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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: |
ChiCTR2400087485 |
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最近更新日期: Date of Last Refreshed on: |
2024-07-29 10:41:48 |
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注册时间: Date of Registration: |
2024-07-29 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: |
经血管介入治疗联合信迪利单抗和雷莫西尤单抗治疗进展期肝细胞癌的前瞻性、单臂、多中心II期研究 |
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Public title: |
A Prospective, Single-Arm, Multicenter Phase II Study of Transarterial Interventional Therapy Combined with Sintilimab and Ramucirumab for Advanced Hepatocellular Carcinoma |
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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: |
经血管介入治疗联合信迪利单抗和雷莫西尤单抗治疗进展期肝细胞癌的前瞻性、单臂、多中心II期研究 |
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Scientific title: |
A Prospective, Single-Arm, Multicenter Phase II Study of Transarterial Interventional Therapy Combined with Sintilimab and Ramucirumab for Advanced Hepatocellular Carcinoma |
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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: |
卢文峰 |
研究负责人: |
张海斌 |
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Applicant: |
Lu Wenfeng |
Study leader: |
Zhang Haibin |
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申请注册联系人电话: Applicant telephone: |
+86 159 2195 3910 |
研究负责人电话: Study leader's telephone: |
+86 139 1732 2068 |
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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: |
463112126@qq.com |
研究负责人电子邮件: Study leader's E-mail: |
drzhanghb@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: |
上海市杨浦区长海路225号 |
研究负责人通讯地址: |
上海市杨浦区长海路225号 |
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Applicant address: |
225 Changhai Road, Yangpu District, Shanghai |
Study leader's address: |
225 Changhai Road, Yangpu District, Shanghai |
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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: |
东方肝胆外科医院 |
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Applicant's institution: |
Eastern Hepatobiliary Surgery Hospital |
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研究负责人所在单位: |
东方肝胆外科医院 |
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Affiliation of the Leader: |
Eastern Hepatobiliary Surgery Hospital |
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是否获伦理委员会批准: |
是/Yes |
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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: |
EHBHKY2024-H023-P001 |
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: |
东方肝胆外科医院伦理学委员会 |
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Name of the ethic committee: |
Ethics Committee of Eastern Hepatobiliary Surgery Hospital |
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伦理委员会批准日期: Date of approved by ethic committee: |
2024-06-27 00:00:00 |
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伦理委员会联系人: |
邰小云 |
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Contact Name of the ethic committee: |
Tai Xiaoyun |
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伦理委员会联系地址: |
上海市杨浦区长海路225号 |
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Contact Address of the ethic committee: |
225 Changhai Road, Yangpu District, Shanghai |
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伦理委员会联系人电话: Contact phone of the ethic committee: |
+86 152 2139 0719 |
伦理委员会联系人邮箱: Contact email of the ethic committee: |
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研究实施负责(组长)单位: |
东方肝胆外科医院 |
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Primary sponsor: |
Eastern Hepatobiliary Surgery Hospital |
