Sunitinib and Chemoembolization in Treating Patients With Liver Cancer That Cannot Be Removed by Surgery

This study has been terminated.
(low accrual)
Sponsor:
Information provided by (Responsible Party):
Roswell Park Cancer Institute
ClinicalTrials.gov Identifier:
NCT00524316
First received: August 31, 2007
Last updated: May 19, 2014
Last verified: May 2014
  Purpose

RATIONALE: Sunitinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor. Chemoembolization kills tumor cells by blocking the blood flow to the tumor and keeping chemotherapy drugs, such as doxorubicin, near the tumor. Giving sunitinib together with chemoembolization may kill more tumor cells.

PURPOSE: This phase II trial is studying how well giving sunitinib together with chemoembolization works in treating patients with liver cancer that cannot be removed by surgery.


Condition Intervention Phase
Liver Cancer
Drug: doxorubicin hydrochloride
Drug: sunitinib malate
Other: laboratory biomarker analysis
Procedure: hepatic artery embolization
Procedure: quality-of-life assessment
Phase 2

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase II Study of SUNITINIB MALATE (Sutent) and Chemoembolization in Patients With Unresectable Hepatocellular Cancer

Resource links provided by NLM:


Further study details as provided by Roswell Park Cancer Institute:

Primary Outcome Measures:
  • Progression-free Survival at 4 Months [ Time Frame: 4 months ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Overall Survival [ Time Frame: Every 6 months after removal from treatment till death ] [ Designated as safety issue: No ]
    median survival in months

  • Tissue Perfusion, Ktrans, IAUC, and Percent Viable Tumor as Measured by DCE-MRI at Baseline and on Days 8 (Before Transarterial Chemoembolization), 10, and 35 [ Time Frame: Baseline, day 8, day 10, day 28 and day 35 ] [ Designated as safety issue: No ]
  • Safety and Tolerability [ Time Frame: Daily while on treatment ] [ Designated as safety issue: Yes ]

    Number of participants with adverse advent.

    Please refer to adverse event reporting for more detail.


  • Quality of Life as Measured by the FACT-HEP Scale Prior to Each Course of Therapy [ Time Frame: Every 6 weeks ] [ Designated as safety issue: No ]
  • Tumor Marker Response (AFP) [ Time Frame: Baseline, week 7 and every 6 weeks after ] [ Designated as safety issue: No ]

Enrollment: 16
Study Start Date: April 2007
Study Completion Date: May 2014
Primary Completion Date: December 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Sunitinib
oral sunitinib malate once daily on days 1-7 and 15-35 in course 1 and on days 1-28 in all subsequent courses
Drug: doxorubicin hydrochloride
Transarterial chemoembolization
Drug: sunitinib malate
Given Orally
Other: laboratory biomarker analysis
Correlative Study
Procedure: hepatic artery embolization
Surgical procedure
Procedure: quality-of-life assessment
Correlative Study

Detailed Description:

OBJECTIVES:

Primary

  • To determine the progression-free survival at 4 months of patients treated with this regimen.

Secondary

  • To determine overall survival of these patients.
  • To determine if dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can be used to measure decrease in tumor perfusion and vascular permeability as a result of treatment with sunitinib malate in combination with TACE, and if it can be useful in prognosis.
  • To examine the safety and tolerability of this regimen.
  • To determine if a change in circulating endothelial precursor cell number and total monocyte count on days 3, 8, 10, and 35 of therapy (as compared with levels at baseline) and decrease in soluble vascular endothelial growth factor receptor-2 in serum on days 8 (before TACE), 10, and 35 of therapy (as compared with baseline) correlate with improved response and survival.
  • To determine the effect of this therapy on quality of life as measured by the FACT-HEP scale prior to each course of therapy.

OUTLINE: This is a multicenter study.

Patients receive oral sunitinib malate once daily on days 1-7 and 15-35 in course 1 and on days 1-28 in all subsequent courses. Patients undergo hepatic artery chemoembolization with doxorubicin hydrochloride on day 8 of course 1 only. Treatment with sunitinib malate repeats every 6 weeks* in the absence of disease progression or unacceptable toxicity.

NOTE: *Course 1 is 7 weeks in duration; all subsequent courses are 6 weeks in duration.

Blood samples are collected at baseline and periodically during study to measure circulating endothelial precursor cell levels, total monocyte count, and soluble vascular endothelial growth factor receptor-2.

Quality of life is assessed by the FACT-HEP scale at baseline, prior to each course of treatment, and then at the completion of treatment.

