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Gefitinib in Treating Patients With Advanced Unresectable Hepatocellular Carcinoma (Liver Cancer)

Primary Purpose

Adult Primary Hepatocellular Carcinoma, Advanced Adult Primary Liver Cancer, Localized Unresectable Adult Primary Liver Cancer

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
gefitinib
laboratory biomarker analysis
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Adult Primary Hepatocellular Carcinoma

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Patients must have advanced unresectable hepatocellular carcinoma based on the following criteria: Histologically or cytologically confirmed, OR Alpha-fetoprotein > 400 ng if patient is not hepatitis surface antigen positive, OR Alpha-fetoprotein > 4000 ng if patient is hepatitis surface antigen positive NOTE: If available, tissue should be submitted to assess EGFR/pathway expression Patients must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as >= 20 mm with conventional techniques or as >= 10 mm with spiral CT scan, assessed within 4 weeks prior to randomization/registration Prior use of liver-directed therapy (radio-frequency ablation, cryoablation, percutaneous ethanol injection, chemo-embolization, hepatic artery embolization and hepatic artery infused FUDR) is allowed, provided the patient has either progressive hepatic disease or measurable extrahepatic disease ECOG performance status of 0, 1 or 2 Leukocytes >= 2,000/uL OR Absolute neutrophil count >= 1,000/uL Platelets >= 50,000/uL Patients may not have Child Pugh Scale's class C cirrhosis AST (SGOT) =< 5 x institutional upper limit of normal Total bilirubin =< 2 x institutional upper limit of normal Creatinine within normal institutional limits OR creatinine clearance >= 60 mL/min for patients with creatinine levels above institutional normal PT =< 6 seconds over control INR =< 2.3 Albumin >= 2.8 g/dL Pregnant women are excluded from this study; sexually active women of child bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control) for the duration of their participation in the study; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately Women who are breastfeeding a child are not eligible, unless they discontinue the breastfeeding Patients must not have had prior systemic chemotherapy, biologic therapy or antiangiogenesis therapy; prior therapy with interferon alpha or interferon beta for treatment of hepatitis B or C is allowed provided Prior palliative radiotherapy is permissible provided it has been completed 2 weeks from registration and the patient has measurable disease outside the radiation field Patients may not be receiving any other investigational agents Patients must not have a history of other malignancies that are active and require therapy (other than local therapies for non melanoma skin cancers) Patients must not have known brain metastases; their poor prognosis would present challenges and their tendency to develop progressive neurologic dysfunction would confound the evaluation of neurologic and other adverse events Patients must not have a history of allergic reactions attributed to compounds of similar chemical or biologic composition to ZD1839 Patients must not have had prior treatment with an EGFR inhibitor Patients must not have a history of an uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements Patients must not be HIV-positive and receiving combination anti-retroviral therapy; this therapy might have possible pharmacokinetic interactions with ZD1839; appropriate studies will be undertaken in patients receiving combination anti-retroviral therapy when indicated Patients must not use the following known inducers of CYP3A4: carbamazepine, dexamethasone, ethosuxamide, glucocorticoids, griseofulvin, nafcillin, nelfinavir nevirapine, oxcarbazepine, phenobarbital, phenylbutazone, phenytoin, primidone, progesterone, rifabutin, rifampin, rofecoxib, St John's Wort, sulfadimidine, sulfinpyrazone, troglitazone, efavirenz, modafinil, and rifapentine; drugs that induce CYP3A4 enzymes can cause reductions in ZD1839 plasma concentrations below levels thought to be biologically active Patients must not be candidates for surgical resection or liver transplantation Patients must not have grade 3 or grade 4 encephalopathy

Sites / Locations

  • Eastern Cooperative Oncology Group

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (gefitinib)

Arm Description

Patients receive oral gefitinib daily on days 1-21. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Outcomes

Primary Outcome Measures

Progression-free survival rate in patients treated with ZD 1839
A 4.5-month (PFS) rate of 63% or more will be taken as evidence of activity in this patient population.

Secondary Outcome Measures

Response (CR+PR) measured by RECIST
Grade 3 or higher toxicity
EGFR expression

Full Information

First Posted
November 4, 2003
Last Updated
February 26, 2013
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00071994
Brief Title
Gefitinib in Treating Patients With Advanced Unresectable Hepatocellular Carcinoma (Liver Cancer)
Official Title
A Phase II Study of ZD1839 (Iressa, Gefitinib, NSC 715055) in Advanced Unresectable Hepatocellular Carcinoma
Study Type
Interventional

