Pembrolizumab Plus Neoadjuvant Chemotherapy vs. Neoadjuvant Chemoradiotherapy for Locally Advanced ESCC (KEYSTONE-002)

Official title

A Multicenter Randomized, Controlled Phase III Clinical Trial of Pembrolizumab Plus Paclitaxel and Cisplatin Versus Neoadjuvant Chemoradiotherapy Followed by Surgery for Locally Advanced Esophageal Squamous Cell Carcinoma (KEYSTONE-002)

Overview

The purpose of this study is to evaluate the efficacy and safety of pembrolizumab plus paclitaxel, cisplatin as neoadjuvant therapy followed by surgery, and pembrolizumab as adjuvant therapy, compared with neoadjuvant chemoradiotherapy and surgery for locally advanced ESCC in multicenter.

Detailed description

Preoperative chemoradiotherapy with radical surgery is the recommended treatment for locally advanced esophageal squamous cell carcinoma (ESCC) in the NCCN guidelines. But many patients refused or abandon radiotherapy because of the intolerable adverse effects. The purpose of this study is to evaluate the efficacy and safety of pembrolizumab plus paclitaxel, cisplatin as neoadjuvant therapy followed by surgery, and pembrolizumab as adjuvant therapy, compared with neoadjuvant chemoradiotherapy and surgery for locally advanced ESCC in multicenter. The primary study hypothesis is that Event Free Survival (EFS) is superior with pembrolizumab plus neoadjuvant chemotherapy compared with neoadjuvant chemoradiotherapy in participants with ESCC.

Interventions

• Biological Pembrolizumab
  Neoadjuvant period: pembrolizumab 200mg IV D1, Q3W, and preoperative therapy with three cycles. Adjuvant period: pembrolizumab 200 mg IV D1, Q3W, up to one year, which should be performed within 3-6 weeks after surgery.
• Drug Paclitaxel
  Neoadjuvant period: paclitaxel 135mg/m\^2 IV on Day 2 Q3W, and a total of three cycles.
• Drug Cisplatin
  Neoadjuvant period: cisplatin 80 mg/m\^2 IV on Day 2 Q3W, and a total of three cycles.
• Radiation neoadjuvant chemoradiotherapy
  neoadjuvant chemoradiotherapy 41.4Gy(1.8Gy×23 fractions) with five cycles of TP(Paclitaxel 50mg/m\^2 on D1 and Cisplatin 25mg/m\^2 D1, repeated every week

Primary outcome measures

• Event Free Survival (EFS) [Time frame: Up to approximately 2.5 years]

Secondary outcome measures (9)

• Overall Survival (OS) [Time frame: 3 and 5 years]
• Disease Free Survival (DFS) [Time frame: 3 and 5 years]
• Major pathologic response (MPR) [Time frame: 1 month after resection]
• Objective response rate (ORR) [Time frame: 1 month after resection]
• Pathologic Complete Response (PCR) [Time frame: 1 month after resection]
• assessment in perioperation [Time frame: perioperative period]
• Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability] [Time frame: up to 16 months]
• Quality of life differences (EORTC QLQ-C30) [Time frame: 2.5 years]
• Quality of life differences (EORTC QLQ-OES18) [Time frame: 2.5 years]

Eligibility criteria

Inclusion criteria

• Histologically confirmed esophageal squamous cell carcinoma;
• R0 resectable thoracic esophageal cancer, cT1-3N1-2M0, cT2-3N0M0 (AJCC V8 TNM classification);
• No suspicious metastatic lymph nodes on the clavicle;
• Have a performance status of 0 or 1 on the ECOG Performance Scale;
• Age 18-75 years old, both men and women;
• Be willing and able to provide written informed consent/assent for the trial;
• Demonstrate adequate organ function ;
• Female subject of childbearing potential should have a negative urine or serum pregnancy within 72 hours before receiving the first dose of study medication. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required;
• Be willing to provide tissue, blood, and urine samples. Tissue should be from a newly obtained core or excisional biopsy of a tumor lesion through repeated biopsies. Newly-obtained is defined as a specimen obtained up to 4 weeks (28 days) before initiation of treatment on Day 1.
• Have not received systemic or local treatment for esophageal cancer in the past.

Exclusion criteria

• Ineligibility or contraindication for esophagectomy;
• Prior therapy (operation, radiotherapy, immunotherapy, or chemotherapy) for esophageal cancer
• Active autoimmune disease or history of autoimmune disease;
• Requiring systemic treatment with either corticosteroids or other immunosuppressive medications;
• Subjects with a history of symptomatic interstitial lung disease;
• History of allergy to study drug components;
• Women must not be pregnant or breast-feeding;
• Patient has received prior chemotherapy, radiotherapy, target therapy ，and immune therapy for this malignancy or any other past malignancy;
• Underlying medical conditions that, in the Investigator's opinion, will make the administration of study drug hazardous or obscure the interpretation of toxicity or adverse events.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

China · 1 center

• Department of minimally invasive esophageal surgery, Tianjin Medical University Cancer Ins — Tianjin

Publications

• Shang X, Zhang W, Zhao G, Liang F, Zhang C, Yue J, Duan X, Ma Z, Chen C, Pang Q, Zhang W, Liu L, Ren X, Meng B, Zhang P, Ma Y, Zhang L, Li H, Kang X, Li Y, Jiang H. Pembrolizumab Combined With Neoadjuvant Chemotherapy Versus Neoadjuvant Chemoradiotherapy Followed by Surgery for Locally Advanced Oesophageal Squamous Cell Carcinoma: Protocol for a Multicentre, Prospective, Randomized-Controlled, Pha PMID 35433421

Identifiers

NCT: NCT04807673 · TianjinCIH20210096

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