HRS-4642 With Nimotuzumab and Chemotherapy for First-line Treatment of Advanced Pancreatic Cancer Patients

A Single-arm Phase II Study of HRS-4642 With Nimotuzumab and Chemotherapy for First-line Treatment of Advanced Pancreatic Cancer Patients With KRAS G12D Mutations

This study is a single-arm phase II clinical study to include 32 patients with advanced pancreatic cancer with KRAS G12D mutation to evaluate the effectiveness of HRS-4642 combined with nitutuzumab and AG for first-line treatment of advanced pancreatic cancer.

Study Overview

• Status: Recruiting
• Conditions: Metastatic Pancreatic Carcinoma
• Intervention / Treatment: Drug: HRS-4642; Drug: Nimotuzumab; Drug: gemcitabine + nab-paclitaxel

Detailed Description

This study used a Simon two-stage design, with at least 15 subjects enrolled in the first stage. During this period, after 6-9 subjects complete the first cycle of treatment, the existing safety data shall be summarized and analyzed to integrate the safety results to assess the tolerance. If tolerated, the proposed dose, other dose level or dosage regimen shall be discussed by investigators. As with> 5 achieved remission (CR / PR), enrollment continued to 32; if 5 were remitted, the SMC assessed assessed and decided. The study process included screening, treatment and follow-up periods (safety and survival follow-up after termination of study treatment).

• Study Type: Interventional
• Enrollment (Estimated): 133
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Yiwen Chen, MD; Phone Number: 86+15088682641; Email: cherry0705@zju.edu.cn
• Study Contact Backup: Name: Tingbo Liang, MD; Phone Number: 86+19941463683; Email: liangtingbo@zju.edu.cn

Study Locations

• China
  • Zhejiang
    • Hangzhou, Zhejiang, China, 310000
      • Recruiting
      • The First Affiliated Hospital of Zhejiang University School of Medicine
      • Contact: Yiwen Chen; Phone Number: 86+19941463683; Email: yiwenchen0705@126.com
    • Hangzhou, Zhejiang, China, 310000
      • Not yet recruiting
      • First Affiliated Hospital of Zhejiang University Schlool of Medicine
      • Contact: Yiwen Chen, MD; Phone Number: 86+15088682641; Email: cherry0705@zju.edu.cn

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1.Age: 18-75 (including 18 and 75); 2.Metastatic pancreatic cancer (from pancreatic ductal epithelium) for Arm A; Locally advanced pancreatic cancer (from pancreatic ductal epithelium) for Arm B; 3.Tumor tissue contains KRAS G12D mutation; 4.No systemic antitumor therapy in advanced stage; if previous neoadjuvant / adjuvant therapy, last treatment should be over 6 months; 5.At least one measurable lesion according to the RECIST v1.1 criteria; 6.The ECOG (Eastern Cooperative Oncology) score was 0-1; 7.Expected survival period of 3 months; 8.The functions of vital organs meets the following requirements (any blood components, cell growth factors are not allowed 2 weeks prior to enrollment):

1. Neutrophil count≥1.5×10^9 / L;
2. Platelet≥100×10^9 / L;
3. Hemoglobin≥100 g / L;
4. Serum albumin≥30 g / L;
5. Total bilirubin≤1.5×ULN; ALT, AST≤3×ULN and ALP≤2.5×ULN; if the patient has liver metastasis, ALT, ALT and AST≤5×ULN; if the patient has liver or bone metastasis, ALP≤5×ULN;
6. Creatinine clearance≥50 mL/min or serum creatinine ≤1.5×ULN;
7. Urinary protein <2+; if urine protein≥2+, an additional 24 hours urine protein quantification should be tested, and if 24 hours urine protein quantification <1g can be enrolled;
8. ECG: QTcF≤450 ms (male), QTcF≤470 ms (female);
9. Cardiac color ultrasound: LVEF (left ventricular ejection fraction) ≥50%; 9.Women of childbearing age must have a blood pregnancy test within 7 days before enrollment, the result should be negative and must be non-lactating and should be willing to use appropriate contraception during the trial and within 6 months of treatment. For men, surgical sterilization or consent to use appropriate contraception during the study and within 6 months after completion of treatment.

10.Volunteer to participate in the study and sign the informed consent form, good compliance, agreed to cooperate with the follow-up.

