Plasmodium Immunotherapy for Lung Cancer

Study Overview
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Brief Summary
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The objective of this study is to evaluate the safety and the effectiveness of Plasmodium immunotherapy (blood-stage infection of Plasmodium vivax) for advanced non-small cell lung cancer.The treatment will last 3-6 months from the day of successful infection and will be terminated by antimalarial drugs.

Detailed Description
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In our study，30 patients with stage III/IV NSCLC will be enrolled to receive vaccination with an optimal concentration and amount of blood-stage P. vivax to observe the infection time, rate and cycle; principal clinical symptoms such as fever and anemia; heart, liver and kidney function; changes in spleen morphology and function, and dynamic changes in the function of peripheral immune cells. Moreover, the patient's tolerance to Plasmodium infection and changes in tumor-related parameters will be observed. The duration of the planned treatment is 3-6 months, and successful infection will be indicated by microscopic observation of parasitemia in peripheral blood samples. The treatment will last at least 12 weeks from the day of finding the Plasmodium from peripheral blood and will be terminated by chloroquine phosphate or Artemisinin compound preparation or Artesunate injection. Each patient will be vaccinated with P. vivax-infected red blood cells containing approximately 0.3-1×10^7 Plasmodium parasites. After vaccination, the onset and duration of peripheral parasitemia and the infection rate; principal clinical symptoms such as Chills, fever, pain (headache, joint pain, etc.), digestive tract reaction;peripheral hemogram changes；heart, liver and kidney function; changes in lung function, and dynamic changes in the function of peripheral immune cells will be observed. Moreover, the patient's tolerance to Plasmodium infection and changes in tumor-related parameters will be observed.

Official Title
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Clinical Study of Plasmodium Immunotherapy for Advanced Non-small Cell Lung Cancer

Conditions
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Lung Cancer, Nonsmall Cell

Intervention / Treatment
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* Biological: Blood-stage infection of P. vivax


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18-70 years of age, male or female Unresectable stage III or IV non-small cell lung cancer, diagnosed by histological and radiological findings (UICC, Seventh Ed.), and of any histological subtype. Cancer staging during the initial diagnosis must be confirmed by radiographic findings (CT and/or MRI and/or PET-CT) During study treatment, the patient should not receive other treatments, including chemotherapy, radiotherapy, targeted therapy, other biological therapy, physical therapy, traditional Chinese medicine, and so on At least 5 half-life of the targeted drug (the half- life calculation is based on the targeted drug instructions) since the end the targeted therapy;More than 12 weeks since the end of radiotherapy or chemotherapy (common or continuous) Expected survival > 16 weeks ECGO score of 0 or 1 PLT ≥100 × 10^9/L, WBC ≥ 4 × 10^9/L, and HGB ≥ 100 g/L; no significant morphological abnormalities of red blood cells, or anemia (iron deficiency anemia, autoimmune hemolytic anemia, thalassemia, etc.) The patient's peripheral blood immune cell count and immune function test are close to normal or normal, and the heart and lungs and kidneys are normal. The patient is willing to receive Plasmodium immunotherapy and is able to sign the informed consent For female patients: the result of a pregnancy test must be negative at screening. All subjects must consent to use birth control methods during treatment and for two months after discharge The subject is willing to follow the in-hospital exam and treatment and follow-up schedule The patient can return for regular scheduled follow-up visits during the 2-year follow-up period The subject agrees that the investigators may report and publish the results of this clinical study Exclusion Criteria: Total ≤ 4 weeks after surgical treatment or other forms of treatments Active chronic lung diseases (hypoxemia due to bronchial asthma, tuberculosis, other conditions); lung metastatic tumor; other comorbid tumors Patients with newly diagnosed brain metastasis (not including the previous brain metastatic lesion, which is not visible by image at the time of screening) Patients with autoimmune disease or other immunodeficiency diseases Patients taking long-term steroids or immunosuppressants Patients with severe hemoglobin disease or severe G6PD deficiency Patients with active or chronic symptomatic hepatitis Patients with other serious complications such as severe hemoptysis and massive pleural and ascitic fluid Liver impairment: ALT > 2.5 x ULN, AST > 2.5 x ULN, bilirubin > 1.5 x ULN Renal impairment: serum creatinine ≥ 1.5 x ULN Patients with chronic heart disease, primarily those with recent (within a year) myocardial infarction, serious arrhythmias, heart failure, or aortic aneurysm Patients with serious drug allergy Patients with splenectomy or splenomegaly Pregnant and nursing women Patients who participating in other clinical trials at the same time or less than 12 weeks since withdraw from other clinical trials Any condition that makes the subject ineligible to participate (in the opinion of the investigator)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Blood-stage infection of P. vivax<br>This is a single arm study that enrolls 30 patients to receive Plasmodium immunotherapy. | Biological: Blood-stage infection of P. vivax<br>* Each patient will be vaccinated with P. vivax-infected red blood cells containing approximately 0.3-1×10^7 Plasmodium parasites.And successful infection will be indicated by microscopic observation of parasitemia in peripheral blood samples.The treatment will last at least 12 weeks from the day of finding the Plasmodium from peripheral blood and will be terminated by chloroquine phosphate or Artemisinin compound preparation or Artesunate injection.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants with treatment-related adverse events as assessed by NCI CTCAE v4.0 | Adverse events will be evaluated according to NCI CTCAE 4.0, and the incidence of adverse events will be calculated. | 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Progression free survival(PFS) | Progression free survival(PFS):Starting from treatment until the disease is first found or the time of any cause of death(disease progression refers to tumor growth, or metastasis of primary tumor, or discovery of new lesions). | 2 years | 
| Overall survival(OS) | The time starting from the treatment to death of whatever causes (when subjects have lost to follow-up before death , the last follow-up time will be calculated as the time of death). | 2 years | 
| Tumor marker level | The patient's sensitive tumor markers will be reviewed periodically from the time they are enrolled into the study. | 2 years | 
| Objective response rate(ORR) | The proportion of patients whose tumor is reduced to a certain amount and maintain a certain period of time. | 2 years | 
| Quality of life score | Patients are regularly with QLQ-C30(cancer patient quality of life scale)to assess the quality of life of the patients. | 2 years | 
| Time to progression(TTP) | The time starting from the research to tumor progression. | 2 years | 
| 1 year of survival rate | The number of cancer cases remaining after 1 year of treatment/the total number of cancer cases treated*100%. | 2 years | 
| 2 year of survival rate | The number of cancer cases remaining after 2 year of treatment/the total number of cancer cases treated*100%. | 2 years | 
| Immunological index | Detection of absolute number of immune cells(such as CD3+CD4+、CD3+CD8+ and so on) in peripheral blood by cytometry. | 2 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Lung cancer Immunotherapy, Plasmodium vivax, Immunotherapy