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CVM-1118 and Sorafenib Combination in Subjects With Advanced Hepatocellular Carcinoma

Primary Purpose

Hepatocellular Carcinoma, Advanced Cancer

Status
Terminated
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Sorafenib
CVM-1118
Sponsored by
TaiRx, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hepatocellular Carcinoma focused on measuring Oncology, Hepatocellular Carcinoma (HCC), Sorafenib, Hepatoma

Eligibility Criteria

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

Inclusion Criteria:

  1. Signed, informed consent
  2. Age 18 or older (for all treatment locations with exception of Taiwan), or age 20 or older (Taiwan only)
  3. Pathologically or cytologically-confirmed, advanced-stage hepatocellular carcinoma without prior systemic treatment except for prior immunotherapy and Child-Pugh liver function class A appropriate for treatment with sorafenib
  4. Measurable disease according to modified Response Evaluation Criteria in Solid Tumors criteria (mRECIST)
  5. Eastern Cooperative Oncology Group (ECOG) performance status: 0 to 1
  6. Adequate laboratory parameters including:

    1. Serum aspartate transaminase (AST) and serum alanine transaminase (ALT) ≤ 3.0 x upper limit of normal (ULN), or AST and ALT ≤ 5.0 x ULN if liver function abnormalities are due to underlying malignancy
    2. Total serum bilirubin ≤ 2.0 x ULN (except for subjects with documented Gilbert's syndrome who have a limit of ≤ 3.0 x ULN)
    3. Absolute neutrophil count (ANC):1500/µL
    4. Platelets: 90,000/µL
    5. Hemoglobin: 9.0 g/dL
    6. Serum creatinine ≤ 2.0 x ULN or creatinine clearance of ≥ 50 mL/min
    7. Serum albumin ≥ 3.0 g/dL
    8. International normalized ratio (INR) ≤ 1.4
    9. Prothrombin Time (PT)/ Activated Partial Thromboplastin Time (aPTT) ≤ 1.2 x ULN
  7. QTc interval (using Fridericia correction) of ≤ 470 msec (QTc interval may be derived from up to 3 separate EKGs performed at least 5 minutes apart)
  8. Willingness to participate in collection of pharmacokinetic and other exploratory blood collection as defined in the protocol
  9. Willingness to use adequate contraception throughout study and for a period of 3 months after last dose of CVM-1118

Exclusion Criteria:

  1. Major surgery (other than diagnostic surgery) or radiation therapy within 28 days of starting study treatment
  2. Prior systemic immunotherapy for hepatoma within 28 days of starting study treatment
  3. Systemic anticancer therapy (e.g., chemotherapy, hormonal, investigational, biological therapies) within 28 days (or fewer than 5 half-lives, whichever is shorter) of starting study treatment except for ongoing hormonal therapy administered for control of a second cancer (e.g., breast or prostate cancer)
  4. Receipt of a CYP3A4 inducer less than 28 days or 5 half-lives of the CYP3A4 inducer prior to the first day of sorafenib administration
  5. Other known active cancer(s) likely to require treatment in the next two (2) years or likely to impact the assessment of any study endpoints
  6. Active, uncontrolled bacterial, viral, or fungal infection(s) requiring systemic therapy (e.g., subjects with known HBV or HCV infections controlled on antivirals are allowed)
  7. Known Central Nervous system (CNS) metastases unless appropriately treated and neurologically stable for ≥ 4 weeks off steroids
  8. Pregnant or currently breast-feeding
  9. Known HIV-positive
  10. Patients with impaired gastrointestinal (GI) diseases that may significantly alter the absorption of oral medications
  11. Psychiatric illness/social situations that would interfere with compliance with study requirements
  12. History of clinically significant cardiovascular abnormalities such as uncontrolled hypertension, congestive heart failure (New York Heart Association classification ≥ 2), unstable angina, poorly controlled arrhythmias, myocardial infarction within 6 months of study entry
  13. Other severe acute or chronic medical or psychiatric conditions or laboratory abnormalities that would impart, in the judgement of the PI and/or Sponsor, excess risk associated with study participation or study drug administration, which would make the subject inappropriate for entry into this study

