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出境医 / 临床实验 / Phase II Study of Toripalimab Plus Stereotactic Body Radiotherapy in Colorectal Cancer Patients With Oligometastasis

Phase II Study of Toripalimab Plus Stereotactic Body Radiotherapy in Colorectal Cancer Patients With Oligometastasis

Study Description
Brief Summary:

Metastatic colorectal cancer is one of the common malignant tumors and the overall prognosis is poor. The introduction of immune-checkpoint inhibition (ICI) has led to a paradigm shift in the treatment of patients with metastatic cancer. Stereotactic body radiation therapy (SBRT) delivers a large dose of radiation to the tumor target with high precision while sparing irradiation of the surrounding normal tissues. It is suggested that SBRT could be the most appropriate radiotherapy modality to be combined with immunotherapy since it induces the expression of a series of cytokines and new tumour-associated antigens (TAAs) and is more likely to cause intense immune response and exert an abscopal effect than conventional radiotherapy.

Thus, this study is to explore the use of SBRT in combination with ICI in colorectal cancer patients with oligometastasis, in order to get better local and systemic tumor control and improve progress-free survival (PFS).


Condition or disease Intervention/treatment Phase
Metastatic Colorectal Cancer Drug: Toripalimab Radiation: Stereotactic Body Radiotherapy Phase 2

Detailed Description:
The investigators plan to recruit patients with mCRC, who have received first-line systemic therapy for more than 3 months and achieved PR/SD. Than all the patients will receive SBRT followed by ICI therapy.
Study Design
Layout table for study information
Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 40 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Intervention Model Description: All enrolled patients will receive Toripalimab following stereotactic body radiotherapy
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase II Study of Toripalimab (JS001) Plus Stereotactic Body Radiotherapy in Colorectal Cancer Patients With Oligometastasis
Actual Study Start Date : March 1, 2019
Estimated Primary Completion Date : March 1, 2021
Estimated Study Completion Date : September 1, 2021
Arms and Interventions
Arm Intervention/treatment
Experimental: SBRT+Toripalimab
Participants received SBRT (BED>80Gy) to oligometastatic lesions and then receive Toripalimab (240mg)/q3w till progression of disease.
Drug: Toripalimab
Participants receive Toripalimab (240mg)/q3w till progression of disease after SBRT

Radiation: Stereotactic Body Radiotherapy
Participants receive SBRT (BED>80Gy) to oligometastatic lesions followed by Toripalimab (240mg)/q3w

Outcome Measures
Primary Outcome Measures :
  1. 1 year Progression-Free-Survival (PFS) [ Time Frame: 1 year ]
    1 year PFS


Secondary Outcome Measures :
  1. Grade 3-5 acute adverse events [ Time Frame: 6 months since last treatment of Toripalimab ]
    Grade 3-5 acute adverse events

  2. Objective response rate [ Time Frame: At the end of 4 cycles of Toripalimab (each cycle is 21 days) ]
    Objective response rate

  3. 2 year local control rate [ Time Frame: 2 year ]
    2 year local control rate

  4. 2 year overall survival [ Time Frame: 2 year ]
    2 year overall survival

  5. T cell receptor repertoire and T cell clones in peripheral blood [ Time Frame: At the end of 6 cycles of Toripalimab (each cycle is 21 days) ]
    Change of T cell receptor repertoire and T cell clones in peripheral blood

  6. Expression of PD-1, ki-67 on T cell [ Time Frame: At the end of 6 cycles of Toripalimab (each cycle is 21 days) ]
    Change of expression of PD-1, ki-67 on T cell

  7. Expression of PD-L1 on Exosomes in peripheral blood [ Time Frame: At the end of 6 cycles of Toripalimab (each cycle is 21 days) ]
    Change of expression of PD-L1 on Exosomes in peripheral blood

  8. Expression of PD-L1 on circulation tumor cell [ Time Frame: At the end of 6 cycles of Toripalimab (each cycle is 21 days) ]
    Change of expression of PD-L1 on circulation tumor cell


Eligibility Criteria
Layout table for eligibility information
Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Age:18-75 years old , Eastern Cooperative Oncology Group (ECOG) performance status of 0-1
  2. Histologically confirmed CRC , metastatic CRC , subjects have received first-line systemic therapy for more than 3 months and achieved PR/SD, the interval between last systemic therapy and SBRT is≥4 weeks
  3. The primary site has been controlled by surgery
  4. Patient has at least 1 lesion of measurable metastatic disease by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and iRECIST , and who can achieve the status of non evidence of disease after local ablative therapy. The number of lesion is ≤ 5, the maximum diameter of the lesion is ≤5cm ,
  5. All metastatic lesions are amenable to SBRT with BED≥80Gy in 3 to 5 fractions;
  6. Have a life expectancy of at least 6 months
  7. Adequate organ function, as defined by the following:

