68Ga PSMA PET Imaging for the Treatment of Advanced Liver Cancer

Optimizing Outcomes of Patients With Advanced HCC Undergoing Immunotherapy Through Novel 68Ga PSMA PET Imaging

This phase II trial tests whether 68-Gallium prostate specific membrane antigen (68Ga-PSMA) positron emission tomography (PET) imaging can improve the diagnosis and management of liver cancer that has spread to other parts of the body (advanced). PSMA is a protein that appears in large amounts on the surface of liver cancer cells. The radioactive chemical compound (68Ga-PSMA) has been designed to circulate through the body and attach itself to the PSMA protein on liver cancer cells. A PET scan is then used to detect the location of the tumor cells. 68Ga-PSMA PET may improve upon the diagnosis and management of liver cancer.

PRIMARY OBJECTIVES: I. To test the performance of novel biomarkers derived from PSMA PET/computed tomography (CT) to measure response compared to Response Evaluation Criteria in Solid Tumors (RECIST) criteria, in advanced hepatocellular carcinoma (HCC) patients treated with immunotherapy. II. To identify precision imaging biomarkers that can predict response of HCC to novel immunotherapy. OUTLINE: Patients undergo 68GA PSMA PET/CT scans at baseline, and after 3, 6, 9, and 12 cycles of standard of care immunotherapy in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed-up every 6 months for 3 years.

Advanced Hepatocellular Carcinoma, Stage III Hepatocellular Carcinoma AJCC v8, Stage IIIA Hepatocellular Carcinoma AJCC v8, Stage IIIB Hepatocellular Carcinoma AJCC v8, Stage IV Hepatocellular Carcinoma AJCC v8, Stage IVA Hepatocellular Carcinoma AJCC v8, Stage IVB Hepatocellular Carcinoma AJCC v8, Unresectable Hepatocellular Carcinoma

Patients undergo 68GA PSMA PET/CT scans at baseline, and after 3, 6, 9, and 12 cycles of standard of care immunotherapy in the absence of disease progression or unacceptable toxicity.

CAT, CAT Scan, Computed Axial Tomography, Computerized Axial Tomography, Computerized Tomography, CT, CT Scan, tomography

(68)Ga labeled Glu-NH-CO-NH-Lys(Ahx)-HBED-CC, (68)Ga-labeled Glu-urea-Lys(Ahx)-HBED-CC, (68)Ga-PSMA Ligand Glu-urea-Lys(Ahx)-HBED-CC, (68)Gallium-PSMA Ligand Glu-urea-Lys(Ahx)-HBED-CC, (68Ga)Glu-urea-Lys(Ahx)-HBED-CC, 68Ga-DKFZ-PSMA-11, 68Ga-HBED-CC-PSMA, 68Ga-labeled Glu-NH-CO-NH-Lys(Ahx)-HBED-CC, 68Ga-PSMA, 68Ga-PSMA-11, 68Ga-PSMA-HBED-CC, [68Ga] Prostate-specific Membrane Antigen 11, [68Ga]GaPSMA-11, Ga PSMA, Ga-68 labeled DKFZ-PSMA-11, Ga-68 labeled PSMA-11, GA-68 PSMA-11, Gallium Ga 68 PSMA-11, Gallium Ga 68-labeled PSMA-11, GALLIUM GA-68 GOZETOTIDE, Gallium-68 PSMA, Gallium-68 PSMA Ligand Glu-urea-Lys(Ahx)-HBED-CC, GaPSMA, PSMA-HBED-CC GA-68

Medical Imaging, Positron Emission Tomography, PET, PET Scan, Positron Emission Tomography Scan, Positron-Emission Tomography, proton magnetic resonance spectroscopic imaging, PT

Time to response, per RECIST 1.1 and per PSMA PET/CT, will be correlated to each other using Cox proportional hazard model with response per RECIST 1.1 as the dependent variable and the time to response per PSMA PET/CT will be included in the model as a time-varying covariate.

Time from study registration to complete response/partial response per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and per PSMA positron emission tomography (PET)/computed tomography (CT), assessed up to 12 cycles of treatment or 36 weeks

Will be calculated among PSMA PET/CT positive patients using Kaplan-Meier method with corresponding confidence interval calculated using Greenwood's formula. In PSMA negative patients, will explore the potential prognostic effect of PSMA status on PFS using Cox proportional hazard model with PSMA PET/CT status (positive versus negative) as the main variable of interest while adjusting for other potential confounders.

RECIST 1.1 and PSMA PET/CT will be correlated to each other using Cox proportional hazard model with response per RECIST 1.1 as the dependent varible and the time to response per PSMA PET/CT will be included in the model as a time-vaying covariate.

Time from study registration to disease progression per RECIST 1.1 and per PSMA PET/CT, assessed up to 3 years

Inclusion Criteria: Patient with pathologically confirmed HCC not amenable to curative resection, transplantation or ablative therapies Have radiographically measurable disease by RECIST Eligible for atezolizumab/bevacizumab front line therapy Male or female with age greater than 18 years, with the capacity and willingness to provide written informed consent Exclusion Criteria: Pregnant and/or breast-feeding patients. A negative pregnancy test within 48 hours of the PET scan Patients with higher than the weight/size limitations of PET/CT scanner