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Biliary Tract Cancer (BTC)Phase 2CASTLE-ZS-04NCT07829874

Cryoablation Combined With QL1706 (Iparomlimab/Tuvonralimab) Plus Lenvatinib in Patients With Advanced Biliary Tract Cancer.

A Phase 2 study testing QL1706 (Iparomlimab/Tuvonralimab), Lenvatinib and Cryoablation in people with Biliary Tract Cancer (BTC), run by Fudan University at 1 site in China.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

This study will evaluate the efficacy and safety of cryoablation combined with QL1706 (iparomlimab/tuvonralimab) plus lenvatinib in patients with advanced biliary tract cancer (BTC) who have progressed after first-line treatment. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Biliary Tract Cancer (BTC)
What is being tested?
QL1706 (Iparomlimab/Tuvonralimab), Lenvatinib and Cryoablation
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
180 participants
Where
1 siteChina
Study dates
20 Sep 2026to 20 Sep 2029
Phase
Phase 2
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Written informed consent obtained.
  • Age ≥ 18 years at time of study entry.
  • Participants must have unresectable or metastatic histologically confirmed biliary tract cancer.
  • Participants must have failed 1 line of GemCis plus PD1/PD-L1 inhibitor for advanced cholangiocarcinoma due to disease progression or toxicity.
  • At least one measurable site of disease as defined by RECIST criteria with spiral CT scan or MRI.
  • Performance status (PS) ≤ 2 (ECOG scale).
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  • Life expectancy of at least 12 weeks.
  • Adequate blood count, liver-enzymes, and renal function: absolute neutrophil count ≥ 1,500/L, platelets ≥75 x103/L; Total bilirubin ≤ 3x upper normal limit; Aspartate Aminotransferase (SGOT), Alanine aminotransferase (SGPT) ≤ 5 x upper normal limit (ULN); International normalized ratio (INR) ≤1.25; Albumin ≥ 31 g/dL; Serum Creatinine ≤ 1.5 x institutional ULN or creatinine clearance (CrCl) ≥ 30 mL/min (if using the Cockcroft-Gault formula )
  • Female patients with reproductive potential must have a negative urine or serum pregnancy test within 7 days prior to start of trial.
  • Subject is willing and able to comply with the protocol for the duration of the study including undergoing treatment, adherence to contraceptive measures, scheduled visits and examinations including follow up.

