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Tocilizumab Combined With First-Line Chemo-Immunotherapy in Metastatic Non-Small Cell Lung Cancer (TOCI)

2026年11月6日 更新者：VA Office of Research and Development

A Phase 1b Study of Tocilizumab Combined With Chemo-Immunotherapy in Metastatic Non-Small Cell Lung Cancer Patients With Cancer-Associated Weight Loss and Elevated Inflammatory Markers. The TOCI Study

This is a Phase 1b/2, multi-site, single-arm, open-label, non-randomized study looking at whether adding tocilizumab to standard treatment for metastatic Non-Small Cell Lung Cancer (NSCLC) is safe, possible, and effective. The study includes people with metastatic NSCLC, that is lung cancer that has spread, who have experienced significant loss of weight or muscle mass.

研究概览

地位

尚未招聘

条件

干预/治疗

详细说明

Lung cancer remains the leading cause of cancer-related mortality globally, with non-small cell lung cancer (NSCLC) accounting for approximately 85% of all diagnoses. For patients with metastatic NSCLC lacking actionable driver mutations (e.g., EGFR, ALK), the standard first-line therapeutic strategy involves immune checkpoint inhibitors (ICIs) targeting the programmed cell death protein 1 (PD-1) or programmed death-ligand 1 (PD-L1) axis, administered either as monotherapy or in combination with platinum-doublet chemotherapy. While these regimens have significantly improved overall survival (OS), a substantial proportion of patients fail to derive durable clinical benefit, and long-term survival rates for metastatic disease remain suboptimal, often due to host-related factors that impair the anti-tumor immune response.

A critical determinant of poor therapeutic outcomes in advanced NSCLC is cancer-associated cachexia (CAC), a multifactorial paraneoplastic syndrome characterized by systemic inflammation, negative protein-energy balance, and the involuntary loss of skeletal muscle mass (sarcopenia). Primary observational studies demonstrate that nutritional derangements closely associated with cachexia - such as significant weight loss and malnutrition - are highly prevalent in lung cancer, particularly in advanced disease, with lung cancer-specific cohorts reporting rates ranging from approximately 35% - 70% depending on disease stage and assessment method. Unlike starvation, it is driven by aberrant systemic inflammation and not fully reversible via nutritional support.

Clinically, cachexia is defined by the international consensus (Fearon criteria) as weight loss >5% over 6 months, or weight loss >2% in individuals with a body mass index (BMI) < 20 kilograms per square meter (kg/m2) or sarcopenia. Sarcopenia is specifically defined by a low skeletal muscle index (SMI) at the L3 vertebral level, with widely validated cutoffs of < 52.4 cm2/m2 for men and < 8.5 cm2/m2 for women.

This is a Phase 1b/2, multi-site, single-arm, open-label, non-randomized study looking at whether adding tocilizumab to standard treatment for metastatic Non-Small Cell Lung Cancer (NSCLC) is safe, possible, and effective. The study includes people with metastatic NSCLC, that is lung cancer that has spread, who have experienced significant loss of weight or muscle mass.

Primary Objective Evaluate the safety/feasibility and efficacy of adding tocilizumab to standard first-line chemo-immunotherapy in biomarker-selected patients with stage IV NSCLC, defined by weight loss ≥5% within the prior 6 months, or ≥2% if BMI < 20 kilograms per square meter (kg/m2).

Co-primary endpoint 1: Safety/Feasibility Proportion of patients completing four cycles of chemo-IO + tocilizumab without grade ≥3 autoimmune or non-hematological treatment-related adverse events (TRAE). Feasibility will be defined as ≥80% completion; unacceptable toxicity as >30% incidence of grade ≥3 serious AEs.

Co-primary endpoint 2: Progression-Free Survival Rate at 6 months Proportion of patients alive and progression-free at 6 months after starting therapy per RECIST v1.1, estimated by Kaplan-Meier and presented with a 95% CI.

Secondary Objectives Assess the effect of tocilizumab on body composition, inflammatory biomarkers, and treatment response.

Secondary Endpoints: change in weight/muscle mass (CT-based sarcopenia/Fearon index); Overall Response Rate (ORR); median Overall Survival Rate; and CRP levels from baseline to end of treatment.

Correlative Objectives Evaluate associations between treatment response (PFS rate at 6 months, ORR) and baseline inflammatory biomarkers (CRP) as well as molecular biomarkers (KRAS, STK11) identified by next-generation sequencing (NGS) of tumor tissue.

