A Phase Ib/II Trial Evaluating the Efficacy and Safety of Adebrelimab, Camrelizumab Plus Apatinib as First-line Therapy in Patients With Advanced Hepatocellular Carcinoma
This is a prospective, single-arm, phase Ib/II trial . The objective of this study is to evaluate the efficacy and safety of adebrelimab, camrelizumab plus apatinib as first-line therapy in patients with advanced hepatocellular carcinoma
⁃ Patients volunteered to join this study and signed informed consent;
⁃ ≥ 18 years old (calculated on the day of signing the informed consent), both men and women can be used;
⁃ Patients with advanced or metastatic solid tumor confirmed by histology or cytology (stage Ⅰb); Patients with hepatocellular carcinoma diagnosed by EASL/AASLD diagnostic criteria, histopathology or cytology are not suitable for surgery or local treatment, or progress after surgery and/or local treatment (stage II);
⁃ Subjects must be able to provide fresh or archived tumor tissues (formalin-fixed, paraffin-embedded \[FFPE\] tissue blocks or at least 5 unstained FFPE slides) and their pathological reports. If the subjects can provide less than 5 unstained slides or the tumor tissue is unavailable (for example, because of previous diagnostic tests), after discussion, they may be allowed to join the group according to the specific circumstances;
⁃ For patients who have progressed after local treatment, local treatment (including but not limited to surgery, radiotherapy, hepatic artery embolization, TACE, hepatic artery perfusion, radiofrequency ablation, cryoablation or percutaneous ethanol injection) has been completed at least 4 weeks before the baseline imaging scan, and the toxic reactions caused by local treatment (except alopecia) must be restored to the fifth edition of the National Cancer Institute-General Terminology Standard for Adverse Events (NCI-CTCAEV 5. 0) rating ≤1 level;
⁃ Never received any systematic treatment for HCC before;
⁃ There is at least one measurable lesion (according to the requirements of RECISTv1.1, the long diameter of the measurable lesion in spiral CT scanning is ≥10mm or the short diameter of swollen lymph nodes is ≥ 15 mm; Lesions that have received local treatment in the past can be used as target lesions after definite progress according to RECISTv1.1 standard);
⁃ Child-Pugh liver function classification: A or B)
⁃ The score of physical condition of the Eastern Cancer Cooperative Group (ECOG) is 0 \
• 2;
⁃ The expected survival time is ≥12 weeks;
⁃ The functions of major organs are basically normal, with serious dysfunction of blood, heart, lung, liver, kidney, bone marrow and immunodeficiency diseases, which meet the requirements of the scheme: a) Routine blood examination: (Except hemoglobin, no blood transfusion within 14 days before screening, no use of granulocyte colony-stimulating factor \[G-CSF\] and no use of corrective treatment within 7 days) i. Hemoglobin ≥ 90g/L. Ii. Neutrophil count ≥ 1.5× 109/L; Iii. Platelet count ≥ 50× 109/L; B) Biochemical examination: (albumin was not transfused within 14 days) i. Serum albumin ≥ 29g/L; Ii. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST)≤2.5 times the upper limit of normal value (ULN); Iii. Total bilirubin (TBIL)≤1.5 times ULN;; Iv. Creatinine Cr≤1.5 times ULN or Cr clearance rate \> 50mL/min(Cockcroft-Gault formula is as follows) Male: Cr clearance rate =((140- age) × body weight) /(72× blood Cr) Female: Cr clearance rate =((140- age) × body weight)/(72 Blood Cr unit: mg/ml; V. Urine protein \< 2+ (if urine protein ≥2+, 24-hour (h) urine protein quantification can be performed, and 24-hour urine protein quantification \< 1.0g can be enrolled); C) Coagulation function: APTT and INR)≤1.5×ULN (for anticoagulant therapy with stable dosage such as low molecular weight heparin or warfarin and INR can be screened within the expected therapeutic range of anticoagulant); D) thyroid stimulating hormone (TSH) ≤ ULN; If abnormal, T3 and T4 levels should be investigated, and normal T3 and T4 levels can be selected; E) Color Doppler echocardiography: Left ventricular ejection fraction (LVEF) is greater than or equal to 60%.
⁃ If the patient suffers from active hepatitis B virus (HBV) infection: the HBV- deoxyribonucleic acid (DNA) must be less than 2× 103 IU/ml and he is willing to receive antiviral treatment (according to local standard treatment, such as entecavir) during the study period, and the doctor will judge whether the patient is eligible for enrollment according to the individual situation of the patient under the condition of monitoring the virus copy number; Hepatitis C virus (HCV) ribonucleic acid (RNA) positive patients must receive antiviral treatment according to local standard treatment guidelines, and their liver function should be within the level 1 increase of CTCAE1.
⁃ Fertile women: they must agree to abstain from sex (avoid heterosexual intercourse) or use reliable and effective methods of contraception for at least 120 days from the signing of the informed consent form to the last administration of the study drug. And the serum HCG test must be negative within 7 days before the start of the study treatment; And must be non-lactating. If a female patient has menstruated, has not yet reached the post-menopausal state (continuous non-menstrual period ≥12 months, and no other reasons have been found except menopause), and has not received sterilization surgery (such as hysterectomy, bilateral tubal ligation or bilateral oophorectomy), it is considered that the patient has fertility.
⁃ For male patients whose partner is a woman of childbearing age, they must agree to abstain from sex for at least 120 days from signing the informed consent form until the last administration of the study drug, or to use reliable and effective methods for contraception. Male subjects must also agree not to donate sperm during the same period. Male subjects whose partners are pregnant must use condoms, and no other contraceptive methods are needed.