Penpulimab-based Combination Neoadjuvant/Adjuvant Therapy for Patients With Resectable Locally Advanced Non-small Cell Lung Cancer: a Phase II Clinical Study (ALTER-L043)

Overview

This is a multicenter, randomized, open label, phase II study.

Detailed description

This is a multicenter, randomized, open label, phase II study assessing the efficacy and safety of penpulimab plus chemotherapy or penpulimab plus anlotinib or penpulimab plus chemotherapy and anlotinib as neoadjuvant/adjuvant treatment in patients with resectable locally advanced non-small cell lung cancer. Eligible patients will be randomized to receive either penpulimab (200mg, iv, Q3W) plus chemotherapy (platinum based chemotherapy) or penpulimab (200mg, iv, Q3W) plus anlotinib (12mg, po, day 1-14, Q3W) or penpulimab (200mg, iv, Q3W) plus chemotherapy (platinum based chemotherapy) and anlotinib (12mg, po, day 1-14, Q3W) in a 1:1:1 ratio.

Interventions

• Drug Penpulimab+Cisplatin/Carboplatin+Pemetrexed/Paclitaxel/Gemcitabine/Docetaxel
  A cycle of treatment is defined as 21 days of once daily treatment.
• Drug Penpulimab+Anlotinib+Cisplatin/Carboplatin+Pemetrexed/Paclitaxel/Gemcitabine/Docetaxel
  A cycle of treatment is defined as 21 days of once daily treatment.
• Drug Penpulimab+Anlotinib
  A cycle of treatment is defined as 21 days of once daily treatment.

Primary outcome measures

• Major pathological response (MPR) [Time frame: About 3-6 weeks following completion of surgery.]

Secondary outcome measures (5)

• Objective response rate (ORR) [Time frame: Within 7 days before surgery.]
• 1 year Event-Free Survival rate [Time frame: Up to 5 Years from randomization]
• Event-Free Survival (EFS) [Time frame: Up to 5 years from randomization.]
• Overall survival (OS) [Time frame: Up to 5 years from randomization.]
• Incidence of adverse events (AEs)/serious adverse events (SAEs) [Time frame: Up to 5 Years from randomization]

Eligibility criteria

Inclusion criteria

• Early stage IIB-IIIB (N2), operable non-small cell lung cancer, confirmed in tissue.
• Epidermal growth factor receptor/anaplastic lymphoma kinase/ROS1 gene fusions mutation was negative in primary tumor or lymph node metastasis.
• Eastern Cooperative Oncology Group (ECOG) Performance Status of 0-1 with no deterioration over the previous 2 weeks and a minimum life expectancy of 12 weeks.
• Lung function capacity capable of tolerating the proposed lung surgery.
• Patients had never received surgery, chemotherapy, radiotherapy or biotherapy.

Exclusion criteria

• Large cell carcinoma and mixed cell lung cancer.
• Any systemic anti-cancer treatment for NSCLC, including cytotoxic drug therapy, immunotherapy, experimental treatment.
• Prior treatment with local radiotherapy.
• Prior treatment with any drug that targets T cell co-stimulations pathways (such as checkpoint inhibitors).
• Prior treatment with antilotinib and other antiangiogenic drugs.
• History of hypersensitivity to any active or inactive ingredient of Penpulimab, Anlotinib or chemotherapy.
• Patients with multiple factors affecting oral medication (e.g. inability to swallow, chronic diarrhea, and intestinal obstruction, etc.).
• Past medical history of interstitial lung disease, drug-induced interstitial lung disease, radiation pneumonitis that required steroid treatment, or any evidence of clinically active interstitial lung disease.
• Patients whose tumor has invaded important blood vessels or whose tumor is likely to invade important blood vessels and cause fatal massive hemorrhage during follow-up study.
• Patients who have had arteriovenous thrombosis events within 6 months, such as cerebrovascular accident (including transient ischemic attack), deep venous thrombosis and pulmonary embolism.
• Pregnant or lactating women.
• History of neurological or mental disorders, including epilepsy or dementia.

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

• The First Affiliated Hospital of Nanchang University — Nanchang

Identifiers

NCT: NCT04846634 · ALTER-L043

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