Exploratory Objectives Identify associations between treatment response (PFS rate at 6 months, ORR) and longitudinal measurements of CRP, IL-6, Cyclin D1 and Bcl-xL mRNA, as well as baseline PTPRT methylation.

Participants will go through the screening and baseline process to assess eligibility. If eligible, participants will attend study treatment visits every 21 days for about 3 months, an End of Treatment (EOT) visit about 30 days after the last dose of treatment, and follow up for up to 12 months after the EOT visit. Tocilizumab will be administered in addition to standard treatment regimens for NSCLC, at a dose of 8 mg/kg intravenous (IV) once every three weeks (once every 21 days); on day one of each treatment cycle. Tocilizumab is administered as a single IV drip infusion over 1 hour; it cannot be administered as bolus or push. Tocilizumab will be given for 4 doses, at the beginning of treatment, or until disease progression or unacceptable toxicities.

The study will be open at 4 VA hospitals, and planned enrollment is about 43 participants in total with about 11 participants from each site. This research study is expected to take about 4 years. Individual participation in the study will take about 18 months.

研究类型

介入性

注册 (估计的)

43

阶段

  • 阶段2
  • 阶段1

联系人和位置

本节提供了进行研究的人员的详细联系信息，以及有关进行该研究的地点的信息。

学习联系方式

学习地点

  • 美国
    • Indiana
      • Indianapolis、Indiana、美国、46202-2884
        • Richard L. Roudebush VA Medical Center, Indianapolis, IN
        • 接触：
        • 接触：
    • Michigan
      • Ann Arbor、Michigan、美国、48105-2303
        • VA Ann Arbor Healthcare System, Ann Arbor, MI
        • 接触：
        • 接触：
    • Ohio
      • Cleveland、Ohio、美国、44106-1702
        • Louis Stokes VA Medical Center, Cleveland, OH
        • 接触：
          • Margaret Tiktin, DNP
          • 电话号码：(216) 231-3241
        • 首席研究员：
          • Charles J Nock, MD
    • Pennsylvania
      • Pittsburgh、Pennsylvania、美国、15240
        • VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA
        • 接触：
        • 接触：

参与标准

研究人员寻找符合特定描述的人，称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。

资格标准

适合学习的年龄

18年 及以上 (成人、年长者)

接受健康志愿者

不

有资格学习的性别

全部

描述

Inclusion Criteria:

  1. Age ≥ 18 years at the time of consent
  2. Histologically confirmed metastatic Non-Small Cell Lung Cancer (NSCLC)
  3. No Epidermal Growth Factor Receptor (EGFR), Anaplastic Lymphoma Kinase (ALK), ROS Proto-Oncogene 1 (ROS1), or Rearranged During Transfection Proto-Oncogene (RET) mutations
  4. ≥ 5% unintentional weight loss or >2% if Body Mass Index (BMI) < 20 kilograms/square meter (kg/m2) in prior 6 months
  5. Candidate for platinum-doublet and Programmed Death-Ligand 1 (PD-L1) inhibitor
  6. Eastern Cooperative Oncology Group (ECOG) Performance Status 0-2
  7. Measurable disease as per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1
  8. Baseline Interleukin-6 (IL-6) and C-reactive protein (CRP) available

Exclusion Criteria:

  1. Prior systemic therapy for metastatic disease
  2. Autoimmune disease requiring immunosuppression
  3. Active infection or high Gastrointestinal (GI) perforation risk
  4. Symptomatic brain metastasis
  5. Active hepatitis B infection
  6. Active or untreated latent Tuberculosis (TB) infection

学习计划

本节提供研究计划的详细信息，包括研究的设计方式和研究的衡量标准。

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
实验性的：Single Arm

Tocilizumab + pembrolizumab + platinum doublet chemotherapy
药品：Tocilizumab

Tocilizumab 8 milligrams per kilogram (mg/kg) intravenous infusion administered once every 21 days (Day 1 of each cycle) for up to 4 doses. The drug is diluted in 0.9% or 0.45% sodium chloride and infused over 60 minutes. Tocilizumab is given in combination with pembrolizumab and platinum-based doublet chemotherapy. Dose reductions to 4 mg/kg are permitted per protocol in the setting of toxicity.

其他名称：
  • Actemra, Actemra ACTPen, Tofidence, Tyenne
药品：Pembrolizumab

Pembrolizumab is administered per standard-of-care dosing every 21 days in combination with platinum-based doublet chemotherapy and tocilizumab.

