A Study to Evaluate the Safety, Tolerability and Efficacy of Cabozantinib in Patients With Hepatocellular Carcinoma and Impaired Liver Function

Studien-Informationen Einschlusskriterien Studien-Rationale Geprüfte Regime

Rekrutierend

NCT-Nummer:
NCT04454762

Studienbeginn:
Juli 2020

Letztes Update:
05.10.2020

Wirkstoff:
Cabozantinib

Indikation (Clinical Trials):
Carcinoma, Carcinoma, Hepatocellular

Geschlecht:
Alle

Altersgruppe:
Erwachsene (18+)

Phase:
Phase 2

Sponsor:
Johannes Gutenberg University Mainz

Collaborator:
Interdisciplinary Center Clinical Trials (IZKS), University Medical Center Mainz

Studienleiter

Marcus-Alexander Wörns, Prof. MD
Principal Investigator
University Medical Center Mainz

Kontakt

Marcus-Alexander Wörns, Prof. MD
Kontakt:
Phone: +49 6131 177389
E-Mail: marcus-alexander.woerns@unimedizin-mainz.de» Kontaktdaten anzeigen

Studienlocations
(1 von 1)

Department of Internal Medicine I, Johannes Gutenberg University Mainz
55131 Mainz
(Rheinland-Pfalz)
GermanyRekrutierend» Google-Maps
Ansprechpartner:
Marcus-Alexander Wörns, Prof. MD
Phone: +49 6131 177389
E-Mail: marcus-alexander.woerns@unimedizin-mainz.de» Ansprechpartner anzeigen

Studien-Informationen

Brief Summary:

This is an prospective, interventional, non-randomized multicenter phase II study to evaluate

the safety, tolerability and efficacy of Cabozantinib as a second-line therapy (after one

prior systemic therapy) in patients with intermediate to advanced HCC (BCLC B/C) and

concomitant impaired liver function CP score B7-8. Subjects who meet all study eligibility

criteria will receive Cabozantinib 40 mg daily orally. Subjects will receive Cabozantinib as

long as they continue to experience clinical benefit in the opinion of the Investigator or

until there is unacceptable toxicity or the need for subsequent systemic anti-cancer

treatment or liver directed local anti-cancer therapy. Treatment may continue in this fashion

after radiographic progression as long as the Investigator believes that the subject is still

receiving clinical benefit from Cabozantinib and that the potential benefit of continuing

Cabozantinib outweighs potential risk. In addition, all subjects will be treated with best

supportive care. This excludes systemic anti-cancer therapy and liver-directed local

anti-cancer therapy.

Ein-/Ausschlusskriterien

Main inclusion criteria:

1. Written informed consent

2. Age ≥ 18

3. Histological/cytological or non-invasive (according to EASL/AASLD guidelines)

diagnosis of HCC

4. Availability of a recent (up to 28 days old) CT/MRI images of thorax and abdomen

5. Subject's HCC is not amenable to a curative treatment approach (e.g., transplant,

surgery, radiofrequency ablation) corresponding to BCLC classification B/C

6. Progression or toxicities following one prior systemic therapy for HCC

7. Recovery to ≤ grade 1 from toxicities related to any prior treatments, unless the

adverse events are clinically non-significant and/or stable on supportive therapy

8. Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2

9. Adequate hematologic function, based upon meeting the following laboratory criteria

within 7 days before enrollment: absolute neutrophil count (ANC) ≥ 1200/mm3 (≥ 1.2 x

109/L); platelets ≥ 60,000/mm3 (≥ 60 x 109/L); hemoglobin ≥ 8 g/dL (≥ 80 g/L)

10. Adequate renal function, based upon meeting the following laboratory criteria within 7

days before enrollment: serum creatinine ≤ 1.5 × upper limit of normal or calculated

creatinine clearance ≥ 40 mL/min (using the Cockcroft-Gault equation)

11. Liver function Child-Pugh (CP) score B7-8

12. ALBI (albumin-bilirubin) grade 1-2

13. Alanine aminotransferase (ALT) and aspartate amino-transferase (AST) < 7.0 × upper

limit of normal (ULN) within 7 days before enrollment

14. Antiviral therapy per local standard of care if active hepatitis B (HBV) infection

15. Capability to understand and comply with the protocol requirements (e.g. sufficient

knowledge of German language to answer the questionnaires, ability to swallow intact

tablets).

