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Not yet recruitingNCT07707882NEXPERTUpdated Jul 16, 2026

Neoadjuvant Pimicotinib Combined With Surgery Versus Upfront Surgery for Diffuse Tenosynovial Giant Cell Tumor

A Phase 2 interventional study of Pimicotinib and Tumor resection surgery in Tenosynovial Giant Cell Tumor, Diffuse, sponsored by Second Affiliated Hospital, School of Medicine, Zhejiang University. Not yet recruiting at 1 site in China. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-07-16.

Sponsored by Second Affiliated Hospital, School of Medicine, Zhejiang University · Phase 2, Interventional, and Treatment

Phase
Phase 2
Study type
Interventional
Enrollment
84
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

Tenosynovial giant cell tumor (TGCT) is a rare neoplasm predominantly occurring in young and middle-aged adults, characterized by high recurrence and high disability rates. Surgery represents the first-line treatment at present. Although surgical resection can eradicate lesions, repeated surgical interventions constitute the major disease-related burden. Particularly for patients with diffuse-type TGCT (D-TGCT), postoperative recurrence rates can exceed 50%.

Pimicotinib is a highly selective colony-stimulating factor 1 receptor (CSF1R) inhibitor. The phase III MANEUVER trial has verified its prominent tumor shrinkage effect and symptomatic improvement in patients with unresectable, symptomatic TGCT, with an objective response rate (ORR) of 54%. In addition, pimicotinib demonstrates a favorable safety profile; most adverse events are mild in severity, mainly including pruritus, edema, fatigue and elevated creatine kinase, without severe hepatotoxicity.

Neoadjuvant therapy followed by surgery falls within the scope of multimodal treatment, which is mostly applied to recurrent and refractory cases rather than the standard upfront regimen for treatment-naive patients. Clinical case reports and real-world observations have preliminarily validated the feasibility and clinical value of sequential systemic targeted therapy followed by surgical resection. To date, systematic and standardized clinical data regarding neoadjuvant strategies remain scarce, especially randomized controlled evidence comparing neoadjuvant targeted therapy plus surgery versus primary upfront surgery. This study aims to compare the efficacy and safety of neoadjuvant pimicotinib combined with surgery versus upfront primary surgery in the management of D-TGCT, so as to generate evidence-based rationale for developing more effective and safe therapeutic regimens for D-TGCT.

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Conditions studied

  • Tenosynovial Giant Cell Tumor, Diffuse
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In context

Synovitis, Pigmented Villonodular

20 studies on the registry are indexed under Synovitis, Pigmented Villonodular; 2 are open to participants now.

This study's planned enrollment of 84 is above the median of 36 across 17 interventional studies indexed under Synovitis, Pigmented Villonodular.

Browse Synovitis, Pigmented Villonodular studies →

Lead sponsor

Second Affiliated Hospital, School of Medicine, Zhejiang University is the lead sponsor of 1,047 studies on the registry; 502 are open to participants now.

Counted across the registry records on this site, refreshed daily.

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Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Male or female subjects aged ≥18 years
  • confirmed tenosynovial giant cell tumor (TGCT)
  • Resectable diffuse tenosynovial giant cell tumor (D-TGCT) were determined by multidisciplinary team (MDT) discussion.
  • as defined by (RECIST) v1.1 with at least one lesion of ≥2 cm
  • Symptomatic disease with a worst pain of at least 4 or/and a worst stiffness of at least 4 (based on a scale of 0-10 with 10 describing the worst condition) prior to randomization Adequate organ and bone marrow function
  • Adequate organ function and bone marrow function
  • Willing and able to complete patient-reported outcome (PRO) assessments throughout the study.