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研究实施负责(组长)单位地址: |
上海市杨浦区长海路225号 |
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Primary sponsor's address: |
225 Changhai Road, Yangpu District, Shanghai |
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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: |
自筹 |
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Source(s) of funding: |
self-raised |
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Target disease: |
Hepatocellular carcinoma |
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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: |
II期临床试验 | ||||||||||||||||||||||
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Study phase: |
2 |
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研究设计: |
单臂 |
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Study design: |
Single arm |
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研究目的: |
探索经血管介入治疗联合信迪利单抗和雷莫西尤单抗一线治疗进展期肝细胞癌的疗效及安全性 |
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Objectives of Study: |
To explore the efficacy and safety of Transarterial Interventional Therapy Combined with Sintilimab and Ramucirumab in the first-line treatment of advanced hepatocellular carcinoma |
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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. 在任何试验相关流程实施之前,签署书面知情同意 2. 年龄18-70周岁 3. ECOG PS评分为0-1 4. 根据中国原发性肝癌诊疗规范(2024年版)诊断标准初次诊断为肝细胞癌 5. 巴塞罗那临床肝癌(Barcelona Clinic Liver Cancer, BCLC)分期为 B、C期 6. 既往未接受过针对肝细胞癌的全身系统性抗肿瘤治疗 7. Child-Pugh评分A级 8. 预期生存时间>3个月; 9. 根据RECIST v1.1/mRECIST标准至少有1个可测量病灶 10. 总三碘甲腺原氨酸(T3)或游离T3和游离甲状腺素(T4)在正常范围内。(可以接受通过甲状腺替代疗法控制)。无症状的T3,游离T3或游离T4异常的受试者可以入选 11. 充分控制血压 12. 具有充分的器官和骨髓功能,入组前7天内实验室检查值符合下列要求(获得实验室检查的前14天内不允许通过给予任何血液成分、细胞生长因子、白蛋白及其他纠正治疗的药物来满足条件),具体如下: 1) 血常规:绝对中性粒细胞计数(absolute neutrophil count, ANC)≥1.5×109/L; 血小板计数(platelet, PLT)≥75×10 9/L; 血红蛋白含量(hemoglobin, HGB)≥9.0 g/dL; 2) 肝功能:血清总胆红素(total bilirubin, TBIL)≤3×正常上限(upper limit of normal value, ULN);丙氨酸氨基转移酶(alanine aminotransferase, ALT)、天门冬氨酸氨基转移酶(aspartate transferase, AST)和碱性磷酸酶(alkaline phosphatase, ALP)≤5×ULN; 血清白蛋白≥28 g/L; 3) 肾功能:血清肌酐(creatinine, Cr)≤ 1.5×ULN 或肌酐清除率(clearance of creatinine, CCr)≥ 50mL/min(Cockcroft-Gault 公式);尿常规结果显示尿蛋白<2+;对基线时尿常规检测显示尿蛋白≥2+的患者,应进行24小时尿液采集且24小时尿蛋白定量<1g; 4) 凝血功能:国际标准化比率(international normalized ratio,INR)和活化部分凝血活酶时间(activated partial thromboplastin time ,APTT)≤ 1.5倍ULN 13. 对于育龄期女性受试者,应在接受首次研究药物给药(第1周期第1天)之前的3天内接受尿液或血清妊娠试验且结果为阴性。如果尿液妊娠试验结果无法确认为阴性,则要求进行血液妊娠试验。非育龄期女性定义为绝经后至少1年,或进行过手术绝育或子宫切除术; 14. 如存在受孕风险,所有受试者(不论男性或女性)均需在整个治疗期间直至治疗末次研究药物给药后120天(或末次化疗药物给药后180天)内采用年失败率低于1%的避孕措施。 |
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Inclusion criteria |
1. Sign a written informed consent form before any trial-related procedures. 2. Age between 18 and 70 years. 3. ECOG PS score of 0-1. 4. Initially diagnosed with hepatocellular carcinoma according to the Chinese Primary Liver Cancer Diagnosis and Treatment Guidelines (2024 edition). 5. Barcelona Clinic Liver Cancer (BCLC) stage B or C. 6. No prior systemic anti-tumor therapy for hepatocellular carcinoma. 7. Child-Pugh score of A. 8. Expected survival time of more than 3 months. 9. At least one measurable lesion according to RECIST v1.1/mRECIST criteria. 10. Total triiodothyronine (T3) or free T3 and free thyroxine (T4) within normal ranges (controlled by thyroid replacement therapy if necessary). Asymptomatic patients with abnormal T3, free T3, or free T4 may be included. 11. Well-controlled blood pressure. 