A Phase 2 interventional study of Cryoablation and Iparomlimab and Tuvonralimab in Melanoma (Skin) Stage IV, sponsored by Sun Yat-sen University. Recruiting at 1 site in China. Open to participants aged 18 Years to 75 Years. Per ClinicalTrials.gov, last updated 2026-09-29.
Sponsored by Sun Yat-sen University · Phase 2, Interventional, and Treatment
To explore the efficacy and safety of cryoablation combined with hepatic arterial infusion of iparomlimab and tuvonralimab, intravenous dacarbazine, and oral lenvatinib in patients with liver metastases from malignant melanoma.
Cryoablation combined with PD-1 blockade has shown encouraging efficacy in melanoma patients with liver metastases, but the response rate remains unsatisfactory and the prognosis is still poor. Our previous CryoCheck-001 study of cryoablation plus sintilimab yielded a response rate of less than 30%. Iparomlimab and tuvonralimab (QL1706) is a novel dual PD-1/CTLA-4 combination antibody with a favorable safety profile, and hepatic arterial infusion of immune checkpoint inhibitors has been confirmed to be effective and safe in melanoma liver metastases. Moreover, adding dacarbazine and lenvatinib may further enhance the efficacy of cryoablation combined with immunotherapy. Herein, we aimed to evaluate the efficacy and safety of cryoablation combined with hepatic arterial infusion of QL1706, intravenous dacarbazine, and oral lenvatinib in patients with liver metastases from malignant melanoma. This is a single-arm, phase II, prospective trial using a Simon two-stage design. Patients receive 1-4 cycles of quadruple therapy (cryoablation plus hepatic arterial infusion of QL1706, intravenous dacarbazine, and oral lenvatinib), followed by maintenance with intravenous QL1706, dacarbazine, and oral lenvatinib until disease progression or intolerable toxicity. The primary endpoint is ORR; secondary endpoints include PFS, OS, and treatment-related adverse events.
Laboratory test results meeting the following criteria:
Exclusion Criteria:
Clinical stability requires all of the following:
no new neurological symptoms, and previous neurological symptoms have returned to normal.
Single-arm, open-label, phase II trial. Patients receive quadruple therapy for 1-4 cycles (3-4 weeks per cycle): (1) cryoablation of intrahepatic lesions; (2) hepatic arterial infusion of iparomlimab and tuvonralimab (QL1706) 7.5 mg/kg over 2 hours, 7-14 days after ablation; (3) intravenous dacarbazine 850-1000 mg/m² divided over 2 days; (4) oral lenvatinib 8 mg once daily. After completing the combination phase, patients enter maintenance with intravenous QL1706, dacarbazine, and oral lenvatinib until disease progression or intolerable toxicity. If oligoprogression occurs in the liver, radical radiotherapy to progressing intrahepatic lesions is permitted while maintenance continues.
Procedure: Cryoablation · Drug: Iparomlimab and Tuvonralimab · Drug: Dacarbazine · Drug: Lenvatinib
Cryoablation is performed using the Hygea Co-ablation System (Hygea Medical Technology Co. Ltd, Beijing, China), a combined cryoablation and hyperthermic ablation device. Under CT guidance and local anesthesia with 2% lidocaine, one to five intrahepatic lesions with a maximum diameter \<5 cm are ablated per session. Each ablation consists of two 10-minute freeze cycles, with a passive thaw between cycles. Technical success is defined as ice-ball extension of at least 0.5 cm beyond the tumor margin. Cryoablation is mandatory in the first cycle and may be repeated in subsequent cycles at the discretion of the investigator, for a maximum of four sessions within 3 months.
Iparomlimab and tuvonralimab (QL1706; Qilu Pharmaceutical Co., Ltd., Jinan, China) is a dual PD-1/CTLA-4 combination antibody. During the combination phase, QL1706 is administered by hepatic arterial infusion. The catheter tip is positioned in the tumor-feeding artery, proper hepatic artery, or left/right hepatic artery based on intra-hepatic tumor location, and correct positioning is confirmed by repeat angiography. QL1706 7.5 mg/kg diluted in 100 mL of 0.9% normal saline is then infused at a constant rate over 2 hours. Hepatic arterial infusion is given every 3 weeks for a maximum of 4 cycles within 3 months, and if combined with cryoablation, it is administered 7-14 days after ablation. During the maintenance phase, QL1706 is administered intravenously at the same dose every 3 weeks until disease progression or intolerable toxicity. Dose reduction of QL1706 is not permitted.
