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Trametinib in Combination With Sorafenib in Patients With Advanced Hepatocellular Cancer

Primary Purpose

Hepatocellular Cancer, Liver Cancer

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Trametinib
Sorafenib
Sponsored by
H. Lee Moffitt Cancer Center and Research Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hepatocellular Cancer focused on measuring Liver Neoplasms, Liver Diseases, Digestive System Diseases, Advanced, Mitogen-Activated Protein Kinase (MEK) Inhibitor, Kinase Inhibitor

Eligibility Criteria

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

Inclusion Criteria:

  • Must have radiographic or histological diagnosis of hepatocellular cancer (HCC), with advanced stage disease that is not amenable to curative surgical resection. Potential participants without histologic diagnosis must meet the radiographic criteria for HCC.
  • Child Pugh score must be 5 or 6 (Child Pugh Class A)
  • Must have measurable disease by RECIST criteria 1.1
  • Eastern Cooperative Oncology Group (ECOG) performance status ≤1
  • Must have normal organ and marrow function
  • Female participants of child-bearing potential must agree to use dual methods of contraception and have a negative serum pregnancy test at screening, and male participants must use an effective barrier method of contraception if sexually active with a female of child-bearing potential. For both male and female participants, effective methods of contraception must be used throughout the study and for four months following the last dose.
  • Able to swallow and retain orally administered medication and does not have any clinically significant gastrointestinal abnormalities that may alter absorption such as malabsorption syndrome or major resection of the stomach or bowels
  • Participants in the dose expansion part must have tumor that is amenable for biopsy.
  • Ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria:

  • Have received radiation therapy, major surgery, other locoregional therapy, within 4 weeks prior to the first dose of study drug
  • All prior treatment-related toxicities must be ≤ Grade 1.
  • Have received sorafenib or other systemic therapies for treatment of HCC in the past
  • Any serious and/or unstable pre-existing medical disorder (aside from malignancy exception), psychiatric disorder, or other conditions that could interfere with participant's safety, obtaining informed consent or compliance to the study procedures
  • History or evidence of cardiovascular risk
  • Known history of human immunodeficiency virus (HIV) positivity
  • History of retinal vein occlusion (RVO)
  • Symptomatic or untreated leptomeningeal or brain metastases or spinal cord compression
  • History of interstitial lung disease or pneumonitis
  • Are pregnant or lactating
  • Any underlying condition that would significantly interfere with the absorption of an oral medication
  • History of another active malignancy in last 3 years. Exception: Potential participants who have been disease-free for 3 years, or have a history of completely resected nonmelanoma skin cancer and/or potential participants with indolent second malignancies are eligible.
  • Uncontrolled infection requiring parenteral antibiotics, antivirals, or antifungals within one week prior to first dose; patients with controlled infection or on prophylactic antibiotics are permitted in the study
  • Have a known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs chemically related to study drug, or excipients or to dimethyl sulfoxide
  • Concurrent therapy with approved or investigational anticancer therapy
  • Concomitant use of strong Cytochrome P450 3A4 (CYP3A4) inducers

Sites / Locations

  • H. Lee Moffitt Cancer Center and Research Institute

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Trametinib plus Sorafenib

Arm Description

Dose Escalation Followed by Dose Expansion. Trametinib: Daily (To start on day 8 during cycle 1 and on day 1 from cycle 2 onwards), according to dose level upon entry. Sorafenib: Twice daily, according to dose level upon entry. Each cycle is repeated every 28 days.

Outcomes

Primary Outcome Measures

Maximum Tolerated Dose (MTD)
The MTD for study is defined as the highest dose level at which 1 or less of 6 patients experience a dose limiting toxicity (DLT).

