Apatinib Combined With Liposomal Irinotecan for Refractory or Metastatic Osteosarcoma

NCT07479732 | Recruiting Phase 1 DMC

• 1 other identifier: PKUPH-sarcoma 24
• Study Type: interventional
• Target: 56
• Locations: 1 country
• Sites: 1

Brief Summary

In advanced osteosarcoma where traditional chemotherapy has failed, the multi-targeted tyrosine kinase inhibitor apatinib has become a mainstream systemic treatment option in China. However, for patients with a high tumor burden or extra-pulmonary lesions, these drugs are prone to secondary resistance, necessitating combination with chemotherapy for more effective comprehensive control. Liposomal irinotecan, a newly approved topoisomerase inhibitor, exhibits lower toxicity compared to traditional irinotecan and is one of the second-line chemotherapy agents for osteosarcoma, making it a suitable candidate for combination therapy with apatinib. The primary objective of this study is to determine the optimal regimen of apatinib combined with liposomal irinotecan injection, while the secondary objective is to evaluate the safety and efficacy of this combination in patients with refractory osteosarcoma who have progressed after second-line chemotherapy.

Conditions

Osteosarcoma; Osteosarcoma Metastatic

Outcome Measures

Primary Outcomes (1)

• Recommended Phase II Dose (RP2D)

  Determination of the recommended phase II dose based on dose-limiting toxicity (DLT) observed during the first two cycles (6 weeks).

  6 weeks

Secondary Outcomes (3)

• Objective Response Rate (ORR)

  Every 6 weeks up to 24 months

• Progression-Free Survival (PFS)

  From treatment initiation until disease progression or death, up to 24 months

• Overall Survival，OS

  From treatment initiation until death from any cause, up to 24 months

Study Arms (1)

Apatinib + Liposomal Irinotecan

EXPERIMENTAL

Patients receive apatinib orally once daily in combination with liposomal irinotecan administered intravenously every week until disease progression or unacceptable toxicity.

Drug: Liposomal Irinotecan; Drug: Apatinib in arm1

Interventions

Liposomal Irinotecan DRUG

Intravenous liposomal irinotecan administered on Day 1, 8, and 15 of each 3-week cycle.

Apatinib + Liposomal Irinotecan

Apatinib in arm1 DRUG

Oral VEGFR-2 tyrosine kinase inhibitor administered in combination with liposomal irinotecan.

Apatinib + Liposomal Irinotecan

Eligibility Criteria

• Age: 12 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• The subject or their legal representative must sign a written informed consent form prior to enrollment.
• Diagnosis of refractory osteosarcoma confirmed by histopathology. Pathological confirmation is mandatory for localized tumors and isolated pulmonary lesions; it is not required for multiple pulmonary metastases.
• Disease progression after standard, adequate first-line and second-line chemotherapy regimens for osteosarcoma, or progression within 6 months of stopping such therapy.
• At least one measurable target lesion according to RECIST version 1.1 criteria.
• ECOG Performance Status score of 0 or 1, with an expected survival of ≥3 months.
• Recovery from prior therapies: all side effects (except alopecia) must have resolved to Grade 1 or lower per NCI-CTCAE version 5.0.
• Adequate organ function as indicated by the following peripheral blood counts and serum biochemistry results
• Women of childbearing potential must agree to use effective contraception (e.g., intrauterine device, oral contraceptives, or condoms) during the study and for 6 months after study completion; they must have a negative serum or urine pregnancy test within 7 days prior to study enrollment and must not be breastfeeding. Male participants must agree to use effective contraception or have undergone surgical sterilization during the study and for 6 months after its completion.

