This multicenter, randomized, open-label, phase II trial is designed to evaluate the efficacy and safety of adjuvant sintilimab in patients with completely resected non-small cell lung cancer who remain at high risk of recurrence after neoadjuvant immunochemotherapy.
Approximately 100 eligible participants will be randomly assigned in a 1:1 ratio to receive either adjuvant sintilimab or observation. Participants assigned to the experimental arm will receive sintilimab at a dose of 200 mg intravenously every 4 weeks for up to 1 year, unless disease recurrence or progression, unacceptable toxicity, withdrawal of consent, or another protocol-defined discontinuation criterion occurs.
The primary outcome is the 18-month disease-free survival rate. Secondary outcomes include disease-free survival, overall survival, and safety. Peripheral blood and tumor tissue samples will also be collected for exploratory analyses of ctDNA, antitumor immune responses, and tumor immune microenvironment biomarkers.
Inclusion Criteria:
Male or female participants aged 18 to 75 years.
Histologically or cytologically confirmed non-small cell lung cancer.
Completion of 2 to 4 cycles of neoadjuvant immune checkpoint inhibitor therapy combined with chemotherapy, followed by complete (R0) surgical resection.
At least one of the following protocol-defined high-risk features for postoperative recurrence:
For participants with lung adenocarcinoma, absence of sensitizing EGFR mutations and ALK rearrangements. Molecular testing is not mandatory for participants with squamous cell carcinoma according to the current protocol.
Eastern Cooperative Oncology Group performance status of 0 or 1.
Adequate organ function within 7 days before randomization, as demonstrated by all of the following:
Women of childbearing potential must have a negative pregnancy test within 7 days before the first dose and must agree to use effective contraception during the study and for 3 months after the last dose of study treatment. Male participants with partners of childbearing potential must agree to use effective contraception during the study and for 8 weeks after the last dose.
Ability to understand the study requirements, willingness to provide written informed consent, and ability to comply with study treatment and follow-up procedures.
Exclusion Criteria:
Small cell lung cancer or non-small cell lung cancer containing a small cell carcinoma component.
Incomplete resection, including R1 or R2 resection, or salvage surgery.
Clinically significant malnutrition as determined by the investigator.
A history of clinically significant immune-related adverse events during prior treatment, including grade 3 or higher immune-mediated pneumonitis, myocarditis, or another serious immune-related adverse event that, in the investigator's judgment, makes further immune checkpoint inhibitor therapy unsafe.
Signs, symptoms, or a known history of clinically significant interstitial lung disease.
Any severe or uncontrolled concurrent medical condition, including:
A concurrent active malignancy, except for malignancies specifically permitted by the final protocol.
An active autoimmune disease or another immune-mediated disease requiring systemic treatment.
Long-term treatment with systemic immunosuppressive therapy or systemic corticosteroids, except for protocol-permitted physiologic replacement therapy.
An active psychiatric disorder, cognitive impairment, or another condition that would prevent provision of informed consent or adherence to study treatment and follow-up.
Any other condition that, in the investigator's judgment, makes the participant unsuitable for the study.
dingzhenyu@scu.edu.cn
Participants will receive sintilimab 200 mg by intravenous infusion once every 4 weeks for up to 1 year. Treatment will continue until completion of the planned treatment period, documented disease recurrence or progression, unacceptable toxicity, withdrawal of consent, or another protocol-defined discontinuation criterion.
Participants will receive no protocol-mandated postoperative immune checkpoint inhibitor therapy and will undergo standard clinical and radiographic surveillance according to the study protocol.
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