Adebrelimab and a TKI in Combination With GEMOX in First-line Treatment of Advanced Biliary Tract Cancers (BTC)

Exclusion Criteria

• •1\) Active malignancies other than BTC within 5 years or at the same time. Cured localized tumors, such as skin basal cell carcinoma, skin squamous cell carcinoma, superficial bladder carcinoma, prostate carcinoma in situ, cervical carcinoma in situ, breast carcinoma in situ, etc., could be included in the group.
• •2\) Patients who are preparing for or have previously received organ or allogeneic bone marrow transplantation;
• •3\) Other investigational drug treatment received within 28 days prior to the start of study treatment;
• •4\) Moderate and severe ascites with clinical symptoms, i.e. requiring therapeutic puncture, drainage or Child-Pugh score \> 2 (except for those with only a small amount of ascites on imaging but without clinical symptoms); uncontrolled or moderate or more pleural effusion and pericardial effusion;
• •6\) Abdominal fistula, gastrointestinal perforation, or abdominal abscess within 6 months prior to the start of study treatment;
• •7\) Known presence of inherited or acquired bleeding (e.g., coagulopathy) or thrombophilia, e.g., in patients with hemophilia; current or recent (within 10 days prior to the start of study treatment) use of full-dose oral or injectable anticoagulants or thrombolytics for therapeutic purposes (low-dose aspirin, low-molecular-weight heparin, prophylactic use permitted);
• •8\) current or recent use (within 10 days prior to study treatment) of aspirin (\> 325 mg/day (maximum antiplatelet dose) or dipyridamole, ticlopidine, clopidogrel, and cilostazol;
• •9\) Thrombotic or embolic events, such as cerebrovascular accident (including transient ischemic attack, cerebral hemorrhage, cerebral infarction), pulmonary embolism, etc., occurred within 6 months before the start of study treatment;
• •10\) Clinical symptoms or diseases of the heart that are not well controlled, such as:
• •1. LVEF (left ventricular ejection fraction) \< 50% according to New York Heart Association (NYHA) standard II or above cardiac dysfunction or cardiac color Doppler ultrasound examination;
• •2. unstable angina pectoris;
• •3. Myocardial infarction within 1 year prior to the start of study treatment;
• •4. Supraventricular or ventricular arrhythmias of clinical significance require treatment or intervention;
• •5. QTc \> 450ms (male); QTc \> 470ms (female) (QTc interval is calculated by Fridericia formula; if QTc is abnormal, it can be detected three times at an interval of 2 minutes, and the average value is taken);
• •11)Hypertension that is not well controlled by antihypertensive medication (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg) (based on the average of BP readings obtained from ≥ 2 measurements) allows the use of antihypertensive therapy to achieve the above parameters; previous hypertensive crisis or hypertensive encephalopathy;
• •12\) Major vascular disease (e.g., aortic aneurysm requiring surgical repair or with recent peripheral arterial thrombosis) within 6 months prior to the start of study treatment; severe, unhealed or dehiscent wounds, and active ulcers or untreated fractures; Major surgery has been performed within 4 weeks prior to the start of study treatment (except for diagnosis) or is expected to be performed during the study period;
• •13\) There is evidence of intra-abdominal pneumatosis that cannot be explained by puncture or recent surgery;
• •14\) prior or present central nervous system metastasis; Metastatic disease involving major Airways or vessels (for example, total occlusion of the main portal vein or vena cava due to tumor invasion, where the main portal vein is the confluence of the splenic vein and the superior mesenteric vein and where the hepatic portal vein divides into left and right branches) or a large mediastinal tumor mass located in the center (\< 30 mm from the carina) should be excluded from the group;
• •15\) Patients with history of hepatic encephalopathy; Current interstitial pneumonia or interstitial lung disease, or a previous history of interstitial pneumonia or interstitial lung disease requiring hormone therapy, or other pulmonary fibrosis, organizing pneumonia that may interfere with the judgment and management of immune-related pulmonary toxicity (e. Bronchiolitis obliterans), pneumoconiosis, drug-associated pneumonia, idiopathic pneumonia, or evidence of active pneumonia on computed tomography (CT) images of the chest during the screening period, or subjects with severely impaired lung function, with a history of radiation pneumonitis in the permissive field; active tuberculosis;
• •16\) Active autoimmune disease or history of autoimmune disease with potential for recurrence (including but not limited to: autoimmune hepatitis, interstitial pneumonia, uveitis, enteritis, hypophysitis, vasculitis, nephritis, hyperthyroidism, hypothyroidism \[only subjects that can be controlled by hormone replacement therapy may be included\]); Subjects with skin diseases that do not require systemic treatment such as vitiligo, psoriasis, alopecia, controlled type I diabetes mellitus on insulin therapy, or asthma that has completely resolved in childhood and does not require any intervention in adulthood may be included; asthma patients who require medical intervention with bronchodilators may not be included;
• •17\) use of immunosuppressant or systemic hormone therapy for immunosuppression (dose \> 10 mg/day prednisone or other iso-effective hormone) within 14 days prior to initiation of study treatment;
• •18\) Known history of severe allergy to any monoclonal antibody drug;
• •19\) Severe infection within 4 weeks prior to the start of study treatment, including but not limited to hospitalization for complications of infection, bacteremia, or severe pneumonia; therapeutic antibiotics administered orally or intravenously within 2 weeks prior to the start of study treatment (patients receiving prophylactic antibiotics (e.g., to prevent urinary tract infection or exacerbation of chronic obstructive pulmonary disease are eligible for the study);
• •20\) patients with congenital or acquired immune deficiency (such as HIV infection);
• •21\) co-infection with hepatitis B and hepatitis C;
• •22\) Have received live attenuated vaccine within 28 days prior to the start of study treatment or are expected to require such vaccine during treatment with or within 60 days of the last dose of Aderbelizumab In the judgment of the investigator, the patient has other factors that may affect the results of the study or lead to the forced termination of the study, such as alcoholism, drug abuse, other serious diseases (including mental illness) requiring combined treatment, serious laboratory abnormalities, accompanied by family or social factors, which will affect the safety of the patient.