Combination of Toripalimab and Chemoradiotherapy in Esophageal Cancer

Sponsor

Mian XI (Other)

Overall Status

Completed

CT.gov ID

NCT04005170

Collaborator

(none)

Enrollment

Location

Arm

37.2

Actual Duration (Months)

1.1

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Definitive chemoradiotherapy (CRT) is the standard treatment option for unresectable esophageal cancer (EC). However, as high as more than 40% of EC patients experienced locoregional recurrence after concurrent CRT. Immunotherapy targeting the PD-1/PD-L1 checkpoints has demonstrated promising activity in advanced EC. The aim of this study was to evaluate the efficacy and safety of the combination of toripalimab (an anti-PD-1 antibody) combined with definitive CRT in locally advanced esophageal squamous cell carcinoma (ESCC).

Condition or Disease	Intervention/Treatment	Phase
Unresectable Esophageal Cancer	Drug: Toripalimab Drug: Paclitaxel/Cisplatin Radiation: Intensity-modulated radiotherapy	Phase 2

Study Design

Study Type:

Interventional

Actual Enrollment :

42 participants

Allocation:

N/A

Intervention Model:

Single Group Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

A Phase II Trial of Combination of Toripalimab and Definitive Chemoradiotherapy in Esophageal Squamous Cell Carcinoma

Actual Study Start Date :

Jun 25, 2019

Actual Primary Completion Date :

Dec 31, 2020

Actual Study Completion Date :

Jul 31, 2022

Arms and Interventions

Arm	Intervention/Treatment
Experimental: PD-1 group All patients will receive standard fractionation radiation therapy (RT) scheme: 50.4 Gy in 28 fractions over 5-6 weeks, concurrently with 5 cycles of paclitaxel/cisplatin (paclitaxel 50mg/m2 and cisplatin 25 mg/m2) on days 1, 8, 15, 22, 29 and 2 cycles of toripalimab 240 mg on days 1, 22 followed by a maintenance phase of toripalimab IV 240 mg every 3 weeks for up to 1 year.	Drug: Toripalimab Patients received toripalimab 240 mg on days 1 and 22 during radiotherapy followed by a maintenance phase of toripalimab IV 240 mg every 3 weeks for up to 1 year. Other Names: JS-001 Drug: Paclitaxel/Cisplatin Patients received 5 cycles of paclitaxel/cisplatin (paclitaxel 50mg/m2 and cisplatin 25 mg/m2) on days 1, 8, 15, 22, 29 during radiotherapy. Other Names: TP Radiation: Intensity-modulated radiotherapy All patients received external-beam radiation using intensity-modulated radiotherapy. The prescribed dose is 50.4 Gy in 28 fractions over 5-6 weeks. Other Names: IMRT

Arm

Intervention/Treatment

Experimental: PD-1 group

All patients will receive standard fractionation radiation therapy (RT) scheme: 50.4 Gy in 28 fractions over 5-6 weeks, concurrently with 5 cycles of paclitaxel/cisplatin (paclitaxel 50mg/m2 and cisplatin 25 mg/m2) on days 1, 8, 15, 22, 29 and 2 cycles of toripalimab 240 mg on days 1, 22 followed by a maintenance phase of toripalimab IV 240 mg every 3 weeks for up to 1 year.

Drug: Toripalimab

Patients received toripalimab 240 mg on days 1 and 22 during radiotherapy followed by a maintenance phase of toripalimab IV 240 mg every 3 weeks for up to 1 year.

Other Names:

JS-001

Drug: Paclitaxel/Cisplatin

Patients received 5 cycles of paclitaxel/cisplatin (paclitaxel 50mg/m2 and cisplatin 25 mg/m2) on days 1, 8, 15, 22, 29 during radiotherapy.

Other Names:

Radiation: Intensity-modulated radiotherapy

All patients received external-beam radiation using intensity-modulated radiotherapy. The prescribed dose is 50.4 Gy in 28 fractions over 5-6 weeks.

Other Names:

IMRT

Outcome Measures

Primary Outcome Measures

clinical complete response rate [3 months after chemoradiotherapy (plus or minus 14 days)]
Tumor response was evaluated 3 months after the completion of chemoradiotherapy based on CT or PET-CT scans, endoscopy with biopsies.

