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Effectiveness and Safety Study of TACE Plus Oral Sorafenib for Unresectable HCC

This study has been terminated.
(Bayer Healthcare is no supplying the study drug)
Sponsor:
Collaborator:
Bayer
Information provided by (Responsible Party):
University of Pittsburgh
ClinicalTrials.gov Identifier:
NCT00576056
First received: December 14, 2007
Last updated: January 9, 2014
Last verified: January 2014
  Purpose

The purpose of this study is to determine if TACE plus Sorafenib will improve outcome in patients with advanced hepatocellular carcinoma (HCC) not amenable to surgery.


Condition Intervention Phase
Carcinoma, Hepatocellular
Drug: Sorafenib
Drug: Transcatheter Arterial Chemoembolization (TACE)
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase II Trial of Transcatheter Arterial Chemoembolization (TACE) Plus Oral Sorafenib (BAY 43-9006, Nexavar®) for Unresectable Hepatocellular Carcinoma (HCC)

Resource links provided by NLM:


Further study details as provided by University of Pittsburgh:

Primary Outcome Measures:
  • Determine progression-free survival in this patient population treated with the proposed combination treatment modality [ Time Frame: Until disease progression ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Determine the time-to-progression [ Time Frame: Until disease progression ] [ Designated as safety issue: No ]
  • Determine the objective tumor response rate in patients with HCC treated with TACE and oral sorafenib [ Time Frame: Determined by CT scan at the end of each cycle ] [ Designated as safety issue: No ]
  • Determine the adverse event rate and examine the toxicities seen in patients treated with this combination regimen [ Time Frame: 47 weeks ] [ Designated as safety issue: Yes ]
  • Determine the symptomatic and quality-of-life improvements in patients treated with this combination regimen [ Time Frame: Until disease progression ] [ Designated as safety issue: No ]
  • Determine the overall survival in patients treated with this combination regimen [ Time Frame: Until death ] [ Designated as safety issue: No ]
  • Determine the change in circulating serum cytokine levels in patients treated with this combination regimen [ Time Frame: 47 weeks ] [ Designated as safety issue: No ]
  • Determine the profile of serum markers of tumor necrosis, inflammation and angiogenesis in patients before, during, and after treatment in patients treated with this combination regimen [ Time Frame: 47 weeks ] [ Designated as safety issue: No ]

Enrollment: 18
Study Start Date: January 2008
Study Completion Date: April 2010
Primary Completion Date: March 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Tace + Sorafenib Drug: Sorafenib
Oral sorafenib (400 mg BID) will be start the next day after the first TACE treatment and will continue until the patient shows disease progression, until unacceptable toxicity occurs, or until study termination.
Drug: Transcatheter Arterial Chemoembolization (TACE)
TACE will be accomplished with gelatin microspheres (Embospheres) following delivery of 125 mg/m2 of cisplatin

Detailed Description:

The proposed study will make an important contribution to understanding not only the safety and efficacy of sorafenib in addition to TACE in patients diagnosed with unresectable HCC, but this will also be the first clinical trial with sorafenib to assess the effects of this novel therapy on HRQL. Understanding the effects of sorafenib on HRQL is critical in the treatment of HCC secondary to the modest benefits in survival that have been reported with conventional therapies. Our team has one of the largest experiences in evaluating HRQL in patients diagnosed with unresectable hepatocellular carcinoma. We have previously reported on alternative methods of evaluating HRQL, solutions for missing data in clinical trials as well as tested statistical and clinically meaningful differences, within and between treatment groups, in clinical trials with patients diagnosed with hepatobiliary carcinoma.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Adult patients with HCC seen at UPMC will be enrolled in this study if they meet the following eligibility criteria:
  • Adults patients (≥ 18 years of age) with a diagnosis of HCC which is not amenable to surgical resection or local ablative therapy
  • Histological confirmed HCC or clinical/laboratory diagnosis of HCC or nodules larger than 2 cm with typical vascular features or AFP > 200
  • Patient must have quantifiable disease limited to the liver
  • Patients must have at least one tumor lesion that meets both of the following criteria:

    • The lesion can be accurately measured in at least one dimension according to RECIST criteria
    • The lesion has not been previously treated with surgery, radiation therapy, radiofrequency ablation, percutaneous ethanol or acetic acid injection, or cryoablation.
  • ECOG performance status (PS) <2
  • No prior targeted antiangiogenic therapy. Metronomic chemotherapies are allowed. At least 4 weeks since prior systemic chemotherapy
  • At least 4 weeks since prior TACE
  • At least 4 weeks since prior interferon
  • Not pregnant
  • No significant baseline liver dysfunction. Cirrhotic status of Child-Pugh class A only
  • No significant renal impairment (creatinine clearance < 30 mL/minute) or patients on dialysis
  • No current infections requiring antibiotic therapy
  • Not on anticoagulation or suffering from a known bleeding disorder
  • No unstable coronary artery disease or recent MI
  • The following laboratory parameters:

