Precision Treatment of Recurrent/Metastatic Salivary Gland Carcinoma Guided by Molecular Typing

Peking Union Medical College

Status and phase: Enrolling; Phase 2

Conditions: Precision Therapy; Salivary Gland Carcinoma

Treatments: Drug: CDK4/6 inhibitor+AI or fulvestrant; Drug: Cohort 1 (HER2-positive, RC48-ADC); Drug: Cohort 2 (NTRK-fusion or NTRK-mutant); Drug: ivonescimab + investigator-choice platinum doublet+; Drug: HER2,trastuzumab deruxtecan± pertuzumab; Drug: iparomlimab + tuvonralimab; Drug: alpelisib+fulvestrant; Drug: TKI; Drug: enfortumab vedotin; Drug: AR,darolutamide + goserelin+pertuzumab/trastuzumab; Drug: Albumin-paclitaxel + carboplatin + apatinib + camrelizumab; Drug: cadonilimab; Drug: Albumin-paclitaxel + platinum; Drug: albumin-bound paclitaxel+trastuzumab+pyrotinib; Drug: AR,darolutamide +goserelin +docetaxel; Drug: Cohort 3 (AR-positive, leuprolide + bicalutamide + abiraterone); Drug: TROP2 ADC; Drug: PARP inhibitor; Drug: HER2, pyrotinib + pertuzumab/trastuzumab

Study type: Interventional

Funder types: Other

Identifiers

NCT06145308

NCC4132

Details and patient eligibility

About

Patients with salivary gland carcinoma were divided into groups according to HER2, NTRK, AR, TROP-2, etc. Patients in different groups were given precision targeted therapy or chemotherapy to evaluate the efficacy (ORR rate) and safety of precision therapy.

Full description

Patients with locally advanced/recurrent or oligometastatic salivary gland carcinoma will be stratified by HER2, NTRK, AR, TROP-2, etc., and receive precision-targeted or chemotherapy regimens, with efficacy (objective response rate, etc.) and safety of neoadjuvant/conversion therapy evaluated.

To assess the efficacy of post-operative adjuvant therapy guided by minimal residual disease (MRD) testing in locally advanced salivary gland carcinoma.

Patients with locally advanced/recurrent or symptomatic, rapidly progressive metastatic salivary gland carcinoma who are intolerant of or refuse surgery and radiotherapy will be molecularly stratified and treated with precision regimens, with efficacy (objective response rate, etc.) and safety of salvage therapy evaluated.

To evaluate efficacy (objective response rate, etc.) and safety of later-line therapy for locally advanced/recurrent or distant metastatic salivary gland carcinoma.

Using multi-omic approaches to explore salivary gland carcinoma heterogeneity and biomarkers associated with recurrence, metastasis, treatment response and prognosis.

To investigate concordance between drug-sensitivity testing using ex-vivo 3D tumour models and actual clinical outcomes, and to guide later-line treatment selection based on drug-sensitivity results.

Enrollment: 39 estimated patients

Sex: All

Ages: 18 to 100 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients with histopathologic diagnosis of salivary gland carcinoma

  • The tumor tissues were subjected to HER2/NTRK/AR/TROP-2 immunohistochemical staining.

    • ECOG physical status 0 or 1 score in the 3 days before the first medication of the study treatment;

      • Age 18 or older - no upper limit;

        • Life expectancy is more than 3 months; ⑥Have at least one measurable lesion according to RECIST1.1 standards; ⑦Women of childbearing age must have a negative pregnancy test within 7 days before the first medication, and agree to receive the necessary contraceptive measures;

          ⑧The patient must have adequate liver, kidney, bone marrow, heart and lung and other organ functions:

          ⑨Understanding and voluntarily signing informed consent prior to performing any research-related evaluation/operation;

          ⑩Ability to comply with research visit schedules and other programmatic requirements.

Exclusion criteria

• Known hypersensitivity or delayed anaphylaxis to any agents in this trial;

  • Major surgery had been performed within 4 weeks prior to the start of the study and did not fully recover;

    • Have received a live vaccine within 4 weeks before the start of the study or plan to receive any vaccine during the study period ;

      • To study the occurrence of arterial/venous thrombosis events within 6 months before medication;

        • Major cardiovascular diseases;

          • Is suffering from uncontrolled systemic diseases, including diabetes, hypertension, pulmonary fibrosis, acute lung disease, interstitial lung disease, cirrhosis, etc.;

            • Is suffering from an active infection that requires systemic treatment;

              • History of active tuberculosis; ⑨ Positive human immunodeficiency virus (HIV) test result; ⑩ Patients with chronic hepatitis B or active hepatitis C. ⑪Conditions that the investigator believes will affect the safety or compliance of the drug therapy in this study ⑫Female/male who is pregnant or breastfeeding or who intends to give birth;

Trial design

Primary purpose: Treatment

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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39 participants in 19 patient groups

Cohort 1 (HER2-positive, RC48-ADC)

Experimental group

Description:

Disitamab vedotin 2.5 mg/kg will be administered as an intravenous infusion every 2 weeks (Q2W) as monotherapy, or in combination with physician-selected platinum-based chemotherapy (carboplatin 200-250 mg/m² IV Q2W or cisplatin 50 mg/m² IV Q2W).

Treatment:

Drug: Cohort 1 (HER2-positive, RC48-ADC)

Cohort 2 (NTRK-fusion or NTRK-mutant)

Experimental group

Description:

larotrectinib 100 mg orally twice daily or entrectinib 600 mg orally once daily;

Treatment:

Drug: Cohort 2 (NTRK-fusion or NTRK-mutant)

Cohort 3 (AR-positive, leuprolide + bicalutamide + abiraterone)

Experimental group

Description:

leuprolide 3.75 mg subcutaneously every 4 weeks, bicalutamide 50 mg orally once daily, and abiraterone 1 000 mg orally once daily.