Sites / Locations

  • Charleston Hematology Oncology Associates
  • National Cheng Kung University Hospital
  • National Taiwan University Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Sorafenib + CVM-1118

Arm Description

Cycle 0 (at least 3 weeks): sorafenib tolerability assessment period (sorafenib alone) 400mg BID daily (starting dose); The subject will be assessed for the need for a dose reduction in sorafenib during this period. Cycle 1+ (28-day cycles): combination period (sorafenib+CVM-1118) Tolerable dose of sorafenib and CVM-1118 150 (starting dose) or 200 mg BID will be administered continuously for a 28-day cycle until progressive disease, unacceptable toxicity, or consent withdrawal.

Outcomes

Primary Outcome Measures

Objective Response Rate (ORR)
Assessment by modified RECIST criteria

Secondary Outcome Measures

Overall survival (OS)
Overall survival (OS) is defined as time from first dose of study drug to death
Progression-free survival (PFS)
Progression-free survival (PFS) is defined as time from the first dose of study drug to the time of progression or death
Time to progression (TTP)
Time to progression (TTP) is defined as the time from the first dose of study drug to the time of progression
Duration of response (DoR)
Duration of response (DoR) is defined as time from the first documentation of response to the time of progression
Disease control rate (DCR)
Disease control rate (DCR) is defined as the sum of complete response (CR), partial response (PR), and stable disease rate (SD) as assessed by modified RECIST criteria
Rate of Adverse event (AE) and Serious Adverse Event (SAE)
Rate of Adverse event (AE) and Serious Adverse Event (SAE) are assessed using Common Terminology Criteria for Adverse Events v5 (CTCAE) criteria
Assessed the baseline and out-of-range vital signs_ body temperature, blood pressure, heart rate, and respiratory rate by CTCAE v4.03
A list of all laboratory normal ranges will also be provided. Values with CTCAE v4.03 Grade ≧ 3 will be identified with flags.
Assessed the baseline and out-of range laboratory parameters_hematology, chemistry, coagulation, and urinalysis by CTCAE v4.03
A list of all laboratory normal ranges will also be provided. Values with CTCAE v4.03 Grade ≧ 3 will be identified with flags.
Abnormalities in electrocardiography (ECG)
a 12-lead (with a 10-second rhythm strip) tracing, with a capacity to calculate the standard intervals automatically, will be used.
Maximum Plasma Concentration [Cmax] of sorafenib, CVM-1118, and its metabolite CVM-1125 after CVM-1118 dosing
Maximum Plasma Concentration [Cmax] of sorafenib, CVM-1118, and its metabolite CVM-1125 will be measured to see maximum exposure after CVM-1118 dosing
Area Under the Curve [AUC] of sorafenib, CVM-1118, and its metabolite CVM-1125 after CVM-1118 dosing
Area Under the Curve [AUC] of sorafenib, CVM-1118, and its metabolite CVM-1125 will be measured to see drug exposure after CVM-1118 dosing
Pharmacodynamics analysis for the relationship of Cmax and ORR
Relationship between Cmax and ORR will be evaluated
Pharmacodynamics analysis for the relationship of AUC and ORR
Relationship between AUC and ORR will be evaluated
Pharmacodynamics analysis for the relationship of Cmax and Adverse Event (AE)
Relationship between Cmax and AE will be evaluated
Pharmacodynamics analysis for the relationship of AUC and Adverse Event (AE)
Relationship between AUC and AE will be evaluated

Full Information

First Posted
May 21, 2018
Last Updated
January 6, 2023
Sponsor
TaiRx, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT03582618
Brief Title
CVM-1118 and Sorafenib Combination in Subjects With Advanced Hepatocellular Carcinoma
Official Title
A Phase 2, Open-Label Study With Orally Administered CVM-1118 and Sorafenib in Subjects With Advanced Hepatocellular Carcinoma
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Terminated
Why Stopped
The study has been terminated due to slow enrollment
Study Start Date
July 12, 2018 (Actual)
Primary Completion Date
November 16, 2021 (Actual)
Study Completion Date
December 30, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
TaiRx, Inc.

