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Phase II Combination of Temsirolimus and Sorafenib in Advanced Hepatocellular Carcinoma

This study is currently recruiting participants. (see Contacts and Locations)
Verified November 2014 by University of California, San Francisco
Sponsor:
Collaborators:
Robert H. Lurie Cancer Center
Pfizer
Information provided by (Responsible Party):
University of California, San Francisco
ClinicalTrials.gov Identifier:
NCT01687673
First received: September 11, 2012
Last updated: November 5, 2014
Last verified: November 2014
  Purpose

This Phase II trial is being developed following the completion of a Phase I study of the combination of temsirolimus and sorafenib in 25 first-line therapy patients with advanced hepatocellular carcinoma (December 2009 through April 2012). The maximum tolerated dose (MTD) and recommended phase II dose (RP2D) of the combination of temsirolimus is 10 mg IV weekly plus sorafenib 200 mg (oral, twice daily).


Condition Intervention Phase
Hepatocellular Carcinoma
Drug: Temsirolimus
Drug: Sorafenib:
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase II Trial of the Combination of Temsirolimus and Sorafenib in Advanced Hepatocellular Carcinoma

Resource links provided by NLM:


Further study details as provided by University of California, San Francisco:

Primary Outcome Measures:
  • Median time to progression (TTP) [ Time Frame: 24 months ] [ Designated as safety issue: No ]
    Median TTP will be calculated in months from date of first dose of protocol therapy to date of removal from study for progression; Kaplan-Meier methods will be used to summarize the primary endpoint (median TTP).


Secondary Outcome Measures:
  • Response rate (RR) [ Time Frame: 24 months ] [ Designated as safety issue: No ]
    Response rate (RR) will be measured by RECIST version 1.1; measurements will be presented descriptively for the study cohort.

  • Progression free survival (PFS) [ Time Frame: 24 months ] [ Designated as safety issue: No ]
    Median PFS will be calculated in months from date of first dose of protocol therapy to date of documented disease progression or death from any cause. Kaplan-Meier methods will be used to summarize time-to-event outcomes including the primary endpoint (median TTP) and secondary endpoints (PFS, TTF, OS).

  • Overall survival (OS) [ Time Frame: 24 months ] [ Designated as safety issue: No ]
    Median OS for all enrolled patients (intention-to-treat) will be calculated from date of first dose of protocol therapy until date of death, using chart review and/or follow up phone calls to determine date of death in patients after removal from study.

  • Time to treatment failure (TTF) [ Time Frame: 24 months ] [ Designated as safety issue: No ]
    TTF will be measured from date of first dose of protocol therapy to date of study discontinuation for progression, death, or toxicity.

  • Toxicity & tolerability [ Time Frame: 24 months ] [ Designated as safety issue: Yes ]
    In patients with baseline AFP ≥ 20 ng/mL, AFP response will be measured by the percent change from baseline value to the value at the time of best AFP response. The change in AFP will also be examined for association with absolute TTP and best response.


Estimated Enrollment: 28
Study Start Date: September 2012
Estimated Study Completion Date: December 2018
Estimated Primary Completion Date: December 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Treatment
Combination temsirolimus plus sorafenib
Drug: Temsirolimus
10 mg weekly will be administered intravenously over 30 to 60 minutes using an infusion pump starting on Cycle 1, Day 1 of study enrollment.
Drug: Sorafenib:
200 mg tablet twice daily starting on Cycle 1, Day 1 of study enrollment after completion of temsirolimus infusion.

Detailed Description:

The hypothesis of this single-arm phase II study is that the combination of temsirolimus and sorafenib will achieve a clinically-meaningful median time to progression (TTP) of at least 6 months, with null hypothesis of less than or equal to 3 months, in first-line systemic therapy for patients with advanced HCC. A randomized trial would be required to formally compare the efficacy of this combination to sorafenib alone and will be indicated if this phase II study achieves a median TTP of at least 6 months. An interim safety analysis will employ stopping rules after 30% of planned patients have been treated with at least one dose of protocol therapy to ensure the combination does not confer excessive toxicity.

