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Sorafenib Plus Toripalimab for Unresectable HCC With Portal Vein Tumor Thrombus (STUHCCPVTT)

Primary Purpose

Unresectable Hepatocellular Cancer, Portal Vein Tumor Thrombus

Status
Unknown status
Phase
Phase 1
Locations
Study Type
Interventional
Intervention
sorafenib; toripalimab
Sponsored by
Sichuan University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Unresectable Hepatocellular Cancer focused on measuring Sorafenib, Toripalimab, Unresectable, Hepatocellular Cancer, Portal Vein Tumor Thrombus

Eligibility Criteria

18 Years - 74 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Histologic or cytologic diagnosis of unresectable hepatocellular carcinoma, or confirmed clinically in accordance with Chinese Association for the Study of Liver Diseases criteria (v2017)
  2. Radiographically measurable disease by RECIST version 1.1 in at least one site
  3. Radiographic evidence of portal vein cancer thrombus
  4. Survival expectation ≥3 months
  5. Eastern Cooperative Oncology Group: 0 or 1
  6. Child-Pugh score A or B: score ≤7
  7. Not previously treated with any systemic anti-cancer treatment (i.e. chemotherapy, target drugs, immune checkpoint inhibitors); Subjects who have received local hepatic therapy such as surgery, ablation, radiotherapy or transcatheter arterial chemoembolization, progression of target lesions after local treatment is required to increase by 25%, or target lesions are untreated, and the end of local treatment is more than 4 weeks.
  8. All eligible patients have adequate organ function (ANC ≥1.5× 10⁹ / L, PLT ≥75 × 10⁹ /L, HGB≥90 g/L (no blood transfusion or EPO tolerance within 7 days), Cr≤1.5 times the ULN, TBN ≤1.5 times ULN, ALT and AST ≤3 times ULN, albumin ≥30g/L (albumin or branched chain amino acids supplementation is not allowed within 14 days), INR≤1.5 times the ULN, Urine protein≤1+).
  9. Signed and dated written informed consent

Exclusion Criteria:

  1. History of severe allergic reactions to chimeric, human or humanized antibodies, or fusion proteins. Hypersensitive to any component of the CHO cell-derived preparation or JS001 preparation
  2. Pregnant or lactating women, men and women of childbearing age who are unwilling or unable to take effective contraceptive measures
  3. History of other malignancy within the past 5 years
  4. Medium or more pleural and ascites with clinical symptoms
  5. Active hemorrhage or abnormal coagulation function (PT>16s, APTT>43s, INR>1.5 x ULN), or having a tendency to bleed or undergoing thrombolysis, anticoagulation or anti-platelet therapy
  6. Central nervous system metastases
  7. Hepatic encephalopathy
  8. History of gastrointestinal bleeding or having a tendency to bleed within 6 months before enrollment, e.g. local active ulcer lesions; fecal occult blood (+ +) or above should not be included; if continuous fecal occult blood (+), gastroscopy should be performed.
  9. Gastric or esophageal varices requiring treatment
  10. Untreated active hepatitis B (i.e. subjects with hepatitis B undergoing antiviral therapy and HBV Load < 100IU/mL before the first administration of Toripalimab , is allowed to be enrolled; for subjects with anti-HBc (+), HBsAg (-), anti-HBs (-) and HBV viral load (-) , prophylactic anti-HBV therapy is not required, but virus activation should be closely monitored)
  11. HCV and the anti-HCV treatment ended within 4 weeks of the first administration. Notably, subjects with untreated chronic HCV infection or untreated HCV are allowed.
  12. History of drug abuse or mental disorders
  13. History of organ or marrow transplants, or active autoimmune diseases requiring systemic treatment occurred within 2 years of the first administration
  14. Immunodeficiency disorders or HIV
  15. Pulmonary fibrosis, interstitial pneumonia, pneumoconiosis, radiation pneumonia, drug-related pneumonia and severe impairment of pulmonary function
  16. Using immunosuppressive agents or systemic or absorbable local corticosteroids for immunosuppressive purposes (prednisone or its equivalent at dose> 10 mg/day) , and the above are used within 2 weeks before admission.
  17. Major liver or other operations were performed within 4 weeks of the first administration, or minor operations were performed within 1 week before the first administration (simple excision, tooth extraction, etc.)
  18. Receiving vaccine within 30 days of the first administration
  19. Abdominal fistula, gastrointestinal perforation or abdominal abscess within 4 weeks of the first administration
  20. Receiving other experimental drugs or medical devices within 4 weeks of the first administration
  21. Any significant clinical and laboratory abnormalities that in the opinion of the investigator would affect safety assessment
  22. Failure to satisfy the investigator of fitness to participate for any other reason.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    sorafenib plus toripalimab

