This is a multicenter, open-label, prospective, randomized controlled Phase II clinical study. All eligible subjects will be randomly assigned in a 1:1 ratio to either the triple therapy group or the double therapy group. Triple therapy group: Subjects will receive Thymalfasin in combination with Regorafenib and Tislelizumab until iCPD is achieved per iRECIST (progressive disease (PD) per iRECIST), or until an intolerable toxicity occurs; Double therapy group: Subjects will receive Regorafenib and Tislelizumab until iCPD is achieved per iRECIST (PD per iRECIST), or until an intolerable toxicity occurs.
Assuming the following hypotheses: H0: The mPFS of the test group minus the mPFS of the control group equals 0 H1: The mPFS of the test group minus the mPFS of the control group does not equal 0 Assuming an mPFS of 5.0 months for the test group and 1.8 months for the control group, with a two-sided alpha level of 0.05 and 80% power, at least 32 events need to be observed. Within a 9-month enrollment period and a total study duration of 15 months, 44 subjects need to be enrolled to achieve this. Considering an additional dropout rate of 15%, 26 subjects per group are required, totaling 52 subjects (using PASS 2023 Log-rank procedure). Enrollment sites: Beijing Friendship Hospital, Capital Medical University, Peking Union Medical College Hospital, Peking University People's Hospital. Allocation of enrollment across sites: Each site will compete for enrollment, with each site enrolling no less than 14 subjects. 1. Regorafenib: Start at 80 mg once daily, orally, taken at a fixed time for 2 consecutive weeks and then stopped for 1 week. If the patient tolerates it well, increase to 120 mg/d in Cycle 2. 2. Tislelizumab: 200 mg, iv.gtt, single infusion, 21 days as a cycle, Day 1. 3. Thymalfasin: 4.8 mg, administered subcutaneously twice weekly. Treatment will continue until disease progression or until an intolerable adverse reaction occurs that does not resolve despite dose modification.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
52
Thymalfasin: 4.8 mg, administered subcutaneously twice weekly.
Regorafenib: Start at 80 mg once daily, orally, taken at a fixed time for 2 consecutive weeks and then stopped for 1 week. If the patient tolerates it well, increase to 120 mg/d in Cycle 2.
Tislelizumab: 200 mg, iv.gtt, single infusion, 21 days as a cycle, Day 1.
Beijing Friendship Hospital, Capital Medical University
Beijing, China, China
RECRUITINGProgression-free survival (PFS)
Time from day of randomization to the date of documented tumor progression or death due to any cause
Time frame: 48 WEEKS
18-week PFS rate
Proportion of patients without disease progression or death at 18 weeks after starting the study treatment.
Time frame: 18 weeks
Objective response rate (ORR)
Proportion of patients with tumor size reduction of a predefined amount and maintaining for a certain time period, ORR = CR + PR
Time frame: 48 WEEKS
Disease control rate (DCR)
Proportion of patients with tumor control with tumor size reduction of a predefined amount and maintaining for a certain time period, DCR = CR + PR + SD
Time frame: 48 WEEKS
Overall survival (OS)
Time from day of randomization to death due to any cause.
Time frame: 3 Years
1-year OS rate
Proportion of patients alive at 1 year after starting the study treatment.
Time frame: 48 WEEKS
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