Exclusion criteria

Exclusion Criteria:

  • Prior treatment with highly selective Colony-Stimulating Factor 1 (CSF1)/ Colony-Stimulating Factor 1 Receptor (CSF1R) inhibitors before randomization
  • Presence of another requiring active treatment, in the investigator's judgment, which may interfere with study participation or results
  • Known TGCT
  • Severe concomitant arthropathy, severe illness, or uncontrolled infection in the affected joint
  • Significant factors affecting oral drug absorption
  • Concomitant use of strong Cytochrome P450 3A4 () inhibitors or inducers within 14 days before randomization
  • Impaired cardiac function or severe cardiac disease
  • Known active (HIV) infection, active , active , or active tuberculosis before randomization
  • Known active liver or biliary disease, or other conditions that may cause abnormal liver function tests during the study
  • Pregnant or lactating female (pregnancy defined as from conception until termination)
  • Fertile males or non-sterilized females who do not agree to use effective from at least 14 days before randomization until 6 months after the last dose of study drug
  • Other serious comorbidities that, in the investigator's judgment, may affect protocol compliance, interfere with interpretation of study results, or increase the patient's risk of safety events
Terms in these criteria, in plain language(10)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Histologically or cytologically confirmed

The diagnosis was confirmed by looking at a sample under a microscope: tissue from a biopsy or surgery (histology), or cells from a fluid or needle sample (cytology).

Your pathology report is the document that shows this.

Measurable disease

The amount of disease can be tracked with a defined measurement, so the study can see whether it shrinks or grows. It might be a tumour measured on a scan or, in some blood cancers such as myeloma, a marker measured in blood or urine.

The criteria or the study team say which measurement counts — having no tumour visible on a scan does not by itself rule you out.

RECIST

The standard rules for measuring tumours on CT or MRI scans, to tell whether a cancer is shrinking, stable or growing during treatment.

“Measurable disease per RECIST 1.1” usually means at least one tumour 10 mm or more at its longest on a CT scan, or a lymph node 15 mm or more across its short axis.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

Metastases

Cancer that has spread from where it began to other parts of the body. “Metastatic” cancer is cancer that has spread this way.

CYP3A (CYP3A4) inhibitors and inducers

CYP3A is a group of enzymes, mainly CYP3A4, in the liver and gut that break down many medicines. Some medicines, supplements and foods (grapefruit, St John’s wort) slow them down or speed them up, which changes how much of a study drug stays in the body.

Studies list them so they can be avoided or switched; bring a list of everything you take, including supplements.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

Hepatitis B tests

Hepatitis B is a virus that infects the liver. These are separate tests: HBsAg positive usually means a current infection (a recent vaccination can briefly cause it too); total anti-HBc (HBcAb) positive means an infection now or in the past; HBV DNA measures how much virus is in the blood.

Some studies accept a past infection if HBV DNA is undetectable, sometimes with antiviral medicine during the study. Check what this study allows.

Hepatitis C tests

Hepatitis C is a virus that infects the liver. An HCV antibody test can stay positive after an infection has cleared (and is occasionally positive without one); an HCV RNA test shows whether the virus is there now.

After treatment, hepatitis C counts as cured when HCV RNA is still undetectable 12 weeks or more after the treatment ended. Studies often accept people cured this way.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
84 participants (estimated)

Study arms

  • Experimental
    Neoadjuvant Therapy plus Surgery

    Patients take neoadjuvant pimicotinib first, then undergo subsequent surgical resection of the lesion.

    Drug: Pimicotinib · Procedure: Tumor resection surgery

  • Active comparator
    Upfront Surgery

    Patients undergo surgical tumor resection right after study enrollment.

    Procedure: Tumor resection surgery

Interventions

  • Pimicotinib 50 mg orally once daily for 12 consecutive weeks.

  • ProcedureTumor resection surgery

    Open surgery will be performed based on patient and tumor characteristics discussed at the multidisciplinary team (MDT) meeting. The specific surgical plan will be determined by the surgeon based on clinical judgment. Surgical procedures will follow national guidelines.

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What researchers measure

Primary outcomes

  1. Event-free survival

    Events are defined as disease progression precluding planned surgery, local recurrence, distant metastasis, treatment discontinuation due to adverse events, or death from any cause.