4. Oversight

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

5. Study Description

Brief Summary
CVM-1118 is a new small molecule chemical entity being developed as a potential anti-cancer therapeutic by TaiRx, Inc. CVM-1118 is a potent anti-cancer agent in numerous human cancer cell lines. The safety of administrating CVM-1118 on human is evaluated from the phase 1 study. The objectives of the phase 2 study is to further investigate the efficacy of CVM-1118 with sorafenib for subjects with advanced hepatoma.
Detailed Description
Sorafenib is a multi-kinase inhibitor that inhibits tumor growth and angiogenesis. Although sorafenib is the first-line treatment of advanced hepatocellular cancer (HCC), patients developing resistance to sorafenib have been reported. To meet the medical need, TaiRx, Inc. develops a new small molecule drug, CVM-1118 targeting the formation of vasculogenic mimicry (VM). VM has been associated with tumor metastasis and poor clinical outcomes. VM is reported to be particularly active in tumor under hypoxia state when patients are treated with the potent vascular endothelial growth factor (VEGF) inhibitor like sorafenib. Hence, the ability of inhibiting the VM network make CVM-1118 a potential good combination drug with sorafenib for advanced diseases. The safety profile of CVM-1118 dosing has been established in the phase 1 study. The analysis of metabolism pathways further showed that the potential of CVM-1118 and sorafenib drug-drug interactions are very low. Based on the mechanism of actions and the safety analysis of sorafenib and CVM-1118, the design of phase 2 trial with the combination therapy might have great potential for the patients with advanced HCC.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hepatocellular Carcinoma, Advanced Cancer
Keywords
Oncology, Hepatocellular Carcinoma (HCC), Sorafenib, Hepatoma

