Controlled Cold Exposure Combined With PD-1/PD-L1 Immunotherapy in Solid Tumors (NIVALIS) (NIVALIS)

NIVALIS Trial: A Single-Center, Prospective, Single-Arm, Open-Label Phase I Exploratory Study Evaluating the Safety, Feasibility, and Preliminary Antitumor Activity of Controlled Cold Exposure Combined With PD-1/PD-L1 Immunotherapy in Patients With Solid Tumors

This is a single-center, prospective, single-arm, open-label phase I exploratory study that plans to enroll 24 participants with solid malignancies. All participants will receive controlled cold exposure in addition to standard PD-1/PD-L1 inhibitor monotherapy or PD-1/PD-L1 inhibitor-based standard combination therapy. A 2-day cold acclimation phase will precede formal intervention, consisting of approximately 20°C exposure for 8 hours on Day -2 and approximately 18°C exposure for 10 hours on Day -1. The first combination cycle begins on Day 1 concurrently with PD-1/PD-L1-based treatment, with exposure to an 18°C temperature-controlled hospital room for 12 hours per day for 7 consecutive days. If tolerated, cold exposure may be repeated in subsequent PD-1/PD-L1 treatment cycles. The primary objective is to evaluate safety, tolerability, and feasibility. Secondary objectives are to explore preliminary antitumor activity and the effects on brown adipose tissue activation, peripheral immune profiling, circulating cytokines, metabolomics, gut microbiota, patient-reported outcomes, and tumor immune/metabolic biomarkers when paired tumor tissue is available.

Study Overview

• Status: Recruiting
• Conditions: Solid Tumors; Solid Malignancies; Immunotherapy; Cold Exposure
• Intervention / Treatment: Other: Controlled Cold Exposure; Drug: Investigator-Selected Standard PD-1/PD-L1 Inhibitor-Based Therapy

Detailed Description

This study does not alter the participant's predetermined standard antitumor treatment pathway. It is non-randomized, does not include a parallel thermoneutral control arm, and uses an open-label design. A total of 24 participants are planned to obtain 20 evaluable participants. For early safety protection, staggered enrollment will be used: the first 2 participants will complete the first combination intervention and the dose-limiting toxicity observation window before further enrollment proceeds, provided no predefined unacceptable toxicity is observed. Efficacy and mechanistic endpoints will be explored primarily through longitudinal within-participant comparisons and descriptive analyses.

• Study Type: Interventional
• Enrollment (Estimated): 24
• Phase: Phase 1

Contacts and Locations

• Study Contact: Name: Xuelei Ma, M.D; Phone Number: +86 13408410416; Email: drmaxuelei@gmail.com
• Study Contact Backup: Name: Shen Li, M.D; Phone Number: +86 19980810727; Email: Daniel_lishen@163.com

Study Locations

• China
  • Sichuan
    • Chengdu, Sichuan, China, 610041
      • Recruiting
      • West China Hospital of Sichuan University
      • Contact: Xuelei Ma, M.D; Phone Number: +86 13408410416; Email: drmaxuelei@gmail.com

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• 1. Age 18-75 years, regardless of sex. 2. Histologically or cytologically confirmed malignant solid tumor. 3. Evaluated by the treating physician or multidisciplinary team (MDT) as currently planned to receive standard PD-1/PD-L1 inhibitor monotherapy or a standard combination regimen containing PD-1/PD-L1 inhibitors.

  4. Applicable settings include neoadjuvant, perioperative, or conversion therapy, as well as unresectable locally advanced, recurrent, or metastatic disease planned for systemic therapy.

  5. At least one evaluable lesion; for patients assessed by RECIST 1.1, at least one measurable lesion is required. Patients planned for surgery may also be included if adequate preoperative imaging and postoperative pathological assessment are available, even if RECIST measurability is not fully met.

  6. ECOG performance status 0-1; selected patients with ECOG 2 may be enrolled at the investigator's discretion if considered able to tolerate the study procedures.

