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
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
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.
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
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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