Official Title
Cadonilimab Plus Anlotinib for Recurrent, Metastasis or Persistent Cervical Cancer
Brief Summary

The goal of this clinical trial is to test a new treatment combination includingcadonilimab, anlotinib and granulocyte-macrophage colony-stimulating factor (GM-CSF) inrecurrent, metastasis and persistent cervical cancer. The main questions it aims toanswer are: - The efficacy of this combination in R/M/P CC; - The tolerance of this combination in R/M/P CC; - Possible biomarker of treatment response for this combination.Participants will receive cadonilimab of 10mg/kg every three weeks at day 1, takeanlotinib (12mg) orally in day 1 to day 14, then take a 7 days break and subcutaneouslyinjection of GM-CSF (200ug) from day 1 to day 14, then also take a 7-days break. Thistreatment will continue until progression or intolerable toxicity or withdraw ofparticipants and it will last for no longer than 2 years.

Detailed Description

The prognosis was poor for recurrent, metastasis and persistent cervical cancer
especially for those who had multiple lesions and history of previous radiation therapy.
KEYNOTE-826 Study demonstrated survival benefit of adding pembrolizumab into the standard
first-line treatment for cervical cancer. Here we designed a exploratory clinical study
to test a new treatment combination including cadonilimab and anlotinib in recurrent,
metastasis and persistent cervical cancer. All participants will receive cadonilimab of
10mg/kg every three weeks at day 1, take anlotinib (8mg) orally in day 1 to day 14, then
take a 7-days break and subcutaneously injection of GM-CSF (200ug) from day 1 to day 14,
then also take a 7-days break. This treatment will continue until progression or
intolerable toxicity or withdraw of participants and it will last for no longer than 2
years.

Recruiting
Cervical Cancer

Drug: Cadonilimab

All Participants will receive cadonilimab of 10mg/kg every three weeks at day 1
Other Name: AK104

Drug: Anlotinib

All Participants will take anlotinib (12mg) orally in day 1 to day 14, then take a 7 days
break.
Other Name: AL001

Drug: Granulocyte-Macrophage Colony-Stimulating Factor

All Participants will have subcutaneously injection of granulocyte-macrophage
colony-stimulating factor from day 1 to day 14, then take a 7 days break.

Eligibility Criteria

Inclusion Criteria:

1. Obtain informed consent signed by the patient or their legal representative;

2. Female patients aged ≥18 and ≤75 years old;

3. ECOG PS score of 0-1;

4. Expected survival period ≥6 months;

5. Pathological types include squamous cell carcinoma, adenocarcinoma, or adenosquamous
carcinoma originating from the cervix;

6. Can provide tumor tissue specimens archived within 2 years or willing to undergo
tumor tissue biopsy to provide fresh specimens for further testing;

7. At least one evaluable lesion meeting the criteria of RECIST 1.1;

8. Have only received standard first-line systemic treatment in the past: (1) If
first-line treatment does not include immunotherapy, failure of first-line treatment
is sufficient (for patients who have previously achieved cure, any number of
neoadjuvant or adjuvant chemotherapy cycles do not count towards the line count,
unless disease progression occurs within 3 months after ≥3 cycles of
neoadjuvant/adjuvant chemotherapy; for persistent disease, ≥2 cycles of previous
chemotherapy can be counted as one line, otherwise not counted); (2) If first-line
treatment includes immunotherapy, clinical benefit must occur after first-line
treatment, namely partial or complete tumor remission, with the duration of efficacy
lasting more than 6 months.

9. Sitting blood pressure in a resting state is below the normal high value (<140/90
mmHg), or 24-hour dynamic blood pressure monitoring average blood pressure is below
the normal high value (<140/90 mmHg), regardless of whether antihypertensive drugs
are being taken orally;

10. Hematological indicators meet the following criteria (not transfused or administered
hematopoietic growth factor drugs within the past 7 days): white blood cell count
(WBC) ≥3.5×109/L, absolute neutrophil count (ANC) ≥1.5×109/L, platelets (PLT)
≥100×109/L, hemoglobin (Hb) ≥90g/L;

11. Liver function indicators meet the following criteria: ALT and AST ≤2.5 times the
upper limit of normal (ULN), bilirubin ≤1.5×ULN, albumin ≥35g/L;

12. Coagulation function indicators meet the following criteria (not receiving
anticoagulant or hemostatic drug therapy): PT and APTT ≤1.5×ULN, while INR ≤1.5 ULN;

13. Renal function indicators meet the following criteria: blood urea nitrogen (BUN) and
creatinine (Cr) ≤1.5×ULN, urinary protein <2+ or 24-hour urinary protein
quantification <1g;

14. Women of childbearing age must undergo serum pregnancy testing within 7 days before
initial medication, with negative results, and not be lactating. Female subjects of
childbearing age must agree to use effective contraception during the study period
and within 180 days after the last dose of the study drug;