  7. Expected survival ≥3 months. 8. Adequate major organ function, including hematologic, hepatic, renal, and electrolyte parameters acceptable for clinical study participation.

  9. Cardiopulmonary function at rest adequate to tolerate the study procedures, without obvious abnormalities indicating intolerance to cold exposure.

  10. Toxicities from prior antitumor therapy must have recovered to ≤ Grade 1, except for alopecia or clinically insignificant abnormalities judged by the investigator; for patients previously treated with PD-1/PD-L1 inhibitors, at least 4 weeks must have elapsed before enrollment, and prior related adverse events must have recovered or stabilized sufficiently for re-exposure.

  11. No clear contraindication to cold exposure, and deemed able to tolerate cold exposure combined with immunotherapy by the investigator.

  12. Negative pregnancy test for women of childbearing potential; participants of reproductive potential must agree to use effective contraception during the study and for at least 3 months after the last dose.

  13. Able to understand the study objectives, procedures, and potential risks, and willing to provide written informed consent.

  14. For participants planned for neoadjuvant, perioperative, or conversion therapy, the investigator must confirm that study procedures will not delay planned surgery or other critical treatments.

Exclusion Criteria:

• 1. Participation in another interventional clinical study or receipt of another investigational treatment within 4 weeks before study treatment initiation.

  2. Uncontrolled active infection, including but not limited to severe bacterial, viral, or fungal infection, or active tuberculosis.

  3. HIV infection; chronic HBV or HCV infection with uncontrolled viral replication or unacceptable liver function.

  4. Known severe hypersensitivity to the intended PD-1/PD-L1 inhibitor or its excipients.

  5. Active autoimmune disease or a requirement for long-term moderate- to high-dose immunosuppressive therapy; physiological replacement-dose steroids may be allowed at the investigator's discretion.

  6. Prior severe or life-threatening immune-related adverse events during PD-1/PD-L1 inhibitor therapy that have not resolved or are considered high-risk for re-exposure.

  7. Significant cardiovascular disease, including but not limited to unstable angina, severe arrhythmia, NYHA class III-IV heart failure, LVEF <50%, or myocardial infarction, stroke, or severe thrombotic events within 6 months.

  8. Severe chronic respiratory disease, especially conditions likely to worsen under cold stimulation, such as severe COPD or severe asthma.

  9. Clear contraindications to cold exposure, including prior severe cold-related injury, cold urticaria, cryoglobulinemia, active Raynaud's syndrome, or other diseases judged by the investigator to preclude tolerance to a cold environment.

  10. Uncontrolled symptomatic central nervous system metastases. 11. Severe psychiatric illness, cognitive impairment, substance abuse, or alcohol dependence that would interfere with compliance.

  12. Pregnancy or breastfeeding. 13. Uncontrolled diabetes, severe malnutrition, marked frailty, or any other condition judged to make the participant unable to tolerate cold exposure or study procedures.

  14. Any situation in which study participation may significantly delay standard therapy, planned surgery, or other critical treatment timing.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Experimental: Controlled Cold Exposure + Standard PD-1/PD-L1-Based Therapy; ll participants will receive standard PD-1/PD-L1 inhibitor monotherapy or PD-1/PD-L1 inhibitor-based standard combination therapy according to tumor type, clinical guidelines, and routine practice, together with controlled cold exposure. A 2-day cold acclimation phase will be performed before formal intervention (approximately 20°C for 8 hours on Day -2 and approximately 18°C for 10 hours on Day -1). The first combination cycle will include exposure to an 18°C temperature-controlled hospital room for 12 hours per day for 7 consecutive days starting on Day 1; if tolerated, the intervention may be repeated in subsequent PD-1/PD-L1 treatment cycles.

