Neoadjuvant Finotonlimab Plus TP Regimen in Locally Advanced INI-1-Deficient Sinonasal Carcinoma - NCT07927465

Sponsor: Eye & ENT Hospital of Fudan University Conditions: SMARCB1-Deficient Sinonasal Carcinoma This is a prospective, multicenter, single-arm phase 2 study in adults with locally advanced (T3/T4) INI-1 (SMARCB1)-deficient sinonasal carcinoma, a very rare and aggressive cancer of the nasal cavity and sinuses. This cancer often invades the skull base, eyes, nerves, and surrounding critical structures, making surgery difficult and potentially disabling. Current standard treatment is usually surgery followed by radiotherapy, but complete removal is often difficult and recurrence is common. Standard chemotherapy before surgery has shown limited tumor shrinkage, so better pre-surgical treatment is urgently needed. The purpose of this study is to find out whether giving an immunotherapy drug, finotonlimab, together with standard chemotherapy (paclitaxel plus cisplatin, the "TP" regimen) before surgery can shrink the tumor and improve treatment results. Finotonlimab is a PD-1 inhibitor that may help the immune system attack the cancer, and it is being given together with chemotherapy because the two treatments may work better in combination. All participants will receive 2 cycles of this combined treatment (each cycle is 21 days), followed by imaging tests to measure tumor response. If the tumor is considered removable, participants will then undergo surgery and, after recovery, standard postoperative radiotherapy. The main question this study is trying to answer is: how many participants experience significant tumor shrinkage (objective response, defined as complete or partial response) after 2 cycles of neoadjuvant finotonlimab plus TP chemotherapy, as assessed by blinded independent imaging review using RECIST v1.1. The study will also look at safety, the rate of complete surgical removal (R0 resection), pathological response, disease-free and overall survival, quality of life, and whether important organs such as the eye can be preserved. About 20 participants will be enrolled across multiple centers. This study is expected to provide the first prospective evidence for this combination in this rare cancer and may help establish a new treatment option before surgery. This phase 2 study is designed to evaluate the efficacy and safety of neoadjuvant finotonlimab combined with TP chemotherapy in patients with locally advanced INI-1 (SMARCB1)-deficient sinonasal carcinoma. INI-1 deficiency defines a rare, aggressive subtype of sinonasal carcinoma with a high propensity for skull base invasion and limited response to conventional induction chemotherapy. The study hypothesis is that adding PD-1 blockade to standard TP chemotherapy will increase the preoperative objective response rate, facilitate tumor downstaging, improve R0 resection, and potentially reduce surgical morbidity while preserving organ function. Approximately 20 eligible participants will be enrolled across multiple centers. All participants will receive 2 cycles of neoadjuvant therapy every 21 days: finotonlimab 200 mg intravenously on day 1, followed by paclitaxel 135-175 mg/m² on day 1 and cisplatin 70-75 mg/m² on days 1-3, with standard premedication, hydration, and antiemetic support. After 2 cycles, tumor response will be assessed by contrast-enhanced MRI of the skull base and chest CT, with independent blinded central review using RECIST v1.1. Participants with complete response, partial response, or stable disease will proceed to definitive surgery aiming for R0 resection, followed by postoperative intensity-modulated radiotherapy (60-66 Gy in 30-33 fractions) after adequate wound healing. Participants with progressive disease will discontinue the study regimen and receive salvage therapy as determined by the multidisciplinary team. The primary endpoint is objective response rate after 2 cycles of neoadjuvant therapy, assessed by blinded independent central review. Secondary assessments include disease control rate, R0 resection rate, major pathological response, pathological complete response, disease-free survival, overall survival, safety and tolerability according to CTCAE v5.0, surgery- and radiotherapy-related complications, quality of life using EORTC QLQ-C30 and QLQ-H\&N35, and organ preservation rate. Exploratory analyses will evaluate the association of PD-L1 CPS, Ki-67, TP53 mutation status, and serial circulating tumor DNA dynamics with treatment response and recurrence risk, and will explore baseline clinical features such as T stage and cranial nerve involvement as potential predictors of benefit. This study is expected to provide the first prospective multicenter evidence for neoadjuvant PD-1 blockade combined with TP chemotherapy in this ultra-rare sinonasal malignancy. If positive, the results may support a new preoperative treatment paradigm aimed at improving resectability and functional outcomes, and will inform future larger studies.