    Hemoglobin ≥ 100 g/L; White blood cell count (WBC) ≥3.5×109/L , Absolute neutrophil count (ANC) ≥ 1.5×109/L; Platelets ≥75×109/L; Serum creatinine ≤ 1.0 x institutional upper limit of normal (ULN) ; Blood Urea Nitrogen(BUN) ≤ 1.0 x institutional (ULN) Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 1.5 x institutional ULN ALkaline Phosphatase (ALP) ≤ 1.5 x institutional ULN Serum total bilirubin (TBIL) ≤1.5 x institutional ULN Urine protein is negative , Coagulation function is normal

  8. patients and his/her mate must agree to follow instructions for method(s) of contraception for the duration of treatment with study drug;
  9. Patient must have the ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

  1. Serious autoimmune disease at the discretion of the treating attending,subjects with leukodermia,allergic asthma syndrome will not be excluded from the study.
  2. Has known active central nervous system (CNS) metastases and/or carcinomatous meningitis.
  3. Has evidence of interstitial lung disease or active, non-infectious pneumonitis requiring systemic steroids.
  4. Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to study Day 1 of the trial treatment.
  5. Has a known additional malignancy,subjects with basal cell carcinoma (BCC), squamous cell carcinoma of skin and carcinoma in situ of cervix will not be excluded from the study.
  6. Has received a vaccine within 30 days prior to study Day 1 of the trial treatment or will receive a vaccine after the trial treatment; active HBV,HCV infection
  7. Has received systemic therapy within 4 weeks prior to study Day 1 of the trial treatment or who has not recovered from adverse events due to a previously administered agent.

    Note: Subjects with ≤ Grade 2 neuropathy or myelosuppression are an exception to this criterion and may qualify for the study.

  8. Any underlying medical or psychiatric condition: partial endocrine organ deficiencies , serious cardiac,pulmonary,renal disease,active infectious disease.
  9. Active diverticulitis, intra-abdominal abscess, Gastrointestinal (GI) obstruction, abdominal carcinomatosis , frequent diarrhea or other known risk factors for bowel perforation.
Contacts and Locations

Contacts
Layout table for location contacts
Contact: Jing Jin, M.D +86-1087787568 jingjin1025@163.com
Contact: Jianyang Wang, M.D. +86-1087788122 pkucell@163.com

Locations
Layout table for location information
China, Beijing
Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Recruiting
Beijing, Beijing, China, 100021
Contact: Wenyang Liu, MD       liuwenyang26@163.com   
Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Recruiting
Beijing, Beijing, China, 100021
Contact: Jianyang Wang, MD    +86-13810095191    pkucell@163.com   
Contact: Jing Jin, MD    +86-10-87788122    jingjin1025@163.com   
China
Department of Radiation Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Recruiting
Beijing, China, 100021
Contact: Jing Jin, MD    +8613601365130    jingjin1025@163.com   
Sponsors and Collaborators
Chinese Academy of Medical Sciences
Shanghai Junshi Bioscience Co., Ltd.
Tracking Information
First Submitted Date  ICMJE April 9, 2019
First Posted Date  ICMJE April 25, 2019
Last Update Posted Date April 25, 2019
Actual Study Start Date  ICMJE March 1, 2019
Estimated Primary Completion Date March 1, 2021   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: April 23, 2019)
1 year Progression-Free-Survival (PFS) [ Time Frame: 1 year ]
1 year PFS
Original Primary Outcome Measures  ICMJE Same as current
Change History No Changes Posted
Current Secondary Outcome Measures  ICMJE
 (submitted: April 23, 2019)
  • Grade 3-5 acute adverse events [ Time Frame: 6 months since last treatment of Toripalimab ]
    Grade 3-5 acute adverse events
  • Objective response rate [ Time Frame: At the end of 4 cycles of Toripalimab (each cycle is 21 days) ]
    Objective response rate
  • 2 year local control rate [ Time Frame: 2 year ]
    2 year local control rate
  • 2 year overall survival [ Time Frame: 2 year ]
    2 year overall survival
  • T cell receptor repertoire and T cell clones in peripheral blood [ Time Frame: At the end of 6 cycles of Toripalimab (each cycle is 21 days) ]
    Change of T cell receptor repertoire and T cell clones in peripheral blood
  • Expression of PD-1, ki-67 on T cell [ Time Frame: At the end of 6 cycles of Toripalimab (each cycle is 21 days) ]
    Change of expression of PD-1, ki-67 on T cell
  • Expression of PD-L1 on Exosomes in peripheral blood [ Time Frame: At the end of 6 cycles of Toripalimab (each cycle is 21 days) ]
    Change of expression of PD-L1 on Exosomes in peripheral blood
  • Expression of PD-L1 on circulation tumor cell [ Time Frame: At the end of 6 cycles of Toripalimab (each cycle is 21 days) ]
    Change of expression of PD-L1 on circulation tumor cell
Original Secondary Outcome Measures  ICMJE Same as current
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Phase II Study of Toripalimab Plus Stereotactic Body Radiotherapy in Colorectal Cancer Patients With Oligometastasis
Official Title  ICMJE Phase II Study of Toripalimab (JS001) Plus Stereotactic Body Radiotherapy in Colorectal Cancer Patients With Oligometastasis
Brief Summary

Metastatic colorectal cancer is one of the common malignant tumors and the overall prognosis is poor. The introduction of immune-checkpoint inhibition (ICI) has led to a paradigm shift in the treatment of patients with metastatic cancer. Stereotactic body radiation therapy (SBRT) delivers a large dose of radiation to the tumor target with high precision while sparing irradiation of the surrounding normal tissues. It is suggested that SBRT could be the most appropriate radiotherapy modality to be combined with immunotherapy since it induces the expression of a series of cytokines and new tumour-associated antigens (TAAs) and is more likely to cause intense immune response and exert an abscopal effect than conventional radiotherapy.

Thus, this study is to explore the use of SBRT in combination with ICI in colorectal cancer patients with oligometastasis, in order to get better local and systemic tumor control and improve progress-free survival (PFS).

Detailed Description The investigators plan to recruit patients with mCRC, who have received first-line systemic therapy for more than 3 months and achieved PR/SD. Than all the patients will receive SBRT followed by ICI therapy.
Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 2
Study Design  ICMJE Allocation: N/A
Intervention Model: Single Group Assignment
Intervention Model Description:
All enrolled patients will receive Toripalimab following stereotactic body radiotherapy
Masking: None (Open Label)
Primary Purpose: Treatment
Condition  ICMJE Metastatic Colorectal Cancer
Intervention  ICMJE
  • Drug: Toripalimab
    Participants receive Toripalimab (240mg)/q3w till progression of disease after SBRT
  • Radiation: Stereotactic Body Radiotherapy
    Participants receive SBRT (BED>80Gy) to oligometastatic lesions followed by Toripalimab (240mg)/q3w
Study Arms  ICMJE Experimental: SBRT+Toripalimab
Participants received SBRT (BED>80Gy) to oligometastatic lesions and then receive Toripalimab (240mg)/q3w till progression of disease.
Interventions:
  • Drug: Toripalimab
  • Radiation: Stereotactic Body Radiotherapy
Publications *
  • Van Cutsem E, Cervantes A, Adam R, Sobrero A, Van Krieken JH, Aderka D, Aranda Aguilar E, Bardelli A, Benson A, Bodoky G, Ciardiello F, D'Hoore A, Diaz-Rubio E, Douillard JY, Ducreux M, Falcone A, Grothey A, Gruenberger T, Haustermans K, Heinemann V, Hoff P, Köhne CH, Labianca R, Laurent-Puig P, Ma B, Maughan T, Muro K, Normanno N, Österlund P, Oyen WJ, Papamichael D, Pentheroudakis G, Pfeiffer P, Price TJ, Punt C, Ricke J, Roth A, Salazar R, Scheithauer W, Schmoll HJ, Tabernero J, Taïeb J, Tejpar S, Wasan H, Yoshino T, Zaanan A, Arnold D. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol. 2016 Aug;27(8):1386-422. doi: 10.1093/annonc/mdw235. Epub 2016 Jul 5.
  • Petrelli F, Comito T, Barni S, Pancera G, Scorsetti M, Ghidini A; SBRT for CRC liver metastases. Stereotactic body radiotherapy for colorectal cancer liver metastases: A systematic review. Radiother Oncol. 2018 Dec;129(3):427-434. doi: 10.1016/j.radonc.2018.06.035. Epub 2018 Jul 9.
  • Joo JH, Park JH, Kim JC, Yu CS, Lim SB, Park IJ, Kim TW, Hong YS, Kim KP, Yoon SM, Park J, Kim JH. Local Control Outcomes Using Stereotactic Body Radiation Therapy for Liver Metastases From Colorectal Cancer. Int J Radiat Oncol Biol Phys. 2017 Nov 15;99(4):876-883. doi: 10.1016/j.ijrobp.2017.07.030. Epub 2017 Jul 31.
  • Luke JJ, Lemons JM, Karrison TG, Pitroda SP, Melotek JM, Zha Y, Al-Hallaq HA, Arina A, Khodarev NN, Janisch L, Chang P, Patel JD, Fleming GF, Moroney J, Sharma MR, White JR, Ratain MJ, Gajewski TF, Weichselbaum RR, Chmura SJ. Safety and Clinical Activity of Pembrolizumab and Multisite Stereotactic Body Radiotherapy in Patients With Advanced Solid Tumors. J Clin Oncol. 2018 Jun 1;36(16):1611-1618. doi: 10.1200/JCO.2017.76.2229. Epub 2018 Feb 13.
  • Lee Y, Auh SL, Wang Y, Burnette B, Wang Y, Meng Y, Beckett M, Sharma R, Chin R, Tu T, Weichselbaum RR, Fu YX. Therapeutic effects of ablative radiation on local tumor require CD8+ T cells: changing strategies for cancer treatment. Blood. 2009 Jul 16;114(3):589-95. doi: 10.1182/blood-2009-02-206870. Epub 2009 Apr 6.
  • Tang C, Welsh JW, de Groot P, Massarelli E, Chang JY, Hess KR, Basu S, Curran MA, Cabanillas ME, Subbiah V, Fu S, Tsimberidou AM, Karp D, Gomez DR, Diab A, Komaki R, Heymach JV, Sharma P, Naing A, Hong DS. Ipilimumab with Stereotactic Ablative Radiation Therapy: Phase I Results and Immunologic Correlates from Peripheral T Cells. Clin Cancer Res. 2017 Mar 15;23(6):1388-1396. doi: 10.1158/1078-0432.CCR-16-1432. Epub 2016 Sep 20.
  • Kwon ED, Drake CG, Scher HI, Fizazi K, Bossi A, van den Eertwegh AJ, Krainer M, Houede N, Santos R, Mahammedi H, Ng S, Maio M, Franke FA, Sundar S, Agarwal N, Bergman AM, Ciuleanu TE, Korbenfeld E, Sengeløv L, Hansen S, Logothetis C, Beer TM, McHenry MB, Gagnier P, Liu D, Gerritsen WR; CA184-043 Investigators. Ipilimumab versus placebo after radiotherapy in patients with metastatic castration-resistant prostate cancer that had progressed after docetaxel chemotherapy (CA184-043): a multicentre, randomised, double-blind, phase 3 trial. Lancet Oncol. 2014 Jun;15(7):700-12. doi: 10.1016/S1470-2045(14)70189-5. Epub 2014 May 13.
  • Huang AC, Postow MA, Orlowski RJ, Mick R, Bengsch B, Manne S, Xu W, Harmon S, Giles JR, Wenz B, Adamow M, Kuk D, Panageas KS, Carrera C, Wong P, Quagliarello F, Wubbenhorst B, D'Andrea K, Pauken KE, Herati RS, Staupe RP, Schenkel JM, McGettigan S, Kothari S, George SM, Vonderheide RH, Amaravadi RK, Karakousis GC, Schuchter LM, Xu X, Nathanson KL, Wolchok JD, Gangadhar TC, Wherry EJ. T-cell invigoration to tumour burden ratio associated with anti-PD-1 response. Nature. 2017 May 4;545(7652):60-65. doi: 10.1038/nature22079. Epub 2017 Apr 10.
  • Chen G, Huang AC, Zhang W, Zhang G, Wu M, Xu W, Yu Z, Yang J, Wang B, Sun H, Xia H, Man Q, Zhong W, Antelo LF, Wu B, Xiong X, Liu X, Guan L, Li T, Liu S, Yang R, Lu Y, Dong L, McGettigan S, Somasundaram R, Radhakrishnan R, Mills G, Lu Y, Kim J, Chen YH, Dong H, Zhao Y, Karakousis GC, Mitchell TC, Schuchter LM, Herlyn M, Wherry EJ, Xu X, Guo W. Exosomal PD-L1 contributes to immunosuppression and is associated with anti-PD-1 response. Nature. 2018 Aug;560(7718):382-386. doi: 10.1038/s41586-018-0392-8. Epub 2018 Aug 8.
  • Seymour L, Bogaerts J, Perrone A, Ford R, Schwartz LH, Mandrekar S, Lin NU, Litière S, Dancey J, Chen A, Hodi FS, Therasse P, Hoekstra OS, Shankar LK, Wolchok JD, Ballinger M, Caramella C, de Vries EGE; RECIST working group. iRECIST: guidelines for response criteria for use in trials testing immunotherapeutics. Lancet Oncol. 2017 Mar;18(3):e143-e152. doi: 10.1016/S1470-2045(17)30074-8. Epub 2017 Mar 2. Review. Erratum in: Lancet Oncol. 2019 May;20(5):e242.
  • Hanna GG, Murray L, Patel R, Jain S, Aitken KL, Franks KN, van As N, Tree A, Hatfield P, Harrow S, McDonald F, Ahmed M, Saran FH, Webster GJ, Khoo V, Landau D, Eaton DJ, Hawkins MA. UK Consensus on Normal Tissue Dose Constraints for Stereotactic Radiotherapy. Clin Oncol (R Coll Radiol). 2018 Jan;30(1):5-14. doi: 10.1016/j.clon.2017.09.007. Epub 2017 Oct 13.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Recruiting
Estimated Enrollment  ICMJE
 (submitted: April 23, 2019)
40
Original Estimated Enrollment  ICMJE Same as current
Estimated Study Completion Date  ICMJE September 1, 2021
Estimated Primary Completion Date March 1, 2021   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  1. Age:18-75 years old , Eastern Cooperative Oncology Group (ECOG) performance status of 0-1
  2. Histologically confirmed CRC , metastatic CRC , subjects have received first-line systemic therapy for more than 3 months and achieved PR/SD, the interval between last systemic therapy and SBRT is≥4 weeks
  3. The primary site has been controlled by surgery
  4. Patient has at least 1 lesion of measurable metastatic disease by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and iRECIST , and who can achieve the status of non evidence of disease after local ablative therapy. The number of lesion is ≤ 5, the maximum diameter of the lesion is ≤5cm ,
  5. All metastatic lesions are amenable to SBRT with BED≥80Gy in 3 to 5 fractions;
  6. Have a life expectancy of at least 6 months
  7. Adequate organ function, as defined by the following:

