- ICH GCP
- Registr klinických studií v USA
- Klinická studie NCT07616141
Neoadjuvant Anlotinib and Epirubicin for T4 Sinonasal Adenoid Cystic Carcinoma (NAET4-SNACC)
Neoadjuvant Anlotinib Combined With Epirubicin for T4 Stage Sinonasal Adenoid Cystic Carcinoma: A Prospective, Multicenter, Single-Arm, Phase II Clinical Trial
T4 stage sinonasal adenoid cystic carcinoma (SNACC) is a rare but aggressive cancer in the nasal cavity and sinuses. These tumors often invade the skull base, eye socket, or brain covering (dura), making complete surgical removal difficult and carrying a high risk of recurrence even after surgery and radiation. The goal of this study is to test whether a new combination of drugs given before surgery - anlotinib (a targeted therapy) plus epirubicin (a chemotherapy drug) - can improve outcomes for patients with T4 SNACC.
This is a prospective, multicenter, single-arm, phase II clinical trial. Eligible participants will receive 2 cycles of neoadjuvant treatment (anlotinib orally for 2 weeks on/1 week off, plus epirubicin intravenously on day 1 of each 3-week cycle). After completing neoadjuvant therapy, participants will undergo surgery to remove the tumor, followed by postoperative radiotherapy. The main question the study tries to answer is whether this approach increases the 3-year progression-free survival (PFS) rate compared to the historical rate of about 70% with standard treatment (surgery plus radiotherapy alone). Secondary questions include how many tumors shrink after neoadjuvant treatment, how many operations achieve complete removal with negative margins, major pathological response rates, overall survival, safety, quality of life, and the chance of avoiding disfiguring surgeries (such as removal of the eye or part of the skull). The study will enroll about 76 participants from 5 top medical centers in China. If positive, this study may establish a new standard of care for T4 SNACC.
Přehled studie
Postavení
Podmínky
Intervence / Léčba
Detailní popis
Sinonasal adenoid cystic carcinoma (SNACC) is a rare cancer. T4 stage tumors often invade the skull base, orbit, or dura, making complete surgical removal difficult. Even with surgery and radiotherapy, the 3-year progression-free survival (PFS) is only about 70%, and extensive resection may cause disfigurement or loss of function.
This is a prospective, multicenter, single-arm, phase II trial. Eligible patients will receive 2 cycles of neoadjuvant therapy (anlotinib 10 mg orally on days 1-14 plus epirubicin 70 mg/m² IV on day 1, 21-day cycle). After neoadjuvant treatment, patients undergo surgery followed by postoperative radiotherapy.
The primary endpoint is 3-year PFS rate, compared with the historical rate of 70%. Secondary endpoints include objective response rate, R0 resection rate, major pathological response, overall survival, safety, quality of life, and organ preservation rate. Exploratory endpoints include biomarkers, ctDNA dynamics, and organoid drug sensitivity.
Target sample size is 76 patients from 5 Chinese centers. The study has been approved by the Institutional Review Board of Eye & ENT Hospital of Fudan University (approval number 2026069-1). Written informed consent will be obtained from all participants.
