Personalized toripalimab therapy for lung cancer based on ctDNA analysis

Consolidation Toripalimab Therapy Guided by Circulating Tumor DNA (ctDNA)-Minimal Residual Disease (MRD) for Completely Resected Stage IB-IIIA Non-small-cell Lung Cancer (Without EGFR or ALK Alterations for Nonsquamous Lung Cancer)

This study is testing if using blood tests to check for leftover cancer DNA can help decide if lung cancer patients should get extra treatment with toripalimab after their initial therapy.

Quick facts

• Phase: PHASE2
• Study type: Interventional
• Enrollment: 80 (estimated)
• Ages: 18 Years to 75 Years
• Sex: All
• Sponsor: Sun Yat-sen University (other)
• Drugs / interventions: toripalimab, chemotherapy
• Locations: 1 site (Guangzhou, Guangdong)
• Trial ID: NCT06426511 on ClinicalTrials.gov

What this trial studies

This study aims to personalize the administration of consolidation toripalimab therapy for patients with resected stage IB-IIIA non-small-cell lung cancer (NSCLC) by utilizing circulating tumor DNA (ctDNA) to identify minimal residual disease (MRD). After standard adjuvant chemotherapy, patients will be monitored for ctDNA levels to determine if they should receive additional toripalimab therapy. The study seeks to compare outcomes between patients with positive ctDNA who receive toripalimab and those with negative ctDNA who are observed without further treatment. This approach is based on emerging evidence that ctDNA can serve as a biomarker for predicting treatment benefit in NSCLC.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18-75 who have undergone complete surgical resection of stage IB-IIIA NSCLC without EGFR or ALK alterations.

Not a fit: Patients with EGFR or ALK alterations, or those who have not undergone complete surgical resection, may not benefit from this study.

Why it matters

Potential benefit: If successful, this study could lead to more personalized treatment strategies, potentially improving outcomes for patients with resected NSCLC.

How similar studies have performed: Other studies have shown promising results with similar approaches using ctDNA as a biomarker for treatment personalization in cancer.

Eligibility criteria

Inclusion Criteria:

* Subjects must have undergone complete surgical resection (R0) of their stage IB , II and select IIIA NSCLC according to the AJCC 8th edition staging;
* Squamous or non-squamous NSCLC histology;
* Subjects should be without EGFR or ALK alterations for nonsquamous NSCLC;
* Male and female, aged 18-75 years;
* Surgery for lung cancer must be completed ≤ 60 days prior to study treatment;
* Eastern Cooperative Oncology Group (ECOG) performance status of 0-1;
* Adequate hematological function: Absolute neutrophil count (ANC) ≥2.0 x 109/L, and Platelet count ≥100 x 109/L, and Hemoglobin ≥9 g/dL (may be transfused to maintain or exceed this level);
* Adequate liver function: Total bilirubin ≤ 1.5 x upper limit of normal (ULN), Aspartate aminotransferase (AST), alanine aminotransferase (ALT) ≤ 2.5 x ULN;
* Adequate renal function: Serum creatinine ≤ 1.25 x ULN, or ≥ 60 ml/min;
* Female subjects should not be pregnant or breast-feeding;
* Written informed consent provided. Being willing and able to comply with the visits, treatment plan, laboratory examinations and other study procedures scheduled in the study.

Exclusion Criteria:

* Not R0 resection, or metastatic disease.
* Subjects with known EGFR sensitive mutations or ALK translocation, EGFR and ALK mutation status needs to be identified for the subjects with non-squamous NSCLC;
* Previous treatment with systemic antitumor therapy for NSCLC;
* Severe allergic reaction to other monoclonal antibodies;
* Subjects with any known or suspected autoimmune disorder or immunodeficiency, with the following exceptions: hypothyroidism, hormone therapy is not needed, or well controlled at physiological dose; controlled type I diabetes;
* Uncontrolled active hepatitis B (defined as positive hepatitis B surface antigen in screening period with HBV-DNA detected higher than the upper limit of normal at the clinical laboratory of the study center); active hepatitis C (defined as positive hepatitis C surface antibody in screening period and positive HCV-RNA);
* Vaccination of live vaccine within 30 days prior to the first dose;
* Evidence of clinically active interstitial lung disease;
* Known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS);
* Inability to comply with protocol or study procedures;
* Any unstable systemic disease (including active infection, active tuberculosis uncontrolled hypertension, unstable angina, congestive heart failure, myocardial infarction within the previous year, serious cardiac arrhythmia requiring medication, hepatic, renal, or metabolic disease);
* A serious concomitant systemic disorder that, in the opinion of the investigator, would compromise the patient's ability to complete the study and may confuse the study results;
* History of another malignancy in the last 5 years with the exception of the following: other malignancies cured by surgery alone and having a continuous disease-free interval of 5 years are permitted. Cured basal cell carcinoma of the skin and cured in situ carcinoma of the uterine cervix are permitted.
* Women who are pregnant or nursing.
* Ingredients mixed with small cell lung cancer patients.

Where this trial is running

Guangzhou, Guangdong

• Sun Yat-sen University Cancer Center — Guangzhou, Guangdong, China (RECRUITING)

Study contacts

• Principal investigator: Si-Yu Wang, MD — Sun Yat-Sen University Cancer Center
• Study coordinator: Si-Yu Wang, MD

Conditions: Lung Cancer, Nonsmall Cell