IBI363 plus chemotherapy before surgery for initially unresectable stage III non-small cell lung cancer

IBI363 (PD-1/IL-2α-bias) in Combination With Chemotherapy as Neoadjuvant Therapy to Convert Initially Unresectable Stage III Non-Small Cell Lung Cancer To Resectable Disease: a Phase II, Single-Arm Clinical Trial

This trial will try IBI363, an immunotherapy that targets PD‑1 and boosts IL‑2 signaling, together with platinum chemotherapy before surgery to see if it can shrink tumors enough for adults with initially unresectable stage III NSCLC.

Quick facts

• Phase: PHASE2
• Study type: Interventional
• Enrollment: 43 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Shanghai Pulmonary Hospital, Shanghai, China (other)
• Drugs / interventions: prednisone, chemotherapy
• Locations: 1 site (Shanghai)
• Trial ID: NCT07408635 on ClinicalTrials.gov

What this trial studies

This is a single-arm phase II trial giving IBI363 combined with platinum-based chemotherapy as neoadjuvant treatment to patients with initially unresectable stage III NSCLC. After up to four treatment cycles, a multidisciplinary team (MDT) reviews each case and patients judged surgically eligible proceed to resection followed by one year of standard adjuvant therapy. Patients still deemed unresectable after neoadjuvant therapy receive concurrent chemoradiotherapy followed by immune checkpoint inhibitor consolidation. The study measures surgical R0 resection rate, major pathological response (MPR), pathological complete response (pCR), and safety outcomes.

Who should consider this trial

Good fit: Adults (≥18) with histologically confirmed stage III NSCLC judged initially unresectable, ECOG performance status 0–1, at least one measurable lesion, and adequate organ function.

Not a fit: Patients with tumors containing small‑cell components, tumors already resectable, ECOG ≥2, significant organ dysfunction, or contraindications to chemotherapy or immunotherapy are unlikely to benefit or be eligible.

Why it matters

Potential benefit: If successful, the combination could increase the number of patients who can have complete tumor removal and improve pathological response rates before surgery.

How similar studies have performed: Other neoadjuvant trials that combined PD‑1 antibodies with chemotherapy have shown promising gains in resection and pathological response rates, but IBI363's PD‑1/IL‑2α‑bias mechanism is novel and less tested.

Eligibility criteria

INCLUSION CRITERIA

1. The patient shall sign the informed consent.
2. Age ≥ 18 years.
3. Eastern Cooperative Oncology Group (ECOG) performance status 0-1.
4. Histologically or cytologically confirmed Stage III (per AJCC 9th) squamous or non-squamous non-small-cell lung cancer (NSCLC) deemed unresectable by the investigator.
5. Tumours with mixed NSCLC histology must be categorised as either squamous or non-squamous on the basis of the predominant component. Tumours containing both NSCLC and small-cell lung cancer (SCLC) are excluded.
6. "Unresectable" is defined as following: (1) Multistation or confluent metastasis in ipsilateral mediastinal lymph nodes (2)Contralateral or supraclavicular lymph node metastasis (N3) (3)Invasion of critical organs or major blood vessels (4)Extensive invasion of the chest wall and pleura (5)Special anatomical locations (6）Patient intolerance to lobectomy or pneumonectomy.
7. At least one measurable lesion per RECIST v1.1.
8. Adequate organ function meet the following standards (within 14 days before first dose, any blood components or growth factor drugs is not permitted):

   * ANC count ≥ 1.5 × 10⁹/L
   * Platelet count ≥ 100 × 10⁹/L
   * Hemoglobin ≥ 90 g/L
   * Serum Cr ≤ 1.5 times of upper limit of normal (ULN) or calculated creatinine clearance (CLcr) ≥ 50 mL/min
   * Total bilirubin ≤ 1.5 × ULN (≤ 3 × ULN in Gilbert's syndrome)
   * AST and ALT ≤ 2.5 × ULN
   * INR or APPT ≤ 1.5 × ULN
   * left ventricular ejection fraction (LVEF) ≥ 50 %
9. Contraception and reproductive status:
10. Fertile female patients must voluntarily use effective contraception during the study period and for at least 3 months after treatment completion, and urine or serum pregnancy test result within 72 hours prior to enrollment are negative and must not be breastfeeding. Male patients with female partners of childbearing potential must use effective contraception during the trial and for 3 months after the last dose of IBI363.

EXCLUSION CRITERIA

1. Non-squamous and squamous NSCLC with EGFR active mutation positive, ALK rearrangement, or any other driver mutation with an approved targeted therapy.
2. History of other malignant tumors within five years or concurrently present, except adequately treated cervical carcinoma in situ, basal- or squamous-cell skin carcinoma, localized prostate cancer after radical prostatectomy, ductal carcinoma in situ after radical prostatectomy, or other tumor deemed cured by the investigator.
3. Histologically confirmed the presence of small cell lung cancer component.
4. Participants who have received any systemic anti-cancer treatment.
5. Clinically significant cardiovascular or cerebrovascular disease, including:

   1. Myocardial infarction or unstable angina within 6 months before first dose
   2. Stroke or transient ischaemic attack within 6 months before first dose
   3. Uncontrolled hypertension (systolic ≥ 160 mmHg and/or diastolic ≥ 100 mmHg) despite optimal therapy
   4. Congestive heart failure (NYHA class III-IV)
   5. Myocarditis
6. Participants who were systemically treated with corticosteroids (prednisone or other corticosteroids \>10 mg/ day) or other immunosuppressive agents within 2 weeks prior to first administration. In the absence of active autoimmune disease, inhaled or topical corticosteroids and adrenal hormone replacement therapy are permitted.
7. Presence of any active autoimmune disease or history of autoimmune disease.
8. Idiopathic pulmonary fibrosis, organizing pneumonia, drug pneumonia, or active pneumonia shown on CT during screening period have been or are currently present.
9. History of allogeneic haematopoietic stem-cell or solid-organ transplantation.
10. The subject has congenital or acquired immune deficiency (such as HIV infected persons).
11. Active hepatitis (HBsAg positive and HBV DNA \>the upper limit of normal value; HCV antibody and HCV RNA positive. Subjects who meet the following criteria may be enrolled: HBV-DNA \<500 IU/mL measured within 28 days prior to study dosing, have received at least 4 weeks of standard antiviral therapy, and are willing to continue antiviral therapy throughout the study period.)
12. Participants who are allergic to the test drug or any auxiliary materials.
13. The vaccine was administered within 30 days before first dose or planned during treatment and up to 90 days after the last dose.
14. Severe active infection within 2 weeks before first dose.
15. Other factors that may increase study risk, interfere with results, or render the patient unsuitable per investigator judgment.

Where this trial is running

Shanghai

• Shanghai Pulmonary Hospital — Shanghai, China (RECRUITING)

Study contacts

• Study coordinator: Chang Chen, MD

Conditions: Unresectable Stage III Non-small Cell Lung Cancer, Carcinoma, Non-Small-Cell Lung Cancer