Clinical trial NCT06933251: PCSK9 Inhibitor and PD-1 Inhibitor Combined With Neoadjuvant Chemoradiotherapy for pMMR/MSS Locally Advanced Rectal Cancer
Official title: Clinical Study of PCSK9 Inhibitor and PD-1 Inhibitor Combined With Neoadjuvant Chemoradiotherapy in the Treatment of pMMR/MSS Locally Advanced Rectal Cancer
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: PHASE2
Conditions: Locally Advanced Rectal Cancer (LARC)
Keywords: neoadjuvant chemoradiotherapy
PD-1 inhibitor
PCSK9 inhibitor
pMMR/MSS
Lead sponsor: Guangdong Provincial People's Hospital
Sponsor class: OTHER
First posted: 2025-04-18
Enrollment: 30
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: This is a single-center, open-label, single-arm clinical study aimed at conducting a preliminary evaluation of the efficacy and safety of combining PCSK9 inhibitors and PD-1 inhibitors (dual inhibitors) with neoadjuvant chemoradiotherapy in patients with pMMR/MSS locally advanced rectal cancer.

Detailed description: This study aims to evaluate the complete response (CR) rate of PCSK9 inhibitor and PD-1 inhibitor combination therapy (dual inhibitors) in conjunction with neoadjuvant chemoradiotherapy for patients with pMMR/MSS locally advanced rectal cancer. Specifically, the study will assess the pathological complete response (pCR) rate two weeks after neoadjuvant therapy, the clinical complete response (cCR) rate under the "watch-and-wait" strategy, objective response rate (ORR), R0 resection rate, tumor regression grade (TRG), and sphincter preservation rate. Additionally, the study will evaluate the 2-year disease-free survival (DFS) and overall survival (OS) following dual-inhibitor combined neoadjuvant chemoradiotherapy. The safety and tolerability of this combination therapy will also be comprehensively assessed based on NCI-CTCAE 4.03 criteria.

Eligibility criteria: Inclusion Criteria:

1. Age between 18 and 75 years, regardless of gender;
2. Histologically confirmed pMMR/MSS rectal adenocarcinoma, with clinical staging of cT3/T4 or cN+, and tumor located ≤12 cm from the anal verge;
3. No distant metastasis;
4. ECOG performance status of 0-1;
5. Baseline hematological and biochemical parameters meet the following criteria: neutrophils ≥1.5×10\^9/L, hemoglobin ≥90 g/L, platelets ≥100×10\^9/L, ALT/AST ≤2.5 ULN, creatinine ≤1 ULN;
6. Good compliance and willingness to sign an informed consent form.

Exclusion Criteria:

1. History of allergies to PCSK9 monoclonal antibody, PD-1 monoclonal antibody, capecitabine, or oxaliplatin;
2. Preoperative pathological diagnosis of non-pMMR/MSS rectal adenocarcinoma;
3. Use of other long-term lipid-lowering drugs leading to conditions such as hypolipidemia;
4. Pregnant or breastfeeding women;
5. History of other malignancies within the past 5 years;
6. Previous history of anti-tumor treatments, including radiotherapy, chemotherapy, immune checkpoint inhibitors, T-cell related therapies, etc.;
7. History of severe neurological or psychiatric disorders (e.g., schizophrenia, dementia, or epilepsy);
8. Current severe cardiovascular disease (heart failure or arrhythmia), renal insufficiency, or liver dysfunction; Note: Whether the patient can tolerate the specific treatment or measures should be assessed by a cardiologist based on the patient's condition.
9. Acute myocardial infarction or ischemic stroke within 6 months prior to enrollment;
10. Presence of uncontrolled infections requiring systemic treatment;
11. Active autoimmune diseases or immunodeficiencies, a history of organ transplantation, or systemic use of immunosuppressive agents;
12. Known history of HIV infection (e.g., HIV 1-2 antibody positive), active syphilis, or active pulmonary tuberculosis;
13. Active hepatitis B virus (HBV) or hepatitis C virus (HCV) infection during screening (e.g., HBsAg positive, HBV DNA positive, HCV RNA positive, or anti-HCV antibody positive);
14. Known allergy to any component of the treatment;
15. Investigator's judgment that other factors exist which may cause early termination of the trial, such as severe disease (including psychiatric disorders), alcohol abuse, drug use, or social or familial factors affecting patient safety or compliance;
16. History of hypocholesterolemia (total cholesterol \[TC\] \<3.6 mmol/L or \<140 mg/dL, low-density lipoprotein cholesterol \[LDL-C\] \<1.8 mmol/L or \<70 mg/dL, high-density lipoprotein cholesterol \[HDL-C\] \<1.0 mmol/L \[male\] or \<1.3 mmol/L \[female\]), hypolipidemia (triglycerides \[TG\] \<0.5 mmol/L or \<45 mg/dL), or a family history of these conditions.

Primary outcomes:
measure: CR
timeFrame: pCR :within 2 weeks after surgery; cCR :2 weeks after radiotherapy ends
measure: AE rate
timeFrame: During neoadjuvant chemoradiotherapy combined with immunotherapy, an average of 6 months
Secondary outcomes:
measure: DFS
timeFrame: 5 years
measure: OS
timeFrame: 5 years
measure: ORR
timeFrame: within 2 weeks after surgery
measure: TRG
timeFrame: At the time of postoperative pathological assessment (within 1 week after surgery)
measure: OPR
timeFrame: immediately after surgery
Other outcomes:
Locations:
city: Guangzhou
country: China
facility: No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou
state: Guangdong
Study officials:
References:
citation: Liu X, Bao X, Hu M, Chang H, Jiao M, Cheng J, Xie L, Huang Q, Li F, Li CY. Inhibition of PCSK9 potentiates immune checkpoint therapy for cancer. Nature. 2020 Dec;588(7839):693-698. doi: 10.1038/s41586-020-2911-7. Epub 2020 Nov 11.
citation: Yuan J, Cai T, Zheng X, Ren Y, Qi J, Lu X, Chen H, Lin H, Chen Z, Liu M, He S, Chen Q, Feng S, Wu Y, Zhang Z, Ding Y, Yang W. Potentiating CD8+ T cell antitumor activity by inhibiting PCSK9 to promote LDLR-mediated TCR recycling and signaling. Protein Cell. 2021 Apr;12(4):240-260. doi: 10.1007/s13238-021-00821-2. Epub 2021 Feb 19.