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AD HOC Trial: Artificial Intelligence-Based Drug Dosing In Hepatocellular Carcinoma

Primary Purpose

Hepatocellular Carcinoma

Status
Not yet recruiting
Phase
Phase 1
Locations
Study Type
Interventional
Intervention
Irinotecan
Sonidegib
Sorafenib
Sponsored by
University of Florida
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hepatocellular Carcinoma focused on measuring hepatocellular carcinoma, Phenotypic Personalized Medicine

Eligibility Criteria

18 Years - 99 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Adults ≥ eighteen years of age Biopsy proven advanced-stage hepatocellular carcinoma (HCC), as confirmed by pathological analysis. Not eligible for, or had disease progression after, surgical or locoregional therapies. Subjects must not have more than one active malignancy at the time of enrollment (Subjects with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen [as determined by the treating physician and approved by the PI] may be included). Eastern Cooperative Oncology Group (ECOG) performance status score of 2 or less. Child-Pugh liver function class A or B7 Life expectancy of 12 weeks or more At least one untreated target lesion that could be measured in one dimension, according to the Response Evaluation Criteria in Solid Tumors (mRECIST). Must have lab values consistent with the following: Platelet count ≥ 60,000 Hemoglobin, ≥8.0 g/dL INR ≤2.5 Albumin ≥2.5 g/dL Total bilirubin, ≤5 mg/dL ALT & AST ≤5 times the upper limit of normal Creatinine ≤ 2 times the upper limit of normal Written informed consent obtained from the subject and the subject agrees to comply with all the study-related procedures. Subjects of childbearing potential (SOCBP) must be using an adequate method of contraception to avoid pregnancy throughout the study and for at least 20 months after the last dose of study drug to minimize the risk of pregnancy. Subjects with partners of child-bearing potential must agree to use physician-approved contraceptive methods (e.g., abstinence, condoms, vasectomy) throughout the study and should avoid conceiving children for 8 months following the last dose of study drug. Exclusion Criteria: Subjects of childbearing potential who are unwilling or unable to use an acceptable method to avoid pregnancy for the entire study period and for at least 8 weeks after the last dose of study drug. Subjects who are pregnant or breastfeeding. History of any other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of protocol therapy or that might affect the interpretation of the results of the study or that puts the subject at high risk for treatment complications or protocol noncompliance, in the opinion of the treating physician. Prisoners or subjects who are involuntarily incarcerated, or subjects who are compulsorily detained for treatment of either a psychiatric or physical illness. Inability to follow up with treatment center for up to 12 weeks after enrollment Anticipated major surgery during the time of planned study Homozygosity for UGT1A1*28 via genotyping History of liver transplant

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    Irinotecan, Sonidegib, and Sorafenib

    Arm Description

    Subjects will be assigned to a dose of each drug following a 3 + 3 design

    Outcomes

    Primary Outcome Measures

    Maximally tolerated dose
    Determine the maximum tolerated dose of irinotecan, sonidegib, and sorafenib

    Secondary Outcome Measures

    Objective response rate
    Determine the objective response rate, as measured by mRECIST 1.1 criteria
    Change in the biomarker AFP
    Measure the change in the blood level of the biomarker AFP
    Change in the biomarker AFP-L3
    Measure the change in the blood level of the biomarker AFP-L3
    Change in the biomarker DGC
    Measure the change in the blood level of the biomarker DGC
    Change in the biomarker TGF-B
    Measure the change in the blood level of the biomarker TGF-B

    Full Information

    First Posted
    December 20, 2022
    Last Updated
    September 28, 2023
    Sponsor
    University of Florida
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05669339
    Brief Title
    AD HOC Trial: Artificial Intelligence-Based Drug Dosing In Hepatocellular Carcinoma
    Official Title
    AD HOC Trial: Artificial Intelligence-Based Drug Dosing In Hepatocellular Carcinoma
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    September 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    November 2023 (Anticipated)
    Primary Completion Date
    April 2026 (Anticipated)
    Study Completion Date
    April 2026 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    University of Florida

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    Yes
    Studies a U.S. FDA-regulated Device Product
    No
    Product Manufactured in and Exported from the U.S.
    No
    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    This study will test the hypothesis that a novel combination of three drugs (sorafenib, sonidegib, and irinotecan), in conjunction with individually optimized doses, can be safely administered and lead to improved clinical outcomes in patients with hepatocellular carcinoma compared to standard of care. The main objective of this study is to establish safe dose ranges for the coadministration of sorafenib, sonidegib, and irinotecan in patients with hepatocellular carcinoma. Furthermore, we will collect data to inform the application of an artificial intelligence/computational approach to individual dosing of combination chemotherapy. Individualization of dosing will be achieved by using Phenotypic Personalized Medicine (PPM) to maximize treatment efficacy in patients with hepatocellular carcinoma, while minimizing toxicity. Drug efficacy will be assessed by measuring plasma circulating tumor DNA (ctDNA). Toxicity will be assessed by quantitating organ injury and patient tolerability. Recommended dosing for future studies will be based on the totality of the data.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Hepatocellular Carcinoma
    Keywords
    hepatocellular carcinoma, Phenotypic Personalized Medicine

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 1
    Interventional Study Model
    Sequential Assignment
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    12 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Irinotecan, Sonidegib, and Sorafenib
    Arm Type
    Experimental
    Arm Description
    Subjects will be assigned to a dose of each drug following a 3 + 3 design
    Intervention Type
    Drug
    Intervention Name(s)
    Irinotecan
    Intervention Description
    All subjects will be given either 25 mg/m2 (dose level -1), 50 mg/m2 (dose level 0), or 75 mg/m2 (dose level +1) irinotecan intravenously every 7 days.
    Intervention Type
    Drug
    Intervention Name(s)
    Sonidegib
    Intervention Description
    All subjects will take 200 mg sonidegib orally either every 96 hours (dose level -1), every 48 hours (dose level 0), or every 24 hours (dose level +1).
    Intervention Type
    Drug
    Intervention Name(s)
    Sorafenib
    Intervention Description
    All subjects will take 200 mg sorafenib orally either every 48 hours (dose level -1), every 24 hours (dose level 0), or every 12 hours (dose level +1).
    Primary Outcome Measure Information:
    Title
    Maximally tolerated dose
    Description
    Determine the maximum tolerated dose of irinotecan, sonidegib, and sorafenib
    Time Frame
    32 days
    Secondary Outcome Measure Information:
    Title
    Objective response rate
    Description
    Determine the objective response rate, as measured by mRECIST 1.1 criteria
    Time Frame
    32 days
    Title
    Change in the biomarker AFP
    Description
    Measure the change in the blood level of the biomarker AFP
    Time Frame
    32 days
    Title
    Change in the biomarker AFP-L3
    Description
    Measure the change in the blood level of the biomarker AFP-L3
    Time Frame
    32 days
    Title
    Change in the biomarker DGC
    Description
    Measure the change in the blood level of the biomarker DGC
    Time Frame
    32 days
    Title
    Change in the biomarker TGF-B
    Description
    Measure the change in the blood level of the biomarker TGF-B
    Time Frame
    32 days

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    99 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Adults ≥ eighteen years of age Biopsy proven advanced-stage hepatocellular carcinoma (HCC), as confirmed by pathological analysis. Not eligible for, or had disease progression after, surgical or locoregional therapies. Subjects must not have more than one active malignancy at the time of enrollment (Subjects with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen [as determined by the treating physician and approved by the PI] may be included). Eastern Cooperative Oncology Group (ECOG) performance status score of 2 or less. Child-Pugh liver function class A or B7 Life expectancy of 12 weeks or more At least one untreated target lesion that could be measured in one dimension, according to the Response Evaluation Criteria in Solid Tumors (mRECIST). Must have lab values consistent with the following: Platelet count ≥ 60,000 Hemoglobin, ≥8.0 g/dL INR ≤2.5 Albumin ≥2.5 g/dL Total bilirubin, ≤5 mg/dL ALT & AST ≤5 times the upper limit of normal Creatinine ≤ 2 times the upper limit of normal Written informed consent obtained from the subject and the subject agrees to comply with all the study-related procedures. Subjects of childbearing potential (SOCBP) must be using an adequate method of contraception to avoid pregnancy throughout the study and for at least 20 months after the last dose of study drug to minimize the risk of pregnancy. Subjects with partners of child-bearing potential must agree to use physician-approved contraceptive methods (e.g., abstinence, condoms, vasectomy) throughout the study and should avoid conceiving children for 8 months following the last dose of study drug. Exclusion Criteria: Subjects of childbearing potential who are unwilling or unable to use an acceptable method to avoid pregnancy for the entire study period and for at least 8 weeks after the last dose of study drug. Subjects who are pregnant or breastfeeding. History of any other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of protocol therapy or that might affect the interpretation of the results of the study or that puts the subject at high risk for treatment complications or protocol noncompliance, in the opinion of the treating physician. Prisoners or subjects who are involuntarily incarcerated, or subjects who are compulsorily detained for treatment of either a psychiatric or physical illness. Inability to follow up with treatment center for up to 12 weeks after enrollment Anticipated major surgery during the time of planned study Homozygosity for UGT1A1*28 via genotyping History of liver transplant
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Shannon Alford
    Phone
    (352) 273-8146
    Email
    PMO@cancer.ufl.edu
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Ali Zarrinpar, MD, PhD
    Organizational Affiliation
    University of Florida
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Learn more about this trial

    AD HOC Trial: Artificial Intelligence-Based Drug Dosing In Hepatocellular Carcinoma

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