This is a single-arm phase II clinical trial to evaluate the initial efficacy and safety of toripalimab combined with axitinib as neoadjuvant therapy for advanced/metastatic non-clear cell renal cell carcinoma
Renal cell carcinoma (RCC) is a malignant tumor with a wide range of heterogeneity, including heterogeneous histological types. In addition to the most common clear cell carcinoma subtype (more than 80%), the remaining histological types are collectively referred to as non clear cell carcinoma (non-ccRCC), including papillary renal cell carcinoma (10-15%), chromophobe renal cell carcinoma (5%), and more rare Xp11.2 translocated RCC, unclassified as well as collecting duct carcinoma. Recent advances in molecular immunology have promoted the discovery of immune checkpoint inhibitors (ICIs) and have been successfully applied in clinic. Blockade to programmed death receptor 1(PD-1) improves survival in patients with metastatic renal cell carcinoma (mRCC), but has not been validated in advanced RCC, especially immune combination TKIs drugs. Preoperative immunotherapy (IO) with immune plus TKIs, that is, neoadjuvant IO plus TKIs therapy, is of therapeutic value. Because primary tumors can serve as antigens for tumor-specific T cell activation, diffusion, and spread, and then activate immune system to monitor micrometastasis. Moreover, peripheral blood can be obtained during neoadjuvant therapy, which lays a foundation for the study of the in vivo effects of PD-1 inhibitors combined with TKIs on the microenvironment of primary tumors. This study intends to validate the safety and feasibility of neoadjuvant immunotherapy combined to TKIs in patients with locally advanced/metastatic renal cell carcinoma. At the same time, this study intends to assess the relationship between somatic gene expression profiles and pathological responses, as well as the dynamic changes in the microenvironment, intratumoral, and immune biomarkers of primary renal cell carcinoma induced by immunotherapy.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
40
Toripalimab (240 mg,ivgtt,q3w) was administered to patients for 6 weeks and underwent surgery within 2-4 weeks
Axitinib (5 mg,po,qd) was administered to patients for 6 weeks and underwent surgery within 2-4 weeks
Major Pathologic Response (MPR)
The residual tumor cells (% RVT) were calculated according to immune related pathologic response criteria (irPRC), MPR is defined as %RVT\<10%
Time frame: 6 week
Pathologic Complete Response (pCR)
The residual tumor cells (% RVT) were calculated according to immune related pathologic response criteria (irPRC), pCR is defined as %RVT\<0%
Time frame: 6 week
Pathologic No Response (pNR)
The residual tumor cells (% RVT) were calculated according to immune related pathologic response criteria (irPRC), pCR is defined as %RVT\>90%
Time frame: 6 week
Objective response rate (ORR)
Rate of patients achieving a complete response (CR) or partial response (PR) by Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1) and immune-related response criteria (IRC)
Time frame: 6 week
Disease-free survival(DFS)
DFS is defined as the time from treatment to recurrence of tumor or death
Time frame: Up to 24 months
Progression-free survival(PFS)
PFS is defined as the time from treatment to progression disease or death. Progression disease is assessed by Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1) and immune-related response criteria (IRC)
Time frame: Up to 24 months
Overall survival(OS)
OS is defined as the time from treatment to death.
Time frame: Up to 24 months
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Functional Assessment of Cancer Therapy (FACT)-Kidney Symptom Index 19 (FKSI-19)
FKSI-19 score change over time from baseline to disease progression. The scale of FKSI-19 is from 0 to 48, and higher scores indicate worse quality of life.
Time frame: Up to 24 months
Functional Assessment of Cancer Therapy- Kidney Symptom Index- Disease related Symptoms (FKSI-DRS)
FKSI-DRS score change over time from baseline to disease progression. The scale of FKSI-DRS is from 0-36, and higher scores indicate worse quality of life.
Time frame: Up to 24 months
EuroQol five-dimension scale (EQ-5D)
EQ-5D-5L score change over time from baseline to disease progression. The EQ-5D-5L is consisted of five dimensions of health (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). Higher scores indicate poorer health.
Time frame: Up to 24 months
Visual analogue scale (VAS)
VAS pain score change over time from baseline to disease progression. The scale of VAS is from 0-10, and higher scores indicate worse symptom of pain.
Time frame: Up to 24 months
Frequency of treatment-related adverse events (AEs)
Treatment related adverse events according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
Time frame: Up to 24 months
Perioperative complication rate
Perioperative complications assessed by The Clavien-Dindo Classification
Time frame: From surgery to postoperative 3 months