    Time frame: 2 years

Secondary outcomes

  1. Local recurrence rate

    Time frame: 2 year

  2. Surgical complication rate

    Time frame: 2 years

  3. Change in range of motion

    Time frame: 2 years

  4. Change in Brief Pain Inventory (BPI)

    Score range: 0-10; Higher scores mean more severe pain and greater life interference; lower scores mean pain relief.

    Time frame: 2 years

  5. Change in stiffness Numerical Rating Scale (NRS)

    Score range: 0-10; Higher score means worse joint stiffness; reduced score indicates improvement.

    Time frame: 2 years

  6. Change in Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF) score

    This PROMIS Physical Function short form contains items with 5-point Likert response (1=unable to do, 5=no difficulty at all).The raw score from these responses is then converted to a standardized T-score on a scale of 0 to 100, with a mean of 50 and a standard deviation of 10. The total score is the final T-score. Higher T-score indicates better physical function.

    Time frame: 2 years

07

Study locations

1 site
  • Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine
    Hangzhou, Zhejiang 310000, China
08

References and documents

Publications

  • Xu H, Niu X, Ravi V, Martin-Broto J, Razak AA, Saleh R, Zhou Y, Shen J, Liu T, Sankhala KK, Serrano C, Stacchiotti S, Wang J, Baldi GG, Feng Y, Hua Y, Li T, Rutkowski P, Zhang X, Tinoco G, Zou Q, Shan B, Zhu X, Gelderblom H. Pimicotinib versus placebo for tenosynovial giant cell tumour (MANEUVER): an international, randomised, placebo-controlled, phase 3 trial. Lancet. 2026 Mar 14;407(10533):1072-1083. doi: 10.1016/S0140-6736(25)02602-9. Epub 2026 Mar 5. PubMed 41796601 ↗
  • van de Sande M, Blay JY, Tap W, Lee M, Kaiser E, Beaver S, Harrow B, Zeringo NA, Bernthal N. The economic and humanistic burden of tenosynovial giant cell tumor: a targeted literature review. Future Oncol. 2025 Aug;21(18):2385-2400. doi: 10.1080/14796694.2025.2520744. Epub 2025 Jun 22. PubMed 40545745 ↗
  • Tap WD, Gelderblom H, Palmerini E, Desai J, Bauer S, Blay JY, Alcindor T, Ganjoo K, Martin-Broto J, Ryan CW, Thomas DM, Peterfy C, Healey JH, van de Sande M, Gelhorn HL, Shuster DE, Wang Q, Yver A, Hsu HH, Lin PS, Tong-Starksen S, Stacchiotti S, Wagner AJ; ENLIVEN investigators. Pexidartinib versus placebo for advanced tenosynovial giant cell tumour (ENLIVEN): a randomised phase 3 trial. Lancet. 2019 Aug 10;394(10197):478-487. doi: 10.1016/S0140-6736(19)30764-0. Epub 2019 Jun 19. PubMed 31229240 ↗
  • Stacchiotti S, Durr HR, Schaefer IM, Woertler K, Haas R, Trama A, Caraceni A, Bajpai J, Baldi GG, Bernthal N, Blay JY, Boye K, Broto JM, Chen WT, Dei Tos PA, Desai J, Emhofer S, Eriksson M, Gronchi A, Gelderblom H, Hardes J, Hartmann W, Healey J, Italiano A, Jones RL, Kawai A, Leithner A, Loong H, Mascard E, Morosi C, Otten N, Palmerini E, Patel SR, Reichardt P, Rubin B, Rutkowski P, Sangalli C, Schuster K, Seddon BM, Shkodra M, Staals EL, Tap W, van de Rijn M, van Langevelde K, Vanhoenacker FMM, Wagner A, Wiltink L, Stern S, Van de Sande VM, Bauer S. Best clinical management of tenosynovial giant cell tumour (TGCT): A consensus paper from the community of experts. Cancer Treat Rev. 2023 Jan;112:102491. doi: 10.1016/j.ctrv.2022.102491. Epub 2022 Dec 6. PubMed 36502615 ↗
