Sorafenib Tosylate With or Without Everolimus in Treating Patients With Localized, Unresectable, or Metastatic Liver Cancer

This is an interventional treatment trial for Liver Cancer focused on measuring adult primary hepatocellular carcinoma, localized unresectable adult primary liver cancer Read More

DISEASE CHARACTERISTICS:

• Histologically, cytologically, or radiologically confirmed hepatocellular carcinoma (HCC)

  • Localized, unresectable, or metastatic disease
  • Child-Pugh class A or mildly decompensated Child-Pugh class B liver dysfunction (Child-Pugh score ≤ 7)
  • Stage B or C disease according to the Barcelona Clinic Liver Cancer (BCLC) staging classification

• Measurable disease

  • At least 1 unidimensionally measurable site of disease (≥ 10 mm in case of a non-nodal lesion or with a short axis ≥ 15 mm in case of a lymph node) by spiral/multi-slice CT/MRI scan according to revised RECIST criteria
• No locally advanced disease AND a candidate for radical surgery
• No known fibrolamellar HCC or mixed cholangiocarcinoma/HCC
• No clinical symptoms or history of CNS metastases or leptomeningeal disease (no imaging required)

PATIENT CHARACTERISTICS:

• WHO performance status 0-1
• Hemoglobin ≥ 90 g/L
• Neutrophil count ≥ 1.5 x 10^9/L
• Platelet count ≥ 75 x 10^9/L
• Creatinine clearance ≥ 40 mL/min
• ALT ≤ 5 times upper limit of normal
• INR ≤ 2
• Urine dipstick for proteinuria ≤ 1+ OR protein spot urine < 0.6 g/L
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception during and for 12 months after completion of study therapy
• No prior malignancy within the past 5 years except adequately treated carcinoma in situ of the cervix or localized nonmelanoma skin cancer
• No history of hemorrhagic or thrombotic cerebrovascular event within the past 12 months
• No documented variceal hemorrhage within the past 3 months
• No requirement for anticoagulant therapy except for low-dose anticoagulants for maintenance of patency of central venous access or prevention of deep vein thrombosis
• No history or presence of clinically significant acute or unstable cardiovascular, cerebrovascular, renal, gastrointestinal, pulmonary, endocrine, central nervous system, or immunological disorders (except for the presence of hepatitis B or C virus or cirrhosis) within the past 6 months
• No encephalopathy
• No known HIV infection
• No active infection requiring IV antibiotics
• No arterial hypertension ≥ 150/100 mm Hg despite therapy
• No ongoing cardiac dysrhythmias of NCI CTCAE grade ≥ 2, atrial fibrillation of any grade, prolongation of QTc > 500 msec on screening electrocardiogram (ECG), or history of familial long QT syndrome
• No repeated paracentesis (more than 1 per month)
• No psychiatric disorder precluding understanding of information of trial-related topics, giving informed consent, or interfering with compliance for oral drug intake
• No concurrent grapefruit, grapefruit juice, or products containing bitter oranges
• Able to take oral medications
• Completed baseline quality of life questionnaire
• Must be compliant and geographically proximal for follow-up

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics

• No prior systemic anticancer treatment for this disease

  • The following prior therapies are allowed provided previously treated lesions remain separate from those to be measured in the current trial and prior treatment is completed within the past 4 weeks

    • Surgery
    • Liver-directed therapy (e.g., transarterial embolization/chemoembolization [limited to 5 treatments], radiofrequency ablation, cryoablation, radiotherapy, or percutaneous ethanol injection)
• No prior organ transplantation
• No concurrent estrogen-containing supplementary therapy
• No concurrent full-dose anticoagulation with coumarin derivatives
• No concurrent elective major surgery
• No concurrent radiotherapy (concurrent analgesic radiotherapy of non-target lesions allowed)

• No concurrent or anticipated need for CYP3A4 inhibitors or inducers, unless the drugs are medically necessary and no substitutes are available, including any of the following:

  • Ketoconazole
  • Itraconazole
  • Voriconazole
  • Erythromycin
  • Clarithromycin
  • Diltiazem
  • Verapamil
  • Protease inhibitors

• No concurrent strong CYP3A4 inducers*, including any of the following:

  • Carbamazepine
  • Continuous dexamethasone (> 2 mg/day for > 7 days)
  • Phenobarbital
  • Phenytoin
  • Rifampicin
  • St. John's wort NOTE: *Concurrent antacids allowed provided they are administered > 1 hour before or > 1 hour after trial drug administration.
• No other concurrent experimental drugs or anticancer therapy or treatment in another clinical trial within the past 30 days
• No other concurrent investigational drugs
• No chronic systemic steroids or other immunosuppressive agents
• No concurrent angiotension converting enzyme inhibitors (ACE-I)