Exclusion Criteria:

1.Previous treatment:

1. Previous treatment of targeted therapy against KRAS G12D.
2. Previous targeted therapy against EGFR.
3. Received major surgery or major trauma within 4 weeks before enrollment, or palliative local treatment (including but not limited to palliative radiotherapy, interventional therapy) within 2 weeks prior to enrollment.
4. Have received any other clinical study medication within 4 weeks before enrollment, except for an observational (non-interventional) clinical study or interventional clinical study follow-up.

(5)14 days before enrollment with drugs that strongly inhibit or induce the hepatic drug-metabolizing enzymes CYP3A4 or CYP2C8.

2.The presence of a central nervous system (CNS) metastases. 3.Acute or chronic pancreatitis requiring clinical intervention. 4.Symptoms and signs of gastrointestinal obstruction or obstruction within 6 months before initiation of study treatment but can be screened if surgery is performed and the obstruction is completely resolved.

5.Within 2 weeks prior to enrollment, there is a third space effusion (such as a large amount of pleural fluid, ascites, etc.) that can not reach the stable state (no intervention treatment is needed after the removal of the drainage tube), and only a small amount of effusion on imaging and without clinical symptoms can be enrolled.

6.Severe infection occurred within 4 weeks before enrollment, such as severe pneumonia, bacteremia, infectious complications, requiring hospitalization; fever of unknown cause> 38.5℃ within 2 weeks before enrollment (fever caused by the tumor according to the investigator); 2 weeks of enrollment (except in cases of prophylactic antibiotics).

7.Severe cardiovascular and cerebrovascular disease. 8.Patients with known or suspected interstitial pneumonia except only interstitial changes on imaging.

9.Prior history of clear neurological or psychiatric disorders, including epilepsy and dementia.

10.Presence of non-healing wounds (severe, non-healing or split), uncured fractures.

11.Adverse events due to prior treatment prior to enrollment did not return to NCI-CTCAE level 1 (except for alopecia and enrollment criteria; except AEs not affecting the study medication).

12.Malignant tumors other than the primary tumor within the 5 years before enrollment, except those with low risk of metastasis and death: adequately treated cervical carcinoma in situ, skin basal cells or squamous cell carcinoma, etc.

13.Combined with active hepatitis B (hepatitis B surface antigen positive and HBV DNA 500 IU / mL), hepatitis C (hepatitis C antibody positive, and HCV-RNA above the lower limit of detection of the analytical method). Those known to have acquired immunodeficiency syndrome or test positive for HIV, and those infected with active syphilis. Subjects with active tuberculosis or a history of active tuberculosis infection within 48 weeks before screening, with or without treatment.

14.Known to be allergic to any component of HRS-4642; allergic to any component of nytuzumab or other monoclonal antibody / fusion proteins, albumin paclitaxel, gemcitabine.

15.By the investigator, the patient had other factors that might affect the study results or lead to the forced termination of the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