12. Adequate organ and bone marrow function with laboratory values within the following criteria within 7 days before enrollment (no administration of blood components, cell growth factors, albumin, or other corrective treatments within 14 days before laboratory tests): 1. Hematology: Absolute neutrophil count (ANC) ≥1.5×10^9/L; Platelet count (PLT) ≥75×10^9/L; Hemoglobin (HGB) ≥9.0 g/dL. 2. Liver function: Serum total bilirubin (TBIL) ≤3×upper limit of normal (ULN); Alanine aminotransferase (ALT), aspartate transferase (AST), and alkaline phosphatase (ALP) ≤5×ULN; Serum albumin ≥28 g/L. 3. Kidney function: Serum creatinine (Cr) ≤1.5×ULN or creatinine clearance (CCr) ≥50 mL/min (Cockcroft-Gault formula); Urinalysis shows proteinuria <2+; For patients with baseline proteinuria ≥2+, a 24-hour urine collection must show <1 g of protein. 4. Coagulation: International normalized ratio (INR) and activated partial thromboplastin time (APTT) ≤1.5×ULN. 13. Female participants of childbearing potential must have a negative urine or serum pregnancy test within 3 days before the first dose of study medication (Day 1 of Cycle 1). If the urine test result is not confirmatory, a blood pregnancy test is required. Women not of childbearing potential are defined as postmenopausal for at least one year or having undergone surgical sterilization or hysterectomy. 14. All participants (both male and female) with reproductive potential must use highly effective contraception (annual failure rate <1%) throughout the treatment period and for 120 days after the last dose of study medication (or 180 days after the last dose of chemotherapy). |
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排除标准: |
1. 既往经组织学/细胞学确诊的含纤维板层肝细胞癌、肉瘤样肝细胞癌、胆管癌等成分 2. 有肝性脑病病史,或有肝移植病史 3. 有临床症状需要引流的胸水、腹水、心包积液 4. 有中枢神经系统转移 5. 既往6个月内出现过门静脉高压导致的食管或胃底静脉曲张出血事件。首次给药前3个月内已知的内镜检查存在重度(G3)静脉曲张。有门静脉高压证据(包括影像学检查发现脾大),经研究者评估出血风险高者 6. 既往3个月内发生任何危及生命的出血事件,包括需要输血治疗、手术或局部治疗、持续药物治疗 7. 既往6个月内动、静脉血栓栓塞事件,包括心肌梗死、不稳定型心绞痛、脑血管意外或一过性脑缺血发作、肺动脉栓塞、深静脉血栓或其它任何严重血栓栓塞的病史。植入式静脉输液港或导管源性血栓形成,或浅表静脉血栓形成,经过常规抗凝治疗后血栓稳定者除外。允许预防性使用小剂量低分子肝素(如依诺肝素40 mg/天) 8. 首次给药前2周内,连续10天使用阿司匹林(> 325 mg/天)或其他已知可以抑制血小板功能的药物如双嘧达莫或氯吡格雷等 9. 不可控制的高血压, 经最佳医学治疗后收缩压>150mmHg或舒张压>90 mmHg,高血压危象或高血压脑病病史 10. 症状性充血性心力衰竭(纽约心脏病协会分级II-IV级)。症状性或控制不佳的心律失常。先天性长QT综合征病史或筛查时校正的QTc>500ms(使用Fridericia法计算) 11. 严重出血倾向或凝血功能障碍,或正在接受溶栓治疗 12. 既往6个月内有胃肠道穿孔和/或瘘管病史,肠梗阻病史(包括需要肠外营养的不完全肠梗阻),广泛肠切除(部分结肠切除或广泛小肠切除,并发慢性腹泻)、克罗恩氏病、溃疡性结肠炎或长期慢性腹泻 13. 首次给药前3周内接受过放射治疗。对于首次给药前3周前接受放射治疗的患者,必须满足下述所有条件方可入组:目前不存在任何放疗相关的毒性反应,不需要服用糖皮质激素,排除放射性肺炎、放射性肝炎、放射性肠炎等 14. 既往和目前有肺纤维化史、间质性肺炎、尘肺、药物相关肺炎、肺功能严重受损等肺部疾病 15. 活动性肺结核(TB),正在接受抗结核治疗或者首次给药前1年内接受过抗结核治疗者 16. 人免疫缺陷病毒(HIV)感染者(HIV 1/2抗体阳性),已知的梅毒感染者 17. 处于活动期或临床控制不佳的严重感染。在首次给药前4周内有重度感染,包括但不限于因感染、菌血症或重度肺炎并发症而住院治疗 18. 首次给药前2年内发生过需要全身性治疗(例如使用缓解疾病药物、皮质类固醇或免疫抑制剂)的活动性自身性免疫疾病。允许使用替代疗法(例如甲状腺素、胰岛素或者用于肾上腺或垂体机能不全的生理性皮质类固醇等)。已知的原发性免疫缺陷病史。仅存在自身免疫抗体阳性的患者需根据研究者判断确认是否存在自身免疫性疾病 19. 首次给药前4周之内使用过免疫抑制药物,不包括喷鼻、吸入性或其他途径的局部糖皮质激素或生理剂量的系统性糖皮质激素(即不超过10mg/天泼尼松或等效剂量的其他糖皮质激素)、允许因治疗哮喘、慢性阻塞性肺疾病等疾病的呼吸困难症状临时使用糖皮质激素 20. 首次给药前4周之内或计划在研究期间接受减毒活疫苗 21. 首次给药前4周之内接受过重大的外科手术(开颅、开胸或开腹手术)或者未愈合的伤口、溃疡或骨折。首次给药之前7天内接受过组织穿刺活检或其他小外科手术,以静脉输液为目的的静脉穿刺置管除外 22. 首次给药前4周之内接受过针对肝癌的局部治疗 23. 首次给药前2周内接受过具有免疫调节作用的药物(包括胸腺肽、干扰素、白介素,除外为控制胸水或腹水局部使用) 24. 不受控制/无法纠正的代谢紊乱或其它非恶性肿瘤器官疾病或全身性疾病或癌症继发反应,并可导致较高医学风险和/或生存期评价不确定性 25. 在首次给药前5年内诊断为其他恶性肿瘤,不包括经过根治的皮肤基底细胞癌、皮肤鳞状细胞癌和/或经过根治切除的原位癌。如果给药前5年以上诊断为其他恶性肿瘤或肝癌,需对复发转移病灶进行病理学或细胞学诊断 26. 既往接受过任何抗PD-1抗体、抗PD-L1抗体、抗CTLA4抗体,或其他免疫治疗。既往接受过抗VEGF和/或VEGFR、RAF、MEK、PDGFR、FGFR等信号通路的靶向治疗。 27. 已知对于任何信迪利单抗、雷莫西尤单抗成分过敏;或既往对其他单克隆抗体或抗血管生成抑制剂产生过严重过敏反应 28. 首次给药前4周内接受过其他临床试验的治疗 29. 妊娠或哺乳的女性患者 30. 可能会导致以下结果的其它急性或慢性疾病、精神疾病或实验室检测值异常:增加研究参与或研究药物给药的相关风险,或者干扰研究结果的解读,而且根据研究者的判断将患者列为不符合参加本研究的资格 |
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Exclusion criteria: |
