PHOENIX: QL1706 Plus Chemotherapy and Bevacizumab in AGA-Resistant, PD-L1 ≥50% Non-Squamous NSCLC (PHOENIX)

A Multicenter Study of Iparomlimab and Tuvonralimab (QL1706) Plus Platinum-Based Doublet Chemotherapy and Bevacizumab in PD-L1 ≥50% Non-Squamous Non-Small Cell Lung Cancer With Actionable Genomic Alterations (AGA) Resistant to Prior Targeted Therapy

The goal of this Phase II clinical trial (The PHOENIX Study) is to evaluate if the combination of QL1706 (Iparomlimab and Tuvonralimab), bevacizumab, and chemotherapy can treat patients with TKI-refractory, driver-gene positive (e.g., EGFR, ALK, ROS1, RET, KRAS, BRAF, HER2), non-squamous non-small cell lung cancer (NSCLC) who have high PD-L1 expression (TPS ≥50%).

The main question[s] it aims to answer [is/are]:

Does the quadruple combination therapy improve the Objective Response Rate (ORR) compared to historical chemotherapy data? What are the secondary efficacy outcomes, including Progression-Free Survival (PFS) and Overall Survival (OS)?

If there is a comparison group: There is no concurrent control group (this is an open-label, multi-cohort study). Researchers will compare the treatment outcomes of the participants to historical control data (standard platinum-based chemotherapy) to see if the objective response rate (ORR) improves from a historical baseline of 29% to a target of 55%.

Participants will:

Receive induction therapy every 3 weeks for 4 cycles, consisting of intravenous infusions of QL1706, bevacizumab, pemetrexed, and platinum chemotherapy (cisplatin or carboplatin).

Receive maintenance therapy every 3 weeks with QL1706 and bevacizumab for up to 2 years or until disease progression.

Undergo regular tumor assessments (CT or MRI scans) to monitor disease status according to RECIST v1.1 criteria.

Provide blood samples for safety monitoring and potential biomarker analysis.

Study Overview

• Status: Not yet recruiting
• Conditions: Lung Adenocarcinoma
• Intervention / Treatment: Drug: QL1706 (bispecific antibody targeting PD-1 and CLTA-4)

• Study Type: Interventional
• Enrollment (Estimated): 61
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Hao Sun, Doctor; Phone Number: +86 16620178852; Email: sunhao@gdph.org.cn

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

The study will enroll adult patients (aged 18-75 years) with histologically confirmed locally advanced or metastatic NSCLC (AJCC 9th Edition, Stage IIIB-IVB), and harbor confirmed actionable driver mutations for which targeted therapies are available; these mutations are stratified as follows: EGFR (19del, L858R); ALK, ROS1, RET fusions; KRAS G12C; BRAF V600; and HER2 exon 20 insertions. Patients must have disease progression following at least one line of TKI therapy and a 2-week washout period is required for prior TKI therapy or chemotherapy. Prior immunotherapy is not permitted. PD-L1 tumor proportion score (TPS) ≥ 50%, as confirmed by central laboratory testing using the 22C3 or SP263 clone on fresh or archival tumor tissue (collected within 2 years). Patients must have an Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 or 1, and presence of at least one measurable lesion per Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.1.

Exclusion Criteria:

• Prior treatment with QL1706 or other investigational PD-1/PD-L1/CTLA-4 antibodies, unless allowed by the protocol.
• Untreated or symptomatic central nervous system (CNS) metastases. Participants with previously treated, stable, and asymptomatic CNS metastases off steroids for at least 2 weeks before first dose may be eligible.
• History of severe allergic reactions or hypersensitivity to monoclonal antibodies, platinum agents, pemetrexed, bevacizumab, or any excipients of the study drugs.
• Clinically significant cardiovascular disease, including but not limited to:
• Uncontrolled hypertension despite optimal medical management
• New York Heart Association (NYHA) class III or IV heart failure
• Unstable angina, myocardial infarction, or stroke within 6 months prior to enrollment
• Significant arrhythmias requiring anti-arrhythmic therapy
• Active or history of autoimmune disease that has required systemic treatment in the past 2 years (e.g., with disease-modifying agents, corticosteroids, or immunosuppressive drugs), except for conditions such as vitiligo, resolved childhood asthma/atopy, or hypothyroidism on stable replacement therapy.
• Active infection requiring systemic therapy, including known active hepatitis B, hepatitis C, or human immunodeficiency virus (HIV) infection, unless well controlled according to protocol-defined criteria.
• Significant hemoptysis (e.g., ≥ 2.5 mL of bright red blood) within 3 months prior to enrollment or any evidence of high-risk bleeding or coagulation disorder that would contraindicate bevacizumab.
• Major surgery within 4 weeks before first dose of study treatment or anticipated need for major surgery during the study.
• Pregnant or breastfeeding women.
• Any other serious medical condition, uncontrolled intercurrent illness, psychiatric illness, or social circumstance that, in the opinion of the investigator, would compromise the participant's safety, interfere with study evaluations, or preclude informed consent.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Cohort 1 (EGFR) consists of patients with EGFR-positive; Cohort 1 (EGFR) consists of patients with EGFR-positive non-small cell lung cancer (NSCLC) who have failed prior EGFR-tyrosine kinase inhibitor (TKI) therapy	Drug: QL1706 (bispecific antibody targeting PD-1 and CLTA-4); All cohorts will receive the same treatment regimen in 3-week cycles.Participants will receive combination therapy, consisting of QL1706 (5.0 mg/kg, day 1), bevacizumab (7.5 mg/kg, days1), pemetrexed(500 mg/m², days1) and Platinum [Cisplatin (75 mg/m²) or Carboplatin (AUC 5/mg/ml, up to 750 mg), Day 1],intravenously every 3 weeks for four cycles in induction phase, followed by QL1706 (5.0 mg/kg, day 1) and bevacizumab (7.5 mg/kg, days1) every 3 weeks for up to 2 years or until disease progression; Other Names: Platinum; bevacizumab; pemetrexed
Experimental: Cohort 2 (ALK/ROS1/RET) includes patients with sensitive ALK, ROS1, or RET mutations; Cohort 2 (ALK/ROS1/RET) includes patients with sensitive ALK, ROS1, or RET mutations who have progressed on prior TKI therapy targeting the respective driver oncogenes,	Drug: QL1706 (bispecific antibody targeting PD-1 and CLTA-4); All cohorts will receive the same treatment regimen in 3-week cycles.Participants will receive combination therapy, consisting of QL1706 (5.0 mg/kg, day 1), bevacizumab (7.5 mg/kg, days1), pemetrexed(500 mg/m², days1) and Platinum [Cisplatin (75 mg/m²) or Carboplatin (AUC 5/mg/ml, up to 750 mg), Day 1],intravenously every 3 weeks for four cycles in induction phase, followed by QL1706 (5.0 mg/kg, day 1) and bevacizumab (7.5 mg/kg, days1) every 3 weeks for up to 2 years or until disease progression; Other Names: Platinum; bevacizumab; pemetrexed
Experimental: Cohort 3 (KRAS/BRAF/HER2) comprises patients with KRAS G12C, BRAF V600, or HER2 exon 20 insertions; Cohort 3 (KRAS/BRAF/HER2) comprises patients with KRAS G12C, BRAF V600, or HER2 exon 20 insertions (20ins) (N=15) who have failed prior targeted therapy for these actionable driver mutations.	Drug: QL1706 (bispecific antibody targeting PD-1 and CLTA-4); All cohorts will receive the same treatment regimen in 3-week cycles.Participants will receive combination therapy, consisting of QL1706 (5.0 mg/kg, day 1), bevacizumab (7.5 mg/kg, days1), pemetrexed(500 mg/m², days1) and Platinum [Cisplatin (75 mg/m²) or Carboplatin (AUC 5/mg/ml, up to 750 mg), Day 1],intravenously every 3 weeks for four cycles in induction phase, followed by QL1706 (5.0 mg/kg, day 1) and bevacizumab (7.5 mg/kg, days1) every 3 weeks for up to 2 years or until disease progression; Other Names: Platinum; bevacizumab; pemetrexed

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Objective Response Rate (ORR) per RECIST 1.1	Objective Response Rate (ORR) is defined as the proportion of participants who achieve a best overall response of complete response (CR) or partial response (PR) according to RECIST 1.1, as assessed by the investigator.	From first dose until disease progression or start of new anti-cancer therapy, up to approximately 24 months.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Progression-Free Survival (PFS)	Progression-Free Survival (PFS) is defined as the time from randomization to the first documented disease progression per RECIST 1.1 or death from any cause, whichever occurs first, as assessed by the investigator.	From enrollment until disease progression or death, whichever occurs first, up to approximately 24 months.

Collaborators and Investigators

• Sponsor: Guangdong Association of Clinical Trials
• Collaborators: Qilu Pharmaceutical Co., Ltd.

Study record dates

Study Major Dates

• Study Start (Estimated): January 31, 2026
• Primary Completion (Estimated): December 31, 2027
• Study Completion (Estimated): December 31, 2028

Study Registration Dates

• First Submitted: February 10, 2026
• First Submitted That Met QC Criteria: February 10, 2026
• First Posted (Actual): February 17, 2026

Study Record Updates

• Last Update Posted (Actual): February 17, 2026
• Last Update Submitted That Met QC Criteria: February 10, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: PD-L1; CTLA-4; QL1706
• Additional Relevant MeSH Terms: Neoplasms by Site; Neoplasms; Neoplasms by Histologic Type; Neoplasms, Glandular and Epithelial; Adenocarcinoma; Respiratory Tract Neoplasms; Thoracic Neoplasms; Lung Neoplasms; Carcinoma; Adenocarcinoma of Lung; Diabetes Mellitus, Insulin-Dependent, 12; Amino Acids, Peptides, and Proteins; Proteins; Heterocyclic Compounds; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal; Antibodies; Immunoglobulins; Immunoproteins; Blood Proteins; Serum Globulins; Globulins; Inorganic Chemicals; Guanine; Hypoxanthines; Purinones; Purines; Glutamates; Amino Acids, Acidic; Amino Acids; Amino Acids, Dicarboxylic; Elements; Metals; Metals, Heavy; Transition Elements; Bevacizumab; Pemetrexed; Platinum
• Other Study ID Numbers: KY2025-1174-02

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No