Efficacy of Sintilimab Combined With Bevacizumab and XELOX/SOX in Initially Unresectable AFP-positive Gastric/Gastroesophageal Junction Adenocarcinoma

Phase 2Not Yet RecruitingNCT07515625

Fudan University46 enrolled

Overview

Alpha-fetoprotein-producing gastric cancer (AFP-positive gastric cancer, AFP-GC), a rare and highly aggressive subtype of gastric cancer, accounts for 1.3% to 15% of all gastric cancer cases. Its clinical features are significantly different from those of common gastric cancer. Not only does it show abnormally elevated serum AFP levels, but it also has a stronger angiogenic ability, a higher rate of distant metastasis, and a poorer prognosis even after a upfront R0 surgery, making it a challenging problem in the field of gastric cancer treatment. Notably, patients with AFP-positive gastric cancer have a relatively low sensitivity to the traditional standard regimens. There is an urgent need to explore targeted treatment strategies to break through the efficacy bottleneck. Combination of sintilimab, bevacizumab and XELOX/SOX for initially unresectable AFP-positive gastric/esophagogastric junction adenocarcinoma could be a novel therapeutic strategy to increase response rate and therapeutic efficacy. This study is a multi-center, single-arm phase 2 clinical trial to evaluate efficacy, tolerability and safety of perioperative sintilimab in combination with bevacizumab and XELOX/SOX in initially unresectable AFP-positive gastric/esophagogastric junction adenocarcinoma.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Gastric Cancer (GC)AFP Gastric or Gastroesophageal Junction Adenocarcinoma

Interventions

SintilimabDRUG

Sintilimab, recombinant humanized anti-PD-1 monoclonal antibody for injection; 200mg iv drip，d1, q3w

BevacizumabDRUG

7.5mg/kg，iv drip，d1, q3w

OxaliplatinDRUG

130mg/m2，iv drip for 2h，d1, q3w

CapecitabineDRUG

1000mg/m2 twice daily, d1-14, q3w

S-1DRUG

40\~60mg Bid，d1\~14, q3w

Eligibility

Sex: ALLMin age: 18 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Signed informed consent; * Patients age 18-75 years; * Histologically CT/MRI confirmed cT3-4N+M0/1 gastric or GEJ adenocarcinoma; (M1 only includes type I liver metastasis of gastric cancer, according to the "Chinese Expert Consensus on Liver Metastasis of Gastric Cancer"); * Serum AFP levels \> 2× upper limit of normal or AFP-positive by IHC staining; * Adequate organ function * ECOG 0-1, no surgery contraindications; * Expected survival ≥3 months; Exclusion Criteria: * HER2-positive status: IHC 3+, or IHC 2+/FISH+ * Prior chemotherapy, radiotherapy, anti-PD-1/PD-L1 therapy, surgery for gastric cancer; * Signs of other distant metastases (e.g., peritoneal, lung, bone, supraclavicular lymph, etc.) * Significant cardiovascular disease --Current treatment with anti-viral therapy or HBV * Pregnancy or breastfeeding * History of malignancy within 5 years prior to screening * Present or history of any autoimmune disease or immune deficiency; * There are active gastric and duodenal ulcers, ulcerative colitis and other gastrointestinal diseases, or active bleeding in unresectable tumors.

Outcomes

Primary Outcomes

Objective response rate(ORR)

Objective response rate(ORR):CR+PR

Time frame: From first dose to end of study treatment or last tumor assessment prior to conversion surgery or disease progression.Up to 24 weeks.

Secondary Outcomes

R0 resection rate

Time frame: From the initiation date of first cycle (each cycle is 21 days) to the date of operation.Up to 24 weeks.

Major pathological response rate

Time frame: From the initiation date of first cycle (each cycle is 21 days) to the date of operation.Up to 24 weeks.

One year progression-free survival (PFS)

Time frame: From the initiation date of first cycle (each cycle is 21 days) to the date of first documented progression or date of death from any cause, whichever came first, assessed up to 1 year.

One year overall survival(OS)

Time frame: The Kaplan-Meier survival from the initiation date of first cycle until death from any cause or the last follow-up date,assessed up to 1 year.