A Study of Nimotuzumab Plus Concurrent Chemoradiotherapy Sequential Maintenance Treatment for Cervical Carcinoma

Official title

A Multicentre, Prospective, Randomized, Double-blind, Placebo-controlled Study of Nimotuzumab Plus Concurrent Chemoradiotherapy Sequential Maintenance Treatment for Locally Advanced Cervical Squamous Cell Carcinoma

Overview

The purpose of this study is to evaluate the efficacy and safety of nimotuzumab plus concurrent chemoradiotherapy sequential maintenance therapy versus placebo combined with concurrent chemoradiotherapy in patients with locally advanced cervical squamous cell carcinoma. The primary hypotheses are that nimotuzumab plus concurrent chemoradiotherapy sequential maintenance therapy is superior to placebo plus concurrent chemoradiotherapy with respect to progression-free survival.

Detailed description

This is a multicenter, prospective, randomized, double-blind, placebo-controlled clinical study.The trail will enroll 460 subjects (FIGO 2018, stageIB3-IVA)who meet enrollment criteria but do not meet exclusion criteria. According to clinical stage (FIGO 2018 stage, stage IB3-IIB or III-IVA) 、tumor diameter (\>4cm or ≤4cm)、 age (≥18 years and \< 65 years old or ≥65 years old and ≤80 years old) for stratified randomization. They are divided into experimental group and control group according to 1:1. Patients in the experimental group will receive nimotuzumab 400mg on the basis of concurrent chemoradiotherapy, once a week for 7-8 weeks, and then maintenance treatment once every 2 weeks for 24 weeks. Using placebo(Nimotuzumab injection mimics) in the control group 80 ml on the basis of concurrent chemoradiotherapy, once a week for 7 to 8 weeks, after the maintenance treatment, once every 2 weeks for 24 weeks. Patients with incomplete tumor response assessed by imaging and pathological examination 3 months after radiotherapy can be given 2-4 cycles of adjuvant chemotherapy with cisplatin/carboplatin combined with paclitaxel regimen. Regular imaging examination and survival follow-up were performed after treatment. The primary efficacy end point was progression-free survival.

Interventions

• Biological Nimotuzumab
  Nimotuzumab 400mg
• Drug Cisplatin
  Cisplatin 40mg/m\^2
• Radiation External Beam Radiotherapy (EBRT)
  External Beam Radiotherapy (EBRT)
• Radiation Brachytherapy
  Brachytherapy
• Drug placebo for Nimotuzumab
  placebo for Nimotuzumab 400mg

Primary outcome measures

• Progression-Free Survival (PFS) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as Assessed Blinded Independent Central Review (BICR) [Time frame: Up to approximately 5 years]

Secondary outcome measures (12)

• Progression-Free Survival (PFS) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as Assessed by by the Investigator [Time frame: Up to approximately 5 years]
• 3-,5-Year Overall Survival (OS) [Time frame: Up to approximately 3 and 5 years]
• 3-,5-Year Disease Free Survival(DFS) [Time frame: Up to approximately 3 and 5 years]
• 3-,5-Year Locoregional Recurrence-Free Survival(LRRFS) [Time frame: Up to approximately 3 and 5 years]
• 3-,5-Year Distant Metastasis-free Survival (DMFS) [Time frame: Up to approximately 3 and 5 years]
• Tumor Regression Rate(TRR) [Time frame: From date of randomization until the date of brachytherapy,assessed up to 5 weeks]
• Complete Response Rate [Time frame: From date of randomization until the date of brachytherapy,assessed up to 5 weeks]
• Complete Response Rate [Time frame: 3 months later after treatment]
• Objective Response Rate [Time frame: 3 months later after treatment]
• Change from Baseline in European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) Global Health Status Score [Time frame: Baseline and up to approximately 5 years]
• Change from Baseline in European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Symptom Specific Scale for Cervical Cancer (EORTC QLQ-CX24) Score [Time frame: Baseline and up to approximately 5 years]
• Incidence of Treatment-Emergent Adverse Events [Time frame: Within 30 days from the start of treatment to the end of the last treatment]

