Primary Objectives:
- To evaluate the safety and efficacy of sintilimab in subjects with CUP
Secondary Objectives:
- To evaluate the overall objective response rate (ORR) (investigator assessed), disease
control rate (DCR), duration of response (DOR), progression-free survival (PFS), overall
survival (OS) and Quality of Life (QOL) on sintilimab in subjects with CUP
Exploratory Objectives:
- To evaluate the correlation between biomarkers in tumor tissue and efficacy, including
but not restricted to PD-L1 expression level, transcriptome sequencing, single-cell
sequencing, and multicolor immunohistochemistry (IHC) analyses;
- To evaluate the correlation between biomarkers in peripheral blood and drug efficacy,
including but not restricted to soluble PD-L1, circulating tumor DNA (ctDNA), and
cytokine analyses.
Inclusion Criteria:
1. Has histopathologically confirmed unresectable, locally advanced, recurrent or
metastatic CUP. Patients must have undergone standard work-up to attempt to identify
the primary tumor prior to enrollment.
2. Is refractory or intolerant to at least one line of systemic chemotherapy. Patient
ineligible for cytotoxic chemotherapy due to contraindications will be eligible.
3. Has an ECOG PS of 0 - 2.
4. Must be unsuitable for definitive treatment, such as definitive chemoradiotherapy
and/or surgery. For subjects who have received (neo)adjuvant or definitive
chemotherapy/chemoradiotherapy, time from the completion of last treatment to disease
recurrence must be > 3 months.
5. Is able to provide archival or fresh tissues for correlative analysis with obtainable
results.
6. Has at least one measurable lesion as per RECIST v1.1.
7. Has adequate organ and bone marrow functions, as defined below:
- Complete blood count: absolute neutrophil count (ANC) ≥ 1.0 × 109/L, platelet
(PLT) count ≥ 75 × 109/L, hemoglobin (HGB) ≥ 9.0 g/dL. Note: Subjects cannot
receive blood transfusion, erythropoietin (EPO), or Granulocyte-colony
stimulating factor (GSF) within 7 days prior to the blood collection.
- Hepatic function: total bilirubin (TBIL) ≤ 1.5 × upper limit of normal (ULN),
alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.5 × ULN
in subjects without hepatic metastasis; TBIL ≤ 1.5 × ULN, ALT and AST ≤ 5 × ULN
in subjects with hepatic metastasis.
Exception: Patients with known Gilbert disease: serum bilirubin level ≤ 3 × ULN.
- Renal function: urine protein < 2+ from random sample or < 1 g from 24-hour urine
collection, and creatinine clearance rate (CrCl) ≥ 30 mL/min by Cockcroft-Gault
formula:
- Female: CrCl=((140-age)×weight(kg)×0.85)/(72×serum creatinine(mg/dL))
- Male: CrCl=((140-age)×weight(kg)×1.00)/(72×serum creatinine(mg/dL))
8. Adequate coagulation function, defined as international normalized ratio (INR) ≤ 1.5
or prothrombin time (PT) ≤ 1.5 × ULN; if the subject is receiving anticoagulant
therapy, the results of coagulation tests need to be within the acceptable range for
anticoagulants.
9. Is expected to survive ≥ 12 weeks.
10. Subject (female subjects of childbearing age or male subjects whose partners are of
childbearing age) must take effective contraceptive measures during the entire course
of the trial and until 180 days after the last dose (see Section 4.3).
11. Is able to sign the informed consent form (ICF) and is able to comply with the
scheduled follow-up visits and related procedures required in the protocol.
Exclusion Criteria:
1. Has received treatment with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, or
anti-CTLA-4 antibody, or any other antibody or drug that specifically targets T-cell
co-stimulation or immune checkpoint pathways.
2. Is enrolled in another interventional clinical study. Current enrollment in an
observational study (non-interventional) or in the follow-up phase of an
interventional study is allowed.
3. Has received palliative therapy for a local lesion within 2 weeks prior to the first
dose.
4. Has received systemic treatment with Chinese traditional medicines with anti-cancer
indications or immunomodulators (including thymosins, interferons, and interleukins)
within 2 weeks prior to the first dose of study treatment.
5. Has received systemic immunosuppressants within 2 weeks. Allowed are local use of
glucocorticoids administered by nasal, inhaled, or other routes, and systemic
glucocorticoids at physiological doses (no more than 10 mg/day of prednisone or
equivalents), or glucocorticoids to prevent allergies to contrast media.
6. Has received a live attenuated vaccine within 4 weeks prior to the first dose of study
treatment or is scheduled to receive live attenuated vaccine during the study period.
Note: Seasonal inactivated influenza virus vaccines within 4 weeks prior to the first
dose of study treatment are permitted, but attenuated influenza vaccines are not.
7. Has undergone major surgery (craniotomy, thoracotomy, or laparotomy) within 4 weeks
prior to the first dose of study treatment or is scheduled to receive major surgery
during the course of the trial.
8. Has any toxicity (excluding alopecia, events that are not clinically significant, or
asymptomatic laboratory abnormalities) due to prior anti-tumor therapy that has not
yet resolved to National Cancer Institute Common Terminology Criteria for Adverse
Events (NCI CTCAE) v5.0 grade 0 or 1 prior to the first dose of study treatment.
9. Has known symptomatic central nervous system (CNS) metastasis or carcinomatous
meningitis. Subjects with brain metastases who have received prior treatment can be
enrolled if the disease is stable (no imaging evidence of PD for at least 4 weeks
prior to the first dose of study treatment), there is no evidence of new brain
metastases or progression of the existing metastatic lesion(s) upon repeated imaging,
and corticosteroids have not been required for at least 14 days prior to the first
dose of study treatment. Patients with carcinomatous meningitis are ineligible,
regardless of whether the disease is clinically stable or not.
10. Has bone metastases and is at risk for paraplegia.
11. Has known active autoimmune disease requiring treatment or a previous autoimmune
disease history within 2 years (subjects with vitiligo, psoriasis, alopecia, or
Graves' disease not requiring systemic treatment, hypothyroidism only requiring
thyroid replacement, or type I diabetes only requiring insulin can be enrolled).
12. Has a known history of primary immunodeficiency diseases.
13. Has a known active pulmonary tuberculosis.
14. Has a known history of allogeneic organ transplantation or allogeneic hematopoietic
stem cell transplantation.
15. Is human immunodeficiency virus (HIV)-infected (has positive anti-HIV antibody).
16. Has an active or poorly controlled serious infections.
17. Has symptomatic congestive heart failure (NYHA Class II-IV) or symptomatic or poorly
controlled arrhythmia.
18. Has uncontrolled hypertension (systolic blood pressure ≥ 160 mmHg or diastolic blood
pressure ≥ 100 mmHg) despite standard treatment.
19. Had any arterial thromboembolic event within 6 months prior to enrollment, including
myocardial infarction, unstable angina, cerebrovascular accident, or transient
cerebral ischemic attack.
20. Has significant malnutrition, such as those requiring continuous parenteral nutrition
≥7 days. Allowed are those who received intravenous treatment for malnutrition that
ended more than 4 weeks before the first dose of study treatment.
21. Has a history of clinically significant deep venous thrombosis, pulmonary embolism, or
other serious thromboembolic events within 3 months prior to enrollment (having an
implantable port or catheter-related thrombosis or incidental pulmonary embolism
detected on scan without symptoms or superficial venous thrombosis is not considered
to be a "serious" thromboembolisms).
22. Has uncontrolled metabolic disorders, non-malignant organ or systemic diseases, or
cancer-related secondary diseases that may lead to higher medical risks and/or
survival evaluation uncertainties.
23. Has severe pulmonary dysfunction.
24. Has hepatic encephalopathy, hepatorenal syndrome, or cirrhosis with Child-Pugh Class B
or C.
25. Has bowel obstruction or history of any of the following diseases: inflammatory bowel
disease, extensive bowel resection (partial colectomy or extensive small intestine
resection accompanied with chronic diarrhea), Crohn's disease, or ulcerative colitis.
26. Has known acute or chronic active hepatitis B (positive HBsAg and hepatitis B (HBV)
DNA viral load ≥ 103 copies/mL or > 200 IU/mL), or acute or chronic active hepatitis C
(positive hepatitis C [HCV] antibody and detectable HCV RNA).
27. Has history of gastrointestinal (GI) perforation and/or fistula within 6 months prior
to study enrollment (having a gastrostomy or enterostomy is allowed).
28. Has interstitial lung disease requiring corticosteroids.
29. Has history of other primary malignant tumors, excluding:
- Malignant tumors that achieved a complete response (CR) at least 2 years prior to
enrollment and expected to require no treatment during the trial.
- Adequately treated nonmelanoma skin cancer or lentigo maligna with no sign of
disease recurrence.
- Adequately treated carcinoma in situ with no sign of disease recurrence.
- Prostate cancer, CLL or other cancers where the indolent nature of tumor allows
for and patient is under active surveillance.
30. Is pregnant or breastfeeding.
31. Has an acute or chronic diseases, psychiatric disorders, or laboratory abnormality
that may lead to the following consequences: increased investigational drug-related
risks, or interference with interpretation of trial results, or is otherwise
considered ineligible for participating in the trial by the investigators.