A key aspect of this study will be the requirement of histologic confirmation along with adequate archival tissue for correlative tissue analyses to explore new biomarkers of response to mTOR inhibition. Circulating biomarker data including enumeration of circulating tumor cells (CTC) and measurement of the tumor marker AFP will be performed at specific timepoints to evaluate for predictive value. Specimen banking of tissue, serum, and peripheral blood mononuclear cells will be undertaken to enable future novel biomarker studies. Modified RECIST will be performed in addition to standard RECIST 1.1 to explore for improved imaging predictors of response.

  Eligibility

Ages Eligible for Study:   18 Years to 85 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

INCLUSION CRITERIA

  1. Patients must have histologically diagnosed AJCC stage II, III, or IV HCC not eligible for curative resection, transplantation, or ablative therapies
  2. Radiographically measurable disease by RECIST version 1.1 in at least one site not previously treated with chemoembolization, radioembolization, or other local ablative procedures (i.e. must have at least one measurable target lesion, either within the liver or in a measurable metastatic site); a new area of tumor progression within or adjacent to a previously-treated lesion, if clearly measurable by a Radiologist, is acceptable
  3. No prior systemic cytotoxic chemotherapy or targeted therapy (including sorafenib) for HCC
  4. Prior chemoembolization, local ablative therapies, or hepatic resection permitted if completed ≥ 4 weeks prior to study enrollment if patient has recovered with ≤ grade 1 toxicity and if measurable disease (criterion 2) is present
  5. Prior radiation for bone or brain metastases is permitted if patient is now asymptomatic and has completed all radiation and steroid therapy (if applicable) for brain or bone metastases ≥ 2 weeks prior to study enrollment.
  6. Age ≥ 18 years.
  7. Child-Pugh score of A or B with ≤ 7 points and meeting laboratory eligibility for all parameters
  8. ECOG performance status of 0 or 1
  9. Life expectancy greater than 3 months
  10. Treatment with appropriate antiviral therapy for patients with active HBV infection is required
  11. Treatment for clinically-significant hyperglycemia, hyperlipidemia, or hypertension that develops on study is required
  12. Baseline blood pressure must be adequately controlled with or without antihypertensive medications prior to enrollment (systolic ≤ 150 mm Hg, diastolic ≤ 90 mm Hg)
  13. Baseline cholesterol must be < 350 mg/dL and triglycerides < 300 mg/dL (with or without the use of antihyperlipidemic medications)
  14. Baseline fasting blood glucose must be ≤ 140 mg/dL and hemoglobin A1c less than 7.5% (with or without the use of anti-diabetic medications)
  15. Adequate baseline organ and marrow function as defined below

    Adequate bone marrow function:

    absolute neutrophil count ≥ 1,000/mcL platelets ≥ 75,000/mcL hemoglobin ≥ 8.5 g/dL

    Adequate hepatic function:

    total bilirubin ≤ 2 mg/dL or ≤ 1.5 times ULN AST(SGOT) & ALT (SGPT) ≤ 5 X ULN INR ≤1. 5 X ULN

    Adequate renal function:

    albumin ≥ 2.8 g/dL creatinine ≤1. 5 X ULN

  16. Able to tolerate oral therapy.
  17. Ability to understand and willingness to provide informed consent, and the willingness to comply with the requirements of the protocol. Informed consent may be obtained with the assistance of a medical translator according to institutional policies.
  18. The effects of temsirolimus on the developing human fetus are unknown. For this reason and because sorafenib - also being used in this trial - is known to be teratogenic, women of child-bearing potential must have a negative pregnancy test within 14 days of study enrollment.

    Also, women of child-bearing potential and men must agree to use two methods adequate contraception (hormonal plus barrier or two forms of barrier) or abstinence prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she needs to inform her treating physician immediately. Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, or be surgically sterile, for the duration of study participation, and for 3 months after completion of study drug administration.

  19. Eligibility of patients receiving any medications or substances known to affect or with potential to affect the activity or pharmacokinetics of temsirolimus and/or sorafenib will be determined following review of the case by the Study Chair. Efforts should be made to switch patients who are taking enzyme-inducing anti-convulsant agents to other medications.

