CVM-1118 in Combination With Nivolumab for Unresectable Advanced Hepatocellular Carcinoma
Hepatocellular Carcinoma, Advanced Cancer
About this trial
This is an interventional treatment trial for Hepatocellular Carcinoma focused on measuring Oncology, Hepatocellular Carcinoma (HCC), Nivolumab, Hepatoma
Eligibility Criteria
Inclusion Criteria:
- Age 18+ (20+ for subjects in Taiwan)
Diagnosis of hepatocellular carcinoma
- Pathologically or cytologically-confirmed or clinically diagnosed in accordance with American Association for the Study of Liver Diseases (AASLD) criteria (i.e., radiologic imaging with cross-sectional multiphasic contrast CT or MRI showing a ≥ 1 cm liver lesion)
- Subjects with advanced-stage, unresectable hepatocellular carcinoma that is not appropriate for potentially curable therapy who have progressed from, been intolerant of prior systemic anti-cancer therapies (e.g., sorafenib, lenvatinib, atezolizumab in combination with bevacizumab).
- Barcelona Clinic Liver Cancer (BCLC) stage B not appropriate for or with disease progression after local regional therapy, or BCLC stage C
- Child-Pugh liver function class A
- Measurable disease (per mRECIST)
- ECOG performance status of 0 to 1
Adequate laboratory parameters including:
- AST and ALT ≤ 3.0 x ULN (≤ 5.0 x ULN if due to liver involvement)
- Total serum bilirubin ≤ 2.0 x ULN (≤ 3.0 x ULN for subjects with documented Gilbert's syndrome)
- ANC ≥1500/µL
- Platelets ≥ 90,000/µL
- HGB ≥ 9.0 g/dL
- Serum creatinine clearance of ≥ 50 mL/min based on Cockcroft-Gault formula
- Serum albumin ≥ 2.8 gm/dL
- INR ≤ 2.3
- PT/aPTT ≤ 1.2 x ULN
- QTcF ≤ 480 msec
Subjects are eligible to enroll if they have HBV-, or HCV-HCC, defined as follows:
- Chronic HBV infection as evidenced by detectable HBV DNA or HBsAg. Subjects with chronic HBV infection must be on antiviral therapy and have HBV DNA <500 IU/mL. If not on an antiviral therapy at screening, then subjects must be willing to start the antiviral therapy at the time of consent.
- Active or resolved HCV infection as evidenced by detectable HCV RNA or antibody.
Exclusion Criteria:
- HCC with portal vein invasion at the main portal branch (Vp4)
- Known history of esophageal varices or gastrointestinal bleeding within the past 3 months
- Prior immunotherapy for hepatoma
- ≤ 7 days from prior limited field palliative irradiation therapy and C1D1
- ≤ 28 days from prior irradiation therapy and C1D1
- ≤ 14 days (or 5 half-lives) from prior systemic anticancer therapy and C1D1
- ≤ 28 days from local regional therapy (e.g., trans-arterial embolization, radiofrequency ablation) and C1D1
- Presence of other active cancer(s) likely to require treatment in the next two (2) years or likely to impact the assessment of any study endpoints
- Active bacterial or fungal infection(s) requiring systemic therapy within 7 days prior to C1D1
- Known CNS metastases
- Known history of HIV infection
- Females who are currently pregnant or breast-feeding
- Known gastrointestinal disease that may significantly alter the absorption of oral medications
- Psychiatric illness or social situation that would interfere with compliance with study requirements
- History of clinically significant cardiovascular abnormalities
Sites / Locations
- Kaohsiung Chang Gung Memorial HospitalRecruiting
- Keelung Chang Gung Memorial HospitalRecruiting
- National Cheng Kung University HospitalRecruiting
- National Taiwan University HospitalRecruiting
- Taipei Veterans General HospitalRecruiting
Arms of the Study
Arm 1
Experimental
Nivolumab + CVM-1118
1 Cycle = 28 days Nivolumab, 240 mg, IV, Q2 weeks with an option for 480 mg, IV, Q4 weeks starting from Cycle 3 if judged to be reasonable by the investigator based on the safety and tolerability. CVM-1118, 200 mg, PO, BID with an option to increase the starting dose to 300 mg, PO, BID for the subsequent subjects following assessment of safety data from the initial 10 subjects. Escalation of the starting dose will be dependent on the absence of Dose Limiting Toxicity in at least 7 of the initial 10 subjects treated at 200 mg, PO, BID. Individual subjects receiving a starting dose of 200 mg, PO, BID and who tolerate the initial 2 cycles with no more than Grade 2 related toxicity, will have the option of increasing their dose of CVM-1118 to 300 mg, PO, BID (600 mg total daily dose) starting with cycle 3 Tolerable dose of Nivolumab and CVM-1118 will be administered continuously for a 28-day cycle until progressive disease, unacceptable toxicity, or consent withdrawal.