Secondary Outcome Measures

Progression Free Survival (PFS)
PFS is defined as the duration of time from start of treatment to time of progression or death, whichever occurs first. Progression will be evaluated in this study using the new international criteria proposed by the revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1). Changes in the largest diameter (unidimensional measurement) of the tumor lesions and the shortest diameter in the case of malignant lymph nodes are used in the RECIST criteria. Further, modified RECIST criteria for HCC will be used to evaluate response. Progressive Disease (PD): At least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression).
Response Rate
Response will be evaluated in this study using the new international criteria proposed by the revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1). Changes in the largest diameter (unidimensional measurement) of the tumor lesions and the shortest diameter in the case of malignant lymph nodes are used in the RECIST criteria. Further, modified RECIST criteria for HCC will be used to evaluate response. Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm. Partial Response (PR): At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters.
Overall Survival (OS)
Overall Survival is defined as the time period from start of treatment to death.

Full Information

First Posted
November 12, 2014
Last Updated
June 9, 2021
Sponsor
H. Lee Moffitt Cancer Center and Research Institute
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1. Study Identification

Unique Protocol Identification Number
NCT02292173
Brief Title
Trametinib in Combination With Sorafenib in Patients With Advanced Hepatocellular Cancer
Official Title
A Phase 1a/1b Trial of Trametinib in Combination With Sorafenib in Patients With Advanced Hepatocellular Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
January 2021
Overall Recruitment Status
Completed
Study Start Date
February 18, 2015 (Actual)
Primary Completion Date
December 18, 2018 (Actual)
Study Completion Date
January 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
H. Lee Moffitt Cancer Center and Research Institute

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
No

5. Study Description

Brief Summary
The main purpose of this study is to see whether the combination of trametinib and sorafenib can help people with hepatocellular cancer. Researchers also want to find out if the combination of trametinib and sorafenib is safe and tolerable.
Detailed Description
Each cycle will last for 4 weeks. Sorafenib and trametinib will be administered orally on continuous basis. During the first cycle sorafenib will be started on day 1 and trametinib on day 8 to improve tolerance. Participants will get restaging scans every 2 cycles. Participants will continue to receive treatment if they have a stable disease or a better response by Response Evaluation Criteria in Solid Tumors (RECIST) criteria 1.1.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hepatocellular Cancer, Liver Cancer
Keywords
Liver Neoplasms, Liver Diseases, Digestive System Diseases, Advanced, Mitogen-Activated Protein Kinase (MEK) Inhibitor, Kinase Inhibitor