药品：Platinum-Doublet Chemotherapy

Standard-of-care platinum doublet chemotherapy administered every 21 days in combination with pembrolizumab and tocilizumab, using either carboplatin with pemetrexed (non-squamous NSCLC) or carboplatin with a taxane (squamous NSCLC), per institutional guidelines.

其他名称：
  • Carboplatin plus pemetrexed; carboplatin plus taxane

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
Safety of adding Tocilizumab to Standard of Care Immunotherapy
大体时间：From Day 1 of treatment through completion of Cycle 4 (approximately 12 weeks)

Safety: Incidence of grade ≥3 non-hematological treatment-related adverse events (TRAEs) or autoimmune toxicities. Unacceptable toxicity is defined as more than 30% incidence of grade ≥3 serious adverse events (AEs), assessed by clinical and laboratory evaluation per National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v5.0.
From Day 1 of treatment through completion of Cycle 4 (approximately 12 weeks)
Progression-Free Survival Rate
大体时间：6 months after after initiation of study treatment

Progression-Free Survival Rate at 6 months: Time from Day 1 of treatment to documented disease progression or death, assessed at 6 months per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and calculated using Kaplan Meier statistics.
6 months after after initiation of study treatment
Feasibility of Treatment Completion
大体时间：From Day 1 of treatment through completion of Cycle 4 (approximately 12 weeks)

Proportion of patients completing four cycles of treatment. Feasibility is defined as ≥80% of patients completing all four cycles.
From Day 1 of treatment through completion of Cycle 4 (approximately 12 weeks)

次要结果测量

结果测量
措施说明
大体时间
Weight Change
大体时间：Baseline to EOT (approximately 3 months)

Measured from baseline to end of treatment (EOT) using objective weight data.
Baseline to EOT (approximately 3 months)
Muscle Mass
大体时间：at baseline and EOT (30 +/- 7 days post last dose)

Assessed via Computed Tomography (CT) -based analysis at baseline and end of treatment.
at baseline and EOT (30 +/- 7 days post last dose)
Overall Response Rate (ORR)
大体时间：at EOT (approximately 3 months)

Defined as complete response (CR) + partial response (PR) per RECIST 1.1 at end of treatment.
at EOT (approximately 3 months)
Median Overall Survivial Rate
大体时间：From Day 1 of treatment until death or last follow-up (up to 12 months post-EOT)

Time from Day 1 of treatment to the point at which 50% of participants have died and 50% remain alive.
From Day 1 of treatment until death or last follow-up (up to 12 months post-EOT)
Inflammatory Biomarkers
大体时间：From baseline to EOT (30 +/- 7 days post last dose)

Changes in C-Reactive Protein (CRP) levels from baseline to end of treatment.
From baseline to EOT (30 +/- 7 days post last dose)
Sarcopenia
大体时间：at baseline and EOT (30 +/- 7 days post last dose)

Assessed via CT-based analysis at baseline and end of treatment.
at baseline and EOT (30 +/- 7 days post last dose)

其他结果措施

结果测量
措施说明
大体时间
Correlation between Baseline IL-6 and Overall Response Rate (ORR)
大体时间：Baseline

Evaluation of the association between baseline Interleukin-6 (IL-6) concentration and Objective Response Rate (ORR).
Baseline
Correlation between Baseline CRP and Overall Response Rate (ORR)
大体时间：Baseline

Assessment of the relationship between baseline C-reactive protein (CRP) levels and ORR.
Baseline
Correlation between Baseline PTPRT Methylation and Overall Response Rate (ORR)
大体时间：Baseline

Assessment of the association between baseline PTPRT methylation status and ORR.
Baseline
Correlation between Baseline KRAS Mutation Status and Overall Response Rate (ORR)
大体时间：Baseline

Evaluation of the correlation between KRAS tumor mutational status at baseline and ORR.
Baseline
Correlation between Baseline STK11 Mutation Status and Overall Response Rate (ORR)
大体时间：Baseline

Evaluation of the correlation between baseline STK11 tumor mutational status and ORR.
Baseline
Correlation between Baseline IL-6 and PFS
大体时间：Baseline

Evaluation of the association between baseline IL-6 concentration and Progression-Free Survival (PFS).
Baseline
Correlation between Baseline CRP and PFS
大体时间：Baseline

Assessment of the relationship between baseline CRP concentration and PFS.
Baseline
Correlation between Baseline PTPRT Methylation and PFS
大体时间：Baseline

Assessment of the association between baseline PTPRT methylation status and PFS.
Baseline
Correlation between Baseline KRAS Mutation Status and PFS
大体时间：Baseline