    • Platelet count ≥ 60,000/µL
    • Hemoglobin ≥ 8.5 g/dL
    • Total bilirubin ≤ 1.5 mg/dL
    • ASL and AST ≤ 5 x upper limit of normal
    • Serum creatinine ≤ 1.5 x upper limit of normal
    • INR ≤ 1.5 or a Pt/PTT within normal limits
    • Absolute neutrophil count (ANC) > 1,500/mm3
  • Ability to understand the protocol and to agree to and sign a written informed consent document

Exclusion Criteria:

  • Previous or concurrent cancer that is distinct in primary site or histology from HCC except cervical carcinoma in situ, treated basal-cell carcinoma of the skin, superficial bladder tumors (Ta, Tis & T1), and any cancer curatively treated > 3 years prior to entry is permitted
  • Renal failure requiring hemo- or peritoneal dialysis
  • Child-Pugh B & C hepatic impairment
  • History of cardiac disease: > NY Heart Association (NYHA) class 2 congestive heart failure, active coronary artery disease, cardiac arrhythmias requiring anti-arrhythmic therapy other than beta blockers or digoxin, and uncontrolled hypertension. Myocardial infarction more than 6 months prior to study entry is permitted.
  • Active clinically serious infections (> CTCAEv3 grade 2)
  • Known history of HIV
  • Known central nervous system tumors including metastatic brain disease
  • History of organ allograft
  • Substance abuse (current), psychological, or social conditions that may interfere with the patient's participation in the study or evaluation of the study results.
  • Known or suspected allergy to the investigational agents or any agent given in association with this trial.
  • Patients unable to swallow oral medications.
  • Pregnant or breast-feeding patients. Women of childbearing potential must have a negative pregnancy test performed within seven days prior to the start of the study drug. Both men and women enrolled in this trial must use adequate barrier birth control measures during the course of the trial.
  • Cardiac ventricular arrhythmias requiring anti-arrhythmic therapy
  • Uncontrolled hypertension defined as systolic blood pressure > 150 mmHg or diastolic blood pressure > 90 mmHg, despite optimal medical management
  • Thrombolic or embolic events such as a cerebrovascular accident including transient ischemic attacks within the past 6 months
  • Pulmonary hemorrhage/bleeding event > CTCAE Grade 2 within 4 weeks of first dose of study drug
  • Any other hemorrhage/bleeding event > CTCAE Grade 3 within 4 weeks of first dose of study drug
  • Serious non-healing wound, ulcer, or bone fracture

Excluded therapies and medications, previous and concomitant:

  • Prior use of Raf-kinase inhibitors (RKI), VEGF inhibitors, MEK inhibitors, or farnesyl transferase inhibitors
  • Major surgery within 6 weeks of start of study drug
  • Radiotherapy during study or within 3 weeks prior to start of study drug.
  • Use of biologic response modifiers such as granulocyte colony-stimulating factor (G-CSF) within 3 weeks prior to study entry.
  • Autologous bone marrow transplant or stem cell rescue within four months of study drug initiation
  • Concomitant treatment with rifampin or St. John's wort.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00576056

Locations
United States, Pennsylvania
University of Pittsburgh Cancer Institute
Pittsburgh, Pennsylvania, United States, 15232
Sponsors and Collaborators
University of Pittsburgh
Bayer
Investigators
Principal Investigator: Thomas C Gamblin, MD University of Pittsburgh
  More Information

No publications provided

Responsible Party: University of Pittsburgh
ClinicalTrials.gov Identifier: NCT00576056     History of Changes
Other Study ID Numbers: 07-047
Study First Received: December 14, 2007
Last Updated: January 9, 2014
Health Authority: United States: Institutional Review Board

Keywords provided by University of Pittsburgh:
Hepatocellular
Carcinoma
TACE
Sorafenib
Transcatheter Arterial Chemoembolization
Nexavar
Unresectable

Additional relevant MeSH terms:
Carcinoma
Carcinoma, Hepatocellular
Adenocarcinoma
Digestive System Diseases
Digestive System Neoplasms
Liver Diseases
Liver Neoplasms
Neoplasms
Neoplasms by Histologic Type
Neoplasms by Site
Neoplasms, Glandular and Epithelial
Sorafenib
Antineoplastic Agents
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Protein Kinase Inhibitors
Therapeutic Uses

ClinicalTrials.gov processed this record on November 20, 2014