Efficacy and Safety of RC48 (Disitamab Vedotin) Combined With Sintilimab and SOX for HER2 IHC 1+/2+ Unresectable Locally Advanced or Advanced Gastric Cancer Conversion Therapy
This study aims to evaluate the efficacy of disitamab vedotin in combination with sintilimab and SOX as conversion therapy in patients with initially unresectable locally advanced or metastatic gastric cancer exhibiting HER2 IHC 1+/2+ expression. The trial plans to enroll patients with a single initial unresectable factor and HER2 IHC 1+/2+ status. Participants will receive disitamab vedotin combined with sintilimab and SOX for 4 to 6 treatment cycles. Those who achieve successful conversion will undergo surgical resection, while patients with unsuccessful conversion will either continue the original regimen or switch to an alternative treatment at the investigator's discretion.
• Voluntarily enrolled and provided written informed consent;
• Aged 18-70 years (inclusive), male or female;
• Histologically and/or cytologically confirmed unresectable locally advanced or metastatic gastric or gastroesophageal junction adenocarcinoma;
• No prior systemic anticancer therapy;
• HER2 immunohistochemistry (IHC) result of 2+ or 1+, based on either previous test results (confirmed by the investigator) or central laboratory assessment;
• Presence of a single initial unresectable factor;
• At least one measurable lesion per RECIST 1.1;
• Life expectancy ≥ 6 months;
• Eastern Cooperative Oncology Group (ECOG) performance status (PS) score of 0 or 1;
⁃ Adequate organ function, defined as follows:
‣ Hematological (within 14 days prior to screening, without transfusion or granulocyte colony-stimulating factor \[G-CSF\] support):
• Hemoglobin ≥ 90 g/L;
• Absolute neutrophil count (ANC) ≥ 1.5 × 10⁹/L;
• White blood cell count ≥ 3.0 × 10⁹/L;
• Platelet count ≥ 80 × 10⁹/L;
• Biochemical (within 14 days prior to screening, without albumin infusion):
• Albumin ≥ 28 g/L;
• Total bilirubin ≤ 2 × upper limit of normal (ULN);
• Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) ≤ 2.5 × ULN in the absence of liver metastases; or ≤ 5 × ULN if liver metastases are present;
• Serum creatinine ≤ 1.5 × ULN; or creatinine clearance (CrCl) ≥ 50 mL/min as calculated by the Cockcroft-Gault formula;
• Coagulation:
• International normalized ratio (INR) or prothrombin time (PT) ≤ 1.5 × ULN;
⁃ Activated partial thromboplastin time (APTT) ≤ 1.5 × ULN.