A Phase 2 interventional study of Cryo-Thermal Ablation and Toripalimab in Carcinoma, Non-Small-Cell Lung (NSCLC), sponsored by West China Hospital. Recruiting at 9 sites in China. Open to participants aged 18 Years to 80 Years. Per ClinicalTrials.gov, last updated 2026-10-02.
Sponsored by West China Hospital · Phase 2, Interventional, and Treatment
Neoadjuvant chemoimmunotherapy has improved outcomes in patients with resectable non-small cell lung cancer (NSCLC), but a substantial proportion of patients do not achieve a major pathological response. Cryo-Thermal Ablation may induce immunogenic tumor cell death and remodel the tumor immune microenvironment, potentially enhancing the antitumor activity of subsequent chemoimmunotherapy.
This multicenter, single-arm, open-label, prospective Phase II study will evaluate the efficacy and safety of CT-guided Cryo-Thermal Ablation followed by toripalimab plus platinum-based doublet chemotherapy as neoadjuvant treatment for patients with resectable stage IB-IIIB NSCLC. For stage IB disease, only patients with cT2aN0M0 disease and a maximum primary tumor diameter of 4.0 cm are eligible. Patients with more advanced disease must be considered resectable by multidisciplinary team assessment according to the study protocol.
Approximately 40 participants will receive Cryo-Thermal Ablation followed by 3 planned cycles of toripalimab plus platinum-based doublet chemotherapy and subsequent curative-intent surgical resection.
The primary outcome is the pathological complete response (pCR) rate. Secondary outcomes include major pathological response (MPR) rate, objective response rate (ORR), R0 resection rate, event-free survival (EFS), overall survival (OS), treatment-emergent adverse events (TEAEs), and health-related quality of life.
Exploratory translational analyses will investigate treatment-associated local and systemic antitumor immune responses and molecular dynamics using spatial transcriptomics, T-cell receptor sequencing, tumor genomic profiling, circulating tumor DNA analysis, imaging mass cytometry, and exploratory intratumoral metagenomic and metabolomic profiling.
6,741 studies on the registry are indexed under Carcinoma; 1,161 are open to participants now.
This study's planned enrollment of 40 is below the median of 45 across 5,170 interventional studies indexed under Carcinoma.
Browse Carcinoma studies →West China Hospital is the lead sponsor of 483 studies on the registry; 240 are open to participants now.
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Diagnosis, Stage, and Resectability
Age, Performance Status, and General Condition
Tumor Tissue and Pulmonary Function
Adequate Organ Function
Laboratory assessments performed within 7 days before the first study intervention must meet the following criteria:
Reproductive Requirements
Exclusion Criteria
Histological or Molecular Characteristics
Contraindications to Percutaneous Biopsy or Cryo-Thermal Ablation
Clinically Significant Cardiovascular or Systemic Disease
Immunotherapy-Related Contraindications
Active or Clinically Significant Infection
Pulmonary Conditions
Other Malignancies
Concurrent or Recent Treatments
Pregnancy, Lactation, and Transplantation
Other Exclusion Criteria
Participants will receive CT-guided Cryo-Thermal Ablation followed by 3 planned cycles of toripalimab plus histology-appropriate platinum-based doublet chemotherapy administered every 3 weeks, followed by curative-intent surgical resection after preoperative reassessment.
Procedure: Cryo-Thermal Ablation · Drug: Toripalimab · Drug: Platinum-based doublet chemotherapy
Cryo-Thermal Ablation is a CT-guided percutaneous local ablation procedure performed on the primary lung tumor before initiation of neoadjuvant systemic therapy. Under CT guidance, one or more ablation probes are placed percutaneously into the target lesion. Sequential cryogenic and thermal treatment is delivered according to the study protocol and device operating instructions. Technical parameters, including probe placement, treatment cycles, treatment duration, and target temperatures, will be standardized according to the protocol.
Also known as: Ablation
Toripalimab, an anti-programmed cell death protein 1 (PD-1) monoclonal antibody, will be administered intravenously at a dose of 240 mg every 3 weeks (q3w) in combination with platinum-based doublet chemotherapy for 3 planned cycles following Cryo-Thermal Ablation. Dose interruption, delay, or discontinuation will be permitted when clinically indicated for treatment-related toxicity.
Participants will receive protocol-specified platinum-based doublet chemotherapy in combination with toripalimab every 3 weeks for 3 planned cycles following Cryo-Thermal Ablation. The specific regimen will be selected according to tumor histology and the study protocol. Chemotherapy dosing, administration, dose modification, and supportive treatment will follow the protocol-defined regimen and standard clinical practice. After neoadjuvant therapy, disease reassessment will be performed before curative-intent surgical resection.
