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审核状态: Project audit state: |
通过审核 Successful |
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注册号: Registration number: |
ChiCTR2500113189 |
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最近更新日期: Date of Last Refreshed on: |
2025-11-25 21:08:21 |
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注册时间: Date of Registration: |
2025-11-25 00:00:00 |
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注册号状态: |
预注册 |
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Registration Status: |
Prospective registration |
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注册题目: |
汉防己甲素片联合米托坦治疗米托坦耐药晚期肾上腺皮质癌的临床研究 |
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Public title: |
A clinical trial of Tetrandrine Tablets in combination with Mitotane for the treatment of mitotane-resistant advanced adrenocortical carcinom |
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注册题目简写: |
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English Acronym: |
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研究课题的正式科学名称: |
汉防己甲素片联合米托坦治疗米托坦耐药晚期肾上腺皮质癌的临床研究 |
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Scientific title: |
A clinical trial of Tetrandrine Tablets in combination with Mitotane for the treatment of mitotane-resistant advanced adrenocortical carcinom |
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研究课题代号(代码): Study subject ID: |
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在二级注册机构或其它机构的注册号: The registration number of the Partner Registry or other register: |
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申请注册联系人: |
刘懿贤 |
研究负责人: |
郑莉 |
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Applicant: |
Liu Yixian |
Study leader: |
Zheng Li |
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申请注册联系人电话: Applicant telephone: |
+86 28 85421784 |
研究负责人电话:
Study leader's |
+86 18980601950 |
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申请注册联系人传真 : Applicant Fax: |
研究负责人传真: Study leader's fax: |
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申请注册联系人电子邮件: Applicant E-mail: |
sculyx1998@163.com |
研究负责人电子邮件: Study leader's E-mail: |
lzheng2005618@163.com |
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申请单位网址(自愿提供): Applicant website(voluntary supply): |
研究负责人网址(自愿提供): Study leader's website(voluntary supply): |
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申请注册联系人通讯地址: |
四川省成都省武侯区国学巷37号 |
研究负责人通讯地址: |
四川省成都省武侯区国学巷37号 |
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Applicant address: |
37 Guoxue Lane, Wuhou District, Chengdu City, Sichuan Province, China |
Study leader's address: |
37 Guoxue Lane, Wuhou District, Chengdu City, Sichuan Province, China |
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申请注册联系人邮政编码: Applicant postcode: |
研究负责人邮政编码: Study leader's postcode: |
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申请人所在单位: |
四川大学华西医院 |
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Applicant's institution: |
West China Hospital of Sichuan University |
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研究负责人所在单位: |
四川大学华西医院 |
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Affiliation of the Leader: |
West China Hospital of Sichuan University |
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是否获伦理委员会批准: |
是 |
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Approved by ethic committee: |
Yes |
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伦理委员会批件文号: Approved No. of ethic committee: |
2025年审(1508)号 |
伦理委员会批件附件: Approved file of Ethical Committee: |
查看附件View |
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批准本研究的伦理委员会名称: |