    Hemoglobin ≥ 100 g/L; White blood cell count (WBC) ≥3.5×109/L , Absolute neutrophil count (ANC) ≥ 1.5×109/L; Platelets ≥75×109/L; Serum creatinine ≤ 1.0 x institutional upper limit of normal (ULN) ; Blood Urea Nitrogen(BUN) ≤ 1.0 x institutional (ULN) Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 1.5 x institutional ULN ALkaline Phosphatase (ALP) ≤ 1.5 x institutional ULN Serum total bilirubin (TBIL) ≤1.5 x institutional ULN Urine protein is negative , Coagulation function is normal

  8. patients and his/her mate must agree to follow instructions for method(s) of contraception for the duration of treatment with study drug;
  9. Patient must have the ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

  1. Serious autoimmune disease at the discretion of the treating attending,subjects with leukodermia,allergic asthma syndrome will not be excluded from the study.
  2. Has known active central nervous system (CNS) metastases and/or carcinomatous meningitis.
  3. Has evidence of interstitial lung disease or active, non-infectious pneumonitis requiring systemic steroids.
  4. Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to study Day 1 of the trial treatment.
  5. Has a known additional malignancy,subjects with basal cell carcinoma (BCC), squamous cell carcinoma of skin and carcinoma in situ of cervix will not be excluded from the study.
  6. Has received a vaccine within 30 days prior to study Day 1 of the trial treatment or will receive a vaccine after the trial treatment; active HBV,HCV infection
  7. Has received systemic therapy within 4 weeks prior to study Day 1 of the trial treatment or who has not recovered from adverse events due to a previously administered agent.

    Note: Subjects with ≤ Grade 2 neuropathy or myelosuppression are an exception to this criterion and may qualify for the study.

  8. Any underlying medical or psychiatric condition: partial endocrine organ deficiencies , serious cardiac,pulmonary,renal disease,active infectious disease.
  9. Active diverticulitis, intra-abdominal abscess, Gastrointestinal (GI) obstruction, abdominal carcinomatosis , frequent diarrhea or other known risk factors for bowel perforation.
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years to 75 Years   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE
Contact: Jing Jin, M.D +86-1087787568 jingjin1025@163.com
Contact: Jianyang Wang, M.D. +86-1087788122 pkucell@163.com
Listed Location Countries  ICMJE China
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT03927898
Other Study ID Numbers  ICMJE 18-223/1781
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE
Plan to Share IPD: No
Responsible Party Jing Jin, M.D., Chinese Academy of Medical Sciences
Study Sponsor  ICMJE Chinese Academy of Medical Sciences
Collaborators  ICMJE Shanghai Junshi Bioscience Co., Ltd.
Investigators  ICMJE Not Provided
PRS Account Chinese Academy of Medical Sciences
Verification Date April 2019

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP

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