Pathological Complete Response (pCR) Rate
The proportion of enrolled participants who achieve pathological complete response (pCR), defined as no residual viable tumor cells in the resected primary tumor and all sampled regional lymph nodes after neoadjuvant treatment (ypT0N0). Participants who do not undergo surgical resection or for whom pathological response cannot be adequately assessed will not be considered to have achieved pCR in the primary efficacy analysis.
Time frame: At pathological evaluation of the surgical resection specimen, with surgery planned approximately 4-6 weeks after the final neoadjuvant treatment.
Objective Response Rate (ORR)
The proportion of enrolled participants who achieve a complete response (CR) or partial response (PR) as their radiographic tumor response before surgery, as assessed according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1.
Time frame: At preoperative radiographic reassessment, approximately 4-6 weeks after the final neoadjuvant treatment.
Major Pathological Response (MPR) Rate
The proportion of enrolled participants who achieve major pathological response (MPR), defined as ≤10% residual viable tumor cells within the primary tumor bed in the resected lung specimen after neoadjuvant treatment, based on pathological assessment according to IASLC recommendations. Pathological response in regional lymph nodes will be assessed and reported separately and will not be included in the primary definition of MPR.
Time frame: At pathological evaluation of the surgical resection specimen, with surgery planned approximately 4-6 weeks after the final neoadjuvant treatment.
R0 resection rate
The proportion of participants undergoing surgical resection who achieve an R0 resection, defined as complete macroscopic resection of the tumor with microscopically negative surgical margins and no residual tumor at the resection margins.
Time frame: At surgical and pathological evaluation of the resection specimen, with surgery planned approximately 4-6 weeks after the final neoadjuvant treatment.
Event-Free Survival (EFS)
Event-free survival (EFS) is defined as the time from enrollment to the first occurrence of any of the following events: radiographic disease progression; local disease progression resulting in unresectability; inability to undergo the planned curative-intent surgery because of treatment-related toxicity or deterioration in clinical condition attributable to study treatment; failure to achieve tumor resection because of intraoperative unresectability; local or distant disease recurrence after surgery; or death from any cause. Participants without an EFS event will be censored at the date of the last disease assessment.
Time frame: From enrollment until the first EFS event, death, last disease assessment, or end of follow-up, up to approximately 5 years.
Overall Survival (OS)
Overall survival (OS) is defined as the time from enrollment to death from any cause. Participants who are alive at the time of analysis will be censored at the date they were last known to be alive.
Time frame: From enrollment until death from any cause or the end of follow-up, up to approximately 5 years.
Change From Baseline in EORTC QLQ-C30 Global Health Status/Quality of Life Score
Health-related quality of life will be assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). The Global Health Status/Quality of Life scale is transformed to a score ranging from 0 to 100, with higher scores indicating better overall health status and quality of life. Changes from baseline will be evaluated across predefined perioperative assessment time points.
Time frame: Baseline before Cryo-Thermal Ablation; preoperative assessment approximately 4-6 weeks after the final neoadjuvant treatment; and approximately 30 days after surgical resection.
Percentage of Participants With Treatment-Emergent Adverse Events (TEAEs)
The proportion of participants who experience one or more treatment-emergent adverse events (TEAEs). Adverse events will be assessed for type, severity, and relationship to study treatment and graded according to NCI-CTCAE version 5.0. Safety assessments will include events associated with Cryo-Thermal Ablation, neoadjuvant chemoimmunotherapy, and the perioperative treatment course.
Time frame: From Cryo-Thermal Ablation through 30 days after surgical resection; for participants not undergoing surgery, through 30 days after discontinuation of protocol-defined treatment.
Changes in the Spatial Tumor Immune Microenvironment Assessed by Atera In Situ Spatial Transcriptomics
Atera In Situ single-cell spatial transcriptomic profiling will be performed on FFPE tumor specimens. Within-participant changes from the baseline tumor biopsy before Cryo-Thermal Ablation to the surgical tumor specimen after neoadjuvant chemoimmunotherapy will be evaluated. Spatial immune features in the surgical specimen will also be compared among residual tumor, adjacent tissue, and normal lung tissue when available. Analyses will characterize spatial distributions and transcriptional states of CD8+ T cells, regulatory T cells, myeloid populations, interferon-related signaling, antigen-presentation pathways, and T-cell activation/exhaustion programs. Features will also be compared between participants with and without MPR; pCR will be explored as a subgroup.
Time frame: Baseline tumor biopsy before Cryo-Thermal Ablation and surgical resection approximately 4-6 weeks after the final neoadjuvant treatment.
