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Cabozantinib to Treat Recurrent Liver Cancer Post Transplant

Primary Purpose

Hepatocellular Carcinoma, Recurrent Cancer, Liver Transplant

Status
Recruiting
Phase
Phase 2
Locations
Canada
Study Type
Interventional
Intervention
Cabozantinib
Sponsored by
University Health Network, Toronto
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hepatocellular Carcinoma

Eligibility Criteria

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

Inclusion Criteria:

  • Have histologically or cytologically confirmed hepatocellular carcinoma that has recurred.
  • Previously underwent a liver transplant as a curative treatment for hepatocellular carcinoma (HCC).
  • Not amenable to curative surgery or local treatment for recurrent disease.
  • Must have measurable disease.
  • No prior treatment with cabozantinib. May be systemic therapy naïve or have received up to 1 line of prior therapy for advanced HCC with sorafenib or lenvatinib.
  • Age ≥18 years.
  • Eastern Cooperative Oncology Group (ECOG) performance status 01.
  • Life expectancy of >3 months.
  • Normal organ and marrow function.
  • Adequate cardiac function.
  • No evidence of active uncontrolled infection.
  • Understand and willing to sign written informed consent document.
  • Recovered from prior toxicities to < grade 1.
  • Able to take oral medications.
  • Agree to use effective contraceptive methods until at least 30 days (for women) and 3 months (for men) after the last administration of study medication. Serum pregnancy test should be negative.

Exclusion Criteria:

  • Had systemic therapy or radiotherapy <3 weeks.
  • Receiving any other investigational agents.
  • With known brain metastases unless stable for >3 months.
  • History of allergic reactions attributed to cabozantinib.
  • Has uncontrolled, significant intercurrent or recent illness:
  • Cardiovascular disorders
  • Gastrointestinal (GI) disorders including those associated with a high risk of perforation or fistula formation
  • Major surgery within 2 months before randomization
  • Cavitating pulmonary lesion(s) or endobronchial disease (untreated)
  • Lesion invading a major blood vessel
  • Clinically significant bleeding risk <3 months
  • Other clinically significant disorders:
  • Active infection requiring systemic treatment, known infection with human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS)-related illness
  • Serious non-healing wound/ulcer/bone fracture
  • Malabsorption syndrome
  • Uncompensated/symptomatic hypothyroidism
  • Requirement for hemodialysis or peritoneal dialysis
  • Pregnant women.
  • Any other condition that would, in the Investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns or compliance with clinical study procedures
  • Active hepatitis B or C in liver graft
  • Patients with a grade >= 2 elevated liver enzymes who are suspected of cellular rejection will undergo biopsy. Patients diagnosed with cellular rejection in the biopsy sample using the Banff schema are ineligible.
  • Fibrolamellar carcinoma or mixed hepatocellular cholangiocarcinoma
  • Moderate or severe ascites
  • Concomitant use of anticoagulants at therapeutic doses
  • Has a known history of prior invasive malignancy except if patient has undergone curative-intent therapy with no evidence of disease recurrence for 2 years prior to study entry.

Sites / Locations

  • Princess Margaret Cancer CentreRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Cabozantinib

Arm Description

Cabozantinib, at a dose of 60 mg orally (by mouth), once a day (at bedtime), continuously.

Outcomes

Primary Outcome Measures

Disease control rate
Proportion of patients with complete response + partial response + stable disease.

Secondary Outcome Measures

Progression-free survival
Duration of time from start of treatment to time of progression.
Overall survival
Duration of time from start of treatment to time of death.
Number of Side Effects Reported

Full Information

First Posted
December 17, 2019
Last Updated
January 25, 2023
Sponsor
University Health Network, Toronto
Collaborators
Ipsen
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1. Study Identification

Unique Protocol Identification Number
NCT04204850
Brief Title
Cabozantinib to Treat Recurrent Liver Cancer Post Transplant
Official Title
A Phase II Trial of Cabozantinib in the Treatment of Recurrent Hepatocellular Carcinoma Post Liver Transplant
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Recruiting
Study Start Date
August 7, 2020 (Actual)
Primary Completion Date
August 7, 2023 (Anticipated)
Study Completion Date
February 7, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University Health Network, Toronto
Collaborators
Ipsen

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 is a phase 2 study that will assess the investigational drug, cabozantinib, in patients with liver cancer (specifically hepatocellular carcinoma) and who had received a liver transplant as a part of curative care, but the cancer has come back (recurred). The purpose of this study is to see how useful cabozantinib is in controlling the disease of these patients. Cabozantinib blocks the function of various proteins found on the surface of the body's cells (called receptor tyrosine kinases) that are important in the development of cancer tumors. All participants will receive cabozantinib until they are no longer receiving benefit from the study drug or they experience an intolerable side effect.
Detailed Description
The study has three main parts: Screening: Participants will have test, procedures, and assessments done for safety and eligibility. Some may be done for research purposes only. Several visits may be needed to complete the screening part of the study. Study Drug Period: During this part, participants will take the study drug as prescribed by the study doctor. While on the study drug, participants will visit the clinic about once a week for tests, procedures, and assessments for safety, eligibility, and research only purposes. End of Study Drug Visit and Follow-up: Participants will be asked to make an End of Study Drug visit about 30 days after the last dose of study drugs for safety, eligibility, and research only purposes. After this visit, participants will continue to have follow-up visits about every 8 weeks. If participants are experiencing side effects, they will be followed weekly for about 4 weeks, then monthly until resolution or stabilization.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hepatocellular Carcinoma, Recurrent Cancer, Liver Transplant

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Cabozantinib
Arm Type
Experimental
Arm Description
Cabozantinib, at a dose of 60 mg orally (by mouth), once a day (at bedtime), continuously.
Intervention Type
Drug
Intervention Name(s)
Cabozantinib
Other Intervention Name(s)
CABOMETYX
Intervention Description
Cabozantinib is a multi-tyrosine kinase inhibitor with activity against VEGFR 1,2,3, MET and AXL, as well as RET, KIT, ant FLT-3.
Primary Outcome Measure Information:
Title
Disease control rate
Description
Proportion of patients with complete response + partial response + stable disease.
Time Frame
4 months
Secondary Outcome Measure Information:
Title
Progression-free survival
Description
Duration of time from start of treatment to time of progression.
Time Frame
3 years
Title
Overall survival
Description
Duration of time from start of treatment to time of death.
Time Frame
3 years
Title
Number of Side Effects Reported
Time Frame
3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Have histologically or cytologically confirmed hepatocellular carcinoma that has recurred. Previously underwent a liver transplant as a curative treatment for hepatocellular carcinoma (HCC). Not amenable to curative surgery or local treatment for recurrent disease. Must have measurable disease. No prior treatment with cabozantinib. May be systemic therapy naïve or have received up to 1 line of prior therapy for advanced HCC with sorafenib or lenvatinib. Age ≥18 years. Eastern Cooperative Oncology Group (ECOG) performance status 01. Life expectancy of >3 months. Normal organ and marrow function. Adequate cardiac function. No evidence of active uncontrolled infection. Understand and willing to sign written informed consent document. Recovered from prior toxicities to < grade 1. Able to take oral medications. Agree to use effective contraceptive methods until at least 30 days (for women) and 3 months (for men) after the last administration of study medication. Serum pregnancy test should be negative. Exclusion Criteria: Had systemic therapy or radiotherapy <3 weeks. Receiving any other investigational agents. With known brain metastases unless stable for >3 months. History of allergic reactions attributed to cabozantinib. Has uncontrolled, significant intercurrent or recent illness: Cardiovascular disorders Gastrointestinal (GI) disorders including those associated with a high risk of perforation or fistula formation Major surgery within 2 months before randomization Cavitating pulmonary lesion(s) or endobronchial disease (untreated) Lesion invading a major blood vessel Clinically significant bleeding risk <3 months Other clinically significant disorders: Active infection requiring systemic treatment, known infection with human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS)-related illness Serious non-healing wound/ulcer/bone fracture Malabsorption syndrome Uncompensated/symptomatic hypothyroidism Requirement for hemodialysis or peritoneal dialysis Pregnant women. Any other condition that would, in the Investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns or compliance with clinical study procedures Active hepatitis B or C in liver graft Patients with a grade >= 2 elevated liver enzymes who are suspected of cellular rejection will undergo biopsy. Patients diagnosed with cellular rejection in the biopsy sample using the Banff schema are ineligible. Fibrolamellar carcinoma or mixed hepatocellular cholangiocarcinoma Moderate or severe ascites Concomitant use of anticoagulants at therapeutic doses Has a known history of prior invasive malignancy except if patient has undergone curative-intent therapy with no evidence of disease recurrence for 2 years prior to study entry.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Jennifer Knox, M.D.
Phone
416-946-2399
Email
jennifer.knox@uhn.ca
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jennifer Knox, M.D.
Organizational Affiliation
Princess Margaret Cancer Centre
Official's Role
Principal Investigator
Facility Information:
Facility Name
Princess Margaret Cancer Centre
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5G 2M9
Country
Canada
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jennifer Knox, M.D.
Phone
416-946-2399
First Name & Middle Initial & Last Name & Degree
Jennifer Knox, M.D.

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
35287469
Citation
Azhie A, Grant RC, Herman M, Wang L, Knox JJ, Bhat M. Phase II clinical trial of cabozantinib for the treatment of recurrent hepatocellular carcinoma after liver transplantation. Future Oncol. 2022 Jun;18(18):2173-2191. doi: 10.2217/fon-2021-1635. Epub 2022 Mar 15.
Results Reference
derived
PubMed Identifier
33867478
Citation
D'Alessio A, Cammarota A, Prete MG, Pressiani T, Rimassa L. The evolving treatment paradigm of advanced hepatocellular carcinoma: putting all the pieces back together. Curr Opin Oncol. 2021 Jul 1;33(4):386-394. doi: 10.1097/CCO.0000000000000744.
Results Reference
derived

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Cabozantinib to Treat Recurrent Liver Cancer Post Transplant

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