Main exclusion criteria:

1. Fibrolamellar carcinoma or mixed hepatocellular cholangiocarcinoma

2. Receipt of more than 1 prior systemic therapy for advanced HCC. Additional prior

systemic therapies used as adjuvant therapy are allowed.

3. Any type of anti-cancer agent (including investigational) within 2 weeks before

enrollment

4. Radiation therapy within 4 weeks (2 weeks for radiation for bone metastases) or

radionuclide treatment (e.g., I-131 or Y-90) within 6 weeks of enrollment. Subject

cannot be enrolled if there are any clinically relevant ongoing complications from

prior radiation therapy.

5. Prior Cabozantinib treatment

6. Known brain metastases or cranial epidural disease unless adequately treated with

radiotherapy and/or surgery (including radiosurgery) and stable for at least 3 months

before enrollment. Eligible subjects must be without corticosteroid treatment at the

time of enrollment.

7. Concomitant anticoagulation, at therapeutic doses, with anticoagulants such as

warfarin or warfarin-related agents, low molecular weight heparin (LMWH), thrombin or

activated coagulation factor X (FXa) inhibitors, or antiplatelet agents (e.g.,

clopidogrel). Low-dose aspirin for cardioprotection (per local applicable guidelines),

low-dose warfarin (≤ 1 mg/day), and low-dose LMWH are permitted.

8. The subject has uncontrolled, significant intercurrent or recent illness including,

but not limited to, the following conditions:

- Cardiovascular disorders including: Symptomatic congestive heart failure,

instable angina pectoris, or serious cardiac arrhythmias, uncontrolled

hypertension defined as sustained BP > 150 mm Hg systolic, or > 100 mm Hg

diastolic despite optimal antihypertensive treatment, stroke (including TIA),

myocardial infarction, or other ischemic event within 6 months before enrollment,

thromboembolic event within 3 months before enrollment. Subjects with thromboses

of portal/hepatic vasculature attributed to underlying liver disease and/or liver

tumor are eligible

- Gastrointestinal (GI) disorders including those associated with a high risk of

perforation or fistula formation: tumors invading the GI tract, active peptic

ulcer disease, inflammatory bowel disease, diverticulitis, cholecystitis,

symptomatic cholangitis or appendicitis, acute pancreatitis or acute obstruction

of the pancreatic duct or common bile duct, or gastric outlet obstruction;

abdominal fistula, GI perforation, bowel obstruction, intra-abdominal abscess

within 6 months before enrollment, Note: Complete healing of an intra-abdominal

abscess must be confirmed prior to enrollment

- Major surgery within 2 months before enrollment. Complete healing from major

surgery must have occurred 1 month before enrollment. Complete healing from minor

surgery (e.g., simple excision, tooth extraction) must have occurred at least 7

days before enrollment. Subjects with clinically relevant complications from

prior surgery are not eligible

- Cavitating pulmonary lesion(s) or endobronchial disease

- Lesion invading a major blood vessel (e.g., pulmonary artery or aorta)

- Clinically significant bleeding risk within 3 months of enrollment including the

following: hematuria, hematemesis, hemoptysis of > 0.5 teaspoon (> 2.5 mL) of red

blood, or other signs indicative of pulmonary hemorrhage, or history of other

significant bleeding if not due to reversible external factors

- Other clinically significant disorders such as: Active infection requiring

systemic treatment, known infection with human immunodeficiency virus (HIV) or

known acquired immunodeficiency syndrome (AIDS)-related illness; serious

non-healing wound/ulcer/bone fracture; malabsorption syndrome;

uncompensated/symptomatic hypothyroidism; requirement for hemodialysis or

peritoneal dialysis; history of solid organ transplantation

9. Subjects with untreated or incompletely treated varices with bleeding or high risk for

bleeding are excluded with the following clarification: subjects with history of prior

variceal bleeding must have been treated with adequate endoscopic therapy without any

evidence of recurrent bleeding for at least 6 months prior to study entry and must be

stable on optimal medical management (e.g. non-selective beta blocker, proton pump

inhibitor) at study entry.

10. Women who are pregnant, nursing, or who plan to become pregnant while in the trial.

11. Women of child-bearing potential (WOCBP) and men who are able to father a child,

unwilling to be abstinent or use highly effective methods of birth control that result

in a low failure rate of less than 1% per year when used consistently and correctly

beginning at informed consent, for the duration of study participation and for at

least 4 months after last dose of the study drug. Because oral contraceptives might

possibly not be considered as "effective methods of contraception" during the

treatment with Cabozantinib, they should be used together with another method, such as

a barrier method.

12. Currently receiving any other investigational agent or received an investigational

agent within 30 days (or within 5 times the half-life of this agent or its relevant

metabolites, the longer period will apply) before the first dose of Cabozantinib.

13. Hepatic encephalopathy Grad I-IV according to CP classification (≥ 2 points) and West

Haven Criteria

14. Moderate or severe ascites according to CP classification (≥ 3 points)

15. Corrected QT interval calculated by the Fridericia formula (QTcF) > 500 ms within 7

days before enrollment.

Studien-Rationale

Primary outcome:

1. Incidence of Adverse Events (AEs) [Safety and Tolerability] (Time Frame - Through study completion, up to approximately 2 years):
An AE is any untoward medical occurrence in a participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. The number of participants who experience an AE will be presented.

2. Number of Participants Who Discontinue Study Treatment Due to Adverse Events (AEs) [Safety and Tolerability] (Time Frame - Through study completion, up to approximately 2 years):
The number of participants who discontinue study treatment due to an AE will be presented.

3. ALBI [Safety and Tolerability] (Time Frame - Through study completion, up to approximately 2 years):
Assessment of the Albumin-Bilirubin (ALBI) Grade. Grade range 1-3, with 3 indicating greatest severity

4. ECOG [Safety and Tolerability] (Time Frame - Through study completion, up to approximately 2 years):
Eastern Cooperative Oncology Group (ECOG) performance status. Score range 0 (normal activity) to 5 (dead).

5. Child-Pugh [Safety and Tolerability] (Time Frame - Through study completion, up to approximately 2 years):
Used to assess the prognosis of chronic liver disease. Classification of severity of liver disease according to the degree of ascites, total bilirubin and albumin, prothrombin time, and degree of encephalopathy. Each measure is scored 1-3, with 3 indicating greatest severity

6. Blood pressure [Safety and Tolerability] (Time Frame - Through study completion, up to approximately 2 years.):
mmHg

Secondary outcome:

1. Overall survival (OS) (Time Frame - Through study completion, up to approximately 2 years):
The time between first application of trial medication to date of death due to any cause.

2. Progression-free survival (PFS) (Time Frame - Through study completion, up to approximately 2 years):
PFS is defined as the time from first intake of trial medication to the date of the first documentation of progressive disease (PD) or death from any cause, whichever occurs first. Per RECIST 1.1, PD is defined as ≥20% increase in the sum of diameters of target lesions. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of ≥5 mm.

3. Objective response rate (ORR) (Time Frame - Through study completion, up to approximately 2 years):
The response rate is defined as the percentage of subjects with a confirmed reduction in tumor size compared to baseline as well as fulfilling the criteria for complete or partial response according to RECIST 1.1.

4. Pharmacokinetics (PK) of Cabozantinib administration. (Time Frame - 6 weeks):
The plasma concentration of Cabozantinib and possible relevant metabolites will be measured in PK samples.

5. Health-related quality of life (HRQOL) (Time Frame - Through study completion, up to approximately 2 years):
Assessed by the validated German version of the Chronic Liver Disease Questionnaire (CLDQ-D). The questionnaire contains 29 items which can be grouped into the liver-disease specific domains like activity, fatigue, worries, abdominal symptoms, and systemic symptoms. Each category can be judged separately between the groups. The results of the CLDQ-D score are presented on a 7-point Likert scale. Higher results indicate better quality of life.

Geprüfte Regime

Cabozantinib (Cabometyx):
oral administration (40 mg daily, reduced dose 20 mg daily)

Quelle: ClinicalTrials.gov

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