Dacarbazine is administered intravenously as a 2-day regimen at a total dose of 850-1000 mg/m², divided over 2 consecutive days, every 3-4 weeks. During the combination phase, dacarbazine is administered intravenously on the day immediately following hepatic arterial infusion of QL1706 (i.e., day 1 after infusion). During the maintenance phase, dacarbazine is continued intravenously at the same dose and schedule until disease progression, intolerable toxicity, or discontinuation after 2 years of maintenance in patients without disease progression.
Lenvatinib is administered orally at a starting dose of 8 mg once daily. During the combination phase, lenvatinib is started on day 3 after hepatic arterial infusion of QL1706 and catheter removal. During the maintenance phase, lenvatinib is continued orally at the same dose until disease progression or intolerable toxicity, and is continued beyond 2 years after discontinuation of immunotherapy and chemotherapy in patients without disease progression.
Objective Response Rate (ORR)
ORR is defined as the proportion of patients whose best overall response is complete response (CR) or partial response (PR) according to RECIST v1.1, assessed by the investigator. Response evaluation is performed exclusively on pre-specified target lesions that are not subjected to cryoablation. For patients with both intrahepatic and extrahepatic metastases, extrahepatic target lesions are preferentially selected whenever feasible; for patients with intrahepatic lesions only, at least one measurable intrahepatic lesion is deliberately spared from ablation and serves as the target lesion for response assessment. Patients with a first documented CR or PR must have the response confirmed by repeat assessment at least 4 weeks later or at the next scheduled time point.
Time frame: From the initiation of study treatment until disease progression, death, or end of study, assessed up to 48 months.
Progression-Free Survival (PFS)
PFS is defined as the time from initiation of study treatment to the first documented disease progression on non-ablated target lesions per RECIST v1.1, as assessed by the investigator, or death from any cause, whichever occurs first.
Time frame: From initiation of study treatment to the first documented radiographic disease progression per RECIST v1.1, as assessed by the investigator, or death from any cause, whichever occurs first, assessed up to 48 months.
Overall Survival (OS)
OS is defined as the time from initiation of study treatment to death from any cause. Patients still alive at the time of analysis are censored at the date of last follow-up. Patients lost to follow-up are censored at the date of last confirmed survival.
Time frame: From the initiation of study treatment to death from any cause, assessed up to 48 months.
6-Month Progression-Free Survival Rate
The 6-month PFS rate is defined as the proportion of patients who are alive and free of disease progression on non-ablated target lesions per RECIST v1.1 at 6 months after initiation of study treatment, as assessed by the investigator.
Time frame: 6 months after initiation of study treatment.
Treatment-Related Adverse Events (TRAEs)
TRAEs are defined as adverse events judged by the investigator to be related to any component of the study treatment (cryoablation, hepatic arterial infusion of QL1706, intravenous dacarbazine, or oral lenvatinib). Adverse events are graded according to NCI-CTCAE v5.0, and the incidence, severity, and type of TRAEs and serious adverse events (SAEs) are recorded.
Time frame: From first dose until 30 days after the last dose of study treatment
Disease Control Rate (DCR)
DCR is defined as the proportion of patients whose best overall response is complete response (CR), partial response (PR), or stable disease (SD) lasting at least 6 weeks according to RECIST v1.1, as assessed by the investigator. Tumor response is assessed on all target lesions, but only non-ablated target lesions are used to determine the best overall response.
Time frame: From the initiation of study treatment until disease progression, death, or end of study, assessed up to 48 months.
Duration of Response (DoR)
DoR is defined as the time from the first documented objective response (CR or PR) on non-ablated target lesions to the first documented disease progression per RECIST v1.1 or death from any cause, whichever occurs first, as assessed by the investigator.
Time frame: From the first documented objective response (CR or PR) to the first documented disease progression per RECIST v1.1 or death from any cause, whichever occurs first, assessed up to 48 months.
Time to Progression (TTP)
TTP is defined as the time from initiation of study treatment to the first documented disease progression on non-ablated target lesions per RECIST v1.1, as assessed by the investigator. Deaths before documented progression are not counted as events for TTP.
Time frame: From the initiation of study treatment to the first documented disease progression per RECIST v1.1, as assessed by the investigator, assessed up to 48 months.
Plan to share: No — Individual participant data will not be shared because the informed consent does not explicitly permit data sharing with other researchers, and patient privacy and institutional data ownership policies apply. Only summary results will be published.
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