四川大学华西医院生物医学伦理审查委员会 |
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Name of the ethic committee: |
Ethics Committee on Biomedical Research West China Hospital of Sichuan University |
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伦理委员会批准日期: Date of approved by ethic committee: |
2025-10-21 00:00:00 | ||
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伦理委员会联系人: |
李娜 |
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Contact Name of the ethic committee: |
Li Na |
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伦理委员会联系地址: |
四川省成都省武侯区国学巷37号 |
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Contact Address of the ethic committee: |
37 Guoxue Lane, Wuhou District, Chengdu City, Sichuan Province, China |
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伦理委员会联系人电话: Contact phone of the ethic committee: |
+86 28 85422654 |
伦理委员会联系人邮箱: Contact email of the ethic committee: |
188974152@qq.com |
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研究实施负责(组长)单位: |
四川大学华西医院 |
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Primary sponsor: |
West China Hospital of Sichuan University |
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研究实施负责(组长)单位地址: |
四川省成都省武侯区国学巷37号 |
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Primary sponsor's address: |
37 Guoxue Lane, Wuhou District, Chengdu City, Sichuan Province, China |
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试验主办单位(项目批准或申办者): Secondary sponsor: |
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经费或物资来源: |
自选课题(自筹) |
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Source(s) of funding: |
Self-funded |
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研究疾病: |
肾上腺皮质癌 |
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Target disease: |
Adrenocortical Carcinoma |
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研究疾病代码: |
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Target disease code: |
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研究类型: |
干预性研究 |
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Study type: |
Interventional study |
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研究所处阶段: |
其它 | ||||||||||||||||||||||
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Study phase: |
N/A |
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研究设计: |
非随机对照试验 |
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Study design: |
Non randomized control |
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研究目的: |
1. 主要目的:评估汉防己甲素片单药及联合米托坦片在晚期ACC患者中的有效性。 主要研究终点:中位无进展生存期(mPFS)。 2. 次要目的:评估汉防己甲素片单药及联合米托坦片治疗晚期ACC患者的安全性。 次要研究终点:中位总生存期(mOS)、客观缓解率(ORR)、疾病控制率(DCR),AE的发生频率及严重程度,SAEs。 3. 探索性研究目的:探索汉防己甲素片治疗前后肿瘤微环境与疗效、米托坦耐药之间的关系 |
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Objectives of Study: |
1. Primary Objective: To evaluate the efficacy of Hanfangji Lignanoside tablets alone and in combination with Mitotane tablets in patients with advanced ACC. Primary Endpoint: Median progression-free survival (mPFS). 2. Secondary Objective: To evaluate the safety of Hanfangji Lignanoside tablets alone and in combination with Mitotane tablets in patients with advanced ACC. Secondary Endpoints: Median overall survival (mOS), objective response rate (ORR), disease control rate (DCR), the frequency and severity of adverse events (AEs), and serious adverse events (SAEs). 3. Exploratory Research Objective: To explore the relationship between the tumor microenvironment before and after Hanfangji Lignanoside treatment and its efficacy, as well as Mitotane resistance. |
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药物成份或治疗方案详述: |
