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An Open Label Phase 2 Study to Evaluate the Safety and Efficacy of Lenvatinib With Pembrolizumab in the Neoadjuvant / Adjuvant Treatment for Patients With Gastric Cancer

NCT04745988

Description:

This study is an open label phase 2 study to evaluate the safety and efficacy of Lenvatinib with Pembrolizumab in the neoadjuvant / adjuvant treatment for Patients with Gastric Cancer.

Related Conditions:
  • Adenocarcinoma of the Gastroesophageal Junction
  • Gastric Adenocarcinoma
Recruiting Status:

Not yet recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: An Open Label Phase 2 Study to Evaluate the Safety and Efficacy of Lenvatinib With Pembrolizumab in the Neoadjuvant / Adjuvant Treatment for Patients With Gastric Cancer
  • Official Title: An Open Label Phase 2 Study to Evaluate the Safety and Efficacy of Lenvatinib With Pembrolizumab in the Neoadjuvant / Adjuvant Treatment for Patients With Gastric Cancer

Clinical Trial IDs

  • ORG STUDY ID: EPOC2001
  • NCT ID: NCT04745988

Conditions

  • Gastric Cancer

Interventions

DrugSynonymsArms
LenvatinibLenvatinib Plus Pembrolizumab
PembrolizumabLenvatinib Plus Pembrolizumab

Purpose

This study is an open label phase 2 study to evaluate the safety and efficacy of Lenvatinib with Pembrolizumab in the neoadjuvant / adjuvant treatment for Patients with Gastric Cancer.

Detailed Description

      This study is an open-label, single-arm, single-center, phase 2 clinical trial. Eligible
      patients are with previously untreated gastric and gastroesophageal junction adenocarcinoma
      as defined by cT2-4 and/or cN+ without evidence of metastatic disease. Patients will receive
      3 cycles of 20 mg oral Lenvatinib daily plus 200 mg intravenous Pembrolizumab every 3 weeks
      as the neoadjuvant treatment followed by surgery, and then 3 cycles of Lenvatinib plus
      Pembrolizumab followed by 11 cycles of Pembrolizumab monotherapy as the adjuvant treatment.
    

Trial Arms

NameTypeDescriptionInterventions
Lenvatinib Plus PembrolizumabExperimentalOne cycle is 21 days, with Lenvatinib plus Pembrolizumab repeated 3 cycles before surgery and 3 cycles after surgery, followed by 11 cycles of pembrolizumab monotherapy as the adjuvant treatment.
  • Lenvatinib
  • Pembrolizumab

Eligibility Criteria

        Inclusion Criteria:

          1. Have gastric and gastroesophageal junction adenocarcinoma

          2. Untreated and cT2-4 and/or cN+ without evidence of metastatic disease

          3. Patients at least 20 years of age on the day of providing consent.

          4. Patients with a performance status of 0 or 1 on the Eastern Cooperative Oncology
             Group.

          5. Patients with adequate organ function at the time of enrollment as defined below:

               -  Neutrophil count ≥1500mm3

               -  Platelet count ≥10 × 100,000/mm3

               -  Hemoglobin (Hb) ≥ 9.0 g/dL,

               -  Total bilirubin ≤1.5 mg/dL

               -  AST (GOT) and ALT (GPT) ≤ 100 IU/L

               -  Creatinine ≤1.5 mg/dL

               -  Urinary protein : It satisfies one of the following (if any of the inspection
                  criteria are satisfied, other examination may not be carried out) (i) urinary
                  protein (test paper method) is 2+ or less (ii) Urine Protein Creatinine (UPC)
                  ratio <3.5 (iii) 24-hour urine protein was measured, urinary protein ≦ 3500 mg

               -  International normalized ratio (INR) ≤ 1.5

          6. Patients who not received a blood transfusion within 14 days of registration.

          7. Patients have recovered adverse events associated with radiation and surgical
             operation as pretreatment to Grade 1 or less or baseline or less with CTCAE v5.0
             excluding stable symptoms. However, adverse events with stable symptoms even with
             Grade 2 or higher excluded.

          8. Female of childbearing potential who are negative in a pregnancy test within 14 days
             before enrollment. Both male and female patients should agree to use an adequate
             method of contraception (total abstinence or use of a male condom plus partner use of
             contraceptive method [an intrauterine device or hormone releasing system, a
             contraceptive implant and an oral contraceptive]) starting with the first dose of
             study therapy through 120 days after the last dose of study therapy. Duration will be
             determined when the subject is assigned to treatment.

          9. Patients capable of taking oral medication.

         10. Patients who provided written informed consent to be subjects in this study.

        Exclusion Criteria:

          1. Patients who have undergone surgical treatment and radiotherapy within 2 weeks before
             enrollment.

          2. Patients with hypertension that is difficult to control (systolic blood pressure ≥160
             mmHg and diastolic blood pressure ≥90 mmHg) despite treatment with several hypotensive
             agents.