  • Mosher H, Dean K, Meli G, Desrosiers J, Crawford B, Temple HT, Hornicek FJ, Rosenberg AE, Jonczak E, Palmerini E, Geiger EJ. Current Treatment Strategies for Diffuse Tenosynovial Giant Cell Tumor: A Review of the Literature. JB JS Open Access. 2026 Jan 13;11(1):e25.00313. doi: 10.2106/JBJS.OA.25.00313. eCollection 2026 Jan-Mar. PubMed 41523664 ↗
  • Mastboom MJL, Lips W, van Langevelde K, Mifsud M, Ng C, McCarthy CL, Athanasou NA, Gibbons CLMH, van de Sande MAJ. The effect of Imatinib Mesylate in diffuse-type Tenosynovial Giant Cell Tumours on MR imaging and PET-CT. Surg Oncol. 2020 Dec;35:261-267. doi: 10.1016/j.suronc.2020.08.030. Epub 2020 Aug 26. PubMed 32932224 ↗
  • Gelderblom H, Bhadri V, Stacchiotti S, Bauer S, Wagner AJ, van de Sande M, Bernthal NM, Lopez Pousa A, Razak AA, Italiano A, Ahmed M, Le Cesne A, Tinoco G, Boye K, Martin-Broto J, Palmerini E, Tafuto S, Pratap S, Powers BC, Reichardt P, Casado Herraez A, Rutkowski P, Tait C, Zarins F, Harrow B, Sharma MG, Ruiz-Soto R, Sherman ML, Blay JY, Tap WD; MOTION investigators. Vimseltinib versus placebo for tenosynovial giant cell tumour (MOTION): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2024 Jun 22;403(10445):2709-2719. doi: 10.1016/S0140-6736(24)00885-7. Epub 2024 Jun 3. PubMed 38843860 ↗
  • Geiger EJ, Jensen AR, Singh AS, Nelson SD, Bernthal NM. Use of neoadjuvant pexidartinib with limb salvage surgery for diffuse tenosynovial giant cell tumor: A case report. J Orthop Sci. 2024 Jan;29(1):458-462. doi: 10.1016/j.jos.2022.10.016. Epub 2022 Nov 16. No abstract available. PubMed 36402606 ↗
  • Bernthal NM, Spierenburg G, Healey JH, Palmerini E, Bauer S; TOPP Study Group; Gelderblom H, Staals EL, Lopez-Bastida J, Fronk EM, Ye X, Laeis P, van de Sande MAJ. The diffuse-type tenosynovial giant cell tumor (dt-TGCT) patient journey: a prospective multicenter study. Orphanet J Rare Dis. 2021 Apr 29;16(1):191. doi: 10.1186/s13023-021-01820-6. PubMed 33926503 ↗
  • Bernthal NM, Randall RL, Zeitlinger LN, Geiger EJ, Healey JH. Complementary Effects of Surgery and Pexidartinib in the Management of Patients with Complex Diffuse-Tenosynovial Giant Cell Tumor. Case Rep Orthop. 2022 Dec 3;2022:7768764. doi: 10.1155/2022/7768764. eCollection 2022. PubMed 36510622 ↗

Individual participant data

Plan to share: No

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Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Jul 16, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT07707882
Responsible party
Sponsor
First posted
Jul 16, 2026
Start date
Oct 1, 2027 (estimated)
Primary completion
Sep 30, 2029 (estimated)
Completion
Sep 30, 2030 (estimated)
Last update
Jul 16, 2026

Study contacts

Zhaoming Ye, MD
Contact
yezhaoming@zju.edu.cn
+86-0571-87783777

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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Studies of the drug tested here: Pimicotinib

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