Secondary Outcome Measures

2-year overall survival [From date of randomization until the date of death from any cause or the date of last follow-up, whichever came first, assessed up to 24 months]
The 2-year overall survival of the whole group
2-year progression-free survival [From date of randomization until the date of death from any cause or the date of first documented disease progression whichever came first, assessed up to 24 months]
The 2-year progression-free survival of the whole group
Duration of response [From date of first CR/PR to the date of first PD according to RECIST criteria, assessed up to 24 months]
Tumor response was evaluated every two months after chemoradiotherapy according to RECIST criteria
Incidence of treatment-related adverse events as assessed by CTCAE v4.0 [From the start of treatment to 2 year after the completion of treatment]
Toxicity of treatment was evaluated according to CTCAE 4.0

Other Outcome Measures

The impact of PD-L1 expression on clinical response [Baseline biopsies of primary tumor in esophagus]
To investigate the impact of programmed cell death-ligand 1 (PD-L1) expression on clinical response
The impact of IDO1 expression on clinical response [Baseline biopsies of primary tumor in esophagus]
To investigate the impact of indoleamine 2,3-dioxygenase 1 (IDO1) expression on clinical response

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years to 70 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Histologically confirmed squamous cell carcinoma of the esophagus;
Absence of hematogenous metastasis disease, confirmed by endoscopic ultrasound (EUS) and PET-CT scan (according to UICC TNM version 8);
Not suitable for surgery (either for medical reasons or patient's choice);
Age at diagnosis 18 to 70 years;
No prior cancer therapy;
Estimated life expectancy >6 months;
Eastern Cooperative Oncology Group performance status ≤ 2
No history of concomitant or previous malignancy;
The function of important organs meets the following requirements: a. white blood cell count (WBC) ≥ 4.0×109/L, absolute neutrophil count (ANC) ≥ 1.5×109/L; b. platelets ≥ 100×109/L; c. hemoglobin ≥ 9g/dL; d. serum albumin ≥ 2.8g/dL; e. total bilirubin ≤ 1.5×ULN, ALT, AST and/or AKP ≤ 2.5×ULN; f. serum creatinine ≤ 1.5×ULN or creatinine clearance rate >60 mL/min;
Ability to understand the study and sign informed consent.

Exclusion Criteria:

Patients who have been treated previously with anti-tumor therapy (including chemotherapy, radiotherapy, surgery, immunotherapy, etc.);
Patients with hematogenous metastasis disease at diagnosis;
Known or suspected allergy or hypersensitivity to monoclonal antibodies, any ingredients of Toripalimab, and the chemotherapeutic drugs paclitaxel or cisplatin;
Patients who have a preexisting or coexisting bleeding disorder;
Female patients who are pregnant or lactating;
Inability to provide informed consent due to psychological, familial, social and other factors;
Presence of CTC grade ≥ 3 peripheral neuropathy;
A history of malignancies other than esophageal cancer before enrollment, excluding non-melanoma skin cancer, in situ cervical cancer, or cured early prostate cancer
A history of diabetes for more than 10 years and poorly controlled blood glucose levels;
Patients who cannot tolerate chemoradiotherapy due to severe cardiac, lung, liver or kidney dysfunction, or hematopoietic disease or cachexia.
Active autoimmune diseases, a history of autoimmune diseases (including but not limited to these diseases or syndromes, such as colitis, hepatitis, hyperthyroidism), a history of immunodeficiency (including a positive HIV test result), or other acquired or congenital immunodeficiency diseases, a history of organ transplantation or allogeneic bone marrow transplantation;
A history of interstitial lung disease or non-infectious pneumonia;
A history of active pulmonary tuberculosis infection within 1 year or a history of active pulmonary tuberculosis infection more than 1 year ago but without formal anti-tuberculosis treatment;
Presence of active hepatitis B (HBV DNA ≥ 2000 IU/mL or 104 copies/mL), hepatitis C hepatitis C antibody, and HCV-RNA levels higher than the lower limit of the assay).