis in CT or MRI examination during screening stage; 6. Patients with
other malignant tumors within 5 years, except for curable malignant tumors (carcinoma
in situ or stage I tumor), such as cervical carcinoma in situ, basal cell or squamous
cell skin cancer and so on); 7. Patients received corticosteroids (>10mg/ day methyl
prednisolone or equivalent dose) or other immunosuppressants (inhalation or local use
of steroids and adrenal replacement treatment were permitted in the absence of an
active autoimmune disease) less than 14 days prior to maintenance medications; 8.
Patients with chronic or acute active hepatitis B (HBsAg positive and hepatitis B
virus (HBV) DNA copy number >ULN), or HCV positive (HCV Ab positive and HCV RNA
positive); Hepatitis B patients with previous HBV infection or who have been cured
(HBsAg negative, HBcAb positive and HBV DNA copy number < ULN) were allowed to be
enrolled; 9. Patients with interstitial lung disease, drug-induced pneumonia,
radiation pneumonitis requiring steroid treatment, or active pneumonia with clinical
symptoms; or other lung diseases causing moderate or severe lung dysfunction; Active
pulmonary tuberculosis or the need for anti-tuberculosis treatment; 10. Patients who
were allergy to one of research drugs, or allergy to any one of the immunocheckpoint
inhibitors or other platinum; 11. Female patients during pregnant and lactation
period, or patients were plan to pregnant; 12. Patients with factors that may cause
the study to be forced to terminate halfway according to investigators' judgement,
such as poor compliance, other serious diseases requiring combined treatment and so
on.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Progression free survival (PFS) |
Time Frame: | Duration of time from the start of chemotherapy to the time of disease progression, assessed up to 3 years |
Safety Issue: | |
Description: | PFS |
Secondary Outcome Measures
Measure: | Adverse event (AE) |
Time Frame: | Duration of time from the start of treatment to the end of study, assessed up to 3 years |
Safety Issue: | |
Description: | The acute and chronic AE profiles associated with the study regimen using CTCAE v5.0 |
Measure: | Objective response rate (ORR) |
Time Frame: | Duration of time from the start of treatment to the end of study, assessed up to 3 years |
Safety Issue: | |
Description: | ORR was the sum percentage of partial response (PR) and stable disease (SD) according to RECIST v1.1 |
Measure: | Disease control rate (DCR) |
Time Frame: | Duration of time from the start of treatment to the end of study, assessed up to 3 years |
Safety Issue: | |
Description: | DCR was the sum percentage of complete response (CR), partial response (PR) and stable disease (SD) according to RECIST v1.1 |
Measure: | Duration of response (DoR) |
Time Frame: | Duration of time from the start of treatment response to the time of disease progression, assessed up to 3 years |
Safety Issue: | |
Description: | DoR |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Not yet recruiting |
Lead Sponsor: | Taizhou Hospital |
Last Updated
April 28, 2020