Who cannot join

  • History of cardiac disease, including clinically significant gastrointestinal bleeding within 4 weeks prior to start of study treatment
  • Thrombotic or embolic events such as cerebrovascular accident (including transient ischemic attacks), deep vein thrombosis or pulmonary embolism within the 6 months Prior to the first dose of study drug with the exception of thrombosis of a segmental portal vein.
  • Prior treatment with cryoablation.
  • RFA and resection administered less than 4 weeks prior to study treatment start.
  • Radiotherapy administered less than 4 weeks prior to study treatment start.
  • Major surgery within 4 weeks of starting the study treatment OR subjects who have not recovered from effects of major surgery.
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  • Patients with second primary cancer, except adequately treated basal skin cancer or carcinoma in-situ of the cervix.
  • Immunocompromised patients, e.g. patients who are known to be serologically positive for human immunodeficiency virus (HIV).
  • Participation in another clinical study with an investigational product during the last 30 days before inclusion or 7 half-lifes of previously used trial medication, whichever is longer.
  • Any condition or comorbidity that, in the opinion of the investigator, would interfere with evaluation of study Treatment or interpretation of patient safety or study results, including but not limited to: a) history of interstitial lung disease b) Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) coinfection (i.e double infection) c) known acute or chronic pancreatitis d) active tuberculosis e) any other active infection (viral, fungal or bacterial) requiring systemic therapy f) history of allogeneic tissue/solid organ transplant g) diagnosis of immunodeficiency or patient is receiving chronic systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to the first dose of treatment. h) Has an active autoimmune disease requiring systemic treatment within the past 3 months or a documented history of clinically severe autoimmune disease, or a syndrome that requires systemic steroids or immunosuppressive agents. Exceptions: Subjects with vitiligo, hypothyroidism, diabetes mellitus type I or resolved childhood asthma/atopy are an exception to this rule. Subjects that require intermittent use of bronchodilators or local steroid injections would not be excluded from the study. Subjects with Hashimoto thyroiditis, hypothyroidism stable on hormone replacement or psoriasis not requiring treatment are not excluded from the study. i) Live vaccine within 30 days prior to the first dose of treatment or during study treatment. j) History or clinical evidence of Central Nervous System (CNS) metastases Exceptions are: Subjects who have completed local therapy and who meet both of the following criteria: I. are asymptomatic and II. have no requirement for steroids 6 weeks prior to start of treatment. Screening with CNS imaging (CT or MRI) is required only if clinically indicated or if the subject has a history of CNS
  • Medication that is known to interfere with any of the agents applied in the trial.
  • Any other efficacious cancer treatment except protocol specified treatment at study start.
  • Patient has received any other investigational product within 28 days of study entry.
  • Prior therapy with an anti-CD137 (4-1BB ligand, a member of the Tumor Necrosis Factor Receptor (TNFR) family), or anti-Cytotoxic T-lymphocyte-associated antigen-4 (anti-CTLA-4) antibody (including ipilimumab or any other antibody or drug specifically targeting T-cell co-stimulation or checkpoint pathways).
  • Female subjects who are pregnant, breast-feeding or male/female patients of reproductive potential who are not employing an effective method of birth control (failure rate of less than 1% per year). [Acceptable methods of contraception are: implants, injectable contraceptives, combined oral contraceptives, intrauterine pessars (only hormonal devices), sexual abstinence or vasectomy of the partner]. Women of childbearing potential must have a negative pregnancy test (serum β-HCG) at screening.
  • Patient with any significant history of non-compliance to medical regimens or with inability to grant reliable informed consent.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Peng Wang contact

86-21-64041990

peng_wang@fudan.edu.cn

China1 site

  • Zhongshan Hospital, Fudan University

    Shanghai, Shanghai Municipality, 200032

    Peng Wang, 86-21-64041990, peng_wang@fudan.edu.cn

    Peng Wang

Other trials in China

About this study

Official title: QL1706 (Iparomlimab/Tuvonralimab) Plus Lenvatinib With or Without Cryoablation for Advanced Biliary Tract Cancer (CASTLE-ZS-04): a Multicenter, Randomized, Phase 2 Study

This study will evaluate the efficacy and safety of cryoablation combined with QL1706 (iparomlimab/tuvonralimab) plus lenvatinib in patients with advanced biliary tract cancer (BTC) who have progressed after first-line treatment.

Read the detailed description

This study is a multicenter, open-label, multi-cohort, phase 2 exploratory clinical trial. Subjects enrolled are patients with advanced biliary tract cancer (BTC) who have failed first-line treatment based on chemotherapy combined with immune checkpoint inhibitors. The study evaluates the efficacy and safety of second-line cryoablation combined treatment regimens.

Eligible patients are divided into three independent cohorts according to the primary site of the tumor: intrahepatic cholangiocarcinoma (ICC) cohort, extrahepatic cholangiocarcinoma (ECC) cohort, and gallbladder cancer (GBC) cohort. Within each cohort, patients are randomly assigned 1:1 to the following two treatment groups: Group 01: QL1706 + Lenvatinib, Group 02: QL1706+lenvatinib +Cryoablation. This results in six study cohorts: ICC-01, ICC-02, ECC-01, ECC-02, GBC-01, and GBC-02.

Being tested
QL1706 (Iparomlimab/Tuvonralimab), Lenvatinib, Cryoablation
Medical subject headings
Biliary Tract Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • QL1706 (Iparomlimab/Tuvonralimab)Drug

    A bifunctional PD1/CTLA4 dual blocker

  • LenvatinibDrug

    An TKI.

