Intrathecal Dual Checkpoint Inhibitor (PD-1 and CTLA-4) in Combination With Pemetrexed for Leptomeningeal Metastasis

NCT06809530 | Recruiting Phase 1 DMC

• 1 other identifier: IT-P-QL1706
• Study Type: interventional
• Target: 34
• Locations: 1 country
• Sites: 2

Brief Summary

This phase I/II study is to evaluate the recommended dose, safety, feasibility, and therapeutic response of intrathecal dual checkpoint inhibitor (targeting PD-1 and CTLA-4 with QL1706) in combination with pemetrexed in patients with leptomeningeal metastasis.

Conditions

Leptomeningeal Metastasis; Pemetrexed; PD-1 Inhibitor; CTLA4; Solid Tumors

Keywords

Leptomeningeal metastasis; dual checkpoint inhibitor; pemetrexed

Outcome Measures

Primary Outcomes (2)

• PR2D

  The recommended phase II dose. The dose limiting toxicity was defined as ≥ grade 3 neurological toxicities (e.g., chemical meningitis) or other grade 4 toxicity.

  From date of treatment until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 6 months

• Incidence of treatment-related adverse events

  The incidence of treatment-related adverse events were measured for determining tolerability and safety. Adverse events (AEs) are evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE). Events of grade 3-5 are defined as moderate and severe adverse events.

  From date of treatment until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 6 months.

Other Outcomes (3)

• Clinical response rate

  From date of treatment until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 6 months

• Progression-free survival related to leptomeningeal metastasis (LMPFS)

  From date of treatment until the date of first documented leptomeningeal metastasis progression or date of death from any cause, whichever came first, assessed up to 6 months

• Overall survival(OS)

  From the enrollment of this study until date of death from any cause, whichever came first, or the last follow-up, assessed up to 6 months.

Study Arms (1)

Intrathecal Dual Checkpoint Inhibition in Combination with Pemetrexed

EXPERIMENTAL

This study is a prospective, single-arm, Phase I/II clinical trial. The primary objectives were to determine the recommended dose of intrathecal dual checkpoint inhibitor (PD-1 and CTLA-4, QL1706) in combination with pemetrexed and safety based on the incidence of treatment-related adverse events. Clinical response rate (CRR), progression-free survival related to leptomeningeal metastasis (LMPFS) and overall survival (OS) are also evaluated. Patients will have cerebrospinal fluid (CSF) and blood specimen collection for the evaluation of predictors (clinical, molecular, and/or immune) of the efficacy and safety of this regimen.

Drug: QL1706 (bispecific antibody targeting PD-1 and CLTA-4); Drug: Pemetrexed (Alimta)

Interventions

QL1706 (bispecific antibody targeting PD-1 and CLTA-4) DRUG

Intrathecal injection of PD-1/CTLA-4 bispecific antibody was administered every 2 weeks for 6 weeks during the induction phase, followed by monthly injections during the maintenance phase, until recurrence or death.

Intrathecal Dual Checkpoint Inhibition in Combination with Pemetrexed

Pemetrexed (Alimta) DRUG

Pemetrexed (Alimta, Eli Lilly and Company) was administrated by intrathecal injection, first as induction therapy, twice per week for 2 weeks, followed by consolidation therapy, once per week for 4 weeks, then maintenance therapy, once per month until the patient's death, leptomeningeal metastasis progresses, or intolerable severe adverse events occurred.

Intrathecal Dual Checkpoint Inhibition in Combination with Pemetrexed

Eligibility Criteria

• Age: 21 Years - 75 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Histologically or cytologically confirmed diagnosis of solid tumors; Cerebrospinal fluid cytopathology is positive.
• Male or female aged between 21 and 75 years; Normal liver and kidney function; WBC≥4000/mm3, Plt≥100000/mm3.
• No history of severe nervous system disease; No severe dyscrasia.

You may not qualify if:

• Any evidence of nervous system failure, including severe encephalopathy, grade 3 or 4 leukoencephalopathy on imaging, and Glasgow Coma Score less than 11.
• Any evidence of extensive and lethal progressive systemic diseases without effective treatment.
• A history of HIV or AIDS, acute or chronic hepatitis B or C infection, previous anti-PD1 therapy-induced pneumonitis, or have ongoing \>Grade 2 adverse events of such therapy; or ongoing autoimmune disease that required systemic treatment in the past 2 years.
• Patients with poor compliance or other reasons that were unsuitable for this study.

Sponsors & Collaborators

• Guangzhou Medical University: lead

Study Sites (2)

The Affiliated Huizhou Hospital, Guangzhou Medical University

Huizhou, Guangdong, 516000, China

RECRUITING

The Affiliated Huizhou Hospital, Guangzhou Medical University

Huizhou, Guangdong, 516000, China

RECRUITING

MeSH Terms

Conditions

Meningeal Carcinomatosis

Interventions

Pemetrexed

Condition Hierarchy (Ancestors)

Meningeal Neoplasms; Central Nervous System Neoplasms; Nervous System Neoplasms; Neoplasms by Site; Neoplasms; Nervous System Diseases

Intervention Hierarchy (Ancestors)

Guanine; Hypoxanthines; Purinones; Purines; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Heterocyclic Compounds; Glutamates; Amino Acids, Acidic; Amino Acids; Amino Acids, Peptides, and Proteins; Amino Acids, Dicarboxylic

Study Officials

• Zhenyu Pan, PhD,MD

  The Affiliated HuizhouHospital, Guangzhou Medical University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Zhenyu Pan

CONTACT

+8618718178286; dr-zypan@163.com

Guozi Yang, PhD,MD

CONTACT

+8615804302755; 2023621057@gzhmu.edu.cn

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: January 26, 2025
• First Posted: February 5, 2025
• Study Start: March 17, 2025
• Primary Completion (Estimated): June 1, 2026
• Study Completion (Estimated): July 1, 2026
• Last Updated: May 18, 2025

Record last verified: 2025-01

Data Sharing

• IPD Sharing: Will not share

Locations

CN (2)