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NCT Number: NCT07707882

Neoadjuvant Pimicotinib Combined With Surgery Versus Upfront Surgery for Diffuse Tenosynovial Giant Cell Tumor

Tenosynovial giant cell tumor (TGCT) is a rare neoplasm predominantly occurring in young and middle-aged adults, characterized by high recurrence and high disability rates. Surgery represents the first-line treatment at present. Although surgical resection can eradicate lesions, repeated surgical interventions constitute the major disease-related burden. Particularly for patients with diffuse-type TGCT (D-TGCT), postoperative recurrence rates can exceed 50%.

Pimicotinib is a highly selective colony-stimulating factor 1 receptor (CSF1R) inhibitor. The phase III MANEUVER trial has verified its prominent tumor shrinkage effect and symptomatic improvement in patients with unresectable, symptomatic TGCT, with an objective response rate (ORR) of 54%. In addition, pimicotinib demonstrates a favorable safety profile; most adverse events are mild in severity, mainly including pruritus, edema, fatigue and elevated creatine kinase, without severe hepatotoxicity.

Neoadjuvant therapy followed by surgery falls within the scope of multimodal treatment, which is mostly applied to recurrent and refractory cases rather than the standard upfront regimen for treatment-naive patients. Clinical case reports and real-world observations have preliminarily validated the feasibility and clinical value of sequential systemic targeted therapy followed by surgical resection. To date, systematic and standardized clinical data regarding neoadjuvant strategies remain scarce, especially randomized controlled evidence comparing neoadjuvant targeted therapy plus surgery versus primary upfront surgery. This study aims to compare the efficacy and safety of neoadjuvant pimicotinib combined with surgery versus upfront primary surgery in the management of D-TGCT, so as to generate evidence-based rationale for developing more effective and safe therapeutic regimens for D-TGCT.

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Key information

Conditions

Tenosynovial Giant Cell Tumor, Diffuse Giant Cell Tumor of Tendon Sheath Giant Cell Tumors Joint Diseases Muscular Diseases Musculoskeletal Diseases Neoplasms Neoplasms by Histologic Type Neoplasms, Connective Tissue Neoplasms, Connective and Soft Tissue Synovitis Synovitis, Pigmented Villonodular Tendinopathy

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 2

Primary location

Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine

Hangzhou, Zhejiang, 310000, China

Location contact

Zhaoming Ye

CONTACT

[email protected]

+86-0571-87783777

Who can participate

Healthy volunteers accepted: No

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

Inclusion criteria

  • Male or female subjects aged ≥18 years
  • Histologically confirmed tenosynovial giant cell tumor (TGCT)
  • Resectable diffuse tenosynovial giant cell tumor (D-TGCT) were determined by multidisciplinary team (MDT) discussion.
  • Measurable disease as defined by Response Evaluation Criteria In Solid Tumors (RECIST) v1.1 with at least one lesion of ≥2 cm
  • Symptomatic disease with a worst pain of at least 4 or/and a worst stiffness of at least 4 (based on a scale of 0-10 with 10 describing the worst condition) prior to randomization Adequate organ and bone marrow function
  • Adequate organ function and bone marrow function
  • Willing and able to complete patient-reported outcome (PRO) assessments throughout the study.

Exclusion criteria

  • Prior treatment with highly selective Colony-Stimulating Factor 1 (CSF1)/ Colony-Stimulating Factor 1 Receptor (CSF1R) inhibitors before randomization
  • Presence of another malignancy requiring active treatment, in the investigator's judgment, which may interfere with study participation or results
  • Known metastatic TGCT
  • Severe concomitant arthropathy, severe illness, or uncontrolled infection in the affected joint
  • Significant factors affecting oral drug absorption
  • Concomitant use of strong Cytochrome P450 3A4 (CYP3A4) inhibitors or inducers within 14 days before randomization
  • Impaired cardiac function or severe cardiac disease
  • Known active Human Immunodeficiency Virus (HIV) infection, active hepatitis B, active hepatitis C, or active tuberculosis before randomization
  • Known active liver or biliary disease, or other conditions that may cause abnormal liver function tests during the study
  • Pregnant or lactating female (pregnancy defined as from conception until termination)
  • Fertile males or non-sterilized females who do not agree to use effective contraception from at least 14 days before randomization until 6 months after the last dose of study drug
  • Other serious comorbidities that, in the investigator's judgment, may affect protocol compliance, interfere with interpretation of study results, or increase the patient's risk of safety events

Treatment and study plan

Pimicotinib

Drug

Pimicotinib 50 mg orally once daily for 12 consecutive weeks.

Tumor resection surgery

Procedure

Open surgery will be performed based on patient and tumor characteristics discussed at the multidisciplinary team (MDT) meeting. The specific surgical plan will be determined by the surgeon based on clinical judgment. Surgical procedures will follow national guidelines.

Primary outcomes

  1. Event-free survival

    Time frame: 2 years

    Events are defined as disease progression precluding planned surgery, local recurrence, distant metastasis, treatment discontinuation due to adverse events, or death from any cause.

Secondary outcomes

  1. Local recurrence rate

    Time frame: 2 year

  2. Surgical complication rate

    Time frame: 2 years

  3. Change in range of motion

    Time frame: 2 years

  4. Change in Brief Pain Inventory (BPI)

    Time frame: 2 years

    Score range: 0-10; Higher scores mean more severe pain and greater life interference; lower scores mean pain relief.

  5. Change in stiffness Numerical Rating Scale (NRS)

    Time frame: 2 years

    Score range: 0-10; Higher score means worse joint stiffness; reduced score indicates improvement.

  6. Change in Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF) score

    Time frame: 2 years

    This PROMIS Physical Function short form contains items with 5-point Likert response (1=unable to do, 5=no difficulty at all).The raw score from these responses is then converted to a standardized T-score on a scale of 0 to 100, with a mean of 50 and a standard deviation of 10. The total score is the final T-score. Higher T-score indicates better physical function.

Study contacts

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

Zhaoming Ye, MD

CONTACT

[email protected]

+86-0571-87783777

Sponsors and collaborators

Lead sponsor

Second Affiliated Hospital, School of Medicine, Zhejiang University

Other

Registry information

Official study title

Neoadjuvant Pimicotinib Combined With Surgery Versus Upfront Surgery for Diffuse Tenosynovial Giant Cell Tumor: A Randomized, Open-label Trial

Acronym: NEXPERT

Important dates

Study start
2027
Primary completion
2029
Study completion
2030
First posted
Jul 16, 2026
Registry last updated
Jul 16, 2026

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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