Pucotenlimab, Lenvatinib, and SBRT Before Surgery for Localized Clear Cell Renal Cell Carcinoma (PLS-NEO-RCC)
A Single-Arm Phase II Study of Neoadjuvant Pucotenlimab, Lenvatinib, and Stereotactic Body Radiotherapy in Patients With Localized Clear Cell Renal Cell Carcinoma and High-Risk Partial Nephrectomy
This single-arm Phase II study will evaluate the efficacy and safety of neoadjuvant pucotenlimab, lenvatinib, and stereotactic body radiotherapy (SBRT) in adults with localized clear cell renal cell carcinoma who are candidates for partial nephrectomy but have tumors that make the operation technically difficult. Approximately 24 participants will receive up to six cycles of pucotenlimab with daily lenvatinib. SBRT will be delivered to the primary renal tumor during neoadjuvant treatment. Surgery is planned after neoadjuvant treatment. The primary outcome is objective response rate.
Studieoversikt
Status
Status
Forhold
Forhold
Intervensjon / Behandling
Intervensjon / Behandling
Detaljert beskrivelse
This is a prospective, single-arm Phase II study using a Simon optimal two-stage design. The study plans to enroll 24 participants. In stage 1, eight participants will be enrolled; if no more than three have an objective response, the study will stop for futility. Otherwise, 16 additional participants will be enrolled.
Participants will receive pucotenlimab 200 mg by intravenous infusion every 3 weeks for up to six cycles and lenvatinib 12 mg orally once daily during neoadjuvant treatment. SBRT will be delivered to the primary renal tumor at a total dose of 40 Gy in five fractions after completion of the second pucotenlimab cycle and before the fourth cycle. Tumor imaging will be performed during neoadjuvant treatment. Surgery, preferably partial nephrectomy when feasible, is planned 2 to 4 weeks after the sixth pucotenlimab cycle. Efficacy, surgical outcomes, and adverse events will be evaluated.
Studietype
Studietype
Registrering (Antatt)
Registrering
Fase
Fase
- Fase 2
Kontakter og plasseringer
Studiekontakt
Studiekontakt
- Navn: Yulu Peng, Doc
- Telefonnummer: 02087342318
- E-post: pengyl1@sysucc.org.cn
Deltakelseskriterier
Kvalifikasjonskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
Tar imot friske frivillige
Kjønn som er kvalifisert for studier
Beskrivelse
Inclusion Criteria:
- Voluntary written informed consent.
- Age 18 years or older.
- ECOG performance status of 0 or 1.
- Life expectancy of at least 3 months.
- Preoperative biopsy confirming clear cell renal cell carcinoma or renal cell carcinoma with a predominant clear cell component.
- Willingness to undergo partial nephrectomy.
- A localized renal tumor for which partial nephrectomy is indicated but technically difficult: a 4-7 cm hilar tumor; a 4-7 cm tumor that is at least 75% endophytic; or a tumor larger than 7 cm.
- At least one measurable lesion suitable for repeated, accurate measurement.
- Adequate organ function: absolute neutrophil count ≥1.5 × 10^9/L; platelet count ≥100 × 10^9/L; hemoglobin ≥90 g/L; total bilirubin ≤1.5 × upper limit of normal (ULN); ALT and AST ≤2.5 × ULN, or ≤5 × ULN for participants with liver metastases; albumin ≥28 g/L; INR and APTT ≤1.5 × ULN. No blood component transfusion or hematopoietic growth-factor support is permitted within 2 weeks before treatment.
- Willingness and ability to comply with study visits, treatment, laboratory assessments, and other study requirements.
Exclusion Criteria:
- Lymph node metastasis or metastatic renal cell carcinoma.
- Tumor encasement of the renal artery, tumor thrombus in the renal vein, or diffuse tumor growth without a clear boundary from normal renal parenchyma.
- Inability to tolerate general anesthesia according to the preoperative assessment.
- Severe cardiovascular or cerebrovascular disease, or uncontrolled hypertension or diabetes.
- Long-term immunosuppressive therapy after organ transplantation, or current use of immunosuppressive medication.
- Active infection or fever.
- T-cell lymphoma or multiple myeloma.
- Concurrent malignancy, current treatment for another benign or malignant tumor, or a history of another malignancy within the previous 6 months.
- Use of herbal medicines with an anticancer indication or systemic immunomodulatory agents, including thymosin, interferon, or interleukin, within 14 days before the first study treatment; local use to control pleural effusion is permitted.
- Active or potentially recurrent autoimmune disease, except vitiligo, alopecia, psoriasis, or eczema not requiring systemic therapy; hypothyroidism due to autoimmune thyroiditis requiring only a stable dose of hormone replacement; or type 1 diabetes requiring only a stable dose of insulin.
- Concurrent enrollment in another interventional clinical study, except participation in its follow-up period; participation in a noninterventional observational study is permitted.