After completion of study treatment, patients are followed every 6 months.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically, cytologically, or serologically* confirmed hepatocellular carcinoma meeting the following criteria:

    • 1-4 lesions
    • Involvement of 1 or both liver lobes NOTE: *Alpha-fetoprotein (AFP) > 500 mcg/L in high-risk patients
  • Measurable disease by CT scan or MRI

    • Disease does not exceed 50% of the liver parenchyma
    • At least 1 lesion ≥ 3 cm in longest diameter
  • Tumor burden involves < 50% of the liver
  • Refused surgery OR unresectable disease due to any of the following:

    • Multifocality
    • Advanced cirrhosis
    • Comorbid illness
  • Candidate for chemoembolization
  • No fibrolamellar histology
  • No ascites
  • No known brain metastases

PATIENT CHARACTERISTICS:

  • ECOG performance status 0-2
  • Life expectancy ≥ 12 weeks
  • WBC ≥ 3,000/mm³
  • ANC ≥ 1,500/mm³
  • Hemoglobin ≥ 8.5 g/dL (transfusion allowed)
  • Platelet count ≥ 100,000/mm³
  • Bilirubin ≤ 2 mg/dL
  • AST ≤ 5 times upper limit of normal (ULN)
  • INR < 1.5
  • Creatinine ≤ 2.0 mg/dL OR creatinine clearance ≥ 30 mL/min
  • No bleeding diathesis or coagulopathy
  • No active congestive heart failure
  • No uncontrolled angina
  • No myocardial infarction within the past 12 months
  • No cardiac arrhythmia
  • Ejection fraction ≥ 45% (in patients with known coronary artery disease and in patients > 50 years of age)
  • Child-Pugh class A or B cirrhosis
  • No impedance of hepatopedal blood flow (portal vein thrombosis)
  • No thrombosis of the main portal vein
  • No encephalopathy
  • No biliary obstruction
  • No variceal bleed within the past 6 months
  • No history of allergic reactions attributed to compounds of similar chemical or biologic composition to sunitinib malate
  • No absolute contraindication to doxorubicin, iodinated contrast material, microfibrillar collage hemostat, or dexamethasone
  • No other concurrent uncontrolled illness including, but not limited to, any of the following:

    • Ongoing or active infection
    • Psychiatric illness or social situation that would limit compliance with study requirements
  • No other active malignancies within the past year except nonmelanoma skin cancer or carcinoma in situ
  • No significant traumatic injury within the past 4 weeks
  • No QTc prolongation (i.e., QTc interval ≥ 500 msec) or other significant ECG abnormalities
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for 6 months after the completion of study treatment

PRIOR CONCURRENT THERAPY:

  • Recovered from prior therapy
  • Prior liver-directed therapy, such as chemoembolization, radiofrequency ablation, cryoablation, or ethanol injection allowed if the following criteria are met:

    • Treated lesion remains inactive by CT scan or MRI and new lesion being embolized is distinct from the previously treated lesion
    • Radiographic progression of previously treated lesion requiring re-embolization
  • Prior liver resection allowed
  • Prior immunotherapy allowed
  • No prior antiangiogenesis therapy
  • No prior liver transplantation

    • Patients awaiting a cadaveric or orthotopic liver transplantation are eligible provided they have end-stage liver disease with a priority score of < 20 points
  • More than 4 weeks since prior radiotherapy or chemotherapy (6 weeks for nitrosoureas or mitomycin C)
  • More than 4 weeks since prior major surgery or open biopsy
  • At least 1 week since prior fine needle biopsy
  • No concurrent immunotherapy
  • No concurrent radiotherapy
  • No concurrent combination antiretroviral therapy for HIV-positive patients
  • No concurrent therapeutic doses of coumarin-derivative anticoagulants (e.g., warfarin)

    • Doses of ≤ 1 mg/day are allowed for prophylaxis of thrombosis as long as INR ≤ 1.5
    • Both full dose and prophylactic dose low molecular weight heparin allowed as long as PT INR ≤ 1.5
  • No anticipated major surgery during and for 3 months after completion of study treatment
  • No other concurrent investigational agents
  • No other concurrent anticancer therapy
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00524316

Locations
United States, New York
Roswell Park Cancer Institute
Buffalo, New York, United States, 14263-0001
Sponsors and Collaborators
Roswell Park Cancer Institute
Investigators
Principal Investigator: Renuka Iyer, MD Roswell Park Cancer Institute
  More Information

Additional Information:
No publications provided

Responsible Party: Roswell Park Cancer Institute
ClinicalTrials.gov Identifier: NCT00524316     History of Changes
Other Study ID Numbers: CDR0000563261, RPCI-I-82706
Study First Received: August 31, 2007
Results First Received: December 26, 2013
Last Updated: May 19, 2014
Health Authority: United States: Food and Drug Administration

Keywords provided by Roswell Park Cancer Institute:
adult primary hepatocellular carcinoma
advanced adult primary liver cancer
localized unresectable adult primary liver cancer
recurrent adult primary liver cancer

Additional relevant MeSH terms:
Liver Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Neoplasms
Digestive System Diseases
Liver Diseases
Doxorubicin
Liposomal doxorubicin
Sunitinib
Antibiotics, Antineoplastic
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Topoisomerase II Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Physiological Effects of Drugs
Growth Inhibitors

ClinicalTrials.gov processed this record on August 28, 2014