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Gastric Cancer Peritoneal Metastasis (GCPM)Phase 2NCT07784413

A Sequential Trial of Low-Dose Radiotherapy Followed by Concurrent Immunotherapy, Systemic Chemotherapy, and Intraperitoneal Perfusion in Gastric Cancer With Peritoneal Carcinomatosis

A Phase 2 study testing low-dose radiotherapy (LDR) sequentially combined with serplulimab, bevacizumab analog, and irinotecan or albumin-bound paclitaxel in people with Gastric Cancer Peritoneal Metastasis (GCPM), run by Zhejiang Cancer Hospital at 1 site in China.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

This study is a prospective, single-center, open-label, exploratory phase II clinical trial aimed at evaluating the safety, tolerability, and preliminary efficacy of low-dose radiotherapy (LDR) sequentially combined with serplulimab, bevacizumab analog, and irinotecan or albumin-bound paclitaxel in patients with… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
low-dose radiotherapy (LDR) sequentially combined with serplulimab, bevacizumab analog, and irinotecan or albumin-bound paclitaxel
Could I receive a placebo?
No, everyone receives an active treatment
How many people
40 participants
Where
1 siteChina
Study dates
1 Sep 2026to 30 Jul 2029
Phase
Phase 2
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 1. Age >18 years on the day of signing the Informed Consent Form; 2. The subject is able to comprehend the procedures and methods of this clinical study, and voluntarily signs the informed consent form after providing full informed consent.
  • 3. Gastric or gastroesophageal junction adenocarcinoma (HER2-negative) confirmed by histology or cytology.
  • 4. Imaging confirmed metastases to peritoneum (PCI score ≥10), not suitable for radical excision 5. Failure of first-line platinum-based chemotherapy (due to progression or inability to tolerate).
  • 6. CT imaging or PET CT suggests metastases to the peritoneum, or ascites cytology is positive.
  • 7. ECOG PS 0-2, expected survival ≥3 months. 8. Organ function meets the following criteria (within 10 days of first receiving the investigational medicinal product).
  • Hematology: Platelet count ≥100×10⁹/L, hemoglobin ≥8g/dL, ANC ≥1.5×10⁹/L, and no blood products, erythropoiesis-stimulating agents, or colony-stimulating factors therapy received within the past 7 days;
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  • Renal function: Serum creatinine is within the normal upper limit range set by the institution;
  • Liver function: Total bilirubin ≤ 1.5×UNL; if total bilirubin > 1.5×UNL, then direct bilirubin should be ≤ UNL, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) both ≤ 2.5×UNL, albumin > 2.5 mg/dL;
  • Coagulation function: International normalized ratio (INR), prothrombin time (PT), activated partial thromboplastin time (APTT) ≤1.5×UNL; if the subject is undergoing anticoagulation therapy, it should be within the established therapeutic range; 9. Women of childbearing age must have a negative serum pregnancy test within 72 hours prior to the first administration of the investigational medicinal product. If the urine test result is positive or cannot be confirmed as negative, further serum pregnancy testing is required.
  • 10. Women of childbearing age must agree to use two effective methods of birth control or undergo surgical sterilization, or choose to avoid any heterosexual intercourse throughout the study period and for 120 days after the last drug administration. (Women who have been postmenopausal for more than one year and have not undergone surgical sterilization are considered infertile.) Lactating women must cease breastfeeding.
  • 11. Male subjects should agree to adopt effective contraceptive measures from the first administration until 120 days after the final administration.