  • CryoablationProcedure or surgery

    Cryoablation will be performed with a two-cycle freeze-thaw phase protocol; US or non-contrast CT images will be obtained to visualize the evolving ablation zone

Study groups in NCT07829874
Study groupRoleWhat they receive
ICC-01ExperimentalIntrahepatic cholangiocarcinoma (ICC) received QL1706 + lenvatinib
Receives: Drug: QL1706 (Iparomlimab/Tuvonralimab); Drug: Lenvatinib
ICC-02ExperimentalIntrahepatic cholangiocarcinoma (ICC) received QL1706 + lenvatinib+cryoablation
Receives: Drug: QL1706 (Iparomlimab/Tuvonralimab); Drug: Lenvatinib; Procedure: Cryoablation
ECC-01ExperimentalExtrahepatic cholangiocarcinoma (ECC) received QL1706 + lenvatinib
Receives: Drug: QL1706 (Iparomlimab/Tuvonralimab); Drug: Lenvatinib
ECC-02ExperimentalExtrahepatic cholangiocarcinoma (ECC) received QL1706 + lenvatinib +cryoablation
Receives: Drug: QL1706 (Iparomlimab/Tuvonralimab); Drug: Lenvatinib; Procedure: Cryoablation
GBC-01ExperimentalGallbladder cancer (GBC) received QL1706 + lenvatinib
Receives: Drug: QL1706 (Iparomlimab/Tuvonralimab); Drug: Lenvatinib
GBC-02ExperimentalGallbladder cancer (GBC) received QL1706 + lenvatinib+cryoablation
Receives: Drug: QL1706 (Iparomlimab/Tuvonralimab); Drug: Lenvatinib; Procedure: Cryoablation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Objective Response Rate (ORR)

    ORR is defined as the percentage of participants who have a confirmed complete response (CR: disappearance of all target lesions) or partial response (PR: at least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum of diameters). Responses are according to RECIST 1.1 as assessed by investigator.

    Measured: 24 months

Secondary outcomes (7)

  1. Disease control rate (DCR) evaluated by the investigator per Response Evaluation Criteria in Solid Tumors Version 1.1

    DCR is defined as the proportion of patients with complete response (CR), partial response (PR) and stable disease (SD).

    Measured: 24 months

  2. Duration of Response (DOR) evaluated by the investigator per Response Evaluation Criteria in Solid Tumors Version 1.1

    DOR is defined as the time from first documented complete or partial response until disease progression, death from any cause, or censoring at date of last tumor assessment.

    Measured: 24 months

  3. Time to Response (TTR) evaluated by the investigator per Response Evaluation Criteria in Solid Tumors Version 1.1

    TTR is defined as the time from the start of treatment until the first objective observation of a response (either partial response, PR, or complete response, CR), provided that the response is subsequently confirmed.

    Measured: 24 months

  4. Progression Free Survival (PFS) evaluated by the investigator per Response Evaluation Criteria in Solid Tumors Version 1.1

    PFS is defined as the time from study treatment to disease progression or all-cause death as assessed by the investigator (whichever occurs first).

    Measured: 24 months

  5. Overall survival (OS) evaluated by the investigator per Response Evaluation Criteria in Solid Tumors Version 1.1

    OS is defined as the time from study treatment to the date of death of the subject, regardless of the cause of death.

    Measured: 42 months

  6. Number of participants with treatment-related adverse events as assessed by CTCAE v5.0

    An adverse event (AE) is any untoward medical occurrence in a clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention. The percentage of participants who experience at least one AE will be reported.

    Measured: 42 months

  7. Translational study

    Proportion of different immune cell types in tumors based on single-cell RNA sequencing between responders and non-responders.

    Measured: 42 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted21 Sep 2026
  2. Study start20 Sep 2026 (estimated)
  3. Primary completion20 Sep 2028 (estimated)
  4. Study completion20 Sep 2029 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
180 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07829874
Sponsor's protocol ID
CASTLE-ZS-04
Acronym
CASTLE-ZS-04
Status last verified
Sep 2026
First submitted
15 Sep 2026
Last updated
21 Sep 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing QL1706 (Iparomlimab/Tuvonralimab), Lenvatinib and Cryoablation in people with Biliary Tract Cancer (BTC), run by Fudan University at 1 site in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 10 inclusion and 16 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 21 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in China. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Peng Wang (86-21-64041990, peng_wang@fudan.edu.cn), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Objective Response Rate (ORR) (time frame: 24 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07829874.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Sep 2026.

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