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The goal of this clinical trial is to study the safety and efficacy of lenvatinib combined with single-agent taxanes therapy in patients with HER2-negative advanced gastric cancer that have failed at the standard first-line therapy.
This study is being conducted to establish safety and preliminary efficacy of Lenvatinib plus taxane drugs treatment for HER2-negative advanced gastric cancer after failure of first-line treatment.
The study will adopt the "3+3" dose escalation design. All patients received a standard dose of chemotherapy: paclitaxel 135mg/m2 every 3 weeks or docetaxel 75mg/m2 every 3 weeks. Lenvatinib is exploring four doses of 4mg, 8mg, 12mg, and 16mg, orally once a day every 3 weeks. In the first cycle, lenvatinib was administered 5 days before chemotherapy,once a day. Chemotherapy lasts up to 6 cycles, and lenvatinib continues to be administered until the disease progresses, intolerable side effects, or death.
In order to avoid the possible ineffectiveness caused by the patient being exposed to low doses, the initial dose of 4 mg was enrolled in 1 patient. If there is no obvious dose-limiting toxicity (DLT) after the first dose, the dose escalation adopts a "3+3" method from the 8mg dose: if none of the 3 subjects in the previous dose group has a DLT within 21 days, the next dose study will be carried out; if one subject in the group has DLT occurs, then 3 additional subjects should be added to the dose group; if the 3 subjects have 1 or more DLTs, the trial terminated and the previous dose was regarded as the maximum tolerated dose (MTD).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Lenvatinib with taxane drugs treatment for advanced gastric cancer | Experimental | Experimental: Lenvatinib plus taxane drugs The subjects in this arm will receive a Lenvatinib combined with single-agent taxanes therapy. A standard dose of chemotherapy: paclitaxel 135mg/m2 every 3 weeks or docetaxel 75mg/m2 every 3 weeks will be administrated. Lenvatinib is exploring four doses of 4mg, 8mg, 12mg, and 16mg, orally once a day every 3 weeks. In the first cycle, lenvatinib was administered 5 days before chemotherapy,once a day. Chemotherapy lasts up to 6 cycles, and lenvatinib continues to be administered until the disease progresses, intolerable side effects, or death. Subjects will be enrolled serially. For subject safety, the preceding subject must have completed therapy and there is no obvious DLT within 21 days before the next subject can be treated. Interventions:
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Lenvatinib plus taxane drugs | Drug |
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| Measure | Description | Time Frame |
|---|---|---|
| Adverse events | Incidence of DLT within 21 days of the first Lenvatinib application | 4 weeks after the last administration |
| Incidence of Treatment Related adverse events (TRAEs) | Number of participants with treatment-related adverse events as assessed by CTCAE v5.0 | 4 weeks after the last administration |
| Incidence of dose-limiting toxicities (DLTs) | All patients who have received at least one dose of treatment will be included in the safety analysis. Number of participants with dose-limiting toxicities as assessed by CTCAE v5.0 | 4 weeks after the last administration |
| Incidence of Treatment Emergent Adverse Event (TEAEs) | Number of participants with treatment emergent adverse events as assessed by CTCAE v5.0 | 4 weeks after the last administration |
| Maximum tolerated dose of lenvatinib | Maximum tolerated dose of lenvatinib in combination with single-agent chemotherapy | 4 weeks after the last administration |
| Measure | Description | Time Frame |
|---|---|---|
| Objective response rate (ORR) | Objective Response Rate is defined as the percentage of patients with a documented complete response or partial response (CR + PR) based on RECIST v1.1. | up to 12 months |
| Disease control rate (DCR) based on the researcher's evaluation |
| Measure | Description | Time Frame |
|---|---|---|
| Exploratory Outcome | Dynamic contrast-enhanced ultrasound (DCE-US) was used to evaluate the the efficacy of anti-angiogenic therapy. Wash-in area under the curve (WiAUC) were quantitatively by DCE-US before the chemotherapy(d-4), d1 and 42 days after chemotherapy. | up to 8 weeks |
| Exploratory Outcome |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Yan Shi | Contact | 13810561979 | sy_rjh@aliyun.com | |
| Hui Yang | Contact | 15216660039 | yanghui0182@163.com |
| Name | Affiliation | Role |
|---|---|---|
| Yan Shi | Ruijin Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ruijin Hospital | Recruiting | Shanghai | Shanghai Municipality | 200025 | China |
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| ID | Term |
|---|---|
| C531958 | lenvatinib |
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Disease control Rate is defined as the percentage of patients with a documented complete response or partial response or stable disease (CR + PR+SD) based on RECIST v1.1. |
| up to 12 months |
| Duration of Remission (DOR) based on the researcher's evaluation | The duration of remission (DOR) is defined as the time interval between the subject's first recording of disease remission to the first recording of disease progression. | up to 12 months |
| Progression-free survival (PFS) based on the researcher's evaluation | Progression-free survival (PFS) is defined as the time interval from the first treatment of the subject to the first recording of disease progression or death due to any cause, whichever occurs first. | up to 12 months |
| Overall survival (OS) | Overall survival is defined as the time from signing ICF until death from any cause. | up to 12 months |
Mass spectrometry flow cytometry was used to detect the ratio and number of CD8+T cells on d0 and d42 after Lenvatinib therapy, and evaluates the correlation between changes in the immune microenvironment and the efficacy. |
| up to 8 weeks |