- Known psychiatric illness or a history of drug abuse, alcohol abuse, or illicit drug use.
- Pregnancy or breastfeeding.
- Any other disease, treatment, or laboratory abnormality that may confound the study results, prevent full participation, or make participation contrary to the participant's best interests.
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: N/A
- Intervensjonsmodell: Enkeltgruppeoppdrag
- Masking: Ingen (Open Label)
Antall våpen
Våpen og intervensjoner
Deltakergruppe / ArmDeltakergruppe / Arm |
Intervensjon / BehandlingIntervensjon / Behandling |
|---|---|
|
Eksperimentell: Pucotenlimab Plus Lenvatinib and SBRT
Participants will receive neoadjuvant pucotenlimab 200 mg intravenously every 3 weeks for up to six cycles and lenvatinib 12 mg orally once daily. SBRT at 40 Gy in five fractions will be delivered to the primary renal tumor after cycle 2 and before cycle 4. Surgery is planned after neoadjuvant treatment, with partial nephrectomy preferred when feasible. |
200 mg administered by intravenous infusion once every 3 weeks for up to six cycles. Lenvatinib 12 mg taken orally once daily during neoadjuvant treatment; treatment is stopped at least 3 days before surgery. SBRT to the primary renal tumor at a total dose of 40 Gy in five fractions, delivered after completion of pucotenlimab cycle 2 and before cycle 4. |
Hva måler studien?
Primære resultatmål
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
Objective Response Rate (ORR)
Tidsramme: From baseline through completion of neoadjuvant treatment, approximately 18 weeks.
|
Percentage of participants with a complete response or partial response of the primary renal tumor according to RECIST version 1.1 during neoadjuvant treatment. |
From baseline through completion of neoadjuvant treatment, approximately 18 weeks.
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
|
Major Pathological Response (MPR) Rate
Tidsramme: At surgery, approximately 20 to 22 weeks after treatment initiation.
|
Percentage of participants with major pathological response in the resected primary tumor. |
At surgery, approximately 20 to 22 weeks after treatment initiation.
|
|
Partial Nephrectomy Success Rate
Tidsramme: At surgery, approximately 20 to 22 weeks after treatment initiation.
|
Percentage of participants who undergo partial nephrectomy after neoadjuvant treatment. |
At surgery, approximately 20 to 22 weeks after treatment initiation.
|
|
R0 Resection Rate
Tidsramme: At surgery, approximately 20 to 22 weeks after treatment initiation.
|
Percentage of surgically treated participants with microscopically negative surgical margins. |
At surgery, approximately 20 to 22 weeks after treatment initiation.
|
|
Surgical Complications
Tidsramme: From surgery through the 3-month postoperative visit.
|
Number and percentage of participants with surgical complications, including bleeding and urinary leakage. |
From surgery through the 3-month postoperative visit.
|
|
Adverse Events
Tidsramme: From informed consent through 30 days after the last dose of study medication.
|
Number and percentage of participants with adverse events, graded according to NCI-CTCAE version 4.0. |
From informed consent through 30 days after the last dose of study medication.
|
Samarbeidspartnere og etterforskere
Sponsor
Sponsor
Studierekorddatoer
Studer hoveddatoer
Studiestart (Antatt)
Studiestart
Primær fullføring (Antatt)
Primær fullføring
Studiet fullført (Antatt)
Studiet fullført
Datoer for studieregistrering
Først innsendt
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Faktiske)
Først lagt ut
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Sist oppdatering lagt ut
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Ytterligere relevante MeSH-vilkår
- Urogenitale sykdommer
- Urogenitale neoplasmer
- Neoplasmer etter nettsted
- Neoplasmer
- Mannlige urogenitale sykdommer
- Nyresykdommer
- Urologiske sykdommer
- Kvinnelige urogenitale sykdommer
- Kvinnelige urogenitale sykdommer og graviditetskomplikasjoner
- Neoplasmer etter histologisk type
- Neoplasmer, kjertel og epitel
- Adenokarsinom
- Urologiske neoplasmer
- Karsinom
- Nyre-neoplasmer
- Karsinom, nyrecelle
- Undersøkelsesteknikker
- Terapeutikk
- Kirurgiske prosedyrer, operativ
- Strålebehandling
- Stereotaksiske teknikker
- Nevrokirurgiske prosedyrer
- Radiokirurgi
- Lenvatinib
Andre studie-ID-numre
Andre studie-ID-numre
- 2024-FXY-321-Urology
- 2024-FXY-321-Urology (Annen identifikator: Sun Yat-sen University cancer center)
Plan for individuelle deltakerdata (IPD)
Planlegger du å dele individuelle deltakerdata (IPD)?
IPD-planbeskrivelse
Individual participant data will not be shared because this small study collects sensitive clinical, imaging, and molecular data that could increase the risk of participant re-identification. Study results will be reported in aggregate form.
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