Eligibility criteria

Inclusion criteria

• 1.Aged 18-80 years old;
• 2.Histologically diagnosed primary cervical squamous cell carcinoma, with clinical stage IB3-IVA (FIGO 2018);
• 3.At least one measurable lesion according to RECIST 1.1;
• 4.Absence of severe hematopoietic dysfunction and heart, lung, liver, kidney dysfunction and immunodeficiency, laboratory test results meet the following criteria: Hemoglobin ≥ 90 g/L; Absolute neutrophil count ≥ 1.5 × 10\^9/L and white blood cell count ≥ 3.0 × 10\^9/L; Platelet count ≥ 100 × 10\^9/L; Aspartate aminotransferase (AST) ≤ 2.5 × ULN; Alanine aminotransferase (ALT) ≤ 2.5 × ULN ; Total bilirubin ≤ 1.5 × ULN; Serum creatinine ≤ 1.0 × ULN;
• 5.ECOG score 0-1 points;
• 6.Women of childbearing potential must have a negative serum or urine HCG within 72 hours prior to enrollment (postmenopausal women must have been amenorrheic for at least 12 months to be considered of non-childbearing potential. A pregnancy test is not required for women who have demonstrated tubal ligation); Women of childbearing potential who are willing to take medically recognized contraceptive measures during the trial;
• 7.Compliance is good and informed consent is voluntarily signed.

Exclusion criteria

• 1.Cervical adenocarcinoma and rare pathological types of malignant tumors;
• 2.Previous surgery for cervical cancer, pelvic radiation therapy, systemic chemotherapy, tumor targeted therapy, immunotherapy;
• 3.Ureteral obstruction, inability to place ureteral stent or pyelostomy;
• 4.Pregnant or lactating women;
• 5.Patients with rectovaginal fistula/vaginovesical fistula/uncontrolled vaginal bleeding or at risk of fistula;
• 6.Had undergone major surgery (except biopsy) within 4 weeks prior to randomization;
• 7.Had received a live vaccine within 4 weeks prior to the initial study drug treatment or planned to vaccinate during the study;
• 8.Human immunodeficiency virus (HIV) infection;Active hepatitis B (the quantitative detection result of HBV DNA exceeds the lower limit of detection), or HCV infection (the quantitative detection result of HCV RNA exceeds the lower limit of detection);
• 9.Had the following serious medical conditions: a) Uncontrolled hypertension (defined as systolic blood pressure > 150 mmHg or diastolic blood pressure > 100 mmHg), or had experienced a hypertensive crisis; b) Myocardial infarction and unstable angina occurred within 6 months before randomization; c) Decompensated heart failure within three months before enrollment (NYHA class III and IV); d) The presence of severe arrhythmias requiring long-term medical intervention, except in patients with asymptomatic atrial fibrillation with stable ventricular rate; e) Left ventricular ejection fraction (LVEF)<50%; f) The presence of uncontrolled hyperglycemia; g) The presence of uncontrollable infections；
• 10.The presence of active or suspected autoimmune diseases, except for type 1 diabetes、hypothyroidism or skin conditions that do not require systemic treatment (vitiligo、psoriasis or alopecia)；
• 11.Conditions requiring systemic treatment with corticosteroids or other immunosuppressive agents within 14 days before randomization；
• 12.Patients with a history of other malignant tumors (except cured cutaneous basal cell carcinoma);
• 13.Patients with Crohn's disease and ulcerative colitis;
• 14.Patients who are participating in other clinical trials or have stopped clinical trials for less than 4 weeks;
• 15.Patients with known hypersensitivity to Nimotuzumab or its components;
• 16.Patients with contraindications to cisplatin、carboplatin and paclitaxel;
• 17.Patients with neurological or psychiatric disorders affecting cognitive ability;
• 18.Patients whose lesions cannot be treated with intracavitary radiotherapy as assessed by the investigator;
• 19.Any condition that, in the opinion of the Investigator, may be inappropriate for patients in the study.

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

Double blind

Primary purpose

Treatment

Study locations

Center list to be confirmed — check the primary protocol.

Publications

• Wei S, Li X, Liu Z, Wei L, Zou L, Zhang Y, Sun X, Gao Y, Zhuo Y, Zhang M, Qu A, Zhang H, Guo H, Jiang P, Wang J. Nimotuzumab plus concurrent chemoradiotherapy sequential maintenance treatment for locally advanced cervical squamous cell carcinoma (NOTABLE-306): a multicenter, prospective, randomized, double-blind, placebo-controlled trial. J Gynecol Oncol. 2026 May;37(3):e46. doi: 10.3802/jgo.2026. PMID 41514314

Identifiers

NCT: NCT06333821 · BPL-Nim-CC-3003

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