Evaluation of the correlation between KRAS mutation status at baseline and PFS.
Baseline
Correlation between Baseline STK11 Mutation Status and PFS
大体时间：Baseline

Evaluation of the association between baseline STK11 mutation status and PFS.
Baseline
Correlation between Longitudinal IL-6 Changes and Overall Response Rate (ORR)
大体时间：Baseline through End of Treatment (30 +/- 7 days post last dose)

Analysis of whether changes in IL-6 levels measured at Baseline, C1D1, C2D1, C3D1, C4D1, and End of Treatment correlate with ORR.
Baseline through End of Treatment (30 +/- 7 days post last dose)
Correlation between Longitudinal CRP Changes and Overall Response Rate (ORR)
大体时间：Baseline through End of Treatment (30 +/- 7 days post last dose)

Analysis of whether changes in CRP levels measured at Baseline, C1D1, C2D1, C3D1, C4D1, and End of Treatment correlate with ORR.
Baseline through End of Treatment (30 +/- 7 days post last dose)
Correlation between Longitudinal Cyclin D1 mRNA Changes and Overall Response Rate (ORR)
大体时间：Baseline through End of Treatment (30 +/- 7 days post last dose)

Assessment of whether changes in Cyclin D1 mRNA expression measured at Baseline, C1D1, C2D1, C3D1, C4D1, and End of Treatment correlate with ORR.
Baseline through End of Treatment (30 +/- 7 days post last dose)
Correlation between Longitudinal Bcl-xL mRNA Changes and Overall Response Rate (ORR)
大体时间：Baseline through End of Treatment (30 +/- 7 days post last dose)

Evaluation of whether changes in Bcl-xL mRNA expression measured at Baseline, C1D1, C2D1, C3D1, C4D1, and End of Treatment correlate with ORR.
Baseline through End of Treatment (30 +/- 7 days post last dose)
Correlation between Longitudinal IL-6 Changes and PFS
大体时间：Baseline through End of Treatment (30 +/- 7 days post last dose)

Evaluation of whether IL-6 level changes measured at Baseline, C1D1, C2D1, C3D1, C4D1, and End of Treatment correlate with PFS.
Baseline through End of Treatment (30 +/- 7 days post last dose)
Correlation between Longitudinal CRP Changes and PFS
大体时间：Baseline through End of Treatment (30 +/- 7 days post last dose)

Evaluation of whether CRP level changes measured at Baseline, C1D1, C2D1, C3D1, C4D1, and End of Treatment correlate with PFS.
Baseline through End of Treatment (30 +/- 7 days post last dose)
Correlation between Longitudinal Cyclin D1 mRNA Changes and PFS
大体时间：Baseline through End of Treatment (30 +/- 7 days post last dose)

Assessment of whether changes in Cyclin D1 mRNA measured at Baseline, C1D1, C2D1, C3D1, C4D1, and End of Treatment correlate with PFS.
Baseline through End of Treatment (30 +/- 7 days post last dose)
Correlation between Longitudinal Bcl-xL mRNA Changes and PFS
大体时间：Baseline through End of Treatment (30 +/- 7 days post last dose)

Assessment of whether changes in Bcl-xL mRNA measured at Baseline, C1D1, C2D1, C3D1, C4D1, and End of Treatment correlate with PFS.
Baseline through End of Treatment (30 +/- 7 days post last dose)

合作者和调查者

在这里您可以找到参与这项研究的人员和组织。

赞助

VA Office of Research and Development

调查人员

  • 首席研究员：Charles J Nock, MD、Louis Stokes VA Medical Center, Cleveland, OH

研究记录日期

这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查，以确保它们在发布到公共网站之前符合特定的质量控制标准。

研究主要日期

学习开始 (估计的)

2026年12月7日

初级完成 (估计的)

2029年5月31日

研究完成 (估计的)

2029年11月30日

研究注册日期

首次提交

2026年9月18日

首先提交符合 QC 标准的

2026年10月15日

首次发布 (实际的)

2026年10月22日

研究记录更新

最后更新发布 (实际的)

2026年11月12日

上次提交的符合 QC 标准的更新

2026年11月6日

最后验证

2026年11月1日

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

  • SPLP-001-26S

计划个人参与者数据 (IPD)

计划共享个人参与者数据 (IPD)？

不

药物和器械信息、研究文件

研究美国 FDA 监管的药品

是的

研究美国 FDA 监管的设备产品

不

在美国制造并从美国出口的产品

不

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