Treatment:

Drug: Cohort 3 (AR-positive, leuprolide + bicalutamide + abiraterone)

Cohort 4 (TROP2 ADC)

Experimental group

Description:

ESG401 16 mg/kg IV (days 1, 8, 15, q4w), sacituzumab govitecan 10 mg/kg IV (days 1 \& 8, q3w), or sacituzumab tirumotecan 5 mg/kg IV q2w.

Treatment:

Drug: TROP2 ADC

Cohort 5 (ACC-TKI)

Experimental group

Description:

apatinib 250 mg qd po or anlotinib 12 mg

Treatment:

Drug: TKI

Cohort 6 (albumin-bound paclitaxel + platinum)

Experimental group

Description:

albumin-bound paclitaxel 260 mg/m² IV q3w plus physician-selected cisplatin 75 mg/m² IV q3w or carboplatin 350 mg/m² IV q3w.

Treatment:

Drug: Albumin-paclitaxel + platinum

Cohort 7 (albumin-bound paclitaxel + carboplatin + apatinib + camrelizumab)

Experimental group

Description:

albumin-bound paclitaxel 260 mg/m² IV q3w, carboplatin 350 mg/m² IV q3w, camrelizumab 200 mg IV q3w, and apatinib 250 mg qd po.

Treatment:

Drug: Albumin-paclitaxel + carboplatin + apatinib + camrelizumab

Cohort 8 (HER2-positive, albumin-bound paclitaxel + trastuzumab + pyrotinib)

Experimental group

Description:

albumin-bound paclitaxel 260 mg/m² + trastuzumab (loading 8 mg/kg → 6 mg/kg IV q3w) + pyrotinib 400 mg PO qd.

Treatment:

Drug: albumin-bound paclitaxel+trastuzumab+pyrotinib

Cohort 9 (HER2-positive, DS-8201 ± pertuzumab)

Experimental group

Description:

trastuzumab deruxtecan 5.4 mg/kg IV q3w ± pertuzumab (loading 840 mg → 420 mg IV q3w).

Treatment:

Drug: HER2,trastuzumab deruxtecan± pertuzumab

Cohort 10 (HER2+/AR+, darolutamide + goserelin + pertuzumab + trastuzumab)

Experimental group

Description:

darolutamide 600 mg PO bid + goserelin 10.8 mg SC q12w + pertuzumab/trastuzumab loading 15 mL → 10 mL SC q3w.

Treatment:

Drug: AR,darolutamide + goserelin+pertuzumab/trastuzumab

Cohort 11 (AR-positive, darolutamide + goserelin + docetaxel)

Experimental group

Description:

darolutamide 600 mg PO bid + goserelin 10.8 mg SC q12w + docetaxel 75 mg/m² IV q3w.

Treatment:

Drug: AR,darolutamide +goserelin +docetaxel

Cohort 12 (ivonescimab)

Experimental group

Description:

ivonescimab 20 mg/kg + investigator-choice platinum doublet (albumin-paclitaxel 260 mg/m², liposomal paclitaxel 175 mg/m², docetaxel 75 mg/m², or vinorelbine 25 mg/m² d1,d8) plus cisplatin 75 mg/m² or carboplatin AUC 5-6 IV q3w.

Treatment:

Drug: ivonescimab + investigator-choice platinum doublet+

Cohort 13 (iparomlimab + tuvonralimab)

Experimental group

Description:

iparomlimab 5 mg/kg + platinum doublet (as above) ± bevacizumab 5 mg/kg IV q3w.

Treatment:

Drug: iparomlimab + tuvonralimab

Cohort 14 (cadonilimab)

Experimental group

Description:

cadonilimab 10 mg/kg + platinum doublet (as above) ± bevacizumab 5 mg/kg IV q3w.

Treatment:

Drug: cadonilimab

Cohort 15 (HR-positive)

Experimental group

Description:

CDK4/6 inhibitor (abemaciclib 150 mg PO bid or palbociclib 125 mg PO qd) plus AI (letrozole 2.5 mg, anastrozole 1 mg, or exemestane 20 mg PO qd) or fulvestrant 500 mg IM q4w

Treatment:

Drug: CDK4/6 inhibitor+AI or fulvestrant

Cohort 16 (PI3K-mutant)

Experimental group

Description:

alpelisib 300 mg PO qd plus fulvestrant 500 mg IM q4w.

Treatment:

Drug: alpelisib+fulvestrant

Cohort 17 (homologous-recombination-deficient)

Experimental group

Description:

PARP inhibitor (olaparib 300 mg PO bid, niraparib 300 mg PO qd, fluzoparib 150 mg PO bid, or pamiparib 60 mg PO bid).

Treatment:

Drug: PARP inhibitor

Cohort 18 (Nectin-4 ADC)

Experimental group

Description:

enfortumab vedotin 1.25 mg/kg IV d1,d8,d15 (max 125 mg) ± ICI (pembrolizumab 200 mg, camrelizumab 200 mg, or toripalimab 240 mg IV q3w).

Treatment:

Drug: enfortumab vedotin

Cohort 19 (HER2-positive, pyrotinib + pertuzumab + trastuzumab)

Experimental group

Description:

pyrotinib 400 mg PO qd + pertuzumab/trastuzumab loading 15 mL → 10 mL SC q3w.

Treatment:

Drug: HER2, pyrotinib + pertuzumab/trastuzumab