Clinical trial NCT05715931: Perioperative Chemotherapy Plus Trastuzumab Plus Toripalimab in HER2 Positive Locally Advanced Gastric or Esophagogastric Junction Adenocarcinoma
Official title: A Multi-center, Phase II Study to Evaluate Efficacy and Safety of Perioperative Chemotherapy With Fluorouracil, Leucovorin, Oxaliplatin, Docetaxel (FLOT) and Trastuzumab in Combination With Toripalimab in Patients With HER2 Positive Locally Advanced Gastric or Esophagogastric Junction Adenocarcinoma
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE2
Conditions: Adenocarcinoma of the Stomach
Adenocarcinoma of Esophagogastric Junction
HER2-positive Gastric Cancer
Keywords: Gastric Adenocarcinoma
Esophagogastric Junction Adenocarcinoma
Perioperative Chemotherapy
Trastuzumab
Toripalimab
Lead sponsor: First Affiliated Hospital of Zhejiang University
Sponsor class: OTHER
First posted: 2023-02-08
Enrollment: 30
Sex: ALL
Minimum age (years): 18
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: Drug: 5-FU, leucovorin, docetaxel, oxaliplatin (FLOT) Drug: Trastuzumab Drug: Toripalimab
Primary purpose: TREATMENT

Brief summary: This study is a prospective, single arm, multi-center phase II clinical trial designed to evaluate the efficacy and safety of perioperative chemotherapy with FLOT regimen and trastuzumab in combination with toripalimab in participants with resectable HER2 positive locally advanced gastric or esophagogastric junction adenocarcinoma.


Eligibility criteria: Inclusion Criteria:

* Voluntary participation in the clinical study; fully understands and is informed of the study and has signed the Informed Consent Form (ICF).
* The gender is not limited. Age: ≥ 18 years and ≤ 80 years old.
* Gastric or esophagogastric junction adenocarcinoma confirmed by pathology.
* HER2-positive status defined as either IHC score of 3+ or IHC 2+ with amplification proven by fluorescent in situ hybridization (FISH) based on pretreatment endoscopic biopsies.
* Clinical stage at presentation: cT2-T4b, N+/-, M0 as determined by AJCC staging system, 8th edition.

  * The definition of metastatic lymph nodes: a lymph node must be ≥ 10mm in short axis when assessed by CT scan (CT scan slice thickness recommended to be no greater than 5 mm) according to the guideline of Response Evaluation Criteria in Solid Tumours (RECIST version 1.1)
* Participants with a performance status of 0 \~ 1 on the Eastern Cooperative Oncology Group (ECOG) within 7 days before the first dose of study treatment.
* Life expectancy ≥ 6 months.
* Agreement of providing pretreatment endoscopic biopsies specimens and surgical specimens for biomarker analysis, as well as the peripheral blood, feces and urine sample.
* The functions of the vital organs meet requirements as follow (within 14 days before the first dose of study treatment, participant has not received treatment of recombinant human thrombopoietin or granulocyte stimulating factor):

  1. Hematological function：

     * White blood cell count (WBC): 3.5 × 10 \^ 9 / L \~12.0 × 10 \^ 9 / L；
     * Absolute neutrophil count (ANC) ≥ 1.5 × 10 \^ 9 / L；
     * Platelet count (PLT) ≥ 100 × 10 \^ 9 / L；
     * Hemoglobin (Hb) ≥ 90 g / L.
  2. Hepatic function：

     * Total bilirubin (TBIL) ≤ 1.5 × ULN (upper limit of normal);
     * Aspartate aminotransferase (AST) ≤ 2.5 × ULN;
     * Alanine aminotransferase (ALT) ≤ 2.5 × ULN;
     * Albumin (ALB) ≥ 30 g / L.
  3. Renal function：

     * Creatinine (Cr) ≤ 1.5 × ULN, or creatinine clearance ≥ 60 ml / min for those with creatinine level \> 1.5 × ULN.
  4. Coagulation function：

     * International normalized ratio (INR) ≤ 1.5;
     * Prothrombin time (PT) and activated partial thromboplastin time (APTT) ≤ 1.5 × ULN.
  5. Cardiac function:

     * The left ventricular ejection fraction (LVEF) value ≥ 55 %, as assessed by echocardiography
* Female of childbearing age must meet requirements: urine or serum pregnancy test must be negative within 7 days before the first dose of study treatment, and she must agree to use adequate contraception methods or keep abstinence (starting with the ICF is signed through 120 days after the last dose of toriplimab, or 210 days after the last dose of trastuzumab, or 180 days after the last dose of chemotherapy, whichever is longer, and should not be breastfeeding. For the male participants must meet requirements: agree to use adequate contraception methods or keep abstinence (starting with the ICF is signed through 120 days after the last dose of toriplimab, or 210 days after the last dose of trastuzumab, or 180 days after the last dose of chemotherapy, whichever is longer).