    Arm Description

    Stage I:Subjects (n=3) in cohort A received oral sorafenib (400 mg qd), in combination with intravenous toripalimab (240 mg d1, q3w). Subjects (n=3) in cohort B received oral sorafenib (400 mg bid) and the administration of toripalimab is consistent with cohort A. If dose-limiting toxicity (DLT) does not occur within 42 days of the first administration, the dose is escalated. Stage II: According to the expansion dose based on stage I, subjects are enlarged to 39.

    Outcomes

    Primary Outcome Measures

    6-month Progression Free Survival rate
    Proportion of patients with Progression Free Survival in 6-month
    Incidence of Treatment-Emergent Adverse Event
    Any adverse events related with treatment with Sorafenib Plus Toripalimab

    Secondary Outcome Measures

    Objective Response Rate
    Proportion of patients whose tumor volume has reached a predetermined value and can maintain a minimum time limit, including complete response and partial response patients
    Disease Control Rate
    Proportion of patients with stable disease, complete response and partial response
    Progression Free Survival
    A duration from the date of initial treatment with Sorafenib Plus Toripalimab to disease progression (defined by RECIST 1.1) or death of any cause.
    Overall Survival
    Duration from the date of initial treatment with Sorafenib Plus Toripalimab to the date of death due to any cause.
    Duration of response
    time from first documented complete or partial response to radiologically confirmed disease progression or death from any cause.

    Full Information

    First Posted
    August 24, 2019
    Last Updated
    October 23, 2019
    Sponsor
    Sichuan University
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    1. Study Identification

    Unique Protocol Identification Number
    NCT04069949
    Brief Title
    Sorafenib Plus Toripalimab for Unresectable HCC With Portal Vein Tumor Thrombus
    Acronym
    STUHCCPVTT
    Official Title
    An Exploratory Study of Sorafenib Plus Toripalimab for Unresectable Hepatocellular Carcinoma With Portal Vein Tumor Thrombus
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    October 2019
    Overall Recruitment Status
    Unknown status
    Study Start Date
    December 1, 2019 (Anticipated)
    Primary Completion Date
    October 1, 2020 (Anticipated)
    Study Completion Date
    October 1, 2021 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Sichuan University

