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NCT Number: NCT06349044

A Randomized, Multicenter Phase II Basket Study of Hypofractionated Radiotherapy/Stereotactic Body Radiotherapy Followed by Immunotherapy-Based Systemic Therapy +/- L. Rhamnosus M9 for the First-Line Treatment of Advanced Digestive System Malignancies.

Based on the interaction between radiation therapy and immunotherapy and the potential potentiation of Probio-M9 for the treatment of ICIs, this study is planned to design an integrated treatment protocol for the first-line treatment of advanced gastrointestinal tumors through the use of macrofractionated radiotherapy as a means of immune activation, combined with the synergistic effect of Probio-M9 microbial agents and PD-1 inhibitors.

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Key information

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • histopathologically confirmed diagnosis of malignant tumors of the gastrointestinal tract (including Her-2 negative adenocarcinoma of the gastroesophageal junction/gastric adenocarcinoma, hepatocellular carcinoma, malignant tumors of the biliary system, colorectal cancer);
  • advanced patients evaluated as initially non-operable resectable who have not received any antitumor therapy;
  • have at least one measurable or evaluable lesion according to RECIST v1.1 criteria in addition to the primary lesion, with non-operable resectable lymph node metastases to the liver, lung, bone, pelvis, retroperitoneum and/or superficial sites (except for brain metastases), as evaluated by discussion in the framework of the MDT
  • age 18-75 years;
  • ECOG score of 0-1;
  • be able to accept the treatment regimen during the study;
  • sign a written informed consent.

Exclusion criteria

  • a history of uncontrolled epilepsy, central nervous system disease, or psychiatric disorder of clinical severity that, in the judgment of the investigator, may preclude the signing of an informed consent form or interfere with the patient's adherence to oral medication;
  • prior immunotherapy for any indication or a history of severe hypersensitivity reactions to other monoclonal antibodies;
  • clinically significant (i.e., active) cardiac disease, such as symptomatic coronary artery disease, New York Heart Association (NYHA) class II or worse congestive heart failure or severe arrhythmias requiring pharmacologic intervention, or history of myocardial infarction within the last 12 months;
  • organ transplantation requiring immunosuppressive therapy;
  • a history of other malignant disease within the last five years;
  • persons with severe uncontrolled recurrent infections, or other severe uncontrolled concomitant diseases;
  • Subjects whose baseline blood routine and biochemical indexes do not meet the following criteria: hemoglobin ≥80g/L; absolute neutrophil count (ANC) ≥1.5×10^9/L; platelets ≥100×10^9/L; ALT, AST ≤2.5 times the upper limit of normal; ALP ≤2.5 times the upper limit of normal; serum total bilirubin <1.5 times the upper limit of normal; serum creatinine <1 times the upper limit of normal; and serum creatinine <1 times the upper limit of normal. times the upper limit of normal;
  • the patient currently has active gastrointestinal diseases such as active gastric and duodenal ulcers, ulcerative colitis, or active bleeding from unresected tumors, or other conditions that may cause gastrointestinal bleeding or perforation as determined by the investigator;
  • persons with active bleeding or bleeding tendencies;
  • women who are pregnant or breastfeeding;
  • allergy to any of the study drug ingredients.

Treatment and study plan

Hypofractionated radiotherapy/SBRT(5-10Gy/fx,3-5 fx)

Radiation

RT: one primary or metastatic focus was selected for hypofractionated radiotherapy/SBRT (5-10 Gy/fx, 3-5 fx) in each round, the target area included only the GTV of the visible tumor lesion, and the GTV was expanded by 5-10 mm to generate the PTV, and the prophylactic lymphatic drainage area could not be irradiated.

Anti-PD-1 monoclonal antibody

Drug

Sintilimab 200mg d1 iv q3w

Oxaliplatin and Capecitabine

Drug

Oxaliplatin130mg/m2 d1 iv;Capecitabine1000mg/m2 d1-d14

Anti-VEGF 15mg/kg

Drug

Bevacizumab 15mg/kg d1 iv q3w

Anti-VEGF 7.5mg/kg

Drug

Bevacizumab 7.5mg/kg d1 iv q3w

Gemcitabine and Cisplatin

Drug

Gemcitabine1000mg/m2 d1 d8 iv;Cisplatin 25mg/m2 d1 d8 iv q3w

Primary outcomes

  1. ORR

    Time frame: ORR will be assessed 2 months after radiotherapy

    for off-target lesions of radiotherapy

Secondary outcomes

  1. ORR

    Time frame: ORR will be assessed 2 months after radiotherapy

    irradiated lesion

  2. adverse effects rate

    Time frame: From date of randomization until the date of death from any cause, assessed up to 5 years ]

    CTC 4.0

  3. Qol

    Time frame: From date of randomization until the date of death from any cause, assessed up to 10 years]

    EORTC-C30

  4. PFS

    Time frame: From the date of randomization to the date when progress was first recorded,assessed up to 36 months.

    Rate of 3 year disease free survival

  5. OS

    Time frame: From date of randomization until the date of death from any cause, assessed up to 36 months

    Rate of 3 year overall survival

  6. Qol

    Time frame: From date of randomization until the date of death from any cause, assessed up to 10 years]

    EQ-5D

Study contacts

Contact information is provided by the study sponsor or research team.

Sponsors and collaborators

Lead sponsor

Zhejiang Cancer Hospital

Other

Registry information

Official study title

A Randomized, Multicenter Phase II Basket Study of Hypofractionated Radiotherapy/Stereotactic Body Radiotherapy Followed by Immunotherapy-Based Systemic Therapy +/- L. Rhamnosus M9 for the First-Line Treatment of Advanced Digestive System Malignancies

Important dates

Study start
2024
Primary completion
2025
Study completion
2025
First posted
Apr 5, 2024
Registry last updated
Aug 27, 2024

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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