Cardenilimab Combined With Lenvatinib in Patients With Perioperative Resectable Clear Cell Renal Cell Carcinoma.

Jilin University

Status and phase: Not yet enrolling; Phase 2

Conditions: Resectable Clear Cell Carcinoma of the Kidney

Treatments: Drug: cardonilizumab combined with renvastinib

Study type: Interventional

Funder types: Other

Identifiers

NCT06574412

2024-HS-091

Details and patient eligibility

About

This study is a single-arm, single-center, phase II clinical study. The main purpose is to evaluate the perioperative efficacy and safety of cardenilimab combined with lenvatinib in patients with resectable clear cell renal cell carcinoma. This study included a screening period, a treatment period, and a follow-up period. After completing the examination and assessment during the screening period, qualified subjects will enter the study treatment period after signing the informed consent form. Subjects should receive induction therapy and maintenance therapy in accordance with the protocol until there is disease progression on imaging as judged by the investigator based on RECIST 1.1 standards, intolerable toxicity, or the subject voluntarily requests to terminate study treatment or withdraws information. Agree, or the researcher determines that treatment needs to be terminated. (1) Primary research endpoint: Objective response rate (ORR) of primary tumor according to RECIST 1.1 criteria (2) Secondary research endpoint: 1. According to RECIST 1.1, as assessed by the investigator: (1) Progression-free survival (Progress Free Survival, PFS); (2) Overall survival (OS); 2. Type, incidence and severity of adverse events (AE) and serious adverse events (SAE) assessed in accordance with NCI-CTCAE 5.0 . 3. Pathological response rate (MPR), R0 resection rate 4. Based on Quality of Life QoL score.

Enrollment: 30 estimated patients

Sex: All

Ages: 18 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Male or female patients: 18-75 years old;
2. ECOG physical condition score: 0~2 points;
3. Histologically confirmed resectable non-metastatic clear cell carcinoma of the kidney (TNM staging criteria for renal carcinoma);
4. Expected survival ≥12 weeks;
5. Have not received systemic anti-tumor therapy before;
6. Major organ function is normal, that is, relevant examination indicators within 14 days before randomization meet the following requirements: 1) Blood routine examination: a) hemoglobin ≥90 g/L (no blood transfusion within 14 days); b) Neutrophil count ≥1.5×109/L; c) Platelet count ≥100×109/L; 2) Biochemical examination: a) Total bilirubin ≤ 1.5×ULN (upper limit of normal value); b) Serum glutamic-pyruvic aminotransferase (ALT) or serum glutamic-oxalic aminotransferase (AST) ≤ 2.5×ULN; If there is liver metastasis, ALT or AST ≤ 5×ULN; c) Serum creatinine <1.5 times the upper limit of normal; Endogenous creatinine clearance ≥ 50 ml/min (Cockcroft-Gault formula); 3) Routine coagulation test: a) International Standardized ratio (INR) or prothrombin time (PT) ≤1.5 X ULN. b) Activated partial thromboplastin time (APTT) ≤1.5 x ULN. 4) Cardiac Doppler ultrasound assessment: left ventricular ejection fraction (LVEF) ≥ 50%.
7. Women of childbearing age must undergo a pregnancy test (serum or urine) within 7 days prior to inclusion, with a negative result, and be willing to use an appropriate method of contraception during the test period and for 8 weeks after the last dose of the test drug. For men, consent to use appropriate methods of contraception or surgical sterilization during the trial period and within 8 weeks after the last dose of the trial drug;
8. The subjects voluntarily joined the study and signed the informed consent, with good compliance and follow-up.