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No
    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    This study aims to evaluate the efficacy and safety of sorafenib plus toripalimab for unresectable hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT).
    Detailed Description
    Investigators aimed to conduct an exploratory study- an open-label, single-arm and multi-center -to evaluate the efficacy and safety of sorafenib plus toripalimab for unresectable hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). The primary objectives are 6-month progression free survival (PFS) rate and safety. Secondary objectives include objective response rate (ORR), disease control rate (DCR), progression free survival (PFS), overall survival (OS) and duration of response. The study is divided into dose escalation stage and expansion stage. Stage I (escalation stage) was designed to identify the dose-limiting toxicity (DLT) of the combination therapy. Subjects enrolled were divided into two cohorts. Subjects (n=3) in cohort A received oral sorafenib at doses of 400 mg once daily, in combination with intravenous toripalimab 240 mg on the first day, every 3 weeks. Subjects (n=3) in cohort B received oral sorafenib at doses of 400 mg twice daily, in combination with intravenous toripalimab 240 mg on the first day, every 3 weeks. If DLT does not occur within 42 days of the first administration, the dose is escalated. If one subject experienced DLTs, additional 3 subjects are enrolled at that level. Unless no DLT occurs, the next dose level test is continued. Once ≥2 subjects in cohort A experienced DLT, the study is suspended in advance. If ≥2 subjects in cohort B experienced DLT, the dose of cohort A is recommended in expansion stage. If DLT does not occur in cohort B or only 1 of 6 subjects suffered DLT, the dose of cohort B is recommended in expansion stage. For subjects who experienced DLT, if adverse events (AEs) return to normal or common terminology criteria for adverse events (CTCAE) level 1 within 2 weeks and researchers believe continuing treatment is beneficial to the subjects, they can continue treatment after dose adjustment. Otherwise, termination of treatment is suggested. According to CTCAE version 4.0, DLT was defined as any grade ≥3 treatment-related toxicity occurring within the first 42 days of administration. Six to twelve patients will be included in this stage. Stage II (Expansion stage): According to the expansion dose based on stage I, subjects are enlarged to 39. Subjects enrolled are treated with oral sorafenib in combination with toripalimab (every 3 weeks) until suffering progressive disease (PD) or un-tolerated toxicities. Previous literature indicated 6-month PFS rate for HCC with PVTT treated with sorafenib is about 20%. Investigators hypothesize sorafenib plus toripalimab could improve 6-month PFS rate to 40%. Software (PASS) is used to calculate the sample size (β=0.2,α=0.05). According to the results, 35 subjects should be enrolled. When 10% missing rate is considered, total subjects is 39.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Unresectable Hepatocellular Cancer, Portal Vein Tumor Thrombus
    Keywords
    Sorafenib, Toripalimab, Unresectable, Hepatocellular Cancer, Portal Vein Tumor Thrombus

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 1, Phase 2
    Interventional Study Model
    Single Group Assignment
    Model Description
    one-arm study
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    39 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    sorafenib plus toripalimab
    Arm Type
    Experimental
    Arm Description
    Stage I:Subjects (n=3) in cohort A received oral sorafenib (400 mg qd), in combination with intravenous toripalimab (240 mg d1, q3w). Subjects (n=3) in cohort B received oral sorafenib (400 mg bid) and the administration of toripalimab is consistent with cohort A. If dose-limiting toxicity (DLT) does not occur within 42 days of the first administration, the dose is escalated. Stage II: According to the expansion dose based on stage I, subjects are enlarged to 39.
    Intervention Type
    Drug
    Intervention Name(s)
    sorafenib; toripalimab
    Intervention Description
    Stage I: cohort A: sorafenib 400 mg qd+ toripalimab 240 mg d1; q3w cohort B: sorafenib 400 mg bid, toripalimab 240 mg d1; q3w Stage II: According to the expansion dose based on stage I, subjects are enlarged to 39.
    Primary Outcome Measure Information:
    Title
    6-month Progression Free Survival rate
    Description
    Proportion of patients with Progression Free Survival in 6-month
    Time Frame
    up to 6 months
    Title
    Incidence of Treatment-Emergent Adverse Event
    Description
    Any adverse events related with treatment with Sorafenib Plus Toripalimab
    Time Frame
    up to 6 months
    Secondary Outcome Measure Information:
    Title
    Objective Response Rate
    Description
    Proportion of patients whose tumor volume has reached a predetermined value and can maintain a minimum time limit, including complete response and partial response patients
    Time Frame
    up to 6 months
    Title
    Disease Control Rate
    Description
    Proportion of patients with stable disease, complete response and partial response
    Time Frame
    up to 6 months
    Title
    Progression Free Survival
    Description
    A duration from the date of initial treatment with Sorafenib Plus Toripalimab to disease progression (defined by RECIST 1.1) or death of any cause.
    Time Frame
    up to 6 months
    Title
    Overall Survival
    Description
    Duration from the date of initial treatment with Sorafenib Plus Toripalimab to the date of death due to any cause.
    Time Frame
    up to 1 year
    Title
    Duration of response
    Description
    time from first documented complete or partial response to radiologically confirmed disease progression or death from any cause.
    Time Frame
    From the date of study enrollment to the time of death from any cause, assessed up to 1 year

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    74 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Histologic or cytologic diagnosis of unresectable hepatocellular carcinoma, or confirmed clinically in accordance with Chinese Association for the Study of Liver Diseases criteria (v2017) Radiographically measurable disease by RECIST version 1.1 in at least one site Radiographic evidence of portal vein cancer thrombus Survival expectation ≥3 months Eastern Cooperative Oncology Group: 0 or 1 Child-Pugh score A or B: score ≤7 Not previously treated with any systemic anti-cancer treatment (i.e. chemotherapy, target drugs, immune checkpoint inhibitors); Subjects who have received local hepatic therapy such as surgery, ablation, radiotherapy or transcatheter arterial chemoembolization, progression of target lesions after local treatment is required to increase by 25%, or target lesions are untreated, and the end of local treatment is more than 4 weeks. All eligible patients have adequate organ function (ANC ≥1.5× 10⁹ / L, PLT ≥75 × 10⁹ /L, HGB≥90 g/L (no blood transfusion or EPO tolerance within 7 days), Cr≤1.5 times the ULN, TBN ≤1.5 times ULN, ALT and AST ≤3 times ULN, albumin ≥30g/L (albumin or branched chain amino acids supplementation is not allowed within 14 days), INR≤1.5 times the ULN, Urine protein≤1+). Signed and dated written informed consent Exclusion Criteria: History of severe allergic reactions to chimeric, human or humanized antibodies, or fusion proteins. Hypersensitive to any component of the CHO cell-derived preparation or JS001 preparation Pregnant or lactating women, men and women of childbearing age who are unwilling or unable to take effective contraceptive measures History of other malignancy within the past 5 years Medium or more pleural and ascites with clinical symptoms Active hemorrhage or abnormal coagulation function (PT>16s, APTT>43s, INR>1.5 x ULN), or having a tendency to bleed or undergoing thrombolysis, anticoagulation or anti-platelet therapy Central nervous system metastases Hepatic encephalopathy History of gastrointestinal bleeding or having a tendency to bleed within 6 months before enrollment, e.g. local active ulcer lesions; fecal occult blood (+ +) or above should not be included; if continuous fecal occult blood (+), gastroscopy should be performed. Gastric or esophageal varices requiring treatment Untreated active hepatitis B (i.e. subjects with hepatitis B undergoing antiviral therapy and HBV Load < 100IU/mL before the first administration of Toripalimab , is allowed to be enrolled; for subjects with anti-HBc (+), HBsAg (-), anti-HBs (-) and HBV viral load (-) , prophylactic anti-HBV therapy is not required, but virus activation should be closely monitored) HCV and the anti-HCV treatment ended within 4 weeks of the first administration. Notably, subjects with untreated chronic HCV infection or untreated HCV are allowed. History of drug abuse or mental disorders History of organ or marrow transplants, or active autoimmune diseases requiring systemic treatment occurred within 2 years of the first administration Immunodeficiency disorders or HIV Pulmonary fibrosis, interstitial pneumonia, pneumoconiosis, radiation pneumonia, drug-related pneumonia and severe impairment of pulmonary function Using immunosuppressive agents or systemic or absorbable local corticosteroids for immunosuppressive purposes (prednisone or its equivalent at dose> 10 mg/day) , and the above are used within 2 weeks before admission. Major liver or other operations were performed within 4 weeks of the first administration, or minor operations were performed within 1 week before the first administration (simple excision, tooth extraction, etc.) Receiving vaccine within 30 days of the first administration Abdominal fistula, gastrointestinal perforation or abdominal abscess within 4 weeks of the first administration Receiving other experimental drugs or medical devices within 4 weeks of the first administration Any significant clinical and laboratory abnormalities that in the opinion of the investigator would affect safety assessment Failure to satisfy the investigator of fitness to participate for any other reason.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Qiu Li, Professor
    Phone
    86-028-85423609
    Email
    fbqiu9@163.com
    First Name & Middle Initial & Last Name or Official Title & Degree
    Yu Yang, Associate Professor
    Phone
    86-18980606616
    Email
    yangyuflying@hotmail.com
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Qiu Li, Professor
    Organizational Affiliation
    West China Hospital
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No
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    Sorafenib Plus Toripalimab for Unresectable HCC With Portal Vein Tumor Thrombus

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