This study aims to investigate the efficacy and safety of neoadjuvant cadonilimab in combination with perioperative SOX chemotherapy, compared to perioperative SOX chemotherapy alone, in patients with diffuse or mixed-type locally advanced gastric or gastroesophageal junction adenocarcinoma. The main questions it seeks to answer are: 1. Is neoadjuvant cadonilimab plus SOX chemotherapy superior to neoadjuvant placebo plus SOX chemotherapy in terms of the pathological complete response (pCR) rate at the time of surgery? 2. To evaluate and compare the 3-year OS rate in patients receiving neoadjuvant cadonilimab plus SOX chemotherapy versus patients receiving placebo plus neoadjuvant SOX chemotherapy regimen. Participants will be divided into two groups: 1. Experimental group: Participants will receive intravenous cadonilimab (10 mg/kg) in combination with the SOX regimen (oxaliplatin 130 mg/m² and S-1, with the initial dose determined based on body surface area). 2. Control group: Participants will receive a placebo in combination with the SOX regimen. After completing 3-4 cycles of treatment, patients in both the experimental and control groups will undergo radical surgery with D2 or D2+ lymphadenectomy. Following surgery, patients will receive 4 cycles of adjuvant SOX chemotherapy at 70% of the standard dosage, administered every 21 days, starting within 3-6 weeks post-surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
668
Cadonilimab: 10 mg/kg, iv, day 1 of every 3 weeks Oxaliplatin: 130 mg/m², iv, day 1 of every 3 weeks S1: 40-60 mg/m², po, day 1-14 of every 3 weeks (BSA \< 1.25 m², 40 mg \* 2/day, 1.25 m² ≤ BSA \< 1.5 m², 50 mg \* 2/day, BSA ≥ 1.5 m², 60 mg \* 2/day)
Placebo: iv, day 1 of every 3 weeks Oxaliplatin: 130 mg/m², iv, day 1 of every 3 weeks S1: 40-60 mg/m², po, day 1-14 of every 3 weeks (BSA \< 1.25 m², 40 mg \* 2/day, 1.25 m² ≤ BSA \< 1.5 m², 50 mg \* 2/day, BSA ≥ 1.5 m², 60 mg \* 2/day)
Gansu Provincial Hospital
Lanzhou, Gansu, China
RECRUITINGLanzhou University Second Hospital
Lanzhou, Gansu, China
RECRUITINGThe First Hospital of Lanzhou University
Lanzhou, Gansu, China
RECRUITINGThe Gastrointestinal Surgery Department, Sun Yat-sen University Cancer Center Gansu Hospital
Lanzhou, Gansu, China
RECRUITINGPathological complete response (pCR) rate
The pCR is defined as no invasive disease within an entirely submitted and evaluated gross lesion, and histologically negative nodes as assessed by BIPR based on Becker regression criteria. pCR rate is defined as the proportion of participants having pCR.
Time frame: From enrollment to surgical treatment, it is expected to require 4 months.
3-year survival rate (3-year OS rate)
3-year OS rate is defined as the proportion of patients alive at 3 years after randomization estimated using the Kaplan-Meier method. Participants without documented death at the time of analysis will be censored at the date of last known alive.
Time frame: 3 years
Major pathological response (MPR) rate
MPR rate by BIPR is defined as the proportion of patients with ≤ 10% residual viable tumor in the resected primary tumor and all resected lymph nodes after completion of neoadjuvant therapy as assessed by BIPR.
Time frame: From enrollment to surgical treatment, it is expected to require 4 months.
Objective response rate (ORR)
ORR is defined as the proportion of patients who had complete response (CR) or partial response (PR) as assessed by BICR per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST v1.1) in all randomized patients with measurable disease at baseline.
Time frame: From enrollment to preoperative imaging evaluation, it is expected to require 3-4 months.
Treatment emergent adverse event
Incidence and severity of TEAEs, including serious adverse events (SAEs) and immune-mediated adverse events (imAEs), with severity determined according to National Cancer Institute-Common Terminology Criteria for Adverse Events Version 5.0 (NCI-CTCAE v5.0).
Time frame: From enrollment to the completion or discontinuation of treatment, an estimated duration of eight months is expected.
Disease control rate (DCR)
DCR is defined as the proportion of patients who had CR, PR or stable disease (SD) as assessed by BICR per RECIST v1.1 in all randomized patients with measurable disease at baseline.
Time frame: From enrollment to preoperative imaging evaluation, it is expected to require 3-4 months.
3-year BICR-assessed disease-free survival (DFS) rate
3-year BICR-assessed DFS rate is defined as the time from the first date of surgery with R0 resection to local or distant recurrence or death due to any cause, whichever occurs first, as determined by BICR during the adjuvant treatment and safety follow-up.
Time frame: 3 years
R0 resection rate
R0 resection rate is defined as the proportion of patients who had no cancer cells could be found at the surgical margins under the microscope, indicating complete removal of the lesion with no residual tumor visible either macroscopically or microscopically.
Time frame: From enrollment to surgical treatment, it is expected to require 4 months.
Surgery-related complications
Surgery-related complications is defined as patients who received surgery within 30 days and experienced any grade surgery-related complications per Clavien-Dindo Classification of Surgical Complications, including vomiting, fever, incision infection, post-operative pneumonia, anastomotic hemorrhage or leakage, chylous leakage, pneumonia, intestinal obstruction, etc,
Time frame: After the completion of surgery, it is expected to take 5 months.
Tumor downstage rate
The tumor downstage rate is defined as the proportion of patients who had overall ypTNM or T or N stage was decreased from cTNM, cT or cN stage at baseline. Tumor stage was evaluated based on baseline cTNM stage and postoperative ypTNM stage according to the 8th edition of the AJCC Gastric Cancer Stage.
Time frame: After the completion of surgery, it is expected to take 4 months.
Programmed death ligand-1 Combined Positive Score (PD-L1 CPS)
PD-L1 expression as the predictive biomarker for efficacy (including but not limited to pCR rate, MPR rate, 3-year OS rate, and 3-year DFS rate). The CPS score ranges from 0 to 100. High levels of PD-L1 expression are usually associated with better responses to immunotherapy, and patients may benefit more from immune checkpoint inhibitors.
Time frame: Baseline
Microsatellite Instability (MSI)
The status of MSI as the predictive biomarker for efficacy (including but not limited to pCR rate, MPR rate, 3-year OS rate, and 3-year DFS rate).
Time frame: Baseline
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