Typ studie
Zápis (Odhadovaný)
Fáze
- Fáze 2
Kontakty a umístění
Studijní kontakt
- Jméno: Quan Liu, MD
- Telefonní číslo: +86 15001959681
- E-mail: liuqent@163.com
Studijní záloha kontaktů
- Jméno: Wanpeng Li, MD
- Telefonní číslo: +86 13262856870
- E-mail: 18879117831@163.com
Studijní místa
-
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Beijing Municipality
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Beijing, Beijing Municipality, Čína, 100053
- Xuanwu Hospital, Capital Medical University
-
Kontakt:
- Zhenlin Wang, MD
- Telefonní číslo: 010-83198899 wzl1812@163.com
- E-mail: wzl1812@163.com
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Guangdong
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Guangzhou, Guangdong, Čína, 510630
- The third affiliated hospital of Sun Yat-Sen University
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Kontakt:
- Zhaohui Shi, MD
- Telefonní číslo: 020-85253333
- E-mail: zhaohuishi@139.com
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Shandong
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Qingdao, Shandong, Čína, 266000
- The Affiliated Hospital of Qingdao University
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Kontakt:
- Yan Jiang, MD
- Telefonní číslo: 0532-82911847
- E-mail: jiangyanoto@163.com
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Shanghai Municipality
-
Shanghai, Shanghai Municipality, Čína, 200031
- Eye & ENT Hospital of Fudan University
-
Kontakt:
- Quan Liu, MD
- Telefonní číslo: +86 15001959681
- E-mail: liuqent@163.com
-
Shanghai, Shanghai Municipality, Čína, 200030
- Zhongshan Hospital, Fudan University
-
Kontakt:
- Xinsheng Huang, MD
- Telefonní číslo: 021-64041990
- E-mail: huang.xinsheng@zs-hospital.sh.cn
-
-
Kritéria účasti
Kritéria způsobilosti
Věk způsobilý ke studiu
- Dospělý
- Starší dospělý
Přijímá zdravé dobrovolníky
Popis
Inclusion Criteria:
- Age 18 to 75 years, any sex.
- Histopathologically confirmed sinonasal adenoid cystic carcinoma (any subtype).
- Stage T4a or T4b according to AJCC 8th edition. If lymph node metastasis is present, it must be surgically resectable. If distant metastasis is present, metastatic lesions must be stable.
- Multidisciplinary team (MDT) assessment confirms that the tumor is technically resectable but with high risk (invasion of skull base, orbit, dura, etc.).
- Eastern Cooperative Oncology Group (ECOG) performance status 0-1.
- Adequate bone marrow, liver, kidney, and cardiac function: absolute neutrophil count ≥1.5×10⁹/L, platelet count ≥100×10⁹/L, hemoglobin ≥90 g/L; ALT/AST ≤2.5×upper limit of normal (ULN), total bilirubin ≤1.5×ULN; creatinine ≤1.5×ULN or creatinine clearance ≥60 mL/min; left ventricular ejection fraction (LVEF) ≥50%.
- Willing to participate and able to provide written informed consent (including for clinical treatment and translational research).
Exclusion Criteria:
- Prior radiotherapy to the head and neck region.
- Prior anthracycline therapy with cumulative dose ≥300 mg/m².
- Known hypersensitivity to any component of anlotinib or epirubicin.
- Uncontrolled hypertension, severe cardiovascular disease, or active infection.
- Pregnant or breastfeeding women.
- Any medical or psychosocial condition that, in the investigator's judgment, may interfere with study compliance or conduct.
Studijní plán
Jak je studie koncipována?
Detaily designu
- Primární účel: Léčba
- Přidělení: N/A
- Intervenční model: Přiřazení jedné skupiny
- Maskování: Žádné (otevřený štítek)
Zbraně a zásahy
Skupina účastníků / Arm |
Intervence / Léčba |
|---|---|
|
Experimentální: Neoadjuvant Anlotinib + Epirubicin
Participants receive neoadjuvant therapy for 2 cycles (each cycle is 21 days).
Anlotinib 10 mg orally once daily on days 1-14 (2 weeks on, 1 week off).
Epirubicin 70 mg/m² intravenous infusion on day 1 of each cycle.
After completion of neoadjuvant therapy, participants undergo radical surgery followed by postoperative radiotherapy as per protocol.
|
Anlotinib 10 mg orally once daily on days 1-14 of each 21-day cycle (2 weeks on, 1 week off) for 2 cycles.
|
Co je měření studie?
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
3-Year Progression-Free Survival
Časové okno: From enrollment to 3 years post-enrollment (assessed every 3 months for the first 2 years, then every 6 months) or until progression or death
|
Progression-free survival (PFS) is defined as the time from enrollment to the first documentation of disease progression (local recurrence, regional recurrence, or distant metastasis) or death from any cause, whichever occurs first.
The 3-year PFS rate is the proportion of participants who remain alive and free from disease progression at 3 years after enrollment.
|
From enrollment to 3 years post-enrollment (assessed every 3 months for the first 2 years, then every 6 months) or until progression or death
|
Sekundární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Objective Response Rate (ORR)
Časové okno: At week 6 (after completion of 2 cycles of neoadjuvant therapy, before surgery)
|
Proportion of participants achieving complete response (CR) or partial response (PR) after neoadjuvant therapy, assessed by RECIST v1.1 (blinded independent central review).
|
At week 6 (after completion of 2 cycles of neoadjuvant therapy, before surgery)
|
|
R0 Resection Rate
Časové okno: At time of surgery (approximately week 10-12 after enrollment)
|
Proportion of participants undergoing surgery who achieve microscopically negative margins (no tumor cells at the resection margin on final pathology).
|
At time of surgery (approximately week 10-12 after enrollment)
|
|
Overall Survival
Časové okno: From enrollment up to 5 years (assessed every 3 months for first 2 years, then every 6 months)
|
Time from enrollment to death from any cause.
Participants who are alive at last follow-up will be censored.
|
From enrollment up to 5 years (assessed every 3 months for first 2 years, then every 6 months)
|
|
Local Control Rate
Časové okno: At 1 year, 2 years, and 3 years post-enrollment
|
Proportion of participants without local recurrence (at primary tumor site) at specified time points.
|
At 1 year, 2 years, and 3 years post-enrollment
|
|
Adverse events
Časové okno: From first dose of study drug until 30 days after last dose or surgery, whichever is later
|
Incidence, type, frequency, and severity of adverse events (AEs) and serious adverse events (SAEs) assessed by CTCAE version 5.0.
|
From first dose of study drug until 30 days after last dose or surgery, whichever is later
|
|
EORTC QLQ-C30
Časové okno: Baseline, at week 6 (after neoadjuvant therapy), at 6 months, 12 months, 24 months, and 36 months post-enrollment
|
Change from baseline in EORTC QLQ-C30.
|
Baseline, at week 6 (after neoadjuvant therapy), at 6 months, 12 months, 24 months, and 36 months post-enrollment
|
|
Organ Preservation Rate
Časové okno: At time of surgery (approximately week 10-12 after enrollment)
|
Proportion of participants who avoid disfiguring surgeries including orbital exenteration, maxillectomy, craniotomy, or skull base resection compared to hypothetical initial surgery without neoadjuvant therapy.
|
At time of surgery (approximately week 10-12 after enrollment)
|
Spolupracovníci a vyšetřovatelé
Publikace a užitečné odkazy
Obecné publikace
- Lupinetti AD, Roberts DB, Williams MD, Kupferman ME, Rosenthal DI, Demonte F, El-Naggar A, Weber RS, Hanna EY. Sinonasal adenoid cystic carcinoma: the M. D. Anderson Cancer Center experience. Cancer. 2007 Dec 15;110(12):2726-31. doi: 10.1002/cncr.23096.
- Mavrikios A, Goudjil F, Beddok A, Zefkili S, Bolle S, Feuvret L, Le Tourneau C, Choussy O, Sauvaget E, Herman P, Dendale R, Calugaru V. Proton therapy and/or helical tomotherapy for locally advanced sinonasal skull base adenoid cystic carcinoma: Focus on experience of the Institut Curie and review of literature. Head Neck. 2023 Jul;45(7):1619-1631. doi: 10.1002/hed.27371. Epub 2023 Apr 25.
- Bjorndal K, Krogdahl A, Therkildsen MH, Overgaard J, Johansen J, Kristensen CA, Homoe P, Sorensen CH, Andersen E, Bundgaard T, Primdahl H, Lambertsen K, Andersen LJ, Godballe C. Salivary gland carcinoma in Denmark 1990-2005: a national study of incidence, site and histology. Results of the Danish Head and Neck Cancer Group (DAHANCA). Oral Oncol. 2011 Jul;47(7):677-82. doi: 10.1016/j.oraloncology.2011.04.020. Epub 2011 May 25.
- Dodd RL, Slevin NJ. Salivary gland adenoid cystic carcinoma: a review of chemotherapy and molecular therapies. Oral Oncol. 2006 Sep;42(8):759-69. doi: 10.1016/j.oraloncology.2006.01.001. Epub 2006 Jun 6.
