Combination Therapy for PD-1 Resistant Recurrent or Metastatic Nasopharyngeal Carcinoma: A Bayesian Adaptive Phase II Trial

Conditions

• Recurrent or Metastatic Nasopharyngeal Carcinoma

Eligibility Criteria

Sex

ALL

Age

18 Years - 70 Years

Healthy Volunteers

Not accepted

Interventions

• Ivonescimab — DRUG
  Ivonescimab 10 mg/kg via intravenous infusion, until the occurrence of intolerable toxicity, withdrawal of informed consent, initiation of new antitumor therapy, loss to follow-up, or death, whichever occurs first.
• Nimotuzumab — DRUG
  Nimotuzumab 400 mg via intravenous infusion, Q3W, until the occurrence of intolerable toxicity, withdrawal of informed consent, initiation of new antitumor therapy, loss to follow-up, or death, whichever occurs first.
• Irinotecan liposome — DRUG
  Irinotecan liposome 50mg/m2 via intravenous infusion, D1, D15, Q4W for up to 6 cycles or until intolerable toxicity, subject withdrawal of informed consent, diseases progression, initiation of new antitumor therapy, loss of follow-up, or death, whichever occurs first.
• S-1 — DRUG
  S-1, D1-D14, BID, p.o., (BSA \< 1.25 m2, 40 mg/dose; 1.25 m2 ⩽ BSA \< 1.5 m2, 50 mg/dose; BSA ⩾ 1.5 m2, 60mg/dose), Q4W for up to 6 cycles or until intolerable toxicity, subject withdrawal of informed consent, diseases progression, initiation of new antitumor therapy, loss of follow-up, or death, whichever occurs first.
• Mitoxantrone Hydrochloride Liposome — DRUG
  Mitoxantrone hydrochloride liposome 20mg/m2 via intravenous infusion, Q3W for up to 8 cycles or until intolerable toxicity, subject withdrawal of informed consent, diseases progression, initiation of new antitumor therapy, loss of follow-up, or death, whichever occurs first
• PD-1 Inhibitors — DRUG
  PD-1 blockade (comprising tislelizumab \<200 mg/cycle\>, carrellimab \<200 mg/cycle\>, or toripalimab \<240 mg/cycle\>) , Q3W for two years, or until intolerable toxicity, subject withdrawal of informed consent, diseases progression, initiation of new antitumor therapy, loss of follow-up, or death, whichever occurs first.

Study Details

This is a prospective, Bayesian adaptive, phase II clinical trial designed to evaluate the safety and efficacy of four treatment regimens in patients with recurrent (unamenable to local therapy) or metastatic nasopharyngeal carcinoma (NPC) who have failed after at least one prior platinum-containing standard regimen and anti-PD-1/PD-L1 therapy. The four treatment arms include: 1. Ivonescimab monotherapy, 2. Ivonescimab combined with nimotuzumab, 3. Liposomal mitoxantrone plus anti-PD-1 antibody, and 4. Liposomal irinotecan plus S-1.

Key Dates

Start date

Jun 24, 2025

Status verified

Jun 2025

Primary completion

Jan 30, 2027

Completion

Jan 30, 2028

Study Design

Enrollment

208 participants (estimated)

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

TREATMENT

Arms

• Experimental: Ivonescimab Monotherapy
  Participants will receive Ivonescimab at a dose of 10 mg/kg via intravenous infusion, Q3W. Treatment will continue until the occurrence of intolerable toxicity, withdrawal of informed consent, initiation of new antitumor therapy, loss to follow-up, or death, whichever occurs first.
• Experimental: Ivonescimab plus Nimotuzumab
  Participants will receive Ivonescimab at a dose of 10 mg/kg via intravenous infusion, combined with Nimotuzumab 400 mg via intravenous infusion, Q3W. Treatment will continue until the occurrence of intolerable toxicity, withdrawal of informed consent, initiation of new antitumor therapy, loss to follow-up, or death, whichever occurs first.
• Experimental: Mitoxantrone Plus PD-1 Inhibitor
  Participants will receive mitoxantrone hydrochloride liposome at 20 mg/m² via intravenous infusion, combined with a PD-1 inhibitor - either tislelizumab (200 mg/cycle), camrelizumab (200 mg/cycle), or toripalimab (240 mg/cycle) - Q3W, for up to 8 cycles. After combination therapy, participants will continue receiving PD-1 blockade monotherapy every 3 weeks for up to 2 years, or until the occurrence of intolerable toxicity, withdrawal of informed consent, initiation of new antitumor therapy, loss to follow-up, or death, whichever occurs first.
• Experimental: Irinotecan plus S-1
  Participants will receive liposomal irinotecan at 50 mg/m² via intravenous infusion on D1 and D15, Q4W, in combination with oral S-1 administered BID on D 1-14 of each cycle, for up to 6 cycles. The dose of S-1 is based on body surface area (BSA). BSA \< 1.25 m²: 40 mg per dose ; 1.25 m² ≤ BSA \< 1.5 m²: 50 mg per dose; BSA ≥ 1.5 m²: 60 mg per dose Treatment will continue until the occurrence of intolerable toxicity, withdrawal of informed consent, initiation of new antitumor therapy, loss to follow-up, or death, whichever occurs first.

Primary Outcome Measure

Overall Response Rate (ORR) [ Time Frame: 1 year ]

Central Contacts

• Mingyuan Chen
  +86 18124188280
  [email protected]