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Description for medicine or protocol of treatment in detail: |
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纳入标准: |
1. 组织学或细胞学证实的肾上腺皮质癌; 2. 使用米托坦单药或含米托坦的联合方案后疾病进展,或不耐受当前治疗方案的复发性或转移性肾上腺皮质癌患者; 3. 年龄>=18岁且<=75岁,性别不限; 4. ECOG全身状态为0-2; 5. 根据RECIST v1.1,至少有一个可测量的病灶(非放射视野); 6. 在治疗前21天内,主要器官功能符合以下标准: (1) 血液学参数(首次给药14天内无输血、未使用G-CSF): 1) 血红蛋白(Hb)>=90g/L; 2) 绝对中性粒细胞计数(ANC)>=1.5×10^9/L; 3) 血小板(PLT)>=75×10^9/L; (2) 生化参数: 1) 总胆红素(TBIL)<=1.5×ULN; 2) 丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)<=3×ULN,对伴肝转移的受试者,允许丙氨酸氨基转移酶 (ALT) 和天门冬氨酸氨基转移酶 (AST) <=5×ULN; 3) 血清肌酐(Cr)<=1.5×ULN或肌酐清除率(CCr)>=60ml/min; (3) 凝血参数: 1) 国际标准化比值(INR)或凝血酶原时间(PT)<=1.5×ULN; 2) 活化部分凝血酶时间(APTT)<=1.5×ULN(接受抗凝治疗的受试者PT和APTT应在预期治疗范围内); (4) 心脏参数: 1) Fridericia 法校正 QT 间期(QTcF)<450ms; 8. 具有生育能力的男性和女性必须同意在研究期间和服用最后一次研究药物后的6个月内采用医学上批准使用的避孕措施(如宫内节育器、避孕药或避孕套); 9. 具有生育能力的女性:在研究药物第一次给药前7天内血妊娠试验阴性;研究参与者不得处于哺乳期; 10. 参加本次试验前未经影像学确认使用汉防己甲素片后疾病进展; 11. 经研究者判断,依从性高,愿意完成试验并能遵守试验方案; 12. 自愿参加本次临床试验,理解研究程序且能够书面签署知情同意书。 |
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Inclusion criteria |
1. Histologically or cytologically confirmed adrenocortical carcinoma (ACC); 2. Patients with recurrent or metastatic ACC with disease progression after mitotane monotherapy or mitotane-containing combination therapy, or intolerance to current treatment; 3. Age >=18 years and <=75 years, any gender; 4. ECOG performance status of 0–2; 5. At least one measurable lesion (non-radiated field) according to RECIST v1.1; 6. Adequate major organ function within 21 days prior to treatment: (1) Hematologic parameters (no transfusion or use of G-CSF within 14 days before first administration): 1) Hemoglobin (Hb) >=90 g/L; 2) Absolute neutrophil count (ANC) >=1.5 × 10^9/L; 3) Platelets (PLT) >=75 × 10^9/L; (2) Biochemical parameters: 1) Total bilirubin (TBIL) <=1.5 × upper limit of normal (ULN); 2) Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) <=3 × ULN; 3) For subjects with liver metastases, ALT and AST <=5 × ULN are allowed; 4) Serum creatinine (Cr) <=1.5 × ULN or creatinine clearance (CCr) >=60 mL/min; (3) Coagulation parameters: 1) International normalized ratio (INR) or prothrombin time (PT) <=1.5 × ULN; 2) Activated partial thromboplastin time (APTT) <=1.5 × ULN (subjects on anticoagulant therapy should have PT and APTT within the expected therapeutic range); (4) Cardiac parameters: 1) Fridericia-corrected QT interval (QTcF) <450 ms; 8. Males and females of reproductive potential must agree to use medically approved contraception (e.g., intrauterine device, oral contraceptives, or condoms) during the study and for 6 months after the last dose of the study drug; 9. Females of reproductive potential: negative blood pregnancy test within 7 days prior to the first dose of study drug; participants must not be breastfeeding; 10. Disease progression prior to this trial without radiographic confirmation after the use of Hanfangji jiasu tablets; 11. High compliance as judged by the investigator, willingness to complete the study, and ability to follow the study protocol; 12. Voluntarily participate in this clinical trial, understand the study procedures, and be able to sign the informed consent form in writing. |
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排除标准: |