- Hanna GJ, Ahn MJ, Muzaffar J, Keam B, Bowles DW, Wong DJ, Ho AL, Kim SB, Worden F, Yun T, Meng X, Van Tornout JM, Conlan MG, Kang H. A Phase II Trial of Rivoceranib, an Oral Vascular Endothelial Growth Factor Receptor 2 Inhibitor, for Recurrent or Metastatic Adenoid Cystic Carcinoma. Clin Cancer Res. 2023 Nov 14;29(22):4555-4563. doi: 10.1158/1078-0432.CCR-23-1030.
- Michel G, Joubert M, Delemazure AS, Espitalier F, Durand N, Malard O. Adenoid cystic carcinoma of the paranasal sinuses: retrospective series and review of the literature. Eur Ann Otorhinolaryngol Head Neck Dis. 2013 Nov;130(5):257-62. doi: 10.1016/j.anorl.2012.09.010. Epub 2013 Jun 6.
- Song X, Sun J, Yang G, Wang X, Wang L. Long-term outcomes of platinum-based chemotherapy for T4 stage sinonasal adenoid cystic carcinoma. Front Pharmacol. 2025 Sep 29;16:1623242. doi: 10.3389/fphar.2025.1623242. eCollection 2025.
- Mauthe T, Holzmann D, Soyka MB, Mueller SA, Balermpas P, Held U, Freiberger SN, Rupp NJ, Meerwein CM. Overall and disease-specific survival of sinonasal adenoid cystic carcinoma: a systematic review and meta-analysis. Rhinology. 2023 Dec 1;61(6):508-518. doi: 10.4193/Rhin23.204.
- Cavalieri S, Mariani L, Vander Poorten V, Van Breda L, Cau MC, Lo Vullo S, Alfieri S, Resteghini C, Bergamini C, Orlandi E, Calareso G, Clement P, Hauben E, Platini F, Bossi P, Licitra L, Locati LD. Prognostic nomogram in patients with metastatic adenoid cystic carcinoma of the salivary glands. Eur J Cancer. 2020 Sep;136:35-42. doi: 10.1016/j.ejca.2020.05.013. Epub 2020 Jul 3.
- Seok J, Lee DY, Kim WS, Jeong WJ, Chung EJ, Jung YH, Kwon SK, Kwon TK, Sung MW, Ahn SH. Lung metastasis in adenoid cystic carcinoma of the head and neck. Head Neck. 2019 Nov;41(11):3976-3983. doi: 10.1002/hed.25942. Epub 2019 Aug 29.
Termíny studijních záznamů
Hlavní termíny studia
Začátek studia (Odhadovaný)
Primární dokončení (Odhadovaný)
Dokončení studie (Odhadovaný)
Termíny zápisu do studia
První předloženo
První předloženo, které splnilo kritéria kontroly kvality
První zveřejněno (Aktuální)
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Aktuální)
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Naposledy ověřeno
Více informací
Termíny související s touto studií
Klíčová slova
Další relevantní podmínky MeSH
- Novotvary
- Novotvary podle histologického typu
- Novotvary, žlázové a epiteliální
- Adenokarcinom
- Karcinom
- Karcinom, Adenoidní Cystický
- Organické chemikálie
- Uhlovodíky
- Uhlovodíky, cyklické
- Uhlohydráty
- Polycyklické aromatické uhlovodíky
- Uhlovodíky, aromatické
- Polycyklické sloučeniny
- Glykosidy
- Antracykliny
- Nafthacenes
- Aminoglykosidy
- Daunorubicin
- Doxorubicin
- Epirubicin
- Anlotinib
Další identifikační čísla studie
- 2026069-1
Plán pro data jednotlivých účastníků (IPD)
Plánujete sdílet data jednotlivých účastníků (IPD)?
Popis plánu IPD
Informace o lécích a zařízeních, studijní dokumenty
Studuje lékový produkt regulovaný americkým FDA
Studuje produkt zařízení regulovaný americkým úřadem FDA
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