Other: Controlled Cold Exposure; Controlled environmental cold exposure in a temperature-controlled hospital room. Cold acclimation includes approximately 20°C for 8 hours on Day -2 and approximately 18°C for 10 hours on Day -1; formal intervention consists of 18°C exposure for 12 hours per day for 7 consecutive days and may be repeated in later cycles if tolerated.; Drug: Investigator-Selected Standard PD-1/PD-L1 Inhibitor-Based Therapy; Standard PD-1/PD-L1 inhibitor monotherapy or PD-1/PD-L1 inhibitor-containing standard combination therapy selected according to tumor type, clinical guidelines, and routine clinical practice.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of Adverse Events, Serious Adverse Events, and Safety-Related Treatment Modifications	The safety of the study treatment will be evaluated by recording adverse events (AEs), serious adverse events (SAEs), treatment-emergent adverse events (TEAEs), immune-related adverse events (irAEs), grade 3-4 TEAEs, and interruptions, delays, or discontinuations of controlled cold exposure or immunotherapy due to adverse events. Results will be reported as the proportion of participants experiencing the corresponding events (%) and the number of events.	From the start of the first study-related intervention until 30 days after the last protocol-specified treatment or the initiation of a new anticancer therapy, whichever occurs first.
Completion Rate and Adherence to Controlled Cold Exposure	The feasibility of the controlled cold exposure intervention will be evaluated by assessing the completion rate of planned cold exposure, intervention adherence, early withdrawal rate, and interruptions or discontinuations of cold exposure due to intolerance. Results will be reported separately as proportions (%).	Primarily assessed during the first combined intervention cycle (Day 1 to Day 7), and continuously recorded until completion of the last protocol-specified cold exposure treatment.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Objective Response Rate	Objective response rate is defined as the proportion (%) of participants with evaluable or measurable lesions who achieve a complete response (CR) or partial response (PR) according to RECIST 1.1.	The first imaging assessment will be performed 6-8 weeks after treatment initiation, and subsequently every 8-12 weeks until disease progression, withdrawal from the study, or study completion, up to 12 months.
Disease Control Rate	Disease control rate is defined as the proportion (%) of participants with evaluable or measurable lesions who achieve complete response (CR), partial response (PR), or stable disease (SD) according to RECIST 1.1.	The first imaging assessment will be performed 6-8 weeks after treatment initiation, and subsequently every 8-12 weeks until disease progression, withdrawal from the study, or study completion, up to 12 months.
Progression-Free Survival	Progression-free survival will be defined as the time from the start of the first study-related intervention to documented disease progression or death from any cause, whichever occurs first.	From the start of the first study-related intervention until study completion, up to 36 months.
Overall Survival	Overall survival will be defined as the time from the start of the first study-related intervention to death from any cause.	From the start of the first study-related intervention until study completion, up to 36 months.
Degree of brown adipose tissue activation after the cold exposure cycle	Brown adipose tissue activation after the first cold exposure cycle will be assessed using 18F-FDG PET/CT and reported using prespecified imaging parameters.	7 ± 2 days after completion of the first cold exposure cycle.
Change from baseline in the proportion of peripheral blood immune cell subsets	The proportions of peripheral blood immune cell subsets, such as CD8+ T cells, will be measured by flow cytometry and reported as percentages (%), and changes from baseline will be assessed.	From enrollment to the end of treatment, an average of 3 months.
Change from baseline in plasma metabolomics	Plasma metabolomics will be measured using LC-MS/MS or another prespecified platform, and changes from baseline will be assessed.	From enrollment to the end of treatment, an average of 3 months.
Change from baseline in the gut microbiota	Changes in the gut microbiota will be assessed using 16S rRNA sequencing or metagenomic sequencing, and changes from baseline will be evaluated.	From enrollment to the end of treatment, an average of 3 months.
Incidence of cold exposure-related discomfort	The proportion (%) of patients experiencing cold exposure-related adverse symptoms, such as shivering and pain, will be recorded.	At baseline, daily during the cold adaptation period, and daily during the initial combined intervention phase, until the end of cold exposure. From enrollment to the end of treatment, an average of 3 months.
Changes in Tumor Immune and Metabolic Biomarkers in Paired Tumor Tissue (If Available)	In participants with available paired tumor tissue samples, changes in immune-related and metabolic biomarkers in tumor tissue before and after treatment will be explored.	At baseline biopsy and at surgical resection, an average of 3 months.
Surgery rate	Among participants who receive neoadjuvant immunotherapy and are scheduled for surgery, the proportion (%) who ultimately undergo surgical treatment will be assessed to reflect surgical feasibility.	Assessed at the planned time point for surgery, an average of 1 months.
R0 resection rate	Among participants who actually undergo surgery, the proportion (%) achieving R0 resection will be assessed.	Assessed at the completion of surgery and postoperative pathological evaluation, an average of 1 months.
Pathological response rate	Among participants who actually undergo surgery, pathological response will be assessed according to prespecified pathological response criteria. Results will be reported as the proportion (%) of participants achieving pathological complete response (pCR) and/or major pathological response (MPR), or as pathological response categories.	Assessed at the completion of surgery and postoperative pathological evaluation, an average of 1 months.
Change from baseline in circulating cytokine concentrations	Circulating cytokine concentrations in serum or plasma, such as IFN-γ, will be measured by ELISA and reported in pg/mL, and changes from baseline will be assessed.	From enrollment to the end of treatment, an average of 3 months.
Change from baseline in tumor metabolic biomarkers in paired tumor tissue (if available)	In participants with available paired tumor tissue samples, metabolic biomarkers in tumor tissue will be assessed before and after treatment, and changes from baseline will be evaluated.	From enrollment to the end of treatment, an average of 3 months.
Change from baseline in tumor immune biomarkers in paired tumor tissue (if available)	In participants with available paired tumor tissue samples, tumor immune biomarkers will be assessed in paired tumor tissue before and after treatment, and changes from baseline will be evaluated.	From enrollment to the end of treatment, an average of 3 months.

Collaborators and Investigators

• Sponsor: West China Hospital

Publications and helpful links

General Publications

• Seki T, Yang Y, Sun X, Lim S, Xie S, Guo Z, Xiong W, Kuroda M, Sakaue H, Hosaka K, Jing X, Yoshihara M, Qu L, Li X, Chen Y, Cao Y. Brown-fat-mediated tumour suppression by cold-altered global metabolism. Nature. 2022 Aug;608(7922):421-428. doi: 10.1038/s41586-022-05030-3. Epub 2022 Aug 3.
• Walker ME, Kodani SD, Mena HA, Tseng YH, Cypess AM, Spite M. Brown Adipose Tissue Activation in Humans Increases Plasma Levels of Lipid Mediators. J Clin Endocrinol Metab. 2024 Jun 17;109(7):1837-1849. doi: 10.1210/clinem/dgae016.
• Lin B, Lin D, Ou X, Wang J, Yu S, Chen G, Wen J. Brown adipose tissue activation and cardiovascular risk following PD-1 antibody therapy in cancer patients: a retrospective cohort study. Eur J Med Res. 2025 Nov 28;30(1):1195. doi: 10.1186/s40001-025-03463-w.

Study record dates

Study Major Dates

• Study Start (Actual): April 20, 2026
• Primary Completion (Estimated): July 31, 2027
• Study Completion (Estimated): June 30, 2029

Study Registration Dates

• First Submitted: April 2, 2026
• First Submitted That Met QC Criteria: April 15, 2026
• First Posted (Actual): April 20, 2026

Study Record Updates

• Last Update Posted (Actual): May 28, 2026
• Last Update Submitted That Met QC Criteria: May 24, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: Approval No. 2270 (2025)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: The plan to share de-identified individual participant data has not yet been finalized. Any future data sharing decision will be made after study completion, in accordance with institutional policies, ethics requirements, participant consent, and applicable regulations.

Drug and device information, study documents

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