You may not qualify if:

• Prior treatment with apatinib.
• Prior use of irinotecan or other analogues of topoisomerase inhibitors.
• Known allergic reactions, hypersensitivity, or intolerance to apatinib, liposomal irinotecan, or any of their excipients.
• Within 3 weeks after the last dose of any prior therapy, including systemic cytotoxic drug therapy, targeted therapy, radiotherapy, immunotherapy, or any other investigational therapy.
• Diagnosis of other malignancies within the past 3 years, except for adequately treated cutaneous basal cell carcinoma, carcinoma in situ of the cervix, or breast cancer that has undergone radical resection and remained disease-free for \>3 years.
• Patients with known brain metastasis, spinal cord compression, carcinomatous meningitis, or those with imaging evidence of leptomeningeal disease or unstable brain lesions detected by CT or MRI during screening.
• Patients with symptomatic serous cavity effusions (e.g., pleural effusion, ascites, or pericardial effusion) requiring surgical intervention.
• Uncontrolled hypertension (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg despite optimal medical therapy).
• Other poorly controlled diseases.
• Participation in clinical trials of other antitumor drugs within the 4 weeks prior to enrollment.
• Treatment with strong CYP3A4 inhibitors within 7 days prior to study participation, or treatment with strong CYP3A4 inducers within 12 days prior to study participation.
• Patients currently receiving concurrent antitumor therapy.
• Patients with target lesions having previously received radiotherapy, but without subsequent progression.
• Patients who have received any vaccination during the treatment period, or have received an adenovirus-based vaccine within 4 weeks.
• Lactating women.

Sponsors & Collaborators

• Peking University People's Hospital: lead

Study Sites (1)

Peking University People's Hospital

Beijing, China

RECRUITING

Related Publications (5)

• Isakoff MS,Bielack SS,Meltzer P,Gorlick R

  BACKGROUND

• Xie L,Xu J,Sun X,Tang X,Yan T,Yang R,Guo W

  BACKGROUND

• Wang-Gillam A, Li CP, Bodoky G, Dean A, Shan YS, Jameson G, Macarulla T, Lee KH, Cunningham D, Blanc JF, Hubner RA, Chiu CF, Schwartsmann G, Siveke JT, Braiteh F, Moyo V, Belanger B, Dhindsa N, Bayever E, Von Hoff DD, Chen LT; NAPOLI-1 Study Group. Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial. Lancet. 2016 Feb 6;387(10018):545-557. doi: 10.1016/S0140-6736(15)00986-1. Epub 2015 Nov 29.

  PMID: 26615328 BACKGROUND

• Wagner LM, McAllister N, Goldsby RE, Rausen AR, McNall-Knapp RY, McCarville MB, Albritton K. Temozolomide and intravenous irinotecan for treatment of advanced Ewing sarcoma. Pediatr Blood Cancer. 2007 Feb;48(2):132-9. doi: 10.1002/pbc.20697.

  PMID: 16317751 BACKGROUND

• Duffaud F, Mir O, Boudou-Rouquette P, Piperno-Neumann S, Penel N, Bompas E, Delcambre C, Kalbacher E, Italiano A, Collard O, Chevreau C, Saada E, Isambert N, Delaye J, Schiffler C, Bouvier C, Vidal V, Chabaud S, Blay JY; French Sarcoma Group. Efficacy and safety of regorafenib in adult patients with metastatic osteosarcoma: a non-comparative, randomised, double-blind, placebo-controlled, phase 2 study. Lancet Oncol. 2019 Jan;20(1):120-133. doi: 10.1016/S1470-2045(18)30742-3. Epub 2018 Nov 23.

  PMID: 30477937 BACKGROUND

MeSH Terms

Conditions

Osteosarcoma

Interventions

irinotecan sucrosofate; apatinib; 26S proteasome non-ATPase regulatory subunit 13

Condition Hierarchy (Ancestors)

Neoplasms, Bone Tissue; Neoplasms, Connective Tissue; Neoplasms, Connective and Soft Tissue; Neoplasms by Histologic Type; Neoplasms; Sarcoma

Central Study Contacts

Xie Lu LuXie

CONTACT

86+13401044719; xie.lu@hotmail.com

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: associate chief physician

Study Record Dates

• First Submitted: March 6, 2026
• First Posted: March 18, 2026
• Study Start: March 5, 2026
• Primary Completion (Estimated): March 5, 2027
• Study Completion (Estimated): January 1, 2028
• Last Updated: March 18, 2026

Record last verified: 2026-03

Data Sharing

• IPD Sharing: Will not share

Locations

CN (1)