- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06411171
Safety and Efficacy of Pembrolizumab in Combination With FLOT About Gastroesophageal Junction Cancer:
Safety and Efficacy of Pembrolizumab in Combination With FLOT as a First-line Treatment in Patients With Gastroesophageal Junction Cancer: a Prospective Multicenter Randomized Controlled Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Gastric cancer, including gastroesophageal junction cancer, is the fifth most common cancer and the third leading cause of death in the world. Among them, although the incidence of distal gastric adenocarcinoma is decreasing, the incidence of gastroesophageal junction cancer is increasing. At present, surgery is still the main treatment for gastroesophageal junction cancer. At the same time, multi-mode comprehensive treatment such as chemotherapy and molecular targeted therapy can effectively alleviate pathological progression, facilitate R0 resection and improve the overall survival of patients. A large number of previous clinical trials on the combination of first-line chemotherapy and molecular targeted drugs in the treatment of gastric and gastroesophageal junction cancer have shown that only trastuzumab can improve the overall survival rate of Her-2 positive patients. In addition, despite various clinical chemotherapy regimens, the median survival time of gastric cancer and gastroesophageal junction cancer is not high. Therefore, the treatment mode of gastroesophageal junction cancer, especially for Her-2 negative patients, needs to be explored and improved.
In recent years, immune checkpoint inhibitors represented by programmed death receptor 1 (PD-1)/programmed death receptor ligand 1 (PD-L1) inhibitors have been applied to the treatment of a variety of solid tumors such as melanoma, non-small cell lung cancer, renal cell carcinoma, head and neck cancer, and urothelial cancer. It has become another important treatment strategy after surgery, chemotherapy, radiotherapy and targeted therapy. Studies have shown that PD-L1 is highly expressed in tumor cells and immune cells in gastric cancer and gastroesophageal junction cancer and plays a key role in tumor immune escape, therefore, the PD-1/ PD-L1 pathway will become an important target for effective intervention in gastroesophageal junction cancer. As a PD-1 inhibitor, Pembrolizumab has been shown to have anti-tumor activity and manageable safety in gastroesophageal junction cancer, and was approved by the US FDA in September 2017 for advanced PD-L1-positive gastric or gastroesophageal junction cancer . The phase Ⅱ KEYNOTE-059 trial used Pembrolizumab as a single agent in the third-line treatment of advanced gastric or gastroesophageal junction cancer, and the results showed that it had controllable safety in patients with PD-L1 positive, with obvious advantages in objective response rate (ORR) and median duration of response (DOR) [12]. Chemotherapy enhances tumor immune responses by enhancing tumor cell immunogenicity and sensitivity to immune killing, and the combination of chemotherapy and immune checkpoint inhibitors has been shown to improve overall survival in several cancer types. Therefore, PD-1/ PD-L1 immunosuppressant combined with chemotherapy has become a hot spot in the research of advanced gastric cancer or gastroesophageal junction cancer . The phase 3 KEYNOTE-062 trial compared Pembrolizumab plus chemotherapy (cisplatin plus 5-FU or capecitabine) with chemotherapy alone or Pembrolizumab alone in the first-line treatment of advanced gastric or gastroesophageal junction cancer. However, compared with chemotherapy alone, Pembrolizumab combined with chemotherapy could not significantly prolong the overall survival of patients, and the overall effect was not better than chemotherapy alone . In contrast, the phase III KEYNOTE-590 study, designed to compare the efficacy and safety of Pembrolizumab plus chemotherapy (cisplatin plus fluorouracil) versus chemotherapy alone as first-line treatment for advanced esophageal and Siwert type I gastroesophageal junction cancer, showed that Pembrolizumab combined with chemotherapy was significantly superior to chemotherapy alone . Neither the KEYNOTE-062 trial nor the KEYNOTE-590 trial analyzed a separate population of patients with gastroesophageal junction cancer, and there are some differences in response to drugs by tissue type. Therefore, The efficacy of Pembrolizumab plus chemotherapy in the only patient population with gastroesophageal junction cancer warrants further investigation.
Study Type
Enrollment (Estimated)
Phase
- Phase 3
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
1) aged from 18 to 75 years old, including 18 and 80 years old;
2) histologically or cytologically confirmed locally advanced unresectable or metastatic gastric or GEJ adenocarcinoma;
3) ECOG PS score 0 or 1;
4) Known PD-L1 expression (assessed centrally using PD-L1 HC22C3)
5) no previous treatment
6) HER2-negative status
7) normal hematological parameters: white blood cell count ≥4×109/L; Absolute neutrophil count ≥1.5×109/L; Platelet count ≥100×109/L; Blood red protein g/L;
8) basically normal renal function: serum creatinine ≤1.5×ULN or creatinine clearance (CrCl)> 60 mL/min(using Cockcroft-Gault formula):
Female CrCl=(140-age)× weight (kg)× 0.85 / (72×Scr mg/dl)
Male CrCl=(140-age)× weight (kg)× 1.00 / (72×Scr mg/dl)
Liver function was basically normal: serum total bilirubin ≤1.5×ULN; Aspartate aminotransferase (AST) ≤2.5×ULN; Alanine aminotransferase (ALT) ≤2.5×ULN.
Female patients must have a negative urine pregnancy test before the start of the study (not applicable to patients with bilateral oophorectomy and/or hysterectomy or postmenopausal patients)
9) Provide written informed consent. Written informed consent was obtained.
