Sintilimab Combined With Bevacizumab Biosimilar as Adjuvant Treatment After Resection of Ruptured Hepatocellular Carcinoma (CLEAR-2)

NCT07331883 | Recruiting Phase 2

• 1 other identifier: CLEAR-2
• Study Type: interventional
• Target: 35
• Locations: 1 country
• Sites: 4

Brief Summary

Primary liver cancer-particularly hepatocellular carcinoma (HCC)-remains a major health burden in China, characterized by high incidence and mortality rates and poor 5-year survival. Spontaneous rupture of HCC (SRHCC), although a relatively uncommon complication, is associated with extremely high mortality and marked geographic variation, with disproportionately higher incidence and rupture-related deaths reported in Asian populations. For patients with preserved liver function and resectable tumors, hepatic resection can offer favorable long-term survival and even a potential cure. However, despite surgical removal, the risk of postoperative recurrence is substantially increased, and long-term outcomes remain unsatisfactory. Currently, there is no validated adjuvant therapy to reduce recurrence or improve survival after resection. In recent years, immune checkpoint inhibitors (ICIs) in combination with anti-angiogenic agents have demonstrated synergistic antitumor activity and manageable safety in advanced HCC. Notably, studies of sintilimab plus a bevacizumab biosimilar have shown significant improvements in overall survival (OS), progression-free survival (PFS), and objective response rate (ORR). Moreover, emerging evidence in the adjuvant and perioperative settings suggests that PD-1 blockade may delay recurrence in high-risk patients, such as those with microvascular invasion. Based on the high postoperative recurrence rate in SRHCC patients and the existing therapeutic gap, along with established evidence of the efficacy of immune checkpoint inhibitors combined with antiangiogenic therapy in advanced HCC, conducting a prospective Phase II single-arm study of adjuvant therapy with sintilimab plus the bevacizumab biosimilar holds significant clinical and scientific value. This study aims to evaluate the tolerability of this combination regimen in postoperative SRHCC patients at high risk of recurrence. It is expected to provide a more effective treatment option for patients diagnosed with spontaneously ruptured hepatocellular carcinoma, improve their prognosis, and offer scientific evidence for future treatment strategies.

Conditions

Hepatocellular Carcinoma (HCC)

Outcome Measures

Primary Outcomes (1)

• DIsease-free Survival (DFS)

  The time from initial curative-intent treatment to the date of the first documented tumor progression as determined by the investigator (per RECIST 1.1), or death due to any cause.

  Through out the study (up to 3 years)

Secondary Outcomes (5)

• Overall Survival (OS)

  Through out the study (up to 3 years)

• Adverse Event description as assessed by CTCAE V5.0

  Through out the study (up to 3 years)

• the proportion and timing of intrahepatic recurrence

  Through out the study (up to 3 years)

• the proportion and timing of extrahepatic metastasis

  Through out the study (up to 3 years)

• the proportion and timing of peritoneal metastasis

  Through out the study (up to 3 years)

Study Arms (1)

Experimental Arm

EXPERIMENTAL

Sintilimab (200 mg, iv, d1, q3w) in combination with bevacizumab biosimilar (15mg/kg, iv, d1, q3w)

Drug: Sintilimab plus bevacizumab biosimilar

Interventions

Sintilimab plus bevacizumab biosimilar DRUG

Sintilimab (200 mg, iv, d1, q3w) in combination with bevacizumab biosimilar (15mg/kg, iv, d1, q3w)

Experimental Arm

Eligibility Criteria

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

You may qualify if:

• Patients voluntarily provide written informed consent, with authorization obtained from the patient or legal representative prior to any protocol-related procedures.
• Age ≥ 18 years and ≤ 75 years; both female and male
• Spontaneous tumor rupture with hemorrhage confirmed by imaging prior to or during surgery, with a postoperative pathological diagnosis of hepatocellular carcinoma (HCC).
• a) For cases where tumor rupture is an incidental finding during surgery, a clinical history of abdominal pain within the two weeks preceding surgery is required.
• CNLC Stage I-II.
• Having undergone curative surgical resection, with intraoperative irrigation using ≥5000 mL of distilled water or normal saline, confirmed negative surgical margins on postoperative pathology, and achieving a complete response (CR) confirmed by imaging within 4-8 weeks after surgery.
• ECOG PS 0-1
• Child-Pugh A (score ≤6).
• Life expectancy ≥12 months
• Laboratory test results obtained within 3 days prior to the first dose must meet the following criteria:
• Hematological:(Except for hemoglobin, the patient must not have received a blood transfusion, granulocyte colony-stimulating factor \[G-CSF\], or hematopoietic agents within 2 weeks prior to screening.) i. Absolute neutrophil count ≥1.5 × 10⁹/L; ii. Platelet count ≥75 × 10⁹/L; iii. Hemoglobin ≥90 g/L.
• Serum biochemistry:
• i. Serum albumin ≥30 g/L; ii. Total bilirubin ≤1.5 × ULN; iii. ALT and AST ≤3 × ULN; iv. Serum creatinine ≤1.5 × ULN, or creatinine clearance \>50 mL/min.
• International normalized ratio (INR) ≤1.2 or prothrombin time (PT) ≤2 seconds above the upper limit of normal.
• Urinalysis:Urine protein \<2+.(If urine protein is ≥2+, a 24-hour urine protein test may be performed; patients may be enrolled if 24-hour urine protein \<1.0 g.)