Exclusion criteria

1. Other malignancies diagnosed within 5 years prior to administration, excluding radical basal cell carcinoma of the skin, squamous cell carcinoma of the skin, and/or radical resection of carcinoma in situ. If another malignant tumor or lung cancer is diagnosed more than 5 years before administration, pathological or cytological diagnosis of recurrent lesions is required.
2. Currently participating in an interventional clinical study or receiving other drugs or investigational devices within 4 weeks prior to initial dosing;
3. Previous treatment with anti-PD-1, anti-PD-L1 or anti-PD-L2 drugs or drugs that target another stimulus or synergistically inhibit T cell receptors (e.g. CTLA-4, OX-40, CD137);
4. Received immunomodulatory drugs (thymosin, interferon, interleukin, etc.) within 2 weeks before the first dose, or received major surgical treatment within 3 weeks before the first dose;
5. Have a history of bleeding, any bleeding event with a severity rating of CTCAE5.0 or higher occurring within 4 weeks prior to screening;
6. Received solid organ or blood system transplantation;
7. Clinically uncontrolled active infections, including but not limited to acute pneumonia;
8. History of idiopathic pulmonary fibrosis, institutional pneumonia (such as bronchiolitis obliterans), and drug-related pneumonia;
9. Uncontrolled or symptomatic hypercalcemia; 10.III-IV and congestive heart failure (New York Heart Association classification), poorly controlled and clinically significant arrhythmias;
10. Known allergic reactions to PD-1 monoclonal antibody, albumin paclitaxel, carboplatin active ingredients and/or any excipients;
11. An active autoimmune disease requiring systemic treatment (e.g. with disease-modifying drugs, corticosteroids, or immunosuppressants) has occurred within 2 years prior to first administration. Replacement therapies (such as thyroxine, insulin, or physiological doses of corticosteroids for adrenal or pituitary insufficiency) are not considered systemic；
12. Patients requiring long-term systemic use of corticosteroids. Patients with COPD or asthma requiring intermittent use of bronchodilators, inhaled corticosteroids, or local injections of corticosteroids could be enrolled；
13. Wounds that have not healed for a long time or fractures that have not healed completely;
14. Have an active infection requiring treatment or have used systemic anti-infective drugs within 1 week prior to first dosing;
15. Arterial thrombotic events, such as cerebrovascular accidents (including transient ischemic attacks), myocardial infarction, and unstable angina pectoris, occurred within 6 months before screening;
16. Known history of human immunodeficiency virus (HIV) infection (i.e., HIV1/2 antibody positive);
17. Untreated active hepatitis B; Note: Hepatitis B subjects who meet the following criteria are also eligible for inclusion: HBV viral load must be < 1000 copies /ml (200IU/ml) prior to initial dosing, and subjects should receive anti-HBV therapy to avoid viral reactivation throughout the duration of study chemotherapy drug treatment. For subjects with anti-HBC (+), HBsAg (-), anti-HBS (-), and HBV viral load (-), prophylactic anti-HBV therapy is not required, but close monitoring of viral reactivation is required.
18. Active HCV-infected subjects (HCV antibody positive and HCV-RNA levels above the lower limit of detection)
19. Those who have a history of psychotropic drug abuse and cannot quit or have mental disorders;
20. Have received live vaccine within 30 days prior to the first dose;Note: Injectable inactivated virus vaccine against seasonal influenza is permitted; However, live attenuated influenza vaccines administered intranasally are not permitted.
21. There is a medical history, illness, treatment, or abnormal laboratory result that could interfere with the test results or prevent the subject from fully participating in the study, or the investigator believes that participation in the study is not in the subject's best interest.

Trial design

Primary purpose: Treatment

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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30 participants in 1 patient group

Neoadjuvant -surgery-adjuvant therapy group

Experimental group

Description:

Preoperative: Cardenilimab was administered at a dose of 10 mg/kg intravenously once daily, with one cycle every 21 days, for a total of 4 cycles. Lenvatinib was prescribed as follows: for patients weighing less than 60 kg, 8 mg was given orally once daily for 4 cycles; for those weighing more than 60 kg, 12 mg was administered orally once daily for a total of 4 cycles. Surgery: The patient underwent standard radical nephrectomy 30 to 40 days after completing the 4 cycles of lenvatinib treatment. Postoperative: Cardenilimab was continued at a dose of 10 mg/kg intravenously once daily, with one cycle every 21 days, for a total of 8 cycles. Lenvatinib dosing postoperatively was as follows: for patients weighing less than 60 kg, 8 mg was given orally once daily for a total of 8 cycles; for those weighing more than 60 kg, 12 mg was administered orally once daily for a total of 8 cycles.

Treatment:

Drug: cardonilizumab combined with renvastinib