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| Name | Class |
|---|---|
| BGI-Shenzhen | INDUSTRY |
| Jiangsu HengRui Medicine Co., Ltd. | INDUSTRY |
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This study aims to evaluate the efficacy of Camrelizumab plus concurrent chemotherapy as neoadjuvant approach for patients with opearble esophageal squamous cell carcinoma. In addition, potential clinical utility of ctDNA in monitoring tumor burden and dynamics of tumor clonality during neoadjuvant immunotherapy will be assessed as well. At the same time, CD8 and PD-L1 will also be used as monitoring indicators.
Immunotherapy improves clinical outcome of patients with advanced stage or metastatic esophageal squamous cell carcinoma (ESCC). In addition, superior effect of immunotherapy for esophageal squamous cell carcinoma was also reported recently. While, clinical application of ctDNA, PD-L1 and CD8 T cell monitoring in neoadjuvant immunotherapy for patients with esophageal squamous cell carcinoma is largely unknown. This trial will evaluate firstly the efficacy and the safety of Camrelizumab plus chemotherapy (albumin-bound paclitaxel plus cisplatin)as neoadjuvant approach. The evaluation indicators include pathological complete response rate (pCR) and objective imaging response rate after neoadjuvant therapy (ORR). ), 2-year progression-free survival (2y-PFS), postoperative progression-free survival (PFS), and overall survival (OS) after treatment. Objective response rate (ORR) based upon immune-Response Evaluation Criteria in Solid Tumors Version (RECIST v1.1). Major pathological response assessed by post-operational pathological review ctDNA efficacy will also be evaluated along with clinical management. Monitoring tumor burden, clonality as well as tumor heterogeneity evaluation will be correlated to radiological assessment and pathological findings.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| camrelizumab plus concurrent chemotherapy | Experimental | Neoadjuvant immunotherapy, PD-1, plus concurrent chemotherapy(albumin-bound paclitaxel + Cisplatin) will be applied to patients with operable esophageal squamous cell carcinoma before surgery. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| camrelizumab | Drug | Participants will receive camrelizumab, 200mg, intravenously over 30 - 60 minutes, day 1 of every 3 weeks for 6 weeks. Discontinuation will be considered due to toxicity, withdrawal of consent, or end of study. Every 3-week treatment period was considered to be a cycle. |
| Measure | Description | Time Frame |
|---|---|---|
| Pathologic complete remission (PCR) | Primary tumor or lymph node surgery specimen pathological examination without residual tumor cell | 4 weeks after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Objective Response Rate (ORR) | Objective Response Rate Determine the tumor shrinkage rate, tumor boundary and the adhesion of tumor | At the end of Cycle 2 (each cycle is 21 days) |
| 2-year progression-free survival (PFS) |
| Measure | Description | Time Frame |
|---|---|---|
| safety of neoadjuvant PD-1 Blockade Plus Chemotherapy | Incidence of grade 3-5 adverse events [Safety and Tolerability] | Every 3 weeks (up to 3 months after surgery) |
| Evaluation of molecular features and ctDNA changing in pre, per and post-treatment plasma |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jun liu, Ph.D, M.D | The First Affiliated Hospital of Guangzhou Medical University | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Jingpei Li | Guangzhou | Guangdong | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 28993052 | Background | Kang YK, Boku N, Satoh T, Ryu MH, Chao Y, Kato K, Chung HC, Chen JS, Muro K, Kang WK, Yeh KH, Yoshikawa T, Oh SC, Bai LY, Tamura T, Lee KW, Hamamoto Y, Kim JG, Chin K, Oh DY, Minashi K, Cho JY, Tsuda M, Chen LT. Nivolumab in patients with advanced gastric or gastro-oesophageal junction cancer refractory to, or intolerant of, at least two previous chemotherapy regimens (ONO-4538-12, ATTRACTION-2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2017 Dec 2;390(10111):2461-2471. doi: 10.1016/S0140-6736(17)31827-5. Epub 2017 Oct 6. | |
| 26254683 |
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| ID | Term |
|---|---|
| D000077277 | Esophageal Squamous Cell Carcinoma |
| ID | Term |
|---|---|
| D002294 | Carcinoma, Squamous Cell |
| D002277 | Carcinoma |
| D009375 | Neoplasms, Glandular and Epithelial |
| D009370 | Neoplasms by Histologic Type |
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| ID | Term |
|---|---|
| C000631724 | camrelizumab |
| D017239 | Paclitaxel |
| D007267 | Injections |
| D002945 | Cisplatin |
| ID | Term |
|---|---|
| D043823 | Taxoids |
| D043822 | Cyclodecanes |
| D003516 | Cycloparaffins |
| D006840 | Hydrocarbons, Alicyclic |
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Patients with II-IVA stage with pathologically diagnosed squamous cell lung carcinoma will be enrolled in this study. Camrelizumab plus chemotherapy will be administrated intravenously per 3 weeks at the dosage of 200mg. Contrast-CT evaluation and peripheral blood collected will be performed at pre-neoadjuvant therapy and pre-operation. 6 weeks after neoadjuvant therapy, participants who meet the indication will be assigned to operation. Another peripheral blood sample will be harvested 3-4 weeks after operation.
