This prospective, single-arm, exploratory multicenter clinical study aims to investigate the safety and efficacy of Becotatug vedotin combined with Pucotenlimab (with or without radiotherapy), followed by Pucotenlimab maintenance therapy, in patients with driver gene-negative (e.g., EGFR, ALK, ROS1), EGFR-overexpressing non-small cell lung cancer (NSCLC). Study Population: The study targets patients with driver gene-negative (EGFR, ALK, ROS1, and other actionable targets) non-squamous and squamous NSCLC. All subjects (regardless of smoking history) must provide testing reports for EGFR, ALK, and ROS1. If no prior report exists, baseline biopsy or submission of archived tissue for assessment of driver gene status (via local or central laboratory) is mandatory. Additionally, eligible patients must have an immunohistochemistry (IHC)-confirmed EGFR expression level of 2+ or higher, be previously untreated with systemic therapy for stage IV NSCLC, have measurable lesions, show no active central nervous system metastases or uncontrolled autoimmune diseases, and voluntarily sign the informed consent form. Treatment Regimen: Subjects meeting the inclusion/exclusion criteria will receive the following treatment regimen: Pucotenlimab (HX008): Administered from Cycle 1 to Cycle 4 at a dose of 3 mg/kg (maximum 200 mg), once every 3 weeks on Day 1 (D1). Intravenous infusion (60 ± 15 minutes; first cycle infusion duration not less than 60 minutes). Becotatug vedotin (MRG003): Administered from Cycle 1 to Cycle 4 at a dose of 2.0 mg/kg, once every 3 weeks on D1. Administration begins at least 30 minutes after the completion of Pucotenlimab infusion. Intravenous infusion (60 ± 10 minutes; first cycle infusion duration not less than 60 minutes). Radiotherapy: Investigators may opt to include sequential radiotherapy based on tumor size, number, location, extent of invasion, and individual patient factors. Radiotherapy options are as follows: Target Volume: Radiotherapy commences 2 weeks (±7 days) after the completion of Cycle 4 treatment, targeting only the primary tumor or specific 1-2 metastatic lesions. Fractionation and Dosage: Conventional Fractionation Group: Applicable for larger target volumes (\>5 cm diameter) or involvement of mediastinal lymph nodes. Total dose: 45-60 Gy; single fraction dose: 1.8-2.0 Gy; administered once daily (Qd). Stereotactic Body Radiotherapy (SBRT) Group: Applicable for oligometastatic lesions (≤3 lesions, each ≤3 cm diameter). Total dose: 30-50 Gy delivered in 3-5 fractions; single fraction dose: 6-10 Gy. Maintenance Therapy: Pucotenlimab (HX008) monotherapy until disease progression (defined by RECIST 1.1), investigator-assessed radiographic progression, unacceptable toxicity, withdrawal of consent, or fulfillment of criteria for discontinuation of intervention.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
39
Administered from Cycle 1 to Cycle 4 at a dose of 3 mg/kg (maximum 200 mg), once every 3 weeks on Day 1 (D1). Intravenous infusion (60 ± 15 minutes; first cycle infusion duration not less than 60 minutes). Maintenance Therapy: Pucotenlimab monotherapy until disease progression (defined by RECIST 1.1), investigator-assessed radiographic progression, unacceptable toxicity, withdrawal of consent, or fulfillment of criteria for discontinuation of intervention.
Administered from Cycle 1 to Cycle 4 at a dose of 2.0 mg/kg, once every 3 weeks on D1. Administration begins at least 30 minutes after the completion of Pucotenlimab infusion. Intravenous infusion (60 ± 10 minutes; first cycle infusion duration not less than 60 minutes).
Investigators may opt to include sequential radiotherapy based on tumor size, number, location, extent of invasion, and individual patient factors.
Anhui Provincial Cancer Hospital
Hefei, Anhui, China
Objective Response Rate
ORR is defined as the proportion of subjects achieving confirmed CompleteResponse (CR) or Partial Response (PR) as assessed by the investigator according to RECISTV1.1 and iRECIST criteria. ORR analysis will be based on the Full Analysis Set (FAS)
Time frame: up to 2 years
Disease Control Rate
rerese control ete o dfined r ts roprte s suhiect seser o theStable Disease (SD) (lasting for at least 6 weeks from the first dose), along with the exact 95% CIIsing the Clopper-Pearson method.
Time frame: up to 2 years
Progression-Free Survival
: Progression-Free Survival (PFS) is defined as the time from enrollment to the firstoccurrence of disease progression or death from any cause. For subjects without observedprogression or death, PFS will be censored at the time of the last valid and adequate assessment.FS analysis will be based on the FAS. The median PFS and its 95% CI will be estimated using theKaplan-Meier method, and progression-free survival curves will be generated.
Time frame: up to 2 years
Overall Survival
Overall Survival (OS) is defined as the time from enrollment to death from any causeFor subjects not followed up to death, OS will be censored at the time of the last valid survival ollow-up. Based on the FAS, the median OS (if applicable) and its 95% CI will be estimated using the Kaplan-Meier method, and survival curves will be plotted.
Time frame: up to 2 years
.Duration of Response
:Duration of Response (DOR) is defined as the time from the first documentedevidence of response (PR or CR according to RECIST v1.1 and iRECIST criteria, whichever is later)to the first documented disease progression (PD) or death from any cause, whichever occurs first,in subjects with a confirmed response. For subjects without observed progression or death, DORvill be censored at the time of the last adequate tumor assessment. DOR analysis will beperformed on subjects who achieve CR or PR. The median DOR and its 95% CI will be estimatedIsing the Kaplan-Meier method, and duration of response curves will be generated.
Time frame: up to 2 years
Safety Endpoints
Incidence of adverse events (AEs), serious adverse events (SAEs), treatment-related adverse events (TRAEs), and immune-related adverse events (irAEs); severity grading; and laboratory abnormalities, assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 6.0.
Time frame: up to 2 years
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