Biomarker-Enriched Kidney-Preserving Strategy With Disitamab Vedotin Plus Tislelizumab in HER2-Positive High-Risk Upper Tract Urothelial Carcinoma
A Prospective, Multicentre, Single-Arm Phase II Study Evaluating a Response-Adapted Kidney-Preserving Strategy Using Neoadjuvant Disitamab Vedotin Plus Tislelizumab in Patients With HER2-Positive High-Risk Upper Tract Urothelial Carcinoma (DISTINCT-II)
This is a prospective, multicentre, single-arm phase II study evaluating a response-adapted kidney-preserving strategy in patients with HER2-positive high-risk upper tract urothelial carcinoma (UTUC). Patients will receive neoadjuvant disitamab vedotin plus tislelizumab, followed by response-adapted local treatment, including kidney-sparing surgery or radical nephroureterectomy based on predefined criteria.
The primary objective is to assess whether this multimodal strategy can achieve clinically meaningful oncologic control while preserving renal function, as measured by 1-year kidney-intact event-free survival (KI-EFS). Secondary and exploratory objectives include evaluation of clinical response, survival outcomes, safety, renal function preservation, and longitudinal dynamics of circulating and urinary tumor DNA.
研究概览
详细说明
This is a prospective, multicentre, single-arm, phase II clinical trial designed to evaluate the efficacy and safety of a response-adapted kidney-preserving treatment strategy in patients with HER2-positive high-risk upper tract urothelial carcinoma (UTUC).
Eligible patients will receive neoadjuvant systemic therapy consisting of disitamab vedotin in combination with tislelizumab administered every 3 weeks for 2-4 cycles. Tumour response will be assessed after two cycles using radiographic evaluation and clinical assessment. Patients demonstrating clinical benefit will proceed to complete induction therapy, followed by comprehensive restaging including imaging, ureteroscopy with biopsy, and urine cytology.
Subsequent local treatment will be determined according to a predefined response-adapted algorithm. Patients meeting protocol-specified criteria will undergo kidney-sparing surgery (KSS), including segmental ureterectomy or endoscopic ablation depending on tumour location and anatomical feasibility. Patients not meeting criteria for KSS will undergo radical nephroureterectomy (RNU).
The primary objective of the study is to determine whether this multimodal strategy can achieve clinically meaningful oncologic control while preserving renal function in a biomarker-selected population.
In addition, longitudinal biospecimen collection will be conducted to evaluate the dynamics of urinary tumor DNA (utDNA) and circulating tumor DNA (ctDNA) as exploratory biomarkers of treatment response and minimal residual disease.
研究类型
注册 (估计的)
阶段
- 阶段2
联系人和位置
学习联系方式
- 姓名：jiwei huang
- 电话号码：8613651682825
- 邮箱：huangjiwei@renji.com
学习地点
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Shanghai Municipality
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Shanghai、Shanghai Municipality、中国
- Ethics Committee of Shanghai Renji Hospital
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接触：
- Qi Lu
- 电话号码：+86021-68383364
- 邮箱：rjllb3364@163.com
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参与标准
资格标准
适合学习的年龄
- 成人
- 年长者
接受健康志愿者
描述
Inclusion Criteria:
- Age ≥18 years at the time of informed consent.
- Histologically confirmed upper tract urothelial carcinoma (UTUC) arising from the renal pelvis or ureter, based on ureteroscopic biopsy.
- High-risk UTUC, defined by at least one of the following features: Tumour size ≥2 cm; High-grade cytology or biopsy; Radiographic evidence of local invasion (≥cT2); Hydronephrosis; Multifocal disease
- Clinical stage cT1-T3, N0-N1, M0, based on radiographic assessment.
- N1 disease is permitted only if lymph nodes are considered resectable.
- HER2-positive disease, defined as immunohistochemistry (IHC) score of 1+，2+ or 3+ on tumour tissue, assessed according to predefined criteria.
- At least one measurable lesion according to RECIST version 1.1.
- ECOG performance status of 0-1
- Adequate organ function, including: Hematologic function; Hepatic function; Renal function (no strict upper/lower limit required);
- Patients must be considered potential candidates for a kidney-preserving treatment strategy, including: Absolute or relative indication for renal preservation (e.g., solitary kidney, baseline renal insufficiency), or Strong preference for kidney preservation after multidisciplinary discussion
- Ability to understand and willingness to sign written informed consent.
Exclusion Criteria:
- Evidence of distant metastatic disease (M1).
- Unresectable or bulky nodal disease (≥N2) not amenable to curative-intent surgery.