1. Previously diagnosed by histology/cytology with hepatocellular carcinoma containing fibrolamellar, sarcomatoid, or cholangiocarcinoma components. 2. History of hepatic encephalopathy or liver transplantation. 3. Clinically significant pleural effusion, ascites, or pericardial effusion requiring drainage. 4. Central nervous system metastasis. 5. History of esophageal or gastric variceal bleeding due to portal hypertension within the past 6 months. Severe (G3) varices observed on endoscopy within 3 months before the first dose. High bleeding risk due to portal hypertension (including splenomegaly on imaging) as assessed by the investigator. 6. Life-threatening bleeding events within the past 3 months, including those requiring transfusion therapy, surgery, local treatment, or ongoing medication. 7. Arterial or venous thromboembolic events within the past 6 months, including myocardial infarction, unstable angina, cerebrovascular accident, transient ischemic attack, pulmonary embolism, deep vein thrombosis, or other severe thromboembolic conditions. Excludes catheter-associated thrombosis or superficial vein thrombosis stabilized by conventional anticoagulation. Prophylactic use of low-dose low molecular weight heparin (e.g., enoxaparin 40 mg/day) is permitted. 8. Continuous use of aspirin (>325 mg/day) or other platelet function inhibitors like dipyridamole or clopidogrel within 2 weeks before the first dose. 9. Uncontrolled hypertension, with systolic BP >150 mmHg or diastolic BP >90 mmHg after optimal medical therapy, or a history of hypertensive crisis or hypertensive encephalopathy. 10. Symptomatic congestive heart failure (NYHA Class II-IV). Symptomatic or poorly controlled arrhythmias. History of congenital long QT syndrome or corrected QTc >500ms (using Fridericia’s formula) at screening. 11. Severe bleeding tendency or coagulation disorder, or currently receiving thrombolytic therapy. 12. History of gastrointestinal perforation and/or fistula, intestinal obstruction requiring parenteral nutrition, extensive bowel resection (partial colectomy or extensive small intestine resection with chronic diarrhea), Crohn’s disease, ulcerative colitis, or chronic diarrhea within the past 6 months. 13. Radiotherapy within 3 weeks before the first dose. For patients receiving radiotherapy more than 3 weeks before the first dose, all related toxicities must have resolved, they must not require corticosteroids, and radiation-related pneumonitis, hepatitis, or enteritis must be excluded. 14. History of or current pulmonary fibrosis, interstitial lung disease, pneumoconiosis, drug-induced pneumonitis, or severely impaired lung function. 15. Active pulmonary tuberculosis (TB), currently undergoing anti-TB treatment or having received anti-TB treatment within the past year. 16. HIV infection (positive HIV 1/2 antibodies), known syphilis infection. 17. Severe infection that is active or poorly controlled, including severe infections requiring hospitalization for bacteremia or severe pneumonia complications within 4 weeks before the first dose. 18. Active autoimmune disease requiring systemic treatment (e.g., disease-modifying drugs, corticosteroids, or immunosuppressants) within 2 years before the first dose. Replacement therapies (e.g., thyroxine, insulin, or physiological corticosteroids for adrenal or pituitary insufficiency) are allowed. Known history of primary immunodeficiency. Patients with only positive autoimmune antibodies need the investigator’s judgment to confirm the absence of autoimmune disease. 19. Use of immunosuppressive drugs within 4 weeks before the first dose, excluding nasal, inhaled, or other local corticosteroids or physiological doses of systemic corticosteroids (no more than 10 mg/day prednisone or equivalent). Temporary use of corticosteroids for dyspnea due to conditions such as asthma or COPD is permitted. 20. Receipt of a live attenuated vaccine within 4 weeks before the first dose or planned during the study period. 21. Major surgery (craniotomy, thoracotomy, or laparotomy) or an unhealed wound, ulcer, or fracture within 4 weeks before the first dose. Minor surgical procedures such as venous catheter placement for infusion are allowed within 7 days before the first dose. 22. Local treatment for hepatocellular carcinoma within 4 weeks before the first dose. 23. Use of immunomodulatory drugs (including thymosin, interferons, interleukins, except for local use to control pleural or ascitic effusion) within 2 weeks before the first dose. 24. Uncontrolled or uncorrectable metabolic disorders, other non-malignant organ diseases, systemic diseases, or cancer-related secondary conditions that pose a high medical risk and/or uncertainty in survival evaluation. 25. Diagnosis of other malignant tumors within 5 years before the first dose, except for radically treated basal cell carcinoma, squamous cell carcinoma of the skin, and/or in-situ cancer. If diagnosed with another malignancy or hepatocellular carcinoma more than 5 years ago, a pathological or cytological diagnosis of recurrent or metastatic lesions is required. 26. Previous treatment with any anti-PD-1 antibody, anti-PD-L1 antibody, anti-CTLA4 antibody, or other immunotherapy. Previous treatment with targeted therapies against VEGF and/or VEGFR, RAF, MEK, PDGFR, FGFR pathways. 27. Known allergy to any component of sintilimab or ramucirumab; or severe allergic reactions to other monoclonal antibodies or anti-angiogenic inhibitors. 28. Participation in another clinical trial within 4 weeks before the first dose. 29. Pregnant or breastfeeding female patients. 30. Other acute or chronic diseases, psychiatric disorders, or abnormal laboratory values that may increase the risk associated with study participation or investigational drug administration, or interfere with the interpretation of study results, rendering the patient ineligible as determined by the investigator. |
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研究实施时间: Study execute time: |
从 From 2024-06-28 00:00:00至 To 2027-06-27 00:00:00 |
征募观察对象时间: Recruiting time: |
从From 2024-08-01 00:00:00 至 To 2026-08-31 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): |
不适用 |
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Randomization Procedure (please state who generates the random number sequence and by what method): |
N/A |
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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: |
公开/Public |
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盲法: |
无 |
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Blinding: |
None |
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试验完成后的统计结果(上传文件): |
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Calculated Results after
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是否共享原始数据: IPD sharing |
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): |
在实验结束,论文完成并发表后 |
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The way of sharing IPD”(include metadata and protocol, If use web-based public database, please provide the url): |
After the end of the experiment, the paper is completed and published |
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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: |
原始数据记录及病例记录表采用excel及SPSS格式进行保存 |
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Data collection and Management (A standard data collection and management system include a CRF and an electronic data capture: |
The original data records and case records were stored in excel and SPSS formats |
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数据与安全监察委员会: Data and Safety Monitoring Committee: |
暂未确定/Not yet |