2. Study Status

Record Verification Date
February 2013
Overall Recruitment Status
Completed
Study Start Date
February 2004 (undefined)
Primary Completion Date
May 2005 (Actual)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
Phase II trial to study the effectiveness of gefitinib in treating patients who have advanced unresectable hepatocellular carcinoma (liver cancer). Gefitinib may stop the growth of tumor cells by blocking the enzymes necessary for their growth
Detailed Description
PRIMARY OBJECTIVES: I. Evaluate the ability of ZD1839 to improve progression free survival in patients with advanced unresectable hepatocellular carcinoma. II. Evaluate response rate of ZD1839 in advanced unresectable hepatocellular carcinoma. III. Evaluate the effect of ZD1839 on measurable disease in patients with unresectable hepatocellular carcinoma. IV. Evaluate the effect of ZD1839 on serum alpha-fetoprotein levels in patients with abnormal pretreatment serum levels. V. Evaluate toxicity of ZD1839 in advanced unresectable hepatocellular carcinoma. VI. Investigate biologic markers for outcome in patients with unresectable hepatocellular carcinoma treated with ZD1839. OUTLINE: This is a multicenter study. Patients receive oral gefitinib daily on days 1-21. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients are followed for 3 years from study entry.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Adult Primary Hepatocellular Carcinoma, Advanced Adult Primary Liver Cancer, Localized Unresectable Adult Primary Liver Cancer, Recurrent Adult Primary Liver Cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
59 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment (gefitinib)
Arm Type
Experimental
Arm Description
Patients receive oral gefitinib daily on days 1-21. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
Intervention Type
Drug
Intervention Name(s)
gefitinib
Other Intervention Name(s)
Iressa, ZD 1839
Intervention Description
Given orally
Intervention Type
Other
Intervention Name(s)
laboratory biomarker analysis
Intervention Description
Correlative studies
Primary Outcome Measure Information:
Title
Progression-free survival rate in patients treated with ZD 1839
Description
A 4.5-month (PFS) rate of 63% or more will be taken as evidence of activity in this patient population.
Time Frame
From the date of entry on the study to the appearance of new metastatic lesions or objective tumor progression, assessed up to 4.5 months
Secondary Outcome Measure Information:
Title
Response (CR+PR) measured by RECIST
Time Frame
Up to 3 years
Title
Grade 3 or higher toxicity
Time Frame
Up to 3 years
Title
EGFR expression
Time Frame
Baseline

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must have advanced unresectable hepatocellular carcinoma based on the following criteria: Histologically or cytologically confirmed, OR Alpha-fetoprotein > 400 ng if patient is not hepatitis surface antigen positive, OR Alpha-fetoprotein > 4000 ng if patient is hepatitis surface antigen positive NOTE: If available, tissue should be submitted to assess EGFR/pathway expression Patients must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as >= 20 mm with conventional techniques or as >= 10 mm with spiral CT scan, assessed within 4 weeks prior to randomization/registration Prior use of liver-directed therapy (radio-frequency ablation, cryoablation, percutaneous ethanol injection, chemo-embolization, hepatic artery embolization and hepatic artery infused FUDR) is allowed, provided the patient has either progressive hepatic disease or measurable extrahepatic disease ECOG performance status of 0, 1 or 2 Leukocytes >= 2,000/uL OR Absolute neutrophil count >= 1,000/uL Platelets >= 50,000/uL Patients may not have Child Pugh Scale's class C cirrhosis AST (SGOT) =< 5 x institutional upper limit of normal Total bilirubin =< 2 x institutional upper limit of normal Creatinine within normal institutional limits OR creatinine clearance >= 60 mL/min for patients with creatinine levels above institutional normal PT =< 6 seconds over control INR =< 2.3 Albumin >= 2.8 g/dL Pregnant women are excluded from this study; sexually active women of child bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control) for the duration of their participation in the study; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately Women who are breastfeeding a child are not eligible, unless they discontinue the breastfeeding Patients must not have had prior systemic chemotherapy, biologic therapy or antiangiogenesis therapy; prior therapy with interferon alpha or interferon beta for treatment of hepatitis B or C is allowed provided Prior palliative radiotherapy is permissible provided it has been completed 2 weeks from registration and the patient has measurable disease outside the radiation field Patients may not be receiving any other investigational agents Patients must not have a history of other malignancies that are active and require therapy (other than local therapies for non melanoma skin cancers) Patients must not have known brain metastases; their poor prognosis would present challenges and their tendency to develop progressive neurologic dysfunction would confound the evaluation of neurologic and other adverse events Patients must not have a history of allergic reactions attributed to compounds of similar chemical or biologic composition to ZD1839 Patients must not have had prior treatment with an EGFR inhibitor Patients must not have a history of an uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements Patients must not be HIV-positive and receiving combination anti-retroviral therapy; this therapy might have possible pharmacokinetic interactions with ZD1839; appropriate studies will be undertaken in patients receiving combination anti-retroviral therapy when indicated Patients must not use the following known inducers of CYP3A4: carbamazepine, dexamethasone, ethosuxamide, glucocorticoids, griseofulvin, nafcillin, nelfinavir nevirapine, oxcarbazepine, phenobarbital, phenylbutazone, phenytoin, primidone, progesterone, rifabutin, rifampin, rofecoxib, St John's Wort, sulfadimidine, sulfinpyrazone, troglitazone, efavirenz, modafinil, and rifapentine; drugs that induce CYP3A4 enzymes can cause reductions in ZD1839 plasma concentrations below levels thought to be biologically active Patients must not be candidates for surgical resection or liver transplantation Patients must not have grade 3 or grade 4 encephalopathy
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Bruce Giantonio
Organizational Affiliation
Eastern Cooperative Oncology Group
Official's Role
Principal Investigator
Facility Information:
Facility Name
Eastern Cooperative Oncology Group
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States

12. IPD Sharing Statement

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Gefitinib in Treating Patients With Advanced Unresectable Hepatocellular Carcinoma (Liver Cancer)

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