Exclusion Criteria:
1) receiving anti-tumor therapy before enrollment, including but not limited to PD-1 inhibitors, CTLA-4 antibodies, EGFR monoclonal antibodies, EGFR-Tkis, and anti-angiogenic drugs;
2) A history of autoimmune disease, including but not limited to: myasthenia gravis, myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, antiphospholipid syndrome-related vascular thrombosis, Wegener's granulomatosis, Sjogren's syndrome, Guillain-Barre syndrome, multiple sclerosis, vasculitis, or glomerulonephritis. (Note: Patients with vitiligo, type I diabetes, or residual hypothyroidism due to autoimmune conditions (e.g., after Hashimoto's syndrome) requiring only hormone-replacement therapy, psoriasis requiring no systemic therapy, or if recurrence was not expected in the absence of an external trigger were allowed.) ;
3) participated in other interventional clinical trials within 30 days before screening;
4) Patients with a history of other malignant tumors (except cured basal cell carcinoma)
5) with severe uncontrolled comorbidities (e.g., heart failure, diabetes mellitus, hypertension, liver failure, renal failure, thyroid disease, mental illness, etc.);
6) known HIV infection or active viral hepatitis or tuberculosis;
7) have a major surgical procedure or planned surgery within 30 days before the first dose of the trial drug;
8) patients who are allergic to the drugs used in this regimen or their components;
9) pregnant (confirmed by blood or urine HCG testing) or lactating women, or childbearing age subjects unwilling or unable to use effective contraception (for both male and female subjects) until at least 6 months after the last trial treatment;
10) The investigator considers that it is not appropriate to participate in the study;
11) unwilling to participate in the study or unable to sign an informed consent form
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Pembrolizumab plus chemotherapy (FLOT)
|
The experimental group was treated with pembrolizumab combined with FLOT, and the control group was treated with FLOT chemotherapy alone
Other Names:
|
Active Comparator: chemotherapy (FLOT)
|
The experimental group was treated with pembrolizumab combined with FLOT, and the control group was treated with FLOT chemotherapy alone
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
objective response rate
Time Frame: 3 year
|
objective response rate
|
3 year
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
duration of response
Time Frame: 1 year
|
duration of response
|
1 year
|
disease control rate
Time Frame: 1 year
|
disease control rate
|
1 year
|
time to response
Time Frame: 1 year
|
time to response
|
1 year
|
overall surival
Time Frame: 5 year
|
overall surival
|
5 year
|
Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Antimetabolites, Antineoplastic
- Antimetabolites
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Tubulin Modulators
- Antimitotic Agents
- Mitosis Modulators
- Protective Agents
- Antineoplastic Agents, Immunological
- Micronutrients
- Vitamins
- Immune Checkpoint Inhibitors
- Antidotes
- Vitamin B Complex
- Docetaxel
- Fluorouracil
- Oxaliplatin
- Pembrolizumab
- Leucovorin
Other Study ID Numbers
- KY20232301-F-1
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Gastroesophageal Junction Cancer
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Rigshospitalet, DenmarkDanish Cancer SocietyCompletedGastroesophageal-junction CancerDenmark
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Jiangsu Alphamab Biopharmaceuticals Co., LtdCompletedGastric/Gastroesophageal Junction CancerChina
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Roswell Park Cancer InstitutePfizerRecruitingAdvanced Malignant Solid Neoplasm | Metastatic Colorectal Adenocarcinoma | Metastatic Gastroesophageal Junction Adenocarcinoma | Stage IV Colorectal Cancer AJCC v8 | Stage IVA Colorectal Cancer AJCC v8 | Stage IVB Colorectal Cancer AJCC v8 | Stage IVC Colorectal Cancer AJCC v8 | Clinical Stage III... and other conditionsUnited States
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City of Hope Medical CenterNational Cancer Institute (NCI)CompletedClinical Stage IV Gastric Cancer AJCC v8 | Clinical Stage IV Gastroesophageal Junction Adenocarcinoma AJCC v8 | Metastatic Gastric Adenocarcinoma | Metastatic Gastroesophageal Junction Adenocarcinoma | Postneoadjuvant Therapy Stage IV Gastroesophageal Junction Adenocarcinoma AJCC v8 | Postneoadjuvant... and other conditionsUnited States
Clinical Trials on Pembrolizumab plus chemotherapy (FLOT)
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Ruijin HospitalCompletedGastric Cancer | Chemotherapy EffectChina
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Ruijin HospitalCompletedChemotherapy EffectChina
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University of Roma La SapienzaAndrea LaghiActive, not recruitingGastric Cancer | Adenocarcinoma of the StomachItaly, Netherlands
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AstraZenecaActive, not recruitingGastrointestinal Neoplasms | Esophagogastric JunctionBelgium, Denmark, Spain, United Kingdom, Canada, United States, Taiwan, Turkey, France, Germany, Korea, Republic of, Brazil, Hungary, Japan, Peru, Poland, Russian Federation, Netherlands, Chile, Argentina
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Shanghai Zhongshan HospitalRecruitingEsophageal Squamous Cell Carcinoma | Neoadjuvant ChemoimmunotherapyChina
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Shenzhen SiBiono GeneTech Co.,LtdUnknown
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Jiangsu HengRui Medicine Co., Ltd.Completed