Cryoablation Combined With Sintilimab Plus Lenvatinib in 1L Treatment of Advanced ICC (CASTLE-ICC-Chemo-free)

Launched by FUDAN UNIVERSITY · Apr 18, 2023

Keywords

ClinConnect Summary

The CASTLE-ICC-Chemo-free clinical trial is exploring a new treatment approach for patients with advanced intrahepatic cholangiocarcinoma (ICC), a type of liver cancer. This study is investigating the combination of cryoablation (a procedure that freezes cancer cells) with two medications, Sintilimab and Lenvatinib, to see if this treatment is safe and effective as a first-line option for patients who haven't previously received chemotherapy or other targeted therapies for ICC.

To participate in this trial, patients must be at least 18 years old, have confirmed advanced ICC, and have at least one measurable tumor that can be tracked. Participants should be able to tolerate the treatment and have a life expectancy of at least 12 weeks. During the trial, patients will receive the combination treatment and will be monitored closely for any side effects and to assess how well the treatment is working. It's important to note that there are specific criteria that would exclude some patients from joining, such as those with other active cancers or certain health conditions.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Written informed consent obtained.
• • Age ≥ 18 years at time of study entry.
• • Advanced ICC with diagnosis confirmed by histology or cytology.
• • Patients with no prior systemic chemotherapy or targeted therapy or loco-regional therapy (including but not limited to transarterial chemoembolization, transarterial embolization, transarterial chemotherapy or transarterial radioembolization) or immunotherapy for ICC. Patients with recurrent disease more than 6 months after completion of adjuvant chemotherapy following curative resection are eligible.
• • At least one measurable site of disease as defined by RECIST v1.1 with spiral CT scan or MRI.
• • Performance status (PS) ≤ 2 (ECOG scale).
• • Life expectancy of at least 12 weeks.
• • Adequate blood count, liver-enzymes, and renal function: absolute neutrophil count ≥ 1,500/L, platelets ≥75 x103/L; Total bilirubin ≤ 3x upper normal limit; Aspartate Aminotransferase (SGOT), Alanine aminotransferase (SGPT) ≤ 5 x upper normal limit (ULN); International normalized ratio (INR) ≤1.25; Albumin ≥ 31 g/dL; Serum Creatinine ≤ 1.5 x institutional ULN or creatinine clearance (CrCl) ≥ 30 mL/min (if using the Cockcroft-Gault formula )
• • Female patients with reproductive potential must have a negative urine or serum pregnancy test within 7 days prior to start of trial.
• • Subject is willing and able to comply with the protocol for the duration of the study including undergoing treatment, adherence to contraceptive measures, scheduled visits and examinations including follow up.
• Exclusion Criteria:
• • Diagnosis of hepatocellular carcinoma (HCC), mixed cholangiocarcinoma and HCC, sarcomatoid hepatocellular carcinoma, or hepatic fibrolamellar carcinoma by histology or cytology.
• • Uncontrolled pericardial effusion, pleural effusion, or clinically significant moderate or severe ascites that is symptomatic or requires thoracentesis or paracentesis during the screening phase for control of symptoms.
• • History of cardiac disease, including clinically significant gastrointestinal bleeding within 4 weeks prior to start of study treatment.
• • Thrombotic or embolic events such as cerebrovascular accident (including transient ischemic attacks), deep vein thrombosis or pulmonary embolism within the 6 months Prior to the first dose of study drug with the exception of thrombosis of a segmental portal vein.
• • Prior treatment with cryoablation.
• • Major surgery within 4 weeks of starting the study treatment OR subjects who have not recovered from effects of major surgery.
• • Patients with second primary cancer, except adequately treated basal skin cancer or carcinoma in-situ of the cervix.
• • Immunocompromised patients, e.g. patients who are known to be serologically positive for human immunodeficiency virus (HIV).
• * Any condition or comorbidity that, in the opinion of the investigator, would interfere with evaluation of study Treatment or interpretation of patient safety or study results, including but not limited to:
• • 1. history of interstitial lung disease
• • 2. Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) coinfection (i.e double infection)
• • 3. known acute or chronic pancreatitis
• • 4. active tuberculosis
• • 5. any other active infection (viral, fungal or bacterial) requiring systemic therapy
• • 6. history of allogeneic tissue/solid organ transplant
• • 7. diagnosis of immunodeficiency or patient is receiving chronic systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to the first dose of Sintilimab treatment.
• • 8. Has an active autoimmune disease requiring systemic treatment within the past 3 months or a documented history of clinically severe autoimmune disease, or a syndrome that requires systemic steroids or immunosuppressive agents. Exceptions: Subjects with vitiligo, hypothyroidism, diabetes mellitus type I or resolved childhood asthma/atopy are an exception to this rule. Subjects that require intermittent use of bronchodilators or local steroid injections would not be excluded from the study. Subjects with Hashimoto thyroiditis, hypothyroidism stable on hormone replacement or psoriasis not requiring treatment are not excluded from the study.
• • 9. Live vaccine within 30 days prior to the first dose of Sintilimab treatment or during study treatment.
• • 10. History or clinical evidence of Central Nervous System (CNS) metastases Exceptions are: Subjects who have completed local therapy and who meet both of the following criteria: I. are asymptomatic and II. have no requirement for steroids 6 weeks prior to start of Tislelizumab treatment. Screening with CNS imaging (CT or MRI) is required only if clinically indicated or if the subject has a history of CNS
• • Medication that is known to interfere with any of the agents applied in the trial.
• • Any other efficacious cancer treatment except protocol specified treatment at study start.
• • Female subjects who are pregnant, breast-feeding or male/female patients of reproductive potential who are not employing an effective method of birth control (failure rate of less than 1% per year). \[Acceptable methods of contraception are: implants, injectable contraceptives, combined oral contraceptives, intrauterine pessars (only hormonal devices), sexual abstinence or vasectomy of the partner\]. Women of childbearing potential must have a negative pregnancy test (serum β-HCG) at screening.
• • Patient with any significant history of non-compliance to medical regimens or with inability to grant reliable informed consent.