1. 近5年内有任何其他恶性肿瘤病史,已治愈的皮肤基底细胞癌、皮肤鳞状细胞癌、原位宫颈癌、甲状腺乳头状癌除外; 2. 活动性(未经医疗控制或有临床症状)的脑转移、癌性脑膜炎、脊髓压迫患者,或有中枢神经系统原发肿瘤病史,或需要类固醇、脱水干预的脑水肿患者;(首次使用研究药物至少28天前已完成治疗且症状稳定的脑转移患者可酌情入组,但须经头颅影像学检查如CT、MRI或静脉造影确认无脑出血); 3. 本研究首次用药前,接受细胞毒性药物、免疫治疗、靶向治疗或其他临床研究末次用药<4周(或小于5个半衰期,以研究者判断的最合适的情况为准,米托坦除外);距离放疗结束间隔<2周; 4. 本研究首次用药前2周内,使用CYP3A4强抑制剂、强诱导剂,或研究期间需要继续接受这些药物治疗(米托坦除外); 5. 研究参与者具有影响口服药物的多种因素之一(比如无法吞咽或肠梗阻等)或具有活动性胃肠道疾病或其他疾病可能导致明显影响药物吸收、分布、代谢或排泄的因素(活动性、炎症性肠病或慢性腹泻,肠内综合征或上消化道手术,包括胃切除术); 6. 严重或控制不佳的高血压,包括:既往有高血压危象、高血压脑病病史;或者研究认为不适合的高血压; 7. 存在中度或重度心脏疾病: (1) 首次给药前6个月内发生过心肌梗塞、心绞痛、III/IV度充血性心力衰竭、心包积液; (2) 心电图异常且需要临床干预:例如症状性或持续性房性或室性心律失常、II度或III度房室传导阻滞、完全性左束支传导阻滞、心室肥大; (3) 既往超声心动图显示有显著的异常:例如中度或重度心脏瓣膜功能缺损,根据机构的正常下限进行评估,或左心室射血分数(LVEF)<50%;微量或轻度瓣膜反流者(三尖瓣、肺动脉瓣、二尖瓣或主动脉瓣)可以纳入本研究; (4) 可能增加QTcF延长风险或心律失常事件风险的各种因素:例如先天性长QT综合征,可能延长QT间期的各种合并用药; 8. 在首次使用研究药物前2周内接受全身糖皮质类固醇(相当于强的松>10 mg/天,ACC术后或ACC病情需要生理替代量补充除外)或其他免疫抑制剂进行全身治疗,除非用于局部炎症、预防过敏、恶心和呕吐。在没有活动性自身免疫性疾病的情况下,允许吸入或局部类固醇和肾上腺皮质类固醇替代治疗,剂量大于10 mg/天的强的松当量; 9. 在过去2年内需要系统性治疗的活动性自身免疫性疾病(即使用改善病情药物、皮质类固醇或免疫抑制药物)。替代治疗(例如,甲状腺素、胰岛素或生理性皮质类固醇替代治疗[<10 mg/天泼尼松等效剂量]治疗肾上腺或垂体功能不全等)不被视为系统性治疗的一种形式; 10. 根据研究者的判断,有严重危害研究参与者安全、或影响研究参与者完成研究的医学状况:例如无法控制的糖尿病、甲状腺疾病、间质性肺炎、严重的活动期感染或未能控制的慢性感染、Child-Pugh分级B或C级肝硬化等; 11. 在第一次服用研究药物前4周内发生严重感染,如需要住院治疗的重症肺炎、败血症、感染并发症等;基线胸部影像显示活动性肺部炎症,在首次服用研究药物前2周内出现感染症状和体征,或需要静脉注射抗生素治疗(不包括预防性使用抗生素); 12. 妊娠或哺乳期妇女; 13. 既往有严重过敏史者(例如过敏性休克),或对汉防己甲素片和米托坦的任何活性或非活性成分过敏的受试者; 14. 需接受治疗的活动性乙型肝炎(乙肝表面抗原和/或乙肝核心抗体阳性且 HBV-DNA >=10^3拷贝/mL或>=200 IU/mL)或丙型肝炎者(丙肝病毒抗体阳性和/或HCV-RNA阳性者); 15. 有免疫缺陷病史,包括HIV检测阳性,或患有其他获得性、先天性免疫缺陷疾病,或有器官移植史,或有异基因骨髓移植史; 16. 经病史或影像学检查发现的活动性结核感染,或入组前1年内有活动性结核感染史,但未得到恰当治疗的; 17. 在研究治疗首次给药前28天内进行过大手术(不包括放置血管通路)或进行小手术操作<=7天。中心静脉置管术、输液港置入术和引流管置入术后无需等待; 18. 在首次研究药物给药前4周内接种抗肿瘤疫苗或接种活疫苗; 19. 研究治疗首次给药前1个月内出现过具有显著临床意义的出血症状或具有明显的出血倾向,如消化道出血、胃溃疡出血、活动性咯血等; 20. 研究治疗首次给药前3个月内发生过严重动静脉血栓事件,如深静脉血栓、肺栓塞等(植入式静脉输液港、导管源性血栓形成或浅表静脉血栓形成除外,这几种情况不被视为“严重”血栓栓塞); 21. 有滥用精神药物、酗酒和吸毒成瘾史,任何可能干扰试验结果、妨碍研究参与者充分参与研究或被研究者认为不符合研究参与者最佳利益的病史、疾病、治疗或异常实验室结果; 22. 研究者认为,受试者的并发症或其他状况(心理、家庭、社会或地理因素等)可能会影响方案的依从性,或者可能不适合参加研究。 |
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Exclusion criteria: |
1. History of any other malignant tumors in the past 5 years, except for cured basal cell carcinoma of the skin, squamous cell carcinoma of the skin, cervical cancer in situ, and papillary carcinoma of the thyroid; 2. Patients with active (uncontrolled or clinically symptomatic) brain metastasis, carcinomatous meningitis, spinal cord compression, or a history of primary tumors of the central nervous system, or cerebral edema requiring steroids or dehydration intervention; (1) Patients with brain metastases who completed treatment at least 28 days prior to the first use of the study drug and have stable symptoms may be enrolled at the investigator’s discretion, provided cranial imaging (e.g., CT, MRI, or venography) confirms the absence of cerebral hemorrhage; 3. Received cytotoxic drugs, immunotherapy, targeted therapy, or participation in another clinical trial within <4 weeks (or <5 half-lives, whichever is longer, per investigator judgment) before the first dose of this study (mitotane excluded); or <2 weeks since completion of radiotherapy; 4. Use of strong CYP3A4 inhibitors or strong inducers within 2 weeks prior to the first dose of the study drug, or requirement to continue these medications during the study period (mitotane excluded); 5. Study participants have one or more factors affecting oral drug administration (e.g., inability to swallow, intestinal obstruction) or active gastrointestinal disease or other conditions that may significantly affect drug absorption, distribution, metabolism, or excretion (e.g., active inflammatory bowel disease, chronic diarrhea, intestinal syndrome, or prior upper gastrointestinal surgery including gastrectomy); 6. Severe or poorly controlled hypertension, including a history of hypertensive crisis or hypertensive encephalopathy, or hypertension deemed unsuitable for study participation by the investigator; 7. Presence of moderate or severe cardiac disease: (1) Myocardial infarction, angina, NYHA Class III/IV congestive heart failure, or pericardial effusion within 6 months prior to first dose; (2) ECG abnormalities requiring clinical intervention, such as symptomatic or sustained atrial/ventricular arrhythmias, second- or third-degree atrioventricular block, complete left bundle branch block, or ventricular hypertrophy; (3) Prior echocardiogram showing significant abnormalities: moderate or severe valvular dysfunction per institutional normal lower limits, or left ventricular ejection fraction (LVEF) <50%; minimal or mild regurgitation of tricuspid, pulmonary, mitral, or aortic valves is permitted; (4) Factors that may increase the risk of QTcF prolongation or arrhythmic events, e.g., congenital long QT syndrome or concomitant medications known to prolong the QT interval; 8. Systemic corticosteroids (equivalent to prednisone >10 mg/day) or other immunosuppressive agents within 2 weeks prior to first study drug dose, except for physiological replacement in ACC (postoperative or disease-related) or for local inflammation, allergy prophylaxis, or antiemesis; inhaled or topical steroids and adrenal replacement therapy (>10 mg/day prednisone equivalent) are permitted in the absence of active autoimmune disease; 9. Active autoimmune disease requiring systemic treatment (e.g., disease-modifying agents, corticosteroids, or immunosuppressants) within the past 2 years; replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement [<10 mg/day prednisone equivalent] for adrenal or pituitary insufficiency) is not considered systemic treatment; 10. Medical conditions, per investigator judgment, that seriously endanger participant safety or interfere with study completion, e.g., uncontrolled diabetes, thyroid disease, interstitial pneumonia, severe active or uncontrolled chronic infection, or Child-Pugh Class B/C cirrhosis; 11. Serious infection requiring hospitalization (e.g., severe pneumonia, sepsis, or infectious complications) within 4 weeks prior to first dose; or baseline chest imaging showing active pulmonary inflammation; or signs/symptoms of infection within 2 weeks prior to first dose; or need for intravenous antibiotics (prophylactic use excluded); 12. Pregnant or lactating women; 13. History of severe allergic reaction (e.g., anaphylactic shock) or known allergy to any active or inactive ingredient of Hanfangji jiasu tablets or mitotane; 14. Active hepatitis B requiring treatment (HBsAg and/or anti-HBc positive with HBV-DNA >=10^3 copies/mL or >=200 IU/mL) or active hepatitis C (anti-HCV positive and/or HCV-RNA positive); 15. History of immunodeficiency, including positive HIV test, other acquired or congenital immunodeficiency disorders, organ transplantation, or allogeneic bone marrow transplantation; 16. Active tuberculosis infection confirmed by medical history or imaging, or history of active TB within 1 year prior to enrollment without appropriate treatment; 17. Major surgery (excluding vascular access placement) within 28 days, or minor surgical procedure within <=7 days prior to first study treatment dose; no waiting period required after central venous catheterization, port placement, or drainage tube insertion; 18. Receipt of anti-tumor vaccines or live vaccines within 4 weeks prior to first study drug dose; 19. Clinically significant bleeding or clear bleeding tendency within 1 month prior to first study treatment dose (e.g., gastrointestinal bleeding, gastric ulcer bleeding, active hemoptysis); 20. Serious arterial or venous thromboembolic events (e.g., deep vein thrombosis, pulmonary embolism) within 3 months prior to first study treatment dose; exceptions include catheter-related thrombosis, port-associated thrombosis, or superficial venous thrombosis, which are not considered "serious" thromboembolism; 21. History of substance abuse, alcoholism, or drug addiction; or any medical history, disease, treatment, or abnormal laboratory finding that may interfere with trial results, impair full participation, or is deemed not in the participant’s best interest by the investigator; 22. In the investigator’s opinion, complications or other factors (psychological, familial, social, or geographic) that may impair protocol compliance or render the participant unsuitable for study participation. |
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研究实施时间: Study execute time: |
从 From 2025-10-31 00:00:00至 To 2027-10-31 00:00:00 |
征募观察对象时间: Recruiting time: |
从 From 2025-12-01 00:00:00 至 To 2027-10-31 00:00:00 |
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干预措施: Interventions: |
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研究实施地点: Countries of recruitment and research settings: |
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测量指标: Outcomes: |
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采集人体标本:
Collecting sample(s)
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征募研究对象情况: Recruiting status: |
尚未开始 Not yet recruiting |
年龄范围: Participant age: |
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性别: |
男女均可 |
Gender: |
Both |
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随机方法(请说明由何人用什么方法产生随机序列): |
根据 A、B 队列剂量扩展阶段样本量确定分配?例为 9:13,区组长度为 22,使?统计软件 Excel,为每个区组?成?个随机序列,其中包含9 个“A”和 13 个“B”。重复此过程两次,?成两个区组的序列。每个序列都是随机的,将两个区组的序列连接起来,形成总长度为 44 的分配列表。根据研究参与者?组号分配具体队列 |
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Randomization Procedure (please state who generates the random number sequence and by what method): |
Based on the sample size in the dose expansion phase of cohorts A and B, the allocation ratio was set at 9:13, with a block size of 22. Using the statistical software Excel, a random sequence was generated for each block, containing 9 "A"s and 13 "B"s. This process was repeated twice to generate two block sequences. Each sequence was randomized, and the two block sequences were concatenated to form a total allocation list of length 44. Participants were assigned to specific cohorts according to their enrollment number. |
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是否公开试验完成后的统计结果: Calculated Results after the Study Completed public access: |
不公开/Private |
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盲法: |
开放标签 |
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Blinding: |
Open-label study |
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是否共享原始数据: IPD sharing |
否No |
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共享原始数据的方式(说明:请填入公开原始数据日期和方式,如采用网络平台,需填该网络平台名称和网址): |
不共享 |
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The way of sharing IPD”(include metadata and protocol, If use web-based public database, please provide the url): |
Do not share |
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数据采集和管理(说明:数据采集和管理由两部分组成,一为病例记录表(Case Record Form, CRF),二为电子采集和管理系统(Electronic Data Capture, EDC),如ResMan即为一种基于互联网的EDC: |
病例记录表 |
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Data collection and Management (A standard data collection and management system include a CRF and an electronic data capture: |
Case Record Form |
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数据与安全监察委员会: Data and Safety Monitoring Committee: |
有/Yes |