このページは自動翻訳されたものであり、翻訳の正確性は保証されていません。を参照してください。 英語版 ソーステキスト用。

ctDNA-Guided Immunotherapy for dMMR/MSI-H Colon Cancer

2026年9月24日 更新者:Junjie Peng、Fudan University

A Single-Arm Phase II Study of Circulating Tumor DNA-Guided Neoadjuvant Immunotherapy for dMMR/MSI-H Colon Cancer

This prospective, multicenter, single-arm phase II interventional study evaluates whether longitudinal circulating tumor DNA (ctDNA) monitoring can guide neoadjuvant immunotherapy and surgical decision-making in dMMR/MSI-H colon cancer. Participants with ctDNA clearance proceed to curative surgery, whereas those with persistent ctDNA positivity escalate to combined PD-1 and CTLA-4 inhibitor therapy.

調査の概要

詳細な説明

This prospective, multicenter, single-arm phase II study evaluates the clinical utility of longitudinal circulating tumor DNA (ctDNA) monitoring to guide neoadjuvant immunotherapy and surgical decision-making in patients with dMMR/MSI-H colon cancer.

Eligible participants will initially receive neoadjuvant PD-1 inhibitor monotherapy. Peripheral-blood ctDNA will be assessed at baseline and after 3 to 4 treatment cycles. Participants with ctDNA clearance will proceed to curative surgery. Participants with persistent ctDNA positivity will be considered to have potential resistance to PD-1 inhibitor monotherapy and will escalate to combined PD-1 and CTLA-4 inhibitor therapy. ctDNA will be reassessed every 2 cycles during combination therapy. Participants will undergo curative surgery after ctDNA clearance or after no more than 4 cycles of combination treatment, regardless of final ctDNA status.

All participants will undergo postoperative ctDNA/minimal residual disease (MRD) testing 1 month after surgery. The study will evaluate pathological response, survival outcomes, the concordance of ctDNA with pathological and imaging assessments, and treatment- and surgery-related safety.

研究の種類

介入

入学 (推定)

23

段階

  • フェーズ2

連絡先と場所

このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。

研究連絡先

  • 名前:Junjie Peng, MD, PhD
  • 電話番号:86-18017317122
  • メール:pengjj@shca.org.cn

研究連絡先のバックアップ

研究場所

      • Shanghai、中国、200000
        • 募集
        • Fudan University Shanghai Cancer Center
        • コンタクト:

参加基準

研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。

適格基準

就学可能な年齢

18年~75年 (大人、高齢者)

健康ボランティアの受け入れ

いいえ

受講資格のある性別

全て

説明

Inclusion Criteria:

  • Written informed consent obtained before any study-related procedures.
  • Age 18 to 75 years, inclusive.
  • Histologically confirmed colon adenocarcinoma, mucinous adenocarcinoma, or signet-ring cell carcinoma, with the tumor located at least 15 cm from the anal verge.
  • dMMR/MSI-H status confirmed by immunohistochemistry, polymerase chain reaction, or next-generation sequencing.
  • Eastern Cooperative Oncology Group performance status of 0 or 1 and an expected survival of at least 3 months.
  • Adequate hematologic, hepatic, renal, coagulation, thyroid, and cardiac function, as defined in the protocol.
  • Negative pregnancy test for women of childbearing potential; agreement to use highly effective contraception, when applicable.

Exclusion Criteria:

  • Prior treatment with a PD-1 inhibitor, CTLA-4 inhibitor, or other immunotherapy.
  • Symptomatic or high-risk bowel obstruction, bleeding, perforation, pneumonitis, or other conditions that may compromise safe study participation.
  • Another malignancy diagnosed within 5 years before the first study treatment, except for specified definitively treated low-risk malignancies.
  • Current participation in another interventional clinical study, or receipt of another investigational drug or investigational device within 4 weeks before the first study treatment.
  • Active autoimmune disease requiring systemic treatment within 2 years before the first study treatment, or recent systemic corticosteroid or other immunosuppressive therapy.
  • Uncontrolled pleural effusion or ascites, prior allogeneic organ transplantation (except corneal transplantation), or allogeneic hematopoietic stem cell transplantation.
  • Known hypersensitivity to any study drug component.
  • Toxicities or complications from prior treatment not recovered to Grade 1 or baseline, except for specified conditions.
  • HIV infection, untreated active hepatitis B infection, or active hepatitis C infection.
  • Receipt of a live vaccine within 30 days before the first study treatment.
  • Pregnancy or breastfeeding.
  • Any serious or uncontrolled systemic disease, active infection, clinically significant laboratory abnormality, or other condition that may interfere with study participation or place the participant at unacceptable risk, as judged by the investigator.

研究計画

このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。

研究はどのように設計されていますか?

デザインの詳細

  • 主な目的:処理
  • 割り当て:なし
  • 介入モデル:単一グループの割り当て
  • マスキング:なし(オープンラベル)

武器と介入

参加者グループ / アーム
介入・治療
実験的:ctDNA-Guided Neoadjuvant Immunotherapy |

Participants receive PD-1 inhibitor monotherapy. ctDNA testing after 3-4 cycles determines whether they proceed to curative surgery or escalate to PD-1 plus CTLA-4 inhibitor therapy; all participants subsequently undergo curative surgery.

200 mg intravenously on Day 1 of each 3-week cycle. All participants receive initial monotherapy.

1 mg/kg intravenously on Day 1 of each 3-week cycle. Administered with the PD-1 inhibitor only to participants with persistent ctDNA positivity after 3-4 cycles of monotherapy.

Peripheral-blood ctDNA testing at baseline and after 3-4 cycles of monotherapy; every 2 cycles during combination therapy, when applicable; and 1 month after surgery.

Curative surgery after ctDNA clearance or after no more than 4 cycles of combination treatment.

この研究は何を測定していますか?

主要な結果の測定

結果測定
メジャーの説明
時間枠
Pathological Complete Response Rate
時間枠:At curative surgery, following completion of neoadjuvant therapy

Pathological assessment of the surgical resection specimen; pCR is defined as no residual viable cancer cells after treatment (ypT0N0M0).

At curative surgery, following completion of neoadjuvant therapy

二次結果の測定

結果測定
メジャーの説明
時間枠
Major Pathological Response Rate
時間枠:At curative surgery, following completion of neoadjuvant therapy

Pathological assessment of the surgical resection specimen; MPR is defined as residual viable tumor cells ≤10%.

At curative surgery, following completion of neoadjuvant therapy
3-Year Event-Free Survival
時間枠:From enrollment up to 3 years

Time from enrollment to first radiographic disease progression or death, whichever occurs first.

From enrollment up to 3 years
3-Year Overall Survival
時間枠:From enrollment up to 3 years

Time from enrollment to death from any cause.

From enrollment up to 3 years
Concordance of ctDNA Status With Pathological Complete Response
時間枠:After 3-4 cycles of PD-1 inhibitor monotherapy (21-day cycles) and at curative surgery; for persistent ctDNA positivity, every 2 cycles of PD-1 plus CTLA-4 inhibitor therapy (21-day cycles; up to 4 cycles).

Preoperative ctDNA status will be compared with postoperative pathological complete response results.

After 3-4 cycles of PD-1 inhibitor monotherapy (21-day cycles) and at curative surgery; for persistent ctDNA positivity, every 2 cycles of PD-1 plus CTLA-4 inhibitor therapy (21-day cycles; up to 4 cycles).
Concordance Between ctDNA Dynamics and Imaging Assessment
時間枠:Baseline through curative surgery, up to 24 weeks (each cycle is 21 days).

ctDNA positivity, clearance, and dynamic changes will be compared with RECIST version 1.1 imaging response assessments.

Baseline through curative surgery, up to 24 weeks (each cycle is 21 days).
Number of Participants With Treatment-Emergent Adverse Events, as Assessed by CTCAE v5.0
時間枠:From first dose through 30 days after the last dose.

Number and proportion of participants with at least one treatment-emergent adverse event, including treatment-related and immune-related adverse events.

From first dose through 30 days after the last dose.
Number of Participants With Grade 3 or Higher Treatment-Related Adverse Events, as Assessed by CTCAE v5.0
時間枠:From first dose through 30 days after the last dose.

Number and proportion of participants with at least one Grade 3 or higher treatment-related adverse event.

From first dose through 30 days after the last dose.
Number of Participants With Serious Adverse Events
時間枠:From first dose through 90 days after the last dose.

Number and proportion of participants with at least one serious adverse event.

From first dose through 90 days after the last dose.
Number of Participants With Treatment-Related Delay of Curative Surgery
時間枠:From first dose through curative surgery up to 24 weeks

Number and proportion of participants whose curative surgery is delayed because of treatment-related toxicity, as determined by the investigator.

From first dose through curative surgery up to 24 weeks

協力者と研究者

ここでは、この調査に関係する人々や組織を見つけることができます。

スポンサー

出版物と役立つリンク

研究に関する情報を入力する責任者は、自発的にこれらの出版物を提供します。これらは、研究に関連するあらゆるものに関するものである可能性があります。

一般刊行物

研究記録日

これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。

主要日程の研究

研究開始 (推定)

2026年9月14日

一次修了 (推定)

2027年12月31日

研究の完了 (推定)

2030年12月31日

試験登録日

最初に提出

2026年9月12日

QC基準を満たした最初の提出物

2026年9月24日

最初の投稿 (実際)

2026年9月25日

学習記録の更新

投稿された最後の更新 (実際)

2026年9月25日

QC基準を満たした最後の更新が送信されました

2026年9月24日

最終確認日

2026年9月1日

詳しくは

本研究に関する用語

個々の参加者データ (IPD) の計画

個々の参加者データ (IPD) を共有する予定はありますか?

いいえ

IPD プランの説明

Individual participant data, including de-identified data, will not be made available to external researchers. Study data will be processed and stored within China. Aggregate results may be published without identifiable participant information.

医薬品およびデバイス情報、研究文書

米国FDA規制医薬品の研究

いいえ

米国FDA規制機器製品の研究

いいえ

この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。

購読する