Who cannot join

  • 1. Presence of active metastases to the central nervous system or meningitis carcinomatosa.
  • 2. There is an uncontrolled abdominal infection, intestinal obstruction, grade 3 abdominal effusion, or risk of gastrointestinal fistula and perforation.
  • 3. Study participants received systemic immunosuppressant therapy within 28 days prior to treatment.
  • 4. Known to be allergic to any investigational product or any excipient of the investigational product.
  • 5. Diagnosed with other malignancies within the past 5 years, and the tumor is currently in a progressive stage or requires therapy (excluding basal cell carcinoma of the skin, squamous cell carcinoma of the skin, or cervical carcinoma in situ that has undergone potential radical treatment).
  • 6. There is active autoimmune disease, and systemic therapy (including the use of disease-modifying drugs, corticosteroids, or immunosuppressants) has been received in the past two years. Replacement therapy (e.g., thyroxine replacement for hypothyroidism, insulin therapy for diabetes, or physiological glucocorticoid supplementation for adrenal/pituitary insufficiency) is not considered systemic therapy.
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  • 7. Previously suffered from (non-infectious) pneumonia requiring glucocorticoid therapy, or currently suffering from pneumonia.
  • 8. There is an active infection requiring systemic therapy. 9. The presence of any history of disease, therapy, or laboratory abnormalities that could potentially interfere with the test results, affect the subject's full participation, or be deemed unsuitable for the subject's participation in the study by the Sub investigator.
  • 10. Past or current presence of mental disease or drug abuse, deemed by the sub investigator as unable to comply with trial requirements.
  • 11. Already pregnant or in lactation, or plans to become pregnant or cause pregnancy during the trial period (from the start of pre-screening or screening visit to 120 days after the final administration).
  • 12. Known infection with Human Immunodeficiency Virus (HIV1/2 antibody positive).
  • 13. Known to have hepatitis B (e.g., HBV Hepatitis B Surface Antigen positive) or hepatitis C (e.g., HCV RNA test positive).
  • 14. Received any live vaccine within 30 days prior to the first use of the investigational medicinal product.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Qi Xu, Master contact

+86-15205813046

zjhzxuqi@163.com

China1 site
  • Zhejiang Cancer Hospital

    Hangzhou, Zhejiang, 310022

    Qi Xu, 15205813046, zjhzxuqi@163.com

Other trials in China

About this study

This study is a prospective, single-center, open-label, exploratory phase II clinical trial aimed at evaluating the safety, tolerability, and preliminary efficacy of low-dose radiotherapy (LDR) sequentially combined with serplulimab, bevacizumab analog, and irinotecan or albumin-bound paclitaxel in patients with gastric cancer and peritoneal metastases. A total of 40 patients with gastric adenocarcinoma who have previously undergone first-line therapy are planned for enrollment. Patients will be grouped based on prior exposure to paclitaxel-based chemotherapy to determine whether they will receive systemic treatment with irinotecan combined with serplulimab or albumin-bound paclitaxel combined with serplulimab, along with local intraperitoneal infusion of bevacizumab analog. The study adopts a Simon two-stage design, with 20 patients enrolled in the first stage. If ≥3 patients achieve objective remission, the study will proceed to the second stage, enrolling an additional 20 patients.

Read the detailed description

In China, most gastric cancer patients are diagnosed at an advanced stage. The peritoneum is the most common site of metastasis for gastric cancer, representing a specific mode of metastasis. Based on cytology of abdominal cavity dropout cells and peritoneal implantation formation, it can be classified into CY1P0, CY1P1, and CY0P1 types. Approximately 20% of patients are diagnosed with peritoneal metastasis preoperatively or intraoperatively, and more than 50% of T3 and T4 stage patients develop peritoneal metastasis after radical surgery. Peritoneal metastasis often leads to malignant ascites, intestinal obstruction, cancer pain, and other complications, severely affecting the quality of life of patients. According to epidemiological data, in 2020, the number of gastric cancer patients with peritoneal metastasis in China reached 523,937 cases 3-6 months, and a 5-year survival rate of less than 2% . Effective control of ascites in gastric cancer patients can not only improve their quality of life but also effectively extend their survival time. The survival period for first-line gastric cancer patients with peritoneal metastasis has increased from 3-6 months with traditional chemotherapy to 12-22 months with comprehensive treatment , but the efficacy for second-line gastric cancer patients with peritoneal metastasis remains limited, and more effective treatment regimens are still needed.

Vascular endothelial growth factor (VEGF) plays a central role in angiogenesis and ascites formation in peritoneal metastases. Research evidence shows that intraperitoneal infusion of anti-VEGF drugs, such as bevacizumab, can effectively control ascites and prolong the time to ascites recurrence. When combined with the immune checkpoint inhibitor sintilimab, the ascites control rate can reach 91%, with partial reduction of peritoneal metastases by more than 30% in some patients. Analysis of immune cells in ascites showed that the CD8+/Treg ratio increased threefold after treatment (P<0.01), and immunohistochemistry results from peritoneal biopsy indicated upregulation of PD-L1 expression in the combination therapy group (combination group vs baseline: +45% vs +10%), suggesting that blocking VEGF can normalize tumor vasculature, reverse the immunosuppressive microenvironment, enhance T-cell infiltration, and exert synergistic effects study, are actively exploring whether combining immunotherapy with VEGFR inhibitors and chemotherapy can improve survival, but further investigation is still needed.

