ctDNA-MRD Guided Escalation of Ivonescimab and Docetaxel in Advanced NSCLC With Long-Term Responses to First-line Immunotherapy (CR1STAL-Adaptive)

This study uses a blood-based cancer detection test (called ctDNA/MRD) to guide treatment decisions for people with advanced non-small cell lung cancer (NSCLC) who have been responding well to first-line immunotherapy for 11–15 months. If residual cancer DNA is detected in the blood, treatment is escalated with additional drugs (ivonescimab and docetaxel); if not, the patient continues current therapy. The goal is to personalize treatment and prevent relapse. **You may be eligible if...** - You are between 18 and 75 years old - You have stage IIIB to IV non-small cell lung cancer (not amenable to local treatment) confirmed by biopsy - You are currently receiving immunotherapy plus platinum-based chemotherapy as first-line treatment - Your disease has not progressed, and your progression-free survival at enrollment is between 11 and 15 months - Your cancer does not have EGFR, ALK, or ROS1 gene changes (for non-squamous cancer) - You are in good overall health (ECOG 0-1) **You may NOT be eligible if...** - Your cancer has progressed on first-line therapy - You have brain metastases that are not stable - You have prior exposure to treatments included in this study Talk to your doctor to see if this trial is right for you.