15. Good compliance.

Exclusion Criteria:

Translation:

1. Any unstable systemic diseases, including but not limited to active infections
within 4 weeks (defined as fever exceeding 38.5°C, evidence of bacteremia, or
evidence of infectious changes in the heart, brain, kidneys, lungs, liver, and
intestines), circulatory accidents within 6 months (malignant hypertensive crisis,
myocardial infarction, severe/unstable angina, heart failure above NYHA class 2,
clinically significant supraventricular or ventricular arrhythmias, or cerebral
vascular accidents not yet recovered from or resulting in severe sequelae),
uncontrolled type 2 diabetes (fasting blood glucose >11.1 mmol/L or glycated
hemoglobin >8%), and pulmonary insufficiency (any cause leading to decreased lung
function, defined as FEV1/FVC <70%, FEV1 <80% of predicted value).

2. History of autoimmune diseases, including but not limited to systemic lupus
erythematosus, rheumatoid arthritis, autoimmune liver diseases, systemic vasculitis,
scleroderma, dermatomyositis, autoimmune hemolytic anemia;

3. Human immunodeficiency virus (HIV) infection or known acquired immunodeficiency
syndrome (AIDS); active hepatitis (hepatitis B, defined as HBV-DNA ≥ 500 IU/ml;
hepatitis C, defined as HCV-RNA higher than the detection limit of the assay) or
combined hepatitis B and hepatitis C infection;

4. History of attenuated live vaccine administration within 28 days before the first
dose of the study drug or expected attenuated live vaccine administration during the
study period;

5. Tumor invasion of major blood vessels on imaging or investigator judgment indicating
a high risk of tumor invasion of important vessels causing fatal bleeding or other
diseases with a high risk of severe bleeding;

6. Previous treatment with anlotinib or cadonilimab;

7. Evidence of active tuberculosis infection within the past year before screening;

8. Diagnosis of any other malignant tumors, adequately treated basal cell carcinoma or
squamous cell skin carcinoma, or cervical carcinoma in situ within 5 years before
entering the study;

9. Major surgery within 28 days before randomization (tissue biopsy for diagnostic
purposes and insertion of a central venous catheter via percutaneous puncture are
allowed);

10. Active venous or arterial thromboembolic events within 6 months before
randomization, such as cerebrovascular accidents (including transient ischemic
attacks), deep vein thrombosis, and pulmonary embolism;

11. Previous or planned allogeneic bone marrow or solid organ transplantation;

12. Clinically significant intestinal obstruction, occurrence of intestinal repair,
intestinal anastomosis, intestinal diversion, or enterocutaneous fistula for any
reason at any time;

13. Participants who experienced symptoms of hemoptysis within 2 months before entering
the study and had a maximum daily hemoptysis volume of approximately ≥2.5 mL.
Participants who experienced significant bleeding symptoms or had a clear bleeding
tendency, such as gastrointestinal bleeding, bleeding gastric ulcers, baseline fecal
occult blood test ++ and above, or vasculitis, within 3 months before entering the
study; known hereditary or acquired bleeding and thrombotic tendencies, such as
hemophilia, coagulation disorders, thrombocytopenia, splenic hyperfunction, etc.;

14. Visible hematuria or other evidence of active urinary system bleeding;

15. Currently receiving thrombolysis or requiring long-term anticoagulant therapy with
warfarin or heparin, or requiring long-term antiplatelet therapy (aspirin ≥300
mg/day or clopidogrel ≥75 mg/day);

16. Known allergy to anlotinib, cadonilimab or any of their excipients;

17. Participation in any other drug clinical studies within the previous 4 weeks before
randomization or within 5 half-lives of the last study drug administration;

18. History of substance abuse, alcoholism, or drug addiction;

19. Coexisting severe cognitive impairment and inability to achieve stable mental
status;

20. As judged by the investigator, patients may have other factors that could lead to
premature termination of the study, such as other serious illnesses or severe
laboratory abnormalities, or factors affecting the safety of the participants or the
collection of trial data and samples due to family or social reasons, etc.

Eligibility Gender
Female
Eligibility Age
Minimum: 18 Years ~ Maximum: 75 Years
Countries
China
Locations

Zhongnan Hospital of Wuhan University
Wuhan, Hubei, China

Investigator: Shaoxing Sun
Contact: +08613871286154
sunshaoxing@whu.edu.cn

Contacts

Shaoxing Sun, M.D.
+08613871286154
sunshaoxing@whu.edu.cn

Hui Qiu, Ph.D., Principal Investigator
Wuhan University

Akeso Biopharma Co., Ltd.
NCT Number
Keywords
Cervical Cancer
Cadonilimab
Anlotinib
Granulocyte-macrophage colony-stimulating factor
Immunotherapy
MeSH Terms
Uterine Cervical Neoplasms
Molgramostim
Sargramostim