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Sorafenib + CVM-1118
Arm Type
Experimental
Arm Description
Cycle 0 (at least 3 weeks): sorafenib tolerability assessment period (sorafenib alone) 400mg BID daily (starting dose); The subject will be assessed for the need for a dose reduction in sorafenib during this period. Cycle 1+ (28-day cycles): combination period (sorafenib+CVM-1118) Tolerable dose of sorafenib and CVM-1118 150 (starting dose) or 200 mg BID will be administered continuously for a 28-day cycle until progressive disease, unacceptable toxicity, or consent withdrawal.
Intervention Type
Drug
Intervention Name(s)
Sorafenib
Other Intervention Name(s)
Nexavar
Intervention Description
Sorafenib will be administered orally at a starting dose of 400mg BID daily and the necessity of dose reduction will be assessed during sorafenib tolerability assessment period
Intervention Type
Drug
Intervention Name(s)
CVM-1118
Other Intervention Name(s)
TRX-818
Intervention Description
CVM-1118 will be administered orally at 150 mg BID or 200 mg BID daily and combined with the tolerable dose of sorafenib for a 28-day cycle
Primary Outcome Measure Information:
Title
Objective Response Rate (ORR)
Description
Assessment by modified RECIST criteria
Time Frame
24 weeks after the last subject starts CVM-1118
Secondary Outcome Measure Information:
Title
Overall survival (OS)
Description
Overall survival (OS) is defined as time from first dose of study drug to death
Time Frame
24 weeks after the last subject starts CVM-1118 and up to 1 year after the last-dose
Title
Progression-free survival (PFS)
Description
Progression-free survival (PFS) is defined as time from the first dose of study drug to the time of progression or death
Time Frame
24 weeks after the last subject starts CVM-1118 and up to 1 year after the last-dose
Title
Time to progression (TTP)
Description
Time to progression (TTP) is defined as the time from the first dose of study drug to the time of progression
Time Frame
24 weeks after the last subject starts CVM-1118 and up to 1 year after the last-dose
Title
Duration of response (DoR)
Description
Duration of response (DoR) is defined as time from the first documentation of response to the time of progression
Time Frame
24 weeks after the last subject starts CVM-1118 and up to 1 year after the last-dose
Title
Disease control rate (DCR)
Description
Disease control rate (DCR) is defined as the sum of complete response (CR), partial response (PR), and stable disease rate (SD) as assessed by modified RECIST criteria
Time Frame
24 weeks after the last subject starts CVM-1118 and up to 1 year after the last-dose
Title
Rate of Adverse event (AE) and Serious Adverse Event (SAE)
Description
Rate of Adverse event (AE) and Serious Adverse Event (SAE) are assessed using Common Terminology Criteria for Adverse Events v5 (CTCAE) criteria
Time Frame
During the course of trial and within 28 days following the last dose of CVM-1118 or prior to the start of new treatment, whichever comes first
Title
Assessed the baseline and out-of-range vital signs_ body temperature, blood pressure, heart rate, and respiratory rate by CTCAE v4.03
Description
A list of all laboratory normal ranges will also be provided. Values with CTCAE v4.03 Grade ≧ 3 will be identified with flags.
Time Frame
During the course of trial and within 28 days following the last dose of CVM-1118 or prior to the start of new treatment, whichever comes first
Title
Assessed the baseline and out-of range laboratory parameters_hematology, chemistry, coagulation, and urinalysis by CTCAE v4.03
Description
A list of all laboratory normal ranges will also be provided. Values with CTCAE v4.03 Grade ≧ 3 will be identified with flags.
Time Frame
During the course of trial and within 28 days following the last dose of CVM-1118 or prior to the start of new treatment, whichever comes first
Title
Abnormalities in electrocardiography (ECG)
Description
a 12-lead (with a 10-second rhythm strip) tracing, with a capacity to calculate the standard intervals automatically, will be used.
Time Frame
During the course of trial and within 28 days following the last dose of CVM-1118 or prior to the start of new treatment, whichever comes first
Title
Maximum Plasma Concentration [Cmax] of sorafenib, CVM-1118, and its metabolite CVM-1125 after CVM-1118 dosing
Description
Maximum Plasma Concentration [Cmax] of sorafenib, CVM-1118, and its metabolite CVM-1125 will be measured to see maximum exposure after CVM-1118 dosing
Time Frame
During Cycle 1 and Cycle 2 (each cycle is 28 days)
Title
Area Under the Curve [AUC] of sorafenib, CVM-1118, and its metabolite CVM-1125 after CVM-1118 dosing
Description
Area Under the Curve [AUC] of sorafenib, CVM-1118, and its metabolite CVM-1125 will be measured to see drug exposure after CVM-1118 dosing
Time Frame
During Cycle 1 and Cycle 2 (each cycle is 28 days)
Title