EXCLUSION CRITERIA:

  1. Mixed tumor histology or fibrolamellar variant tumors are excluded.
  2. Prior systemic or antiangiogenic therapy for HCC (including thalidomide, sorafenib, sunitinib, or bevacizumab). Prior systemic therapy for other diagnoses is permitted if greater than 6 months have elapsed since last dose, any prior toxicity has recovered to ≤ grade 1 by CTCAE v4.0, and treatment was not discontinued for toxicity.
  3. Prior treatment with mTOR inhibitor or other molecularly targeted therapy.
  4. Prior systemic cytotoxic therapies for HCC (chemoembolization is permitted if inclusion criteria are met).
  5. Treatment with other investigational agents.
  6. Immunosuppressive medications including systemic corticosteroids unless used for adrenal replacement, appetite stimulation, acute therapy for asthma or bronchitis exacerbation (≤ 2 weeks), or antiemesis
  7. Patients with known HIV infection are ineligible due to risk of pharmacokinetic interactions between anti-retroviral therapy and the study drugs, as well as potential for significant immunosuppression and serious infections with mTOR inhibition.
  8. Patients who have undergone liver transplantation are excluded.
  9. Uncontrolled hypertension (> 150/90 mmHg).
  10. Uncontrolled hyperlipidemia (total cholesterol > 350 or triglycerides > 300).
  11. Symptomatic brain or bone metastases; prior radiation and/or steroid therapy for brain or bone metastases (if applicable) must be completed ≥ 2 weeks prior to study enrollment.
  12. History of seizure disorder requiring antiepileptic medication or brain metastases with seizures.
  13. Serious non-healing wound, ulcer, bone fracture, or abscess.
  14. Major surgical procedure less than 4 weeks from start of protocol treatment.
  15. Patients requiring chronic anticoagulation with warfarin are excluded. Patients treated with low molecular weight heparin or unfractionated heparin are eligible if on a stable dose without evidence of clinically significant bleeding for at least 2 weeks prior to enrollment.
  16. Active second malignancy other than non-melanoma skin cancer or cervical carcinoma in situ. (Patients with history of malignancy are not considered to have a "currently active" malignancy if they have completed therapy and are now considered by their physician to be at less than 30% risk for relapse.)
  17. Uncontrolled intercurrent illness including, but not limited to: Ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, uncontrolled cardiac arrhythmia, uncontrolled peripheral vascular disease, myocardial infarction within preceding 12 months, cerebrovascular accident within preceding 12 months, pulmonary disease impairing functional status or requiring oxygen, impairment in gastrointestinal function that may affect or alter absorption of oral medications (such as malabsorption or history of gastrectomy or bowel resection).
  18. Patients will be excluded if there is any history of allergic reaction(s) attributed to compounds of similar composition to temsirolimus, sorafenib, their metabolites, or any component of their formulation (including excipients and polysorbate 80). This includes hypersensitivity to macrolide antibiotics due to potential for cross-reactivity with temsirolimus.
  19. Pregnant or lactating women are excluded from this study because temsirolimus and sorafenib are drugs with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with temsirolimus or sorafenib, breastfeeding should be discontinued if the mother is receiving temsirolimus/sorafenib treatment.
  20. Patients who require prohibited medications with potential for serious interactions with protocol therapy, and who cannot have therapeutic substitution are excluded. Patients receiving any medications or substances that are inhibitors or inducers of CYP450 enzyme(s) are ineligible. Lists of prohibited medications and substances known, or with the potential to interact with the specified CYP450 enzyme(s) isoenzymes are provided in Appendices 6-9 Prohibited Medications
  21. Psychiatric illness, other significant medical illness, or social situation which, in the investigator's opinion, would limit compliance or ability to comply with study requirements.
  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: NCT01687673

Contacts
Contact: Kate Kelley, MD 415-353-9888 katie.kelley@ucsf.edu
Contact: Jennifer Luan 415-514-6220 Jennifer.Luan@ucsf.edu

Locations
United States, California
University of California, San Francisco Recruiting
San Francisco, California, United States, 94143
Contact: Kate Kelley, MD    415-353-9888    katie.kelley@ucsf.edu   
Contact: Blake Rosenthal    415-514-5633    Blake.Rosenthal@ucsf.edu   
Sub-Investigator: Chloe E Atreya, MD, PhD         
Sub-Investigator: Emily K Bergsland, MD         
Sub-Investigator: Michael Korn, MD