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
17 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Trametinib plus Sorafenib
Arm Type
Experimental
Arm Description
Dose Escalation Followed by Dose Expansion. Trametinib: Daily (To start on day 8 during cycle 1 and on day 1 from cycle 2 onwards), according to dose level upon entry. Sorafenib: Twice daily, according to dose level upon entry. Each cycle is repeated every 28 days.
Intervention Type
Drug
Intervention Name(s)
Trametinib
Other Intervention Name(s)
MEKINIST®
Intervention Description
Dose Escalation: Level 1: 1 mg daily. Level 2: 1.5 mg daily. Level 3: 1.5 mg daily. Level 4: 2 mg daily. Dose Expansion: Maximum Tolerated Dose (MTD)
Intervention Type
Drug
Intervention Name(s)
Sorafenib
Other Intervention Name(s)
Nexavar®
Intervention Description
Dose Escalation: Level 1: 200 mg twice daily. Level 2: 200 mg twice daily. Level 3: 400 mg twice daily. Level 4: 400 mg twice daily. Dose Expansion: Maximum Tolerated Dose (MTD)
Primary Outcome Measure Information:
Title
Maximum Tolerated Dose (MTD)
Description
The MTD for study is defined as the highest dose level at which 1 or less of 6 patients experience a dose limiting toxicity (DLT).
Time Frame
Up to 18 months
Secondary Outcome Measure Information:
Title
Progression Free Survival (PFS)
Description
PFS is defined as the duration of time from start of treatment to time of progression or death, whichever occurs first. Progression will be evaluated in this study using the new international criteria proposed by the revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1). Changes in the largest diameter (unidimensional measurement) of the tumor lesions and the shortest diameter in the case of malignant lymph nodes are used in the RECIST criteria. Further, modified RECIST criteria for HCC will be used to evaluate response. Progressive Disease (PD): At least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression).
Time Frame
Up to 3 years
Title
Response Rate
Description
Response will be evaluated in this study using the new international criteria proposed by the revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1). Changes in the largest diameter (unidimensional measurement) of the tumor lesions and the shortest diameter in the case of malignant lymph nodes are used in the RECIST criteria. Further, modified RECIST criteria for HCC will be used to evaluate response. Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm. Partial Response (PR): At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters.
Time Frame
Up to 3 years
Title
Overall Survival (OS)
Description
Overall Survival is defined as the time period from start of treatment to death.
Time Frame
Up to 3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Must have radiographic or histological diagnosis of hepatocellular cancer (HCC), with advanced stage disease that is not amenable to curative surgical resection. Potential participants without histologic diagnosis must meet the radiographic criteria for HCC. Child Pugh score must be 5 or 6 (Child Pugh Class A) Must have measurable disease by RECIST criteria 1.1 Eastern Cooperative Oncology Group (ECOG) performance status ≤1 Must have normal organ and marrow function Female participants of child-bearing potential must agree to use dual methods of contraception and have a negative serum pregnancy test at screening, and male participants must use an effective barrier method of contraception if sexually active with a female of child-bearing potential. For both male and female participants, effective methods of contraception must be used throughout the study and for four months following the last dose. Able to swallow and retain orally administered medication and does not have any clinically significant gastrointestinal abnormalities that may alter absorption such as malabsorption syndrome or major resection of the stomach or bowels Participants in the dose expansion part must have tumor that is amenable for biopsy. Ability to understand and the willingness to sign a written informed consent document Exclusion Criteria: Have received radiation therapy, major surgery, other locoregional therapy, within 4 weeks prior to the first dose of study drug All prior treatment-related toxicities must be ≤ Grade 1. Have received sorafenib or other systemic therapies for treatment of HCC in the past Any serious and/or unstable pre-existing medical disorder (aside from malignancy exception), psychiatric disorder, or other conditions that could interfere with participant's safety, obtaining informed consent or compliance to the study procedures History or evidence of cardiovascular risk Known history of human immunodeficiency virus (HIV) positivity History of retinal vein occlusion (RVO) Symptomatic or untreated leptomeningeal or brain metastases or spinal cord compression History of interstitial lung disease or pneumonitis Are pregnant or lactating Any underlying condition that would significantly interfere with the absorption of an oral medication History of another active malignancy in last 3 years. Exception: Potential participants who have been disease-free for 3 years, or have a history of completely resected nonmelanoma skin cancer and/or potential participants with indolent second malignancies are eligible. Uncontrolled infection requiring parenteral antibiotics, antivirals, or antifungals within one week prior to first dose; patients with controlled infection or on prophylactic antibiotics are permitted in the study Have a known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs chemically related to study drug, or excipients or to dimethyl sulfoxide Concurrent therapy with approved or investigational anticancer therapy Concomitant use of strong Cytochrome P450 3A4 (CYP3A4) inducers
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Richard Kim, M.D.
Organizational Affiliation
H. Lee Moffitt Cancer Center and Research Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
H. Lee Moffitt Cancer Center and Research Institute
City
Tampa
State/Province
Florida
ZIP/Postal Code
33612
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
32776632
Citation
Kim R, Tan E, Wang E, Mahipal A, Chen DT, Cao B, Masawi F, Machado C, Yu J, Kim DW. A Phase I Trial of Trametinib in Combination with Sorafenib in Patients with Advanced Hepatocellular Cancer. Oncologist. 2020 Dec;25(12):e1893-e1899. doi: 10.1634/theoncologist.2020-0759. Epub 2020 Sep 14.
Results Reference
derived

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Trametinib in Combination With Sorafenib in Patients With Advanced Hepatocellular Cancer

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