          3. Patients with acute coronary syndrome (including myocardial infarction and unstable
             angina), and with a history of coronary angioplasty or stent placement performed
             within 6 months before enrollment.

          4. Patients with a history of New York Heart Association congestive heart failure of
             grade II or above, unstable angina, myocardial infarction.

          5. Patients have an addigional active malignancy (except for definitively treated
             melanoma in-situ, basal or squamous cell carcinoma of the skin, or carcinoma in-situ
             of the cervix) within the past 24 months.

          6. Patients have severe (hospitalization required) complications (intenstinal palsy,
             intestinal obstruction, pulmonary fibrosis, diabetes difficult to control, heart
             failure, myocardial infarction, unstable angina, renal failure, liver failure, mental
             disease, cerebrovascular disease etc).

          7. Patients with a history of a gastrointestinal perforation and /or gastrointestinal
             fistula within 6 months before enrollment.

          8. Is infected with active hepatitis B (defined as HBs antigen positive) or hepatitis C.

          9. Patients with a history of human immunodeficiency virus (HIV).

         10. Patients with a history of (non-infectious) pneumonitis that required steroids or has
             current pneumonitis.

         11. Patients who are administered live vaccines <30 days before the initiation of
             treatment with the investigational drug.

         12. Patients with concurrent autoimmune disease, or a history of chronic or recurrent
             autoimmune disease.

         13. Patients who require systemic corticosteroids (excluding temporary usage for tests,
             prophylactic administration for allergic reactions, or to alleviate swelling
             associated with radiotherapy) or immunosuppressants, or who have received such a
             therapy <14 days before enrollment.

         14. Patients have serious non-healing wound, ulcer, or bone fracture.

         15. Females who are pregnant or breastfeeding.

         16. Patients have no intention to comply with the protocol or cannot comply.

         17. Patients were judged unsuitable as subject of this study by investigator.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:20 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Major pathological response (MPR) rate
Time Frame:6 months
Safety Issue:
Description:The MPR rate will be defined as the proportion of patients whose percentage of residual tumor in the stomach and lymph node decreased to < 10%, as determined by a pathologist.

Secondary Outcome Measures

Measure:Pathological complete response (pCR) rate
Time Frame:6 months
Safety Issue:
Description:The pCR rate will be defined as the proportion of patients whose tumor in the stomach and lymph node completely disappeared, as determined by a pathologist.
Measure:Tumor response in the gastric primary lesion
Time Frame:6 months
Safety Issue:
Description:The number of patients achieving endoscopic CR, PR, SD, or PD will be separately tabulated.
Measure:Radical resection rate
Time Frame:6 months
Safety Issue:
Description:The radical resection rate will be defined as the proportion of patients who underwent a radical resection (R0 resection).
Measure:Treatment completion rate until surgery
Time Frame:6 months
Safety Issue:
Description:The treatment completion rate will be defined as the proportion of patients who started the protocol treatment, completed a three-cycle treatment with the study drug, and then underwent a radical resection (R0 resection).
Measure:Treatment completion rate until adjuvant treatment
Time Frame:1 year 8 months
Safety Issue:
Description:The treatment completion rate will be defined as the proportion of patients who started the protocol treatment, completed a three-cycle treatment with the study drug, and then underwent a radical resection (R0 resection) and adjuvant treatment was performed up to 14 cycles.
Measure:Event free survival (EFS)
Time Frame:3 years
Safety Issue:
Description:The registration date is the starting date, and is defined as the period until the event that occurs any of the following. Disease progression based on image evaluation using RECIST 1.1 Recurrence based on CT or biopsy among patients with no postoperative lesions Death of any cause If it is determined to be exacerbated based on the image evaluation, the inspection date on which the image inspection was performed shall be the exacerbation date. Secondary primary malignancies are not an EFS event. Patients for whom no EFS event has been recorded will be censored on the final image evaluation date.
Measure:Overall survival (OS)
Time Frame:3 years
Safety Issue:
Description:The period will be from the day of enrollment, as the starting date of the computation, to the day of death of any cause. Surviving patients should be censored on the last day of PFS confirmed (Confirmation of survival by telephone inquiry will be acceptable. However, the fact of confirming survival should be documented in medical records.). Patients who are lost to follow up should be censored on the last day when their survival is confirmed before being lost to follow up.
Measure:The incidence of adverse events
Time Frame:Up to 30 days after the last dose
Safety Issue:
Description:For adverse events due to protocol treatment, determine the frequency of worst grades in all courses according to CTCAE v5.0, the incidence of adverse events of Grade 3 or higher, and the incidence of adverse events of Grade 4 or higher.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:National Cancer Center Hospital East

Last Updated

June 1, 2021