Iparomlimab Tolvorlimab as Neoadjuvant Immunotherapy for Locally Advanced Gastric Adenocarcinoma With Microsatellite Instability/Mismatch Repair Deficiency

Sponsor
Peking University Cancer Hospital & Institute
Study ID
NCT07595523
Phase
PHASE2
Status
Not Yet Recruiting

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Conditions

Eligibility Criteria

Sex
ALL
Age
18 Years - 75 Years
Healthy Volunteers
Not accepted

Interventions

  • Iparomlimab/Tuvonralimab (QL1706) — DRUG
    In this study, QL1706 is administered as a single-agent immunotherapy in the perioperative setting for patients with locally advanced dMMR/MSI-H gastric or gastroesophageal junction adenocarcinoma. The intervention consists of: Neoadjuvant phase: 5 mg/kg intravenous infusion on Day 1 of each 3-week cycle, for a total of 4 cycles Adjuvant phase: 5 mg/kg intravenous infusion on Day 1 of each 3-week cycle, for an additional 4 cycles, starting 4-6 weeks after radical D2 gastrectomy

Study Details

Study Background 1. Clinical Rationale and Unmet Medical Need Gastric cancer is the 5th most common malignancy and the 3rd leading cause of cancer death worldwide. China accounts for \>40% of global new cases, with nearly 90% of patients diagnosed at locally advanced stages and a 5-year overall survival (OS) rate of only 10%-49%. East Asia alone represents 58% of the global gastric cancer burden, with China reporting approximately 400,000 new cases and high mortality annually. Although D2 radical gastrectomy remains the standard surgical treatment, local recurrence rates after surgery alone range from 24% to 54%, with most recurrences occurring within 2 years. Neoadjuvant chemotherapy is recommended by NCCN, ESMO, JGCA, and CSCO guidelines for locally advanced gastric cancer. However, the microsatellite instability-high/mismatch repair-deficient (dMMR/MSI-H) subtype demonstrates poor response to chemotherapy but exceptional sensitivity to immunotherapy. Currently, no consensus exists on the optimal perioperative treatment for this population, and CSCO guidelines only recommend clinical trial participation or active surveillance. 2. Immunotherapy Advances in dMMR/MSI-H Gastric Cancer Immune checkpoint inhibitors (ICIs) targeting PD-1/PD-L1 have revolutionized the treatment of dMMR/MSI-H tumors by restoring anti-tumor immune responses. The phase II KEYNOTE-585 study (NCT03221426), the largest trial of neoadjuvant PD-1 monotherapy in this population, demonstrated a pathological complete response (pCR) rate of 32.8%, objective response rate (ORR) of 65.3%, and 3-year progression-free survival (PFS) rate of 78.5%-significantly superior to traditional chemotherapy (pCR 12.3%, 3-year PFS 52.1%). A phase II study of sintilimab monotherapy reported a pCR rate of 34.2%, major pathological response (MPR) rate of 52.2%, and grade ≥3 treatment-related adverse event (TRAE) rate of only 8.7%. Dual immune checkpoint blockade further improves efficacy. The INFNITY study showed that neoadjuvant tremelimumab plus durvalumab achieved a pCR rate of 60% and MPR rate of 80% in 18 patients with resectable dMMR/MSI-H gastric adenocarcinoma. These data confirm that immunotherapy, particularly dual checkpoint inhibition, offers superior efficacy and acceptable safety compared to chemotherapy in this patient subset. 3. Study Agent: Apalimab/Tovorilimab (QL1706) Apalimab/Tovorilimab (QL1706) is a first-in-class bifunctional combination antibody developed using the MabPair® technology platform. It comprises anti-PD-1 antibody (apalimab) and anti-CTLA-4 antibody (tovorilimab) in a 2:1 molar ratio, simultaneously blocking both immune checkpoint pathways for synergistic anti-tumor activity. Compared to separate administration of PD-1 and CTLA-4 inhibitors, QL1706 offers improved pharmacokinetics, enhanced targeting specificity, reduced off-target effects, lower TRAE rates, and simplified dosing (single infusion) that improves patient adherence. Clinical trials have demonstrated promising efficacy and safety across multiple tumor types: Cervical cancer (DUBHE-C-206): ORR 33.8%, disease control rate (DCR) 64.9%, median PFS 5.4 months in platinum-refractory recurrent/metastatic disease Hepatocellular carcinoma (DUBHE-H-308): ORR 40%, median PFS 8.1 months, 12-month OS rate 73.3% in combination with bevacizumab Non-small cell lung cancer (DUBHE-L-201): Median PFS 8.51 months, median OS 26.51 months, grade ≥3 TRAE rate 35.5% in combination with chemotherapy and bevacizumab 4. Study Objectives and Significance This is a prospective, single-arm, single-center phase II clinical trial designed to evaluate the efficacy and safety of QL1706 as neoadjuvant therapy in patients with dMMR/MSI-H locally advanced gastric adenocarcinoma. The primary objective is to assess the pCR rate, with secondary objectives including ORR, MPR rate, R0 resection rate, PFS, OS, and safety profile. This study will provide critical clinical evidence for the use of QL1706 in the neoadjuvant setting. The results will: (1) establish a new treatment option for dMMR/MSI-H gastric cancer patients; (2) lay the foundation for subsequent multicenter randomized phase III trials; (3) explore potential predictive biomarkers of response and resistance mechanisms; and (4) investigate the feasibility of surgery-sparing strategies for selected patients with exceptional response. Ultimately, this trial has the potential to transform the perioperative treatment paradigm for dMMR/MSI-H gastric cancer and improve patient outcomes.

Key Dates

First listed
May 19, 2026
Start date
Jun 1, 2026
Status verified
May 2026
Primary completion
Jul 1, 2028
Completion
Jul 1, 2029

Study Design

Enrollment
30 participants (estimated)
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT

Arms

  • Experimental: Iparomlimab/Tuvonralimab (QL1706) Neoadjuvant and Adjuvant Immunotherapy
    All eligible patients will receive a fixed perioperative treatment regimen consisting of neoadjuvant immunotherapy, radical surgery, and adjuvant immunotherapy: Neoadjuvant Phase: Iparomlimab/tovorilimab (QL1706) 5 mg/kg administered as an intravenous infusion on Day 1 of each 3-week cycle, for a total of 4 cycles. Surgical Phase: Radical D2 gastrectomy will be performed 4-8 weeks after the last dose of neoadjuvant therapy, according to standard surgical practice for gastric cancer. Adjuvant Phase: Patients who recover adequately from surgery will receive an additional 4 cycles of iparomlimab/tovorilimab (QL1706) 5 mg/kg intravenously every 3 weeks, starting 4-6 weeks postoperatively. Dosing may be delayed or adjusted based on treatment-related adverse events graded according to the NCI-CTCAE version 5.0 criteria. Patients will be monitored for safety throughout the treatment period and followed for long-term survival outcomes.

Primary Outcome Measure

Pathological Complete Response (pCR) Rate [ Time Frame: Assessed at the time of radical gastrectomy, which is performed 4-8 weeks after completion of neoadjuvant therapy. ]

Central Contacts

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