Exclusion Criteria:

* Prior systemic therapy for treatment of gastric cancer (surgery, chemotherapy, radiotherapy, targeted therapy or immunotherapy).
* Previous or concurrent have other active malignant tumors within the past 5 years (except for basal cell or squamous cell carcinoma of the skin, superficial bladder cancer, prostate cancer or cervical cancer or breast cancer in situ that has undergone curative therapy).
* Participants with gastric outlet obstruction, or unable for oral take, or severe gastrointestinal bleeding.
* Myocardial infarction within 6 months before the first dose of study treatment, uncontrolled angina, arrhythmia which need medical intervention (including but not limited to cardiac pacemaker), congestive heart failure (New York Heart Association (NYHA) class III or IV).
* Existence of chronic diarrhea (watery diarrhea: ≥ 5 times per day).
* Participants with active infection within 14 days before the first dose of study treatment which need medical intervention.
* Participants with active tuberculosis.
* Previous or concurrent diagnosed with interstitial lung disease by imaging or symptoms.
* Any of the following test is positive: Human Immunodeficiency Virus (HIV) antibody, Hepatitis B surface Antigen (HBsAg), or Hepatitis C Virus (HCV) antibody.
* Participants who need long-term systemic steroid therapy (\> 10 mg/d prednisone equivalent) or any other form of immunosuppressive therapy within 14 days before the first dose of study treatment or during the study period.
* Concurrent or previous have severe allergic reaction to any antibody-based drugs.
* Existence of any concurrent autoimmune disease, excepting participants with diabetes mellitus type I, hypothyroidism requiring only hormone replacement therapy.
* Receive live vaccines within 28 days before the first dose of study treatment or during the study period, excepting inactivated viral vaccines for seasonal influenza.
* Known history of allogeneic organ transplantation and allogeneic hematopoietic stem cell transplantation.
* Existence of systemic disease that is difficult to control despite treatment with several agents, for example, diabetes mellitus, hypertension, etc.
* Existence of other serious physical or mental diseases or serious laboratory abnormalities that may increase the risk of participating in the study. Participants who were judged unsuitable as subjects of this trial by investigator.

Primary outcomes:
measure: Rate of pathological complete responses (pCR)
timeFrame: From enrollment to surgery after pre-operative treatment (up to approximately 24 months)
Secondary outcomes:
measure: Overall survival
timeFrame: From enrollment to the end of follow up or death from any cause (up to approximately 60 months)
measure: Progression-free survival
timeFrame: From enrollment to the end of follow up or the time of disease progression or relapse or death from any cause (up to approximately 60 months)
measure: The incidences and types of adverse events (AE) and severe adverse events (SAE)
timeFrame: From enrollment to 90-day after the last dose administration (up to approximately 27 months)
Other outcomes:
Locations:
city: Hangzhou
country: China
facility: The First Affiliated Hospital, College of Medicine, Zhejiang University
state: Zhejiang
city: Hangzhou
country: China
facility: The Second Affiliated Hospital, College of Medicine, Zhejiang University
state: Zhejiang
city: Huzhou
country: China
facility: Huzhou Central Hospital
state: Zhejiang
city: Lishui
country: China
facility: Lishui Central Hospital
state: Zhejiang
city: Ningbo
country: China
facility: Ningbo First Hospital
state: Zhejiang
city: Ningbo
country: China
facility: Ningbo Medical Center LiHuiLi Hospital
state: Zhejiang
city: Ningbo
country: China
facility: Ningbo Second Hospital
state: Zhejiang
city: Taizhou
country: China
facility: Taizhou Hospital
state: Zhejiang
Study officials:
affiliation: First Affiliated Hospital of Zhejiang University
name: Jiren Yu
role: PRINCIPAL_INVESTIGATOR
References: