GAPP Induction and Concurrent Chemoradiotherapy for High-risk Locoregionally Advanced NPC.

April 18, 2026 updated by: YiJun Hua, Sun Yat-sen University

An Open-label, Multicenter, Randomized Controlled Phase III Clinical Trial of PD-1 Monoclonal Antibody Plus Anlotinib Combined With Induction and Concurrent Chemoradiotherapy for High-risk Locoregionally Advanced Nasopharyngeal Carcinoma.

The investigators have designed a multicenter, open-label, randomized controlled phase III clinical study of GAPP induction therapy followed by concurrent chemoradiotherapy and toripalimab maintenance therapy for high-risk locoregionally advanced nasopharyngeal carcinoma (stage III, AJCC 9th edition). The aim is to obtain high-level, high-quality evidence-based data to clarify the efficacy and safety of combining chemoradiotherapy with PD-1 antibody and anlotinib, thereby providing a new treatment strategy to improve the prognosis of patients with high-risk locoregionally advanced nasopharyngeal carcinoma. In this study, GPP induction chemotherapy followed by concurrent chemoradiotherapy and toripalimab maintenance therapy is selected as the control group. This regimen is currently the standard treatment recommended by guidelines for high-risk locoregionally advanced nasopharyngeal carcinoma, with well-established efficacy and broad clinical application. It provides a reliable benchmark for comparing the efficacy and safety of the experimental group, meets ethical requirements, and has mature clinical operational procedures.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

The investigators have designed a multicenter, open-label, randomized controlled phase III clinical study of GAPP (gemcitabine + anlotinib + cisplatin + toripalimab) induction therapy followed by concurrent chemoradiotherapy (cisplatin) and toripalimab maintenance therapy for high-risk locoregionally advanced nasopharyngeal carcinoma (stage III, AJCC 9th edition). The aim is to obtain high-level, high-quality evidence-based data to clarify the efficacy and safety of combining chemoradiotherapy with PD-1 antibody and anlotinib, thereby providing a new treatment strategy to improve the prognosis of patients with high-risk locoregionally advanced nasopharyngeal carcinoma. In this study, GPP (gemcitabine + cisplatin + toripalimab) induction chemotherapy followed by concurrent chemoradiotherapy (cisplatin) and toripalimab maintenance therapy is selected as the control group. This regimen is currently the standard treatment recommended by guidelines for high-risk locoregionally advanced nasopharyngeal carcinoma, with well-established efficacy and broad clinical application. It provides a reliable benchmark for comparing the efficacy and safety of the experimental group, meets ethical requirements, and has mature clinical operational procedures.

Study Type

Interventional

Enrollment (Estimated)

442

Phase

  • Phase 3

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • China
    • Guangdong
      • Guangzhou, Guangdong, China, 510060
        • Sun yat-sen University Cancer Center
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Voluntary participation and signed informed consent.
  • Age 18-65 years, male or non-pregnant female.
  • Pathologically confirmed non-keratinizing nasopharyngeal carcinoma (differentiated or undifferentiated type, i.e., WHO type II or III).
  • Previously untreated patients with no history of other malignancies; initial treatment for nasopharyngeal carcinoma.
  • Stage III: TanyN3M0 / T4N0-2M0 (9th AJCC/UICC staging system).
  • ECOG performance status 0-1, with no severe dysfunction of vital organs (heart, lung, liver, kidney, etc.).
  • Hemoglobin (HGB) ≥90 g/L, white blood cell count (WBC) ≥4.0×10^9 /L, platelet count (PLT) ≥100×10^9/L.
  • Liver function: ALT and AST <2.5× upper limit of normal (ULN); total bilirubin <2.0×ULN.
  • Renal function: serum creatinine <1.5×ULN.

Exclusion Criteria:

  • Patients with recurrent or distant metastatic nasopharyngeal carcinoma.
  • Pathologically confirmed keratinizing squamous cell carcinoma (WHO type I).
  • Receipt of systemic or topical glucocorticoid therapy within 4 weeks prior to enrollment.
  • Participation in another clinical trial of an investigational drug within 3 months prior to treatment.
  • Known history of allogeneic organ transplantation or allogeneic hematopoietic stem cell transplantation.
  • Patients with idiopathic pulmonary fibrosis, drug-induced pneumonitis, organizing pneumonia (i.e., bronchiolitis obliterans), radiation pneumonitis that is clinically symptomatic or requires steroid therapy, active pneumonitis, or other moderate-to-severe pulmonary diseases that significantly affect lung function.
  • Comorbidities requiring long-term immunosuppressive medication or systemic/topical corticosteroids at immunosuppressive doses.
  • Prior use of anti-PD-1, anti-PD-L1, anti-PD-L2, or anti-CTLA-4 antibodies (or any other antibodies targeting T-cell co-stimulatory or checkpoint pathways) with documented disease progression at the time of study entry.
  • Presence of any active autoimmune disease or history of autoimmune disease (including but not limited to: interstitial pneumonia, uveitis, enteritis, hepatitis, hypophysitis, nephritis). Patients with vitiligo or childhood asthma that has completely resolved and requires no intervention in adulthood may be included; patients requiring bronchodilators for medical management of asthma are excluded.
  • HIV-positive; HBsAg-positive with detectable HBV DNA copy number (quantitative detection ≥1000 cps/mL); positive hepatitis C antibody (HCV Ab) with detectable HCV RNA.
  • Receipt of any anti-infective vaccine (e.g., influenza vaccine, varicella vaccine) within 4 weeks prior to enrollment.
  • Positive pregnancy test in women of childbearing potential, or lactating women.
  • Inability to comply with scheduled follow-up due to psychological, social, family, or geographical reasons.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: GAPP group
GAPP (gemcitabine + anlotinib + cisplatin + toripalimab) induction therapy followed by concurrent chemoradiotherapy (cisplatin) and toripalimab maintenance therapy for high-risk locoregionally advanced nasopharyngeal carcinoma (stage III, AJCC 9th edition)
Drug: Toripalimab
Toripalimab, 240 mg per administration, on Day 1, diluted in 100 mL of normal saline, administered as an intravenous infusion over 30 minutes (no less than 20 minutes and no more than 60 minutes). After the toripalimab infusion, there should be an interval of 30-60 minutes before administering gemcitabine and cisplatin. Each treatment cycle is 21 days. If the subject's toxicity recovery does not meet the criteria for the next cycle of chemotherapy, the start of the next cycle may be appropriately delayed, but the delay should not exceed 21 days. A total of 9 cycles will be administered.
Drug: Anlotinib
Anlotinib, 8 mg per dose per day, once daily on Days 1-14, taken orally before breakfast. Each treatment cycle is 21 days. If the subject's toxicity recovery does not meet the criteria for the next cycle of chemotherapy, the start of the next cycle may be appropriately delayed, but the delay should not exceed 21 days. A total of 3 cycles will be administered.
Drug: Cisplatin
Cisplatin, with a treatment cycle of 21 days. If the subject's toxicity recovery does not meet the criteria for the next cycle of chemotherapy, the start of the next cycle may be appropriately delayed, but the delay should not exceed 21 days. A total of 5 cycles will be administered.
Drug: Gemcitabine
Gemcitabine, 1000 mg/m², on Days 1 and 8, diluted in 500 mL of 0.9% normal saline, administered as an intravenous infusion. Each treatment cycle is 21 days. If the subject's toxicity recovery does not meet the criteria for the next cycle of chemotherapy, the start of the next cycle may be appropriately delayed, but the delay should not exceed 21 days. A total of 3 cycles will be administered.
Radiation: radiation
IMRT
Active Comparator: GPP group
GPP (gemcitabine + cisplatin + toripalimab) induction therapy followed by concurrent chemoradiotherapy (cisplatin) and toripalimab maintenance therapy for high-risk locoregionally advanced nasopharyngeal carcinoma (stage III, AJCC 9th edition)
Drug: Toripalimab
Toripalimab, 240 mg per administration, on Day 1, diluted in 100 mL of normal saline, administered as an intravenous infusion over 30 minutes (no less than 20 minutes and no more than 60 minutes). After the toripalimab infusion, there should be an interval of 30-60 minutes before administering gemcitabine and cisplatin. Each treatment cycle is 21 days. If the subject's toxicity recovery does not meet the criteria for the next cycle of chemotherapy, the start of the next cycle may be appropriately delayed, but the delay should not exceed 21 days. A total of 9 cycles will be administered.
Drug: Cisplatin
Cisplatin, with a treatment cycle of 21 days. If the subject's toxicity recovery does not meet the criteria for the next cycle of chemotherapy, the start of the next cycle may be appropriately delayed, but the delay should not exceed 21 days. A total of 5 cycles will be administered.
Drug: Gemcitabine
Gemcitabine, 1000 mg/m², on Days 1 and 8, diluted in 500 mL of 0.9% normal saline, administered as an intravenous infusion. Each treatment cycle is 21 days. If the subject's toxicity recovery does not meet the criteria for the next cycle of chemotherapy, the start of the next cycle may be appropriately delayed, but the delay should not exceed 21 days. A total of 3 cycles will be administered.
Radiation: radiation
IMRT

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
3-year progression-free survival
Time Frame: From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 3 years.
3-year progression-free survival
From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 3 years.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sun Yat-sen University

Collaborators

Union Hospital, Tongji Medical College, Huazhong University of Science and Technology

Investigators

  • Principal Investigator: Yi-Jun Hua, Phd., Sun yat-sen University Cancer Center

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

May 8, 2026

Primary Completion (Estimated)

December 31, 2032

Study Completion (Estimated)

December 31, 2032

Study Registration Dates

First Submitted

April 13, 2026

First Submitted That Met QC Criteria

April 13, 2026

First Posted (Actual)

April 20, 2026

Study Record Updates

Last Update Posted (Actual)

April 22, 2026

Last Update Submitted That Met QC Criteria

April 18, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2025-FXY-482-NPC

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Researchers who have been approved can share.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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.

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