Changes in Peripheral and Tumor T-cell Receptor Clonality Assessed by Bulk TCR Sequencing
Bulk T-cell receptor sequencing (TCR-seq) will be performed on peripheral blood mononuclear cells and tumor tissue to characterize treatment-associated T-cell clonal dynamics. Peripheral blood will be collected at baseline before Cryo-Thermal Ablation, approximately 14 days after ablation before Cycle 1, before Cycles 2 and 3 of neoadjuvant chemoimmunotherapy, and after completion of neoadjuvant therapy before surgery. TCR repertoire diversity, clonality, and clonal expansion will be evaluated longitudinally. Tumor tissue from the baseline biopsy and surgical resection specimen will also undergo TCR-seq. Changes in intratumoral T-cell clonality and overlap between blood and tumor TCR clonotypes will be explored in relation to pathological response and treatment-related toxicity.
Time frame: Peripheral blood: baseline; Day 14 after ablation before Cycle 1; before Cycle 2 (approximately Day 35) and Cycle 3 (approximately Day 56); and preoperative assessment 4-6 weeks after Cycle 3. Tumor tissue: baseline biopsy and surgical resection.
Tumor Genomic Alterations Assessed by a 919-Gene Next-Generation Sequencing Panel
Baseline FFPE tumor biopsy specimens will undergo next-generation sequencing using a 919-gene cancer-associated panel. Somatic genomic alterations, including relevant mutations and other detectable genomic features, will be characterized. Exploratory analyses will evaluate associations between baseline tumor genomic characteristics and pathological response to Cryo-Thermal Ablation combined with neoadjuvant chemoimmunotherapy.
Time frame: Baseline tumor biopsy before Cryo-Thermal Ablation.
Longitudinal Changes in Circulating Tumor DNA and Molecular Residual Disease
Circulating tumor DNA (ctDNA) will be longitudinally assessed to characterize changes in tumor-derived molecular signals during treatment and postoperative surveillance. During neoadjuvant treatment, ctDNA levels and detectable tumor-associated alterations will be evaluated at baseline before ablation, 14 days after ablation, and at the preoperative assessment after completion of neoadjuvant therapy. ctDNA clearance and changes in variant allele abundance will be explored according to pathological response. Serial postoperative ctDNA testing will be used to assess molecular residual disease (MRD) and its relationship with subsequent disease recurrence. Longitudinal ctDNA profiles will also be explored for changes in detectable tumor clones over time.
Time frame: Baseline before ablation; Day 14 after ablation; at the preoperative assessment approximately 4-6 weeks after the final neoadjuvant treatment; and Months 1, 4, 7, 10, 16, 22, 28, and 34 after surgery.
Spatial Immune Phenotypes Assessed by Imaging Mass Cytometry
Imaging Mass Cytometry (IMC) will be performed on selected FFPE surgical tumor specimens after neoadjuvant treatment as an orthogonal protein-level validation of spatial immune findings. Analyses will quantify selected immune cell populations and protein markers, including CD8+ T cells, regulatory T cells, myeloid populations, PD-L1, antigen-presentation markers, and markers of immune activation or proliferation such as granzyme B (GZMB) and Ki-67. Spatial relationships between immune cells and tumor cells, including immune-cell density, cellular proximity, and tumor-immune spatial organization, will be compared between participants with MPR and those without MPR. pCR cases will be explored as a subgroup where evaluable tissue is available.
Time frame: At surgical resection, approximately 4-6 weeks after the final neoadjuvant treatment.
Intratumoral Microbial Relative Abundance Assessed by Metagenomic Sequencing
Tumor or tumor-bed specimens obtained at surgical resection will undergo metagenomic sequencing to characterize the intratumoral microbiome. The relative abundance of detected microbial taxa will be quantified and reported as the percentage of the total microbial abundance represented by each taxon. Microbial relative abundance profiles will be compared between participants with major pathological response (MPR) and those without MPR. Pathological complete response (pCR) cases will be explored as a subgroup when tumor-bed specimens are technically evaluable.
Time frame: At surgical resection, approximately 4-6 weeks after the final neoadjuvant treatment.
Intratumoral Metabolite Abundance Assessed by Metabolomic Profiling
Tumor or tumor-bed specimens obtained at surgical resection will undergo metabolomic profiling to characterize intratumoral metabolic features. Detected metabolites will be quantified using normalized metabolite abundance, expressed as normalized signal intensity in arbitrary units. Metabolite abundance profiles will be compared between participants with major pathological response (MPR) and those without MPR. Pathological complete response (pCR) cases will be explored as a subgroup when tumor-bed specimens are technically evaluable.
Time frame: At surgical resection, approximately 4-6 weeks after the final neoadjuvant treatment.
Plan to share: No — Individual participant data are not planned for public sharing because the study includes sensitive clinical, genomic, and multi-omics data. Data sharing may be considered in accordance with participant consent, ethics committee approval, institutional policies, and applicable data protection requirements.
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