5

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Arm A-STAGE 1; Approximately 10-15 subjects will be enrolled in the first stage. During this period, after obtaining the initial efficacy evaluation results from the first 10 subjects, the existing safety and efficacy data will be summarized and analyzed. Integrating safety and efficacy outcomes, the SMC will assess whether to proceed to the second stage at the planned dose, or to discuss and determine alternative dose levels or dosing regimens. Eligible patients will receive HRS-4642, combined with Nimotuzumab and AG regimen, predose regimen: HRS-4642 500mg intravenous infusion, D1,1200mg IV infusion, D8, every 3 weeks; Nimotuzumab 400mg intravenous infusion, D1,8, every 3 weeks; Albumin paclitaxel 125mg/m2 intravenous infusion, gemcitabine 1000mg / m2, D1,8, a cycle every 3 weeks until disease progression or toxicity intolerance.	Drug: HRS-4642; HRS-4642 is a KRAS G12D inhibitor; Drug: Nimotuzumab; Nimotuzumab is a humanized IgG 1 monoclonal antibody targeting EGFR; Drug: gemcitabine + nab-paclitaxel; Albumin paclitaxel 125mg/m2 intravenous infusion, gemcitabine 1000mg / m2, D1,8, a cycle every 3 weeks
Experimental: Arm A (STAGE 2: Cohort 1); The second stage is a randomized, open-label study, with a planned enrollment of 39 subjects per group. Eligible subjects will be randomized in a 1:1 ratio, with stratification factors including history of radical surgery (yes vs. no). Eligible subjects will be randomized into Cohort 1 or Cohort 2 to receive corresponding treatments. In Cohort 1, subjects will receive HRS-4642 in combination with nimotuzumab and AG.	Drug: HRS-4642; HRS-4642 is a KRAS G12D inhibitor; Drug: Nimotuzumab; Nimotuzumab is a humanized IgG 1 monoclonal antibody targeting EGFR; Drug: gemcitabine + nab-paclitaxel; Albumin paclitaxel 125mg/m2 intravenous infusion, gemcitabine 1000mg / m2, D1,8, a cycle every 3 weeks
Active Comparator: Arm A (STAGE 2: Cohort 2); The second stage is a randomized, open-label study, with a planned enrollment of 39 subjects per group. Eligible subjects will be randomized in a 1:1 ratio. Eligible subjects will be randomized into Cohort 1 or Cohort 2 to receive corresponding treatments. In cohort 2, subjects will receive HRS-4642 in combination with AG.	Drug: HRS-4642; HRS-4642 is a KRAS G12D inhibitor; Drug: gemcitabine + nab-paclitaxel; Albumin paclitaxel 125mg/m2 intravenous infusion, gemcitabine 1000mg / m2, D1,8, a cycle every 3 weeks
Experimental: Arm B: Cohort 1; Cohort 1 will enroll 5-10 subjects with LAPC to evaluate the efficacy of HRS-4642 combined with AG and nimotuzumab as first-line treatment. Based on safety and efficacy data, a decision will be made on whether to continue enrollment in this cohort up to a maximum of 30 subjects.	Drug: HRS-4642; HRS-4642 is a KRAS G12D inhibitor; Drug: Nimotuzumab; Nimotuzumab is a humanized IgG 1 monoclonal antibody targeting EGFR; Drug: gemcitabine + nab-paclitaxel; Albumin paclitaxel 125mg/m2 intravenous infusion, gemcitabine 1000mg / m2, D1,8, a cycle every 3 weeks
Experimental: Arm B: cohort 2; Cohort 2 will enroll 5-10 subjects with LAPC to evaluate the efficacy of HRS-4642 combined with AG as first-line treatment.	Drug: HRS-4642; HRS-4642 is a KRAS G12D inhibitor; Drug: gemcitabine + nab-paclitaxel; Albumin paclitaxel 125mg/m2 intravenous infusion, gemcitabine 1000mg / m2, D1,8, a cycle every 3 weeks

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Objective reponse rate (ORR)	The proportion of patients who had tumor evaluated as PR according to RECIST1.1 criteria during the whole study	Up to 2 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Duration of remission （DoR）	The time from the first assessment of the tumor as CR or PR to the first assessment of PD or death from any cause during the whole study.	Up to 2 years
Disease control rate (DCR)	The proportion of patients who had tumor evaluated as PR or SD according to RECIST1.1 criteria during the whole study.	Up to 2 years
Progression-free survival （PFS）	The time from enrolled to disease pregression or death from any cause during the whole study.	Up to 2 years
Overall survival (OS)	The time from enrolled to death from any cause during the whole study.	Up to 2 years

Collaborators and Investigators

• Sponsor: Zhejiang University

Study record dates

Study Major Dates

• Study Start (Actual): March 25, 2025
• Primary Completion (Estimated): February 1, 2027
• Study Completion (Estimated): February 1, 2028

Study Registration Dates

• First Submitted: January 7, 2025
• First Submitted That Met QC Criteria: January 7, 2025
• First Posted (Actual): January 13, 2025

Study Record Updates

• Last Update Posted (Actual): June 3, 2026
• Last Update Submitted That Met QC Criteria: June 1, 2026
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Endocrine System Diseases; Neoplasms by Site; Neoplasms; Digestive System Neoplasms; Digestive System Diseases; Endocrine Gland Neoplasms; Pancreatic Diseases; Pancreatic Neoplasms; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Deoxycytidine; Cytidine; Pyrimidine Nucleosides; Pyrimidines; Gemcitabine; 130-nm albumin-bound paclitaxel; nimotuzumab
• Other Study ID Numbers: CAPT04

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No