Recent research findings indicate that low-dose radiation therapy (Low-Dose Radiation, LDR, single dose ≤1 Gy) exhibits distinct biological effects compared to conventional radiation therapy (fractionated dose1.8-3 Gy)20.LDR not only does not cause significantDNA double-strand breaks and apoptosis but also remodels the tumor microenvironment by activating various immune-related pathways.

Based on the aforementioned background, this study proposes an innovative combination therapy strategy: low-dose radiotherapy (LDR) followed by immunochemotherapy. The core mechanisms are as follows: (1) Immune initiation effect: LDR acts as an "immune initiator," inducing immunogenic cell death and activating antigen-presenting cells. The peak of immune activation occurs 24-72 hours after LDR, during which administration of the PD-1 inhibitor (serplulimab) can maximize synergistic effects. (2) Vascular normalization window: A peak in vascular normalization is observed 7-14 days after LDR treatment. Combining anti-VEGF drugs (bevacizumab analog) can maintain the vascular normalization state and improve the distribution of chemotherapeutic drugs in metastases to the peritoneum. (3) Overcoming chemotherapy resistance: LDR downregulates the expression of DNA repair genes in tumor cells, enhancing the cytotoxic action of irinotecan and albumin-bound paclitaxel. Preclinical studies show that 0.5 Gy radiotherapy can increase the concentration of paclitaxel in metastases to the peritoneum by 2.8 times.

This study selected low-dose radiotherapy combined with intraperitoneal infusion of bevacizumab. Based on whether first-line chemotherapy regimens included intravenous chemotherapy with albumin-bound paclitaxel, patients were chosen to receive second-line systemic treatment with irinotecan/albumin-bound paclitaxel combined with serplulimab. The study explores the approach of immune rechallenge and low-dose radiotherapy sequential systemic treatment combined with intraperitoneal infusion therapy, aiming to provide new therapeutic strategies and methods for second-line patients with gastric cancer accompanied by peritoneal metastasis.

Being tested
low-dose radiotherapy (LDR) sequentially combined with serplulimab, bevacizumab analog, and irinotecan or albumin-bound paclitaxel
Keywords
GCPM, Serplulimab, HLX04, Intraperitoneal infusion

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • low-dose radiotherapy (LDR) sequentially combined with serplulimab, bevacizumab analog, and irinotecan or albumin-bound paclitaxelDrug

    low-dose radiotherapy (LDR) sequentially combined with serplulimab, bevacizumab analog, and irinotecan or albumin-bound paclitaxel

Study groups in NCT07784413
Study groupRoleWhat they receive
Experimental GroupExperimentallow-dose radiotherapy (LDR) sequentially combined with serplulimab, bevacizumab analog, and irinotecan or albumin-bound paclitaxel group
Receives: Drug: low-dose radiotherapy (LDR) sequentially combined with serplulimab, bevacizumab analog, and irinotecan or albumin-bound paclitaxel

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. PFS

    Progression-free survival

    Measured: 12 months

Secondary outcomes (5)
  1. ORR

    Objective Response Rate

    Measured: 12 months

  2. OS

    Overall Survival

    Measured: 36 months

  3. DOR

    Duration of remission

    Measured: 36 months

  4. DCR

    Disease Control Rate

    Measured: 12 months

  5. Safety assessment

    TEAEs

    Measured: 36 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted25 Aug 2026
  2. Study start1 Sep 2026 (estimated)
  3. Primary completion1 Sep 2028 (estimated)
  4. Study completion30 Jul 2029 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
A single-arm, single-center, phase II study
Masking
None (open label)
Enrolment
40 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07784413
Sponsor's protocol ID
R-ICP
Status last verified
Aug 2026
First submitted
21 Aug 2026
Last updated
25 Aug 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing low-dose radiotherapy (LDR) sequentially combined with serplulimab, bevacizumab analog, and irinotecan or albumin-bound paclitaxel in people with Gastric Cancer Peritoneal Metastasis (GCPM), run by Zhejiang Cancer Hospital at 1 site in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 11 inclusion and 13 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 25 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in China. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Qi Xu, Master (+86-15205813046, zjhzxuqi@163.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

PFS (time frame: 12 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Aug 2026.

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