You may not qualify if:

• Pathological diagnosis other than hepatocellular carcinoma, including cholangiocarcinoma or combined hepatocellular-cholangiocarcinoma.
• Intraoperative intraperitoneal lavage with chemotherapeutic agents
• Child-Pugh class B or C
• ECOG PS \> 1
• Postoperative imaging confirming the presence of extrahepatic metastasis, residual disease, or recurrence.
• Prior systemic antitumor therapy, including targeted therapy, immunotherapy, investigational drugs, or local therapies such as TACE (preoperative TAE for hemostasis is allowed). Patients who received adjuvant TACE after resection are also excluded.
• Clinically symptomatic moderate or severe ascites requiring therapeutic paracentesis or drainage, or a Child-Pugh ascites score \>2 (the presence of minimal ascites on imaging only, without associated symptoms, is excluded). Uncontrolled or moderate-to-large pleural effusion or pericardial effusion.
• Current interstitial lung disease (ILD), or a history of ILD requiring glucocorticoid treatment, or other conditions that might interfere with the diagnosis or management of immune-related pulmonary toxicity, including pulmonary fibrosis, organizing pneumonia (e.g., bronchiolitis obliterans), pneumoconiosis, drug-induced pneumonia, or idiopathic pneumonia. Patients with evidence of active pneumonia on screening chest computed tomography (CT) scans or severely impaired pulmonary function are excluded. History of radiation pneumonitis within the radiation field is permitted. Active tuberculosis.
• Presence of an active autoimmune disease, or a history of autoimmune disease with potential for recurrence \[including, but not limited to, autoimmune hepatitis, pneumonitis, uveitis, colitis, hypophysitis, vasculitis, nephritis, hyperthyroidism, hypothyroidism (patients with hypothyroidism controlled only with hormone replacement therapy are eligible)\]. Patients with vitiligo, psoriasis, or alopecia not requiring systemic treatment, or well-controlled type I diabetes on insulin, or childhood asthma that has completely resolved in adulthood without any intervention are eligible. Asthmatic patients requiring bronchodilators for medical intervention are excluded.
• Use of immunosuppressive agents or systemic corticosteroids for immunosuppressive purposes (at doses \>10 mg/day prednisone or equivalent) within 2 weeks prior to initiation of study treatment. Inhaled or topical corticosteroids, and adrenal replacement steroid doses ≤10 mg/day prednisone equivalent, are permitted in the absence of active autoimmune disease.
• History of gastrointestinal bleeding within 6 months prior to treatment, or definite predisposition to gastrointestinal bleeding, such as high-risk or severe esophageal/gastric varices, active peptic ulcer disease, or persistently positive fecal occult blood test (unless follow-up endoscopy rules out high-risk varices). Patients with esophageal/gastric varices identified on baseline CT/MRI may be eligible if assessed by the investigator as mild to moderate. Presence of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within 6 months prior to randomization.
• Known hereditary or acquired bleeding (e.g., coagulation disorders) or thrombotic tendency, such as hemophilia, coagulopathy, thrombocytopenia, etc. Current therapeutic use of full-dose oral or injectable anticoagulants or thrombolytic agents (prophylactic use of low-dose aspirin, etc., is permitted).
• History of thrombotic or embolic events within 6 months prior to treatment, such as cerebrovascular accident (including transient ischemic attack, cerebral hemorrhage, cerebral infarction), pulmonary embolism, etc.
• Poorly controlled or significant cardiac disease, including: (1) Cardiac dysfunction ≥ Grade II per New York Heart Association (NYHA) classification, or left ventricular ejection fraction (LVEF) \<50% on echocardiography; (2) Unstable angina; (3) Myocardial infarction within 1 year prior to initiation of study treatment; (4) Clinically significant supraventricular or ventricular arrhythmia requiring treatment or intervention; (5) QTc interval \>450 ms (males) or \>470 ms (females).
• Hypertension that is not adequately controlled with antihypertensive medication (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, based on the average of ≥2 readings). History of hypertensive crisis or hypertensive encephalopathy.

Sponsors & Collaborators

• Ruijin Hospital: lead

Study Sites (4)

Sanming First Hospital

Sanming, Fujian, 365000, China

NOT YET RECRUITING

The Third Bethune Hospital of Jilin University

Changchun, Jilin, 130033, China

RECRUITING

Ruijin Hospital, Shanghai Jiao Tong University School of Medicine

Shanghai, Shanghai Municipality, 200025, China

RECRUITING

Huashan Hospital, Fudan University

Shanghai, Shanghai Municipality, 200031, China

RECRUITING

MeSH Terms

Conditions

Carcinoma, Hepatocellular

Interventions

sintilimab

Condition Hierarchy (Ancestors)

Adenocarcinoma; Carcinoma; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type; Neoplasms; Liver Neoplasms; Digestive System Neoplasms; Neoplasms by Site; Digestive System Diseases; Liver Diseases

Central Study Contacts

Yongjun Chen

CONTACT

+86 21 64370045; swakchenyj@hotmail.com

Feng Ye

CONTACT

+86 18917762950

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: November 26, 2025
• First Posted: January 12, 2026
• Study Start: November 17, 2025
• Primary Completion (Estimated): December 1, 2028
• Study Completion (Estimated): March 31, 2029
• Last Updated: March 27, 2026

Record last verified: 2025-11

Data Sharing

• IPD Sharing: Will not share

Locations

CN (4)