Pharmacodynamics analysis for the relationship of Cmax and ORR
Description
Relationship between Cmax and ORR will be evaluated
Time Frame
During Cycle 1 and Cycle 2 (each cycle is 28 days)
Title
Pharmacodynamics analysis for the relationship of AUC and ORR
Description
Relationship between AUC and ORR will be evaluated
Time Frame
During Cycle 1 and Cycle 2 (each cycle is 28 days)
Title
Pharmacodynamics analysis for the relationship of Cmax and Adverse Event (AE)
Description
Relationship between Cmax and AE will be evaluated
Time Frame
During Cycle 1 and Cycle 2 (each cycle is 28 days)
Title
Pharmacodynamics analysis for the relationship of AUC and Adverse Event (AE)
Description
Relationship between AUC and AE will be evaluated
Time Frame
During Cycle 1 and Cycle 2 (each cycle is 28 days)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Signed, informed consent Age 18 or older (for all treatment locations with exception of Taiwan), or age 20 or older (Taiwan only) Pathologically or cytologically-confirmed, advanced-stage hepatocellular carcinoma without prior systemic treatment except for prior immunotherapy and Child-Pugh liver function class A appropriate for treatment with sorafenib Measurable disease according to modified Response Evaluation Criteria in Solid Tumors criteria (mRECIST) Eastern Cooperative Oncology Group (ECOG) performance status: 0 to 1 Adequate laboratory parameters including: Serum aspartate transaminase (AST) and serum alanine transaminase (ALT) ≤ 3.0 x upper limit of normal (ULN), or AST and ALT ≤ 5.0 x ULN if liver function abnormalities are due to underlying malignancy Total serum bilirubin ≤ 2.0 x ULN (except for subjects with documented Gilbert's syndrome who have a limit of ≤ 3.0 x ULN) Absolute neutrophil count (ANC):1500/µL Platelets: 90,000/µL Hemoglobin: 9.0 g/dL Serum creatinine ≤ 2.0 x ULN or creatinine clearance of ≥ 50 mL/min Serum albumin ≥ 3.0 g/dL International normalized ratio (INR) ≤ 1.4 Prothrombin Time (PT)/ Activated Partial Thromboplastin Time (aPTT) ≤ 1.2 x ULN QTc interval (using Fridericia correction) of ≤ 470 msec (QTc interval may be derived from up to 3 separate EKGs performed at least 5 minutes apart) Willingness to participate in collection of pharmacokinetic and other exploratory blood collection as defined in the protocol Willingness to use adequate contraception throughout study and for a period of 3 months after last dose of CVM-1118 Exclusion Criteria: Major surgery (other than diagnostic surgery) or radiation therapy within 28 days of starting study treatment Prior systemic immunotherapy for hepatoma within 28 days of starting study treatment Systemic anticancer therapy (e.g., chemotherapy, hormonal, investigational, biological therapies) within 28 days (or fewer than 5 half-lives, whichever is shorter) of starting study treatment except for ongoing hormonal therapy administered for control of a second cancer (e.g., breast or prostate cancer) Receipt of a CYP3A4 inducer less than 28 days or 5 half-lives of the CYP3A4 inducer prior to the first day of sorafenib administration Other known active cancer(s) likely to require treatment in the next two (2) years or likely to impact the assessment of any study endpoints Active, uncontrolled bacterial, viral, or fungal infection(s) requiring systemic therapy (e.g., subjects with known HBV or HCV infections controlled on antivirals are allowed) Known Central Nervous system (CNS) metastases unless appropriately treated and neurologically stable for ≥ 4 weeks off steroids Pregnant or currently breast-feeding Known HIV-positive Patients with impaired gastrointestinal (GI) diseases that may significantly alter the absorption of oral medications Psychiatric illness/social situations that would interfere with compliance with study requirements History of clinically significant cardiovascular abnormalities such as uncontrolled hypertension, congestive heart failure (New York Heart Association classification ≥ 2), unstable angina, poorly controlled arrhythmias, myocardial infarction within 6 months of study entry Other severe acute or chronic medical or psychiatric conditions or laboratory abnormalities that would impart, in the judgement of the PI and/or Sponsor, excess risk associated with study participation or study drug administration, which would make the subject inappropriate for entry into this study
Facility Information:
Facility Name
Charleston Hematology Oncology Associates
City
Charleston
State/Province
South Carolina
ZIP/Postal Code
29403
Country
United States
Facility Name
National Cheng Kung University Hospital
City
Tainan
ZIP/Postal Code
704
Country
Taiwan
Facility Name
National Taiwan University Hospital
City
Taipei
ZIP/Postal Code
11502
Country
Taiwan

12. IPD Sharing Statement

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CVM-1118 and Sorafenib Combination in Subjects With Advanced Hepatocellular Carcinoma

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