Study Design Prospective, single-arm, multicenter clinical study.
Study Drugs
Neoadjuvant phase: QL1706 (Aipaluo Tuoworilimab, an anti-PD-1/CTLA-4 combination antibody) plus lenvatinib.
Adjuvant phase: QL1706 monotherapy.
Target Population Patients with high-risk localized or locally advanced clear cell renal cell carcinoma (ccRCC) meeting AJCC staging criteria (e.g., cT3a G3-4 cN0M0, etc.) who are candidates for neoadjuvant therapy and surgical resection.
Treatment Flow
Screening (28 days): Informed consent obtained, baseline assessments completed.
Neoadjuvant phase (4 cycles, 21 days/cycle):
QL1706 5 mg/kg IV, Q3W; plus oral lenvatinib 12 mg QD.
Efficacy evaluation every 2 cycles; surgery after 4 cycles (unless early termination).
Adjuvant phase (13-17 cycles, 21 days/cycle):
Eligible patients continue QL1706 5 mg/kg IV, Q3W.
Imaging every 3 months until recurrence, new therapy, death, or completion of 21 cycles total.
Follow-up: Safety follow-up (90 days after last QL1706 dose or 30 days after last other drug, whichever is longer), then survival follow-up every 90 days.
Endpoints
Primary: Objective response rate (ORR) per RECIST 1.1.
Secondary: Pathological complete response rate (pCR), median disease-free survival (mDFS), 12-/24-month DFS rates, median overall survival (mOS), and safety.
Sample Size Planned enrollment: 54 subjects.
Ability to understand and agree to comply with the study requirements and assessment schedule, and voluntarily provide written informed consent (ICF) prior to any trial-related procedures.
Age ≥ 18 years and ≤ 75 years, male or female.
Histologically or cytologically confirmed localized and locally advanced clear cell renal cell carcinoma.
Locally advanced renal cell carcinoma (stage III per AJCC): cT3a G3-4 cN0 M0; cT3b-T4 Gany cN0 M0; cTany cN1 Gany cM0; or high-risk localized renal cell carcinoma: cT1b G4 or with sarcomatoid features cN0 cM0; cT2 G3-4 cN0 cM0.
Presence of symptomatic or untreated known brain metastases or other central nervous system (CNS) metastases. CNS metastases that have been completely resected and/or irradiated with documented stability or improvement are not exclusionary, provided that computed tomography (CT) shows stability for at least 4 weeks prior to screening, with no evidence of cerebral edema and no requirement for glucocorticoids or anticonvulsants
Patients with advanced or metastatic renal cell carcinoma, or non-clear cell renal cell carcinoma
Known hypersensitivity to the investigational product or any of its excipients; or previous allergy to Chinese hamster ovary cell products or other recombinant human or humanized antibodies.
Prior discontinuation of immunotherapy due to severe and/or life-threatening immune-related adverse events
Single group
Iparomlimab and Tuvonralimab in combination with Lenvatinib
DrugNeoadjuvant phase (4 cycles, 21 days/cycle): From Cycle 1, Day 1: IV QL1706 (anti-PD-1/CTLA-4) 5 mg/kg Q3W for 4 cycles. Infusion interruptions allowed up to 8 hours total at room temperature. Concurrent oral lenvatinib 12 mg once daily for 4 cycles. Tumor response assessed every 2 cycles. After 4 cycles, subjects proceed to surgery unless early termination occurs due to clinical/radiographic progression (RECIST 1.1), unacceptable toxicity, consent withdrawal, or meeting discontinuation criteria. Adjuvant phase (13-17 cycles, 21 days/cycle): Based on postoperative pathology and investigator assessment, eligible patients (with consent) continue treatment. QL1706 5 mg/kg IV on Day 1 of each cycle, for 13-17 cycles. No lenvatinib in this phase. Key endpoints (implicit): safety and efficacy (ORR, pCR, DFS, OS) - but the summary focuses on treatment procedures as requested.
Objective Response Rate(ORR)
During the neoadjuvant treatment phase, the objective response rate (ORR) is defined as the percentage of subjects who achieve complete response (CR) or partial response (PR).
Pathological Complete Response Rate(pCR)
After neoadjuvant treatment, subjects undergo surgical resection, and the percentage of subjects who achieve pathological complete response (pCR) on pathological evaluation is calculated.
Disease-Free Survival(DFS)
Time from surgery to disease recurrence or metastasis.
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The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School
Lead sponsor
Wuxi No. 2 People's Hospital
Collaborator
Changzhou No.2 People's Hospital
Collaborator
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