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|
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| Paclitaxel for injection (albumin-bound) | Drug | Paclitaxel for injection (albumin-bound): 260mg/m2(in total), ivgtt d1, d8, q3w,for 2 cycle |
|
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| Cisplatin | Drug | 75mg/m2(in total), ivgtt d1-d3, q3w, for 2 cycles |
|
|
From date of surgery until the date of first documented progression or date of death from any cause
| every 2 months (up to 24 months) |
| Progression-free survival (PFS) | From date of surgery until the date of first documented progression or date of death from any cause | every 2 months (up to 24 months) |
| Overall survival (OS) | Defined from date of Signing ICF to date of first documentation of death from any cause or censored at the date of the last follow-up. | every 2 months (up to 24 months) |
All DNA samples were tested to calculate single nucleotide variants (SNV's), small insertions or deletions (Indels), copy number variations (CNV's), splice variations (SV's), gene fusions (GF's), tumor mutation burden (TMB) and micro-satellite instability (MSI) and others value by all enrolled. NGS (Next generation sequencing)-panel (688 genes) for monitoring on post-treatment residual disease in order to identify mechanisms of response. Measurement of different baseline ctDNA for their prognostic value.
| every 2 months (up to 12 months) |
| Evaluation of Immunomicroenvironment changing in pre, per and post-treatment plasma | the tumor immune microenvironment evaluated with multiplexed immunohistochemistry (mIHC), The evaluation of immune microenvironment uses the method of multiple immunofluorescence, through the detection of CD8, CD163, CD68, PD-1 and PD-L1 four bio-markers, determine the situation of related immune cells in the process and efficacy. | every 2 months (up to 12 months) |
| perioperative adverse events | The participants were followed up daily and perioperative adverse events as defined by the American College of Surgeons National Quality Improvement Program. The participants were followed up until discharge or 30 days of in hospital stay and the secondary outcome measures entered into a questionnaire. | Time to discharge or 30 days of in hospital stay whichever came first |
| Background |
| Shapiro J, van Lanschot JJB, Hulshof MCCM, van Hagen P, van Berge Henegouwen MI, Wijnhoven BPL, van Laarhoven HWM, Nieuwenhuijzen GAP, Hospers GAP, Bonenkamp JJ, Cuesta MA, Blaisse RJB, Busch ORC, Ten Kate FJW, Creemers GM, Punt CJA, Plukker JTM, Verheul HMW, Bilgen EJS, van Dekken H, van der Sangen MJC, Rozema T, Biermann K, Beukema JC, Piet AHM, van Rij CM, Reinders JG, Tilanus HW, Steyerberg EW, van der Gaast A; CROSS study group. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol. 2015 Sep;16(9):1090-1098. doi: 10.1016/S1470-2045(15)00040-6. Epub 2015 Aug 5. |
| 30089078 | Background | Yang H, Liu H, Chen Y, Zhu C, Fang W, Yu Z, Mao W, Xiang J, Han Y, Chen Z, Yang H, Wang J, Pang Q, Zheng X, Yang H, Li T, Lordick F, D'Journo XB, Cerfolio RJ, Korst RJ, Novoa NM, Swanson SJ, Brunelli A, Ismail M, Fernando HC, Zhang X, Li Q, Wang G, Chen B, Mao T, Kong M, Guo X, Lin T, Liu M, Fu J; AME Thoracic Surgery Collaborative Group. Neoadjuvant Chemoradiotherapy Followed by Surgery Versus Surgery Alone for Locally Advanced Squamous Cell Carcinoma of the Esophagus (NEOCRTEC5010): A Phase III Multicenter, Randomized, Open-Label Clinical Trial. J Clin Oncol. 2018 Sep 20;36(27):2796-2803. doi: 10.1200/JCO.2018.79.1483. Epub 2018 Aug 8. |
| D009369 | Neoplasms |
| D018307 | Neoplasms, Squamous Cell |
| D004938 | Esophageal Neoplasms |
| D005770 | Gastrointestinal Neoplasms |
| D004067 | Digestive System Neoplasms |
| D009371 | Neoplasms by Site |
| D006258 | Head and Neck Neoplasms |
| D004066 | Digestive System Diseases |
| D004935 | Esophageal Diseases |
| D005767 | Gastrointestinal Diseases |
| D006844 |
| Hydrocarbons, Cyclic |
| D006838 | Hydrocarbons |
| D009930 | Organic Chemicals |
| D004224 | Diterpenes |
| D013729 | Terpenes |
| D004333 | Drug Administration Routes |
| D004358 | Drug Therapy |
| D013812 | Therapeutics |
| D017606 | Chlorine Compounds |
| D007287 | Inorganic Chemicals |
| D017672 | Nitrogen Compounds |
| D017671 | Platinum Compounds |