- Prior systemic therapy for urothelial carcinoma, including:Chemotherapy; Immunotherapy; HER2-targeted therapy.
- Prior radical nephroureterectomy for current disease.
- Active autoimmune disease requiring systemic treatment within the past 2 years.
- Current use of immunosuppressive medication, excluding physiologic doses of corticosteroids.
- Uncontrolled intercurrent illness, including but not limited to: Active infection requiring systemic therapy; Uncontrolled cardiovascular disease; Significant pulmonary disease
- Known active hepatitis B, hepatitis C, or HIV infection with uncontrolled viral replication.
- History of another malignancy within the past 5 years, except: Adequately treated basal cell carcinoma; Squamous cell skin cancer; In situ carcinoma.
- Pregnant or breastfeeding women.
- Any condition that, in the opinion of the investigator, would interfere with study participation or interpretation of results.
学习计划
研究是如何设计的？
设计细节
- 主要用途：治疗
- 分配：不适用
- 介入模型：单组作业
- 屏蔽：无（打开标签）
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
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实验性的：Neoadjuvant disitamab vedotin + tislelizumab followed by response-adapted surgery
Drug: Disitamab Vedotin Administered intravenously at 2.0 mg/kg every 3 weeks Drug: Tislelizumab Administered intravenously at 200 mg every 3 weeks Procedure: Surgery Kidney-sparing surgery (segmental ureterectomy or endoscopic ablation) or radical nephroureterectomy based on predefined criteria |
In this trial, RC48 was scheduled to be administered at a dose of 2.0 mg/kg every 3 weeks, with the first dose on day 1 of the first cycle.
Tislelizumab was administered at a dose of 200 mg every 3 weeks, with the first dose on day 1 of the first 21-day cycle.
The drug is diluted with normal saline and administered by intravenous drip for one hour.
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研究衡量的是什么？
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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Kidney-Intact Event-Free Survival (KI-EFS) at 1 year
大体时间：From enrollment to 12 months
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KI-EFS is defined as the time from study enrollment to the first occurrence of any of the following events: High-risk recurrence of upper tract urothelial carcinoma (local, regional, or distant), defined according to prespecified clinical or radiographic criteria Death from any cause Conversion to radical nephroureterectomy (RNU) for any reason Patients without an event will be censored at the date of last disease assessment. |
From enrollment to 12 months
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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Kidney-Intact Event-Free Survival at 2 years
大体时间：Up to 24 months
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KI-EFS is defined as the time from study enrollment to the first occurrence of any of the following events: High-risk recurrence of upper tract urothelial carcinoma (local, regional, or distant), defined according to prespecified clinical or radiographic criteria Death from any cause Conversion to radical nephroureterectomy (RNU) for any reason Patients without an event will be censored at the date of last disease assessment. |
Up to 24 months
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Disease-Free Survival (DFS) Renal Function Preservation
大体时间：Up to 24 months
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Time from definitive local treatment (KSS or RNU) to upper tract recurrence or death from any cause.
Isolated bladder recurrence will not be counted as an event.
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Up to 24 months
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Clinical Complete Response (cCR) Rate After Induction Therapy
大体时间：Immediately after Induction Therapy
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Clinical complete response (cCR) was defined as concordant negative findings on cross-sectional imaging, ureteroscopy, urine cytology, and targeted biopsy according to predefined criteria
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Immediately after Induction Therapy
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Clinical Complete Response (cCR) Rate After Kidney-Sparing Surgery
大体时间：1 month after surgery
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Clinical complete response (cCR) was defined as concordant negative findings on cross-sectional imaging, ureteroscopy, urine cytology, and targeted biopsy according to predefined criteria
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1 month after surgery
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Renal Function Preservation
大体时间：Up to 12 months
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Change in estimated glomerular filtration rate (eGFR)
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Up to 12 months
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Safety and Tolerability
大体时间：Up to 90 days post-treatment
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Incidence of treatment-related adverse events graded by CTCAE v5.0
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Up to 90 days post-treatment
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其他结果措施
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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ctDNA/utDNA Dynamics
大体时间：Up to 12 months
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Detection tumor DNA (ctDNA/utDNA) using a fixed deep-sequencing panel.
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Up to 12 months
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HER2 expression level Exploratory Molecular Analyses
大体时间：baseline, pre-Induction Therapy
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HER2 expression level pre-Induction Therapy
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baseline, pre-Induction Therapy
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合作者和调查者
研究记录日期
研究主要日期
学习开始 (估计的)
初级完成 (估计的)
研究完成 (估计的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
与本研究相关的术语
其他相关的 MeSH 术语
其他研究编号
- DISTINCT II
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