The Combination of Radiotherapy，Surufatinib and Sintilimab in High-Risk Localized Soft Tissue Sarcoma

Phase 2RecruitingNCT05839275

Fudan University52 enrolled

Overview

This is a prospective, single-center, single-arm, phase Ib/II clinical trial. The study aims to evaluate the safety and efficacy of the treatment which combines radiotherapy, Sintilimab (Anti-PD1 Antibody) and Surufatinib (small-molecule Tyrosine Kinase inhibitor) in patients with high-risk localized soft tissue sarcoma. There will be 52 patients with high-risk localized extremity and trunck soft tissue sarcoma recruited. The trail is designed as a two-stage study. In safety lead-in phase (phase Ib), using 3+3 design, 6 cycles of Surufatinib (250mg, 200mg, qd) and Sintilimab (200mg, q3w) will be applied. And radiotherapy (BED=50-60Gy (α/β=10)) will begin in week 4 of the therapy. In extended phase (phase II), Surufatinib will be applied in the recommended phase 2 dose (RP2D) according to phase Ib. And 200mg Sintilimab and radiotherapy will be applied as before. The dose-limiting toxicity (DLT) in phase Ib and objective response rate (ORR) in phase Ib+Phase II will be mainly analyzed.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

High-Risk Localized Soft Tissue Sarcoma

Interventions

Eligibility

Sex: ALLMin age: 18 YearsMax age: 70 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Aged from 18 to 70, with life expectancy more than 2 years * Histologically confirmed STS, G2 or G3 * Has imaging-confirmed localized lesions on the limbs or trunk without distant metastases * Has\>5 cm lesions, or the lesions are determined to be borderline resectable or unresectable by a multidisciplinary consultation. * Experience local recurrence after surgery (disease-free survival more than 2 months after surgery) or primary tumor * ECOG performance status 0-1 * Demonstrate adequate organ function (bone marrow, liver, kidney and clotting function) within 7 days before the first administration without using blood products or hematopoietic stimulating factors. * Fully informed and willing to provide written informed consent for the trial Exclusion Criteria: * The presence of regional or distant metastases detected by imaging evaluation * The following histological types: osteosarcoma, chordoma, classic chondrosarcoma, Kaposi's sarcoma, malignant mesothelioma, radiation-induced sarcomas * History of another primary malignant tumor within the past three years or at the same time (excluding localized basal cell carcinoma, cutaneous squamous cell carcinoma, ductal carcinoma in situ, lobular carcinoma in situ, adenocarcinoma in situ of cervix, or other previous malignant tumor with a disease-free survival of more than 10 years) * Receiving any other chemotherapy or targeted therapy within 4 weeks before enrollment * Prior treatment using anti-PD1 immunotherapy * Prior radiotherapy towards the target lesion or has other contraindications to radiotherapy or surgery * Baseline laboratory indicators do not meet the following criteria: neutrophils ≥1.5×10\^9/L, Hb≥90g/L, PLT≥100×10\^9/L , ALT ≤2.5 ULN, AST ≤2.5 ULN, Cr≤ 1.5 ULN or creatinine clearance rate \<50ml/min, TBIL ≤1.5 ULN, APTT≤1.5 ULN, PT ≤1.5 ULN * Urinary protein ≥ 2+, or 24-hour urine protein ≥1.0g/24h * Uncontrolled hypertension: SBP \>140mmHg or DBP \> 90mmHg * Uncontrolled hyperglycemia or coagulation disorder * Active infection requiring systemic anti-infective therapy * Uncontrolled mental diseases * Previous surgery within 2 weeks of before enrollment (excluding diagnostic biopsy or peripherally inserted central catheter implantation) * History of immunodeficiency diseases or active autoimmune disease requiring systemic treatment * Pregnant or lactating women * Allergic to any component of the therapy

Outcomes

Primary Outcomes

Objective Response Rate (ORR)

The percentage of patients with objective response. Objective response is defined as complete response (CR) or partial response (PR) per response evaluation criteria (RECIST v1.1) before surgery.

Time frame: The objective response rate (ORR) will be evaluated before surgery.

Secondary Outcomes

Pathological Complete Response (pCR) and Near pCR Rate

The proportion of subjects whose pathological response rate of tumor tissue in postoperative specimens is ≥90% after preoperative treatment.

Time frame: The pathologic complete response (pCR) rate will be evaluated from surgical samples, immediately after surgery.

Non-Perfused Volume (NPV)

The changes in tumour volume that are not enhanced in imaging images with contrast agent before and after treatment.

Time frame: The non-perfused volume (NPV) will be measured in four weeks before preoperative treatment and before surgery in week18-21.

Adverse Events

The toxic reactions are evaluated and graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events, Edition 5 (NCI-CTCAE V. 5).

Time frame: From the beginning of treatment to 90 days after the end of the last treatment.

Wound Complications

Postoperative incision healing, with reference to the Canadian study for grading of wound complications.

Time frame: Up to 120 days from the surgery.

Local Control Rate

The proportion of subjects who recurred within the radiotherapy exposure field from the start of treatment to the imaging assessment of all evaluable subjects.

Time frame: From the start of treatment to local recurrence, up to 5 years.

Progression-Free Survival (PFS)

The time from initiation of treatment to PD or death from any cause.

Time frame: Up to 5 years

Overall Survival (OS)

The time from initiation of treatment to death from any cause.

Time frame: Up to 5 years

Quality of Life (QoL) according to the Musculoskeletal Tumor Society (MSTS)

The Musculoskeletal Tumor Society (MSTS) is a measure of physical function across 7 items, including pain, range of motion, strength, joint stability, joint deformity, emotional acceptance, and overall function. Each item is scored from 0(worst) to 5(best) with a maximum possible score of 35, which is converted to a scale from 0 to 100 points

Time frame: Quality of Life (QoL) will be evaluated at least five times: before treatment, at 3, 6, 12 and 24 months respectively after surgery.

Quality of Life (QoL) according to the Toronto Extremity Salvage Score (TESS)

The Toronto Extremity Salvage Score (TESS) is a self-administered questionnaire evaluating possible limitations in physical activity. A total of 30 questions are included in the TESS, and the degree of disability is rated from 0 (complete disability) to 5 (no functional impairment) in each item

Time frame: Quality of Life (QoL) will be evaluated at least five times: before treatment, at 3, 6, 12 and 24 months respectively after surgery.

Quality of Life (QoL) according to the Short Form (SF)-36 questionnaires

The Short Form (SF)-36 questionnaires is a 36-item health survey status which is composed of the following eight domains: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. Each of these domains can be rated from 0 (worst) to 100 (best). The final SF-36 score is converted to a 0-100 points range scale

Time frame: Quality of Life (QoL) will be evaluated at least five times: before treatment, at 3, 6, 12 and 24 months respectively after surgery.

The Combination of Radiotherapy，Surufatinib and Sintilimab in High-Risk Localized Soft Tissue Sarcoma

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts