Dose Escalation Study of Cabozantinib for Advanced HCC Patients With Compensated Liver Cirrhosis

  • STATUS
    Recruiting
  • End date
    Sep 25, 2023
  • participants needed
    40
  • sponsor
    Institut für Klinische Krebsforschung IKF GmbH at Krankenhaus Nordwest
Updated on 25 February 2021
Investigator
Prof. Dr. Jörg Trojan, MD
Primary Contact
BAG / Onkologische Gemeinschaftspraxis (7.4 mi away) Contact
+6 other location

Summary

Open-label, single arm, multicenter phase II trial assessing the tolerability of a reduced starting dose of 40 mg cabozantinib for 4 weeks and subsequent dose escalation to 60 mg cabozantinib until disease progression or intolerable toxicities.

Description

The primary objective is to assess the tolerability of a reduced starting dose of 40 mg cabozantinib once-daily for 4 weeks and subsequent dose escalation to 60 mg cabozantinib once-daily to be maintained until disease progression or intolerable toxicities. Using the same study treatment discontinuation criteria as in the pivotal CELESTIAL trial will allow for comparison of treatment discontinuation rates due to treatment related adverse events (TRAEs) defined as unresolved intolerable Grade 2 TRAEs or any unresolved Grade 3 TRAEs (see Section 6).

Patients eligible for this trial are cirrhotic HCC patients treated with sorafenib or lenvatinib in first line.

Secondary objectives comprise the assessment of overall survival (OS), progression free survival (PFS) at 10 weeks, objective response rate (ORR), time on treatment, treatment exposure (dose intensity/dose reductions), toxicity, and quality of life (QLQ-C30).

In addition, tissue samples (optional) will be analyzed for molecular parameters and immune cell composition to identify biomarkers potentially associated with clinical efficacy (OS, PFS and ORR).

This is an open label, single-arm, multicenter phase II trial. 40 patients suffering from advanced stage hepatocellular carcinoma (HCC) with compensated liver cirrhosis in second line treatment, after first line treatment with sorafenib or lenvatinib, will be enrolled in this trial.

Patients will be recruited from up to 10 sites and patients withdrawn from the trial will not be replaced.

Details
Condition Adenocarcinoma, HEPATIC NEOPLASM, HEPATOCELLULAR CARCINOMA, Compensated Liver Cirrhosis, Liver Cancer, Malignant Adenoma, second-line therapy, second line therapy, liver cell carcinoma
Treatment Cabozantinib Oral Tablet
Clinical Study IdentifierNCT04522908
SponsorInstitut für Klinische Krebsforschung IKF GmbH at Krankenhaus Nordwest
Last Modified on25 February 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Fully-informed written consent
Males and females 18 years of age
There are no data that indicate special gender distribution. Therefore, patients will be enrolled in the study gender-independently
Patients with HCC who have been previously treated with sorafenib or lenvatinib in first line
Locally advanced or metastatic and/or unresectable HCC with diagnosis confirmed by histology/cytology or clinically by guideline criteria in cirrhotic patients
Disease that is not amenable to curative surgical and/or locoregional therapies, or progressive disease after surgical and/or locoregional therapies
ECOG performance status 2
Resolution of any acute, clinically significant treatment-related toxicity from prior therapy to Grade 1 prior to study entry, with the exception of alopecia
Women of childbearing potential must have a negative serum pregnancy test result within 14 days prior to initiation of study treatment
For women of childbearing potential (WOCBP): agreement to remain abstinent (refrain from heterosexual intercourse) or use highly effective contraceptive methods from the time of signing the informed consent through at least 4 months after the last dose of study drug, or agree to completely abstain from heterosexual intercourse. Male patients, even if surgically sterilized (i.e. status post-vasectomy) must agree to practice effective barrier contraception (e.g. condom) and to refrain from sperm donation during the entire study treatment period and through at least 4 months after the last dose of study drug or agree to completely abstain from heterosexual intercourse

Exclusion Criteria

Pregnancy or breastfeeding, or intention of becoming pregnant during study treatment or within at least 4 months
Significant portal hypertension (moderate or severe ascites). Significant hypertension, defined as blood pressure 140 mmHg (systolic) or 90 mmHg (diastolic) in repeated measurements
Known fibrolamellar HCC, sarcomatoid HCC, or mixed cholangiocarcinoma and HCC
Liver cirrhosis Child-Pugh B or C
Severely impaired kidney function
Elevations of AST/ALT > 5 x ULN at baseline
History of encephalopathy in past 12 months
Significant cardiovascular disease (such as NYHA Class II or greater cardiac disease, myocardial infarction, or cerebrovascular accident) within 3 months prior to initiation of study treatment, unstable arrhythmia, or unstable angina
Baseline QTcF > 500 ms
Major surgical procedure, other than for diagnosis, within 4 weeks prior to initiation of study treatment, or anticipation of need for a major surgical procedure during the study
Severe infection within 4 weeks prior to initiation of study treatment, including, but not limited to, hospitalization for complications of infection, bacteremia, or severe pneumonia
Any other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding that contraindicates the use of an investigational drug, may affect the interpretation of the results, or may render the patient at high risk from treatment complications
Treatment with investigational systemic therapy within 28 days or five times the elimination half-life of the investigational product, whichever is longer, prior to initiation of study treatment
Prior cabozantinib use
Known or suspected hypersensitivity to cabozantinib or any other excipients of the IMP
Rare hereditary galactose intolerance, total lactase deficiency or glucose-galactose malabsorption
Is currently participating in or has participated in a study of an investigational agent or has used an investigational device within 4 weeks prior to the first dose of study treatment
Patient who has been incarcerated or involuntarily institutionalized by court order or by the authorities 40 Abs. 1 S. 3 Nr. 4 AMG
Patients who are unable to consent because they do not understand the nature, significance and implications of the clinical trial and therefore cannot form a rational intention in the light of the facts [ 40 Abs. 1 S. 3 Nr. 3a AMG]
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