D-BACE plus chemotherapy and camrelizumab for resectable stage II–IIIA and potentially resectable T3–4N2 IIIB non-small cell lung cancer

D-BACE in Combination With Chemotherapy and Carelizumab for Resectable II-IIIA or Potentially Resectable T3-4N2 Stage IIIB NSCLC

This study will see if adding D-BACE (drug-eluting bead bronchial arterial chemoembolization) to standard neoadjuvant chemotherapy and camrelizumab helps adults with resectable stage II–IIIA or potentially resectable T3–4N2 IIIB NSCLC respond better before surgery.

Quick facts

• Phase: PHASE3
• Study type: Interventional
• Enrollment: 70 (estimated)
• Ages: 18 Years to 75 Years
• Sex: All
• Sponsor: Guangdong Provincial People's Hospital (other)
• Drugs / interventions: chemotherapy, immunotherapy, carelizumab, camrelizumab
• Locations: 1 site (Guangzhou, Guangdong)
• Trial ID: NCT07016126 on ClinicalTrials.gov

What this trial studies

This is a single-arm, single-center phase II trial enrolling 70 untreated patients with resectable stage II–IIIA or potentially resectable T3–4N2 IIIB NSCLC. Participants receive three cycles of D-BACE using epirubicin-loaded microspheres (50 mg) combined with investigator-selected platinum-containing doublet chemotherapy and camrelizumab. Adverse events will be recorded and graded by NCI CTCAE v5.0, and tissue and blood samples will be collected during treatment for translational biomarker studies.

Who should consider this trial

Good fit: Adults aged 18–75 with untreated, measurable, resectable stage II–IIIA or potentially resectable T3–4N2 IIIB NSCLC, ECOG 0–1, and available tumor tissue for PD-L1 and biomarker testing are eligible.

Not a fit: Patients with significant comorbidities that affect clinical status, unresectable disease, prior systemic therapy for this cancer, or who cannot tolerate intra-arterial procedures may not receive benefit from this approach.

Why it matters

Potential benefit: If successful, the regimen could increase tumor shrinkage and improve the chance of complete surgical resection or a better pathological response.

How similar studies have performed: Neoadjuvant PD-1 inhibitors combined with chemotherapy have shown promising results in resectable NSCLC, but the combination of D-BACE with chemotherapy and PD-1 blockade is relatively novel with limited prior data.

Eligibility criteria

Inclusion Criteria:

Only patients who met all the following criteria were eligible for inclusion in the study:

Provide written informed consent Male or female, aged 18-75 years Eastern Cooperative Oncology Group performance status ≤1 Measurable lesions in accordance with RECIST, version 1.1 Subjects must be able to provide a specimen containing tumor tissue or have a biopsy sample of newly resected tumor tissue available PD-L1 IHC testing was performed at a central laboratory during the screening phase

1. Before treatment, formalin-fixed, paraffin-embedded (FFPE) tissue blocks or non-stained tumor tissue sections and relevant pathology reports must be submitted for biomarker assessment. Tumor-tissue specimens could be fresh or archived within 6 months before enrollment.
2. The tissue must be core needle biopsy section, excisional biopsy section or open biopsy section;
3. It is recommended that fresh paraffin sections (PD-L1 assays be performed within 7 days of sectioning) slides be stored and transported in the dark
4. It is recommended that fresh tissue be fixed in 10% neutral buffered formalin for 24 to 48 hours The patient's lung function or other organ function was evaluated by the surgeon to tolerate local surgical treatment.

Adequate organ function assessment and laboratory screening should be performed within 7 days of initiation of therapy

Reproductive status:

1. A negative pregnancy test (serum or urine) in a woman of childbearing age within 72 hours before the start of treatment
2. women were non-lactating
3. For female patients, appropriate contraception should be used during treatment and for 6 months after the last dose of treatment (i.e., the time required for the 30-day ovulation cycle + the 5 half-lives of the drug).
4. Male subjects must agree to use appropriate contraception during treatment and for 7 months after the last dose of treatment (i.e., the duration of 90-day sperm turnover + 5 half-lives of the drug).

And male subjects had to be willing to avoid donating sperm during this period.

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Exclusion Criteria:

Medical conditions Stage I, IIIB/IIIC (N3), and stage IV NSCLC patients with previous ICIs immunotherapy, targeted therapy, chemotherapy, and other systemic antitumor therapies were excluded.

Patients with allergy to contrast media were not eligible. Patients were excluded if their tumors had targeted alterations in EGFR and/or ALK or were known to have targeted alterations in ROS1, BRAF, HER-2, NTRK, MET, or RET. K-RAS mutations could be enrolled.

Active known or suspected autoimmune disease Participants were eligible if they had type I diabetes, hypothyroidism requiring only hormone-replacement therapy, skin conditions (e.g., vitiligo, psoriasis, or alopecia) that did not require systemic treatment, or other conditions that were not expected to recist in the absence of an external trigger.

Patients with active hepatitis B (positive hepatitis B surface antigen HBsAg test) or hepatitis C (positive HCV RNA test) Patients with previous HBV infection or a decommissioned HBV infection (defined as positive for the hepatitis B core antibody HBcAb and negative for HBsAg) were eligible to participate. Patients were required to provide HBV DNA test results before enrollment, and participants who were HBV carriers or required antiviral therapy were not eligible. Patients who tested positive for HCV antibodies could participate in the study only if they had negative PCR results for HCV RNA.

Any history of arterial thrombosis within 6 months of human immunodeficiency virus (HIV) -positive or acquired immunodeficiency syndrome (AIDS), History of deep vein thrombosis, pulmonary embolism, or any other major thromboembolism within 3 months uncontrolled angina, arrhythmia, or congestive heart failure within 5 years other active malignancy (except adequately treated carcinoma in situ of the cervix or basal cell or squamous cell skin cancer, superficial bladder cancer, or prostate cancer, breast cancer in situ) Patients with contraindications to local treatment (including surgery or intervention) as judged by the investigator.

Serious or uncontrolled medical illness The patient has psychosis or other medical conditions that result in treatment nonadherence History of severe hypersensitivity reactions to other monoclonal antibodies Patients who are unwilling to sign informed consent forms Patients who do not want follow-up Physical and laboratory tests Laboratory screening values must exclude the following criteria (CTCAE version 5 applies)

1. Bone marrow function:

   White blood cell count \< 2000/uL, neutrophil \< 1500/uL, platelet \< 100×103/Ul, hemoglobin \< 9.0g/dL
2. Liver function:

   1. Serum total bilirubin \> 1.5 times the upper limit of normal value (ULN);
   2. In the case of liver metastases, AST and ALT were \> 5×ULN and total bilirubin \> 1.5ULN
3. Coagulation function:

   Abnormal coagulation function was defined as international normalized ratio (INR) or prothrombin time (PT) \> 1.5 times ULN; If the subject was receiving anticoagulant therapy, PT was outside the intended use of anticoagulant drugs.
4. Renal function:

Urinary protein \> 2+, or 24-hour urinary protein ≥1g; Serum creatinine \> 1.5×ULN or calculated creatinine clearance (CrCl) \< 50ml/min (using Cockcroft-Gault formula) Female CrCL=(\[140-age\] × weight (kg) ×0.85)/(72× serum creatinine (mg/dL) Male CrCL=(\[140-age\] × weight (kg) ×1.00)/(72× serum creatinine (mg/dL) Allergy and adverse drug reactions 1) A history of hypersensitivity to other monoclonal antibodies 2) A history of allergic or hypersensitive reactions to the components of the study drug Other exclusion criteria

1. Prisoners or subjects under compulsory confinement.
2. subjects who have been involuntarily detained for treatment of mental or physical illness (e.g., infectious disease).

Careful consideration has been given to the eligibility criteria for this study to ensure the safety of the study subjects and to ensure the availability of the study results.

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Where this trial is running

Guangzhou, Guangdong

• Guangdong provincial people's hospital — Guangzhou, Guangdong, China (RECRUITING)

Study contacts

• Study coordinator: Wei Cui, Dr

Conditions: NSCLC, Drug-eluting beads bronchial arterial chemoembolization