Neoadjuvant therapy for resectable esophageal squamous cell carcinoma

Pembrolizumab Plus Albumin Paclitaxel or 5-fluorouracil and Cisplatin Versus 5-fluorouracil and Cisplatin in Neoadjuvant Therapy for Resectable Esophageal Squamous Cell Carcinoma: a Prospective, Randomized Controlled Trial Study

This study is testing if a new combination of treatments can help people with operable esophageal cancer do better than the usual chemotherapy before surgery.

Quick facts

• Phase: PHASE2
• Study type: Interventional
• Enrollment: 114 (estimated)
• Ages: 18 Years to 75 Years
• Sex: All
• Sponsor: Tang-Du Hospital (other)
• Drugs / interventions: immunotherapy, radiation, prednisone, pembrolizumab, chemotherapy
• Locations: 3 sites (Xi'an, Shaanxi and 2 other locations)
• Trial ID: NCT06006650 on ClinicalTrials.gov

What this trial studies

This study investigates the efficacy and safety of pembrolizumab combined with albumin paclitaxel and cisplatin compared to standard chemotherapy for patients with stage II-IVa resectable esophageal squamous cell carcinoma. A total of 114 eligible patients will be randomly assigned to receive either the immunochemotherapy regimen or chemotherapy alone, followed by surgery and additional adjuvant immunotherapy. The study aims to evaluate tumor response and safety through various assessments during and after treatment.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18-75 with a pathological diagnosis of stage II-IVa esophageal squamous cell carcinoma and no prior antitumor therapy.

Not a fit: Patients with prior antitumor therapies or those with severe organ dysfunction may not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could improve treatment outcomes for patients with esophageal squamous cell carcinoma.

How similar studies have performed: Other studies have shown promising results with similar immunotherapy approaches in treating various cancers, indicating potential for success in this context.

Eligibility criteria

Inclusion Criteria:

1.Pathological diagnosis: esophageal squamous cell carcinoma. 2.18-75 years old; 3.Clinical stage II-IVa; 4.no prior antitumor therapy, such as immunotherapy or chemoradiotherapy; 5.ECOG PS score 0-1. 6.Organs function well:Hemoglobin ≥100g/L, white blood cell count ≥4\*10\^9/L or neutrophil count ≥2.5\*10\^9/L, platelet count ≥100\*10\^9/L, serum total bilirubin level ≤1.5 times the upper limit of normal, aspartate aminotransferase (AST) ≤2.5 times the upper limit of normal,Alanine aminotransferase (ALT) ≤2.5 times the upper limit of normal, serum creatinine level below the upper limit of normal or creatinine clearance rate ≥60ml/min, urea nitrogen ≤200mg/L, urinary protein \<+, if urinary protein +, 24-hour total protein must be \<500mg, blood glucose:In patients with normal-range and/or diabetes under treatment but stable glycemic control, pulmonary function: baseline FEV1 of at least 2L;If the baseline FEV1 was \<2L, the predicted FEV1 after surgery was \>800ml, and the cardiac function was: no myocardial infarction within 1 year;Unstable angina pectoris;Asymptomatic severe arrhythmias;The centerless function is incomplete; 7.Non-surgically sterilized women, or women of reproductive age, need to use a medically approved contraceptive method (such as an intrauterine device, birth control pill, or condom) during and for 3 months after the end of the study treatment period.Women of childbearing age who were not surgically sterilized had to have a negative serum or urine HCG test within 72 hours before study enrollment.And must be non-lactation period;For male patients with partners of women of childbearing age, effective methods of contraception should be used during the trial period and within 3 months after the last dose of treatment; 8.Sign an informed consent form.

Exclusion Criteria:

1. Pathological findings suggest compound squamous cell carcinoma, including squamous adenocarcinoma, squamous cell carcinoma, carcinosarcoma, sarcomatoid carcinoma, etc.
2. History of subtotal gastrectomy;
3. accompanied by a second primary cancer;
4. Tumor metabolic imaging prior to treatment suggested distant metastasis.
5. people who have previously received chemoradiotherapy;
6. preesophageal perforation signs
7. pregnant women of reproductive age;
8. Any active autoimmune disease or a history of autoimmune disease (such as autoimmune hepatitis, interstitial pneumonia, uveitis, enteritis, hypophysitis, vasculitis, myocarditis, nephritis, hyperthyroidism, hypothyroidism, etc.);
9. People with the following active infectious diseases, including active tuberculosis, hepatitis, and known human immunodeficiency virus (HIV) infection;
10. Someone who has a known or concomitant hemorrhagic disease or other uncontrollable disease that cannot be treated surgically;
11. Physical examination or clinical trial findings that researchers believe could interfere with the outcome or put the patient at increased risk of treatment complications;
12. A previous history of interstitial lung disease, drug-induced interstitial disease, radiation pneumonitis requiring hormone therapy, or any clinically documented active interstitial lung disease, and the presence of idiopathic pulmonary fibrosis on CT scan at baseline;Uncontrolled massive pleural or pericardial effusion;
13. unstable systemic diseases (active infection, moderately severe chronic obstructive pulmonary disease (copd), poorly controlled hypertension, unstable angina and congestive heart failure, 6 months occurrence of myocardial infarction, drug control severe mental disorders, liver, kidney or other metabolic disease, nerve mental disease such as Alzheimer 's disease);
14. Gastrointestinal dysfunction, malabsorption syndrome, active gastrointestinal ulcers;
15. Previously treated with anti-PD-1 or anti-PD-L1 antibodies;
16. Receiving any investigational drug within 4 weeks before the first use of the investigational drug;
17. Enroll in another clinical study at the same time, unless it's an observational (non-intervention) clinical study or an intervention clinical study follow-up;
18. Subjects who require systematic treatment with corticosteroids (equivalent dose of prednisone \> 10 mg per day) or other immunosuppressive agents within 2 weeks prior to the first use of the study drug, except for the use of corticosteroids for local esophageal inflammation and prevention of allergy, nausea, and vomiting.Other special circumstances, need to communicate with the sponsor.In the absence of active autoimmune disease, inhaled or topical steroids and adrenocorticosteroid replacement at doses \> 10mg/ day in response to prednisone are permitted;
19. People who have been vaccinated with anti-tumor vaccine or who have been vaccinated with live vaccine within 4 weeks prior to the first administration of the study drug;
20. Major surgery or severe trauma within 4 weeks before the first use of the study drug;
21. Congenital or acquired immunodeficiency disease or a history of organ transplantation;A history of allergies to monoclonal antibodies, albumin paclitaxel, 5-fluorouracil, cisplatin, and other platinum-based drugs

Where this trial is running

Xi'an, Shaanxi and 2 other locations

• Tangdu Hospital of the Fourth Millitary Medical University — Xi'an, Shaanxi, China (RECRUITING)
• Hongtao Duan — Xi’an, Shanxi, China (RECRUITING)
• Tangdu Hospital, the Air Force Military University — Xi'an, China (RECRUITING)

Study contacts

• Principal investigator: Xiaolong Yan, MD — Tang-Du Hospital
• Study coordinator: Xiaolong Yan, MD

Conditions: Neoadjuvent, PD-1 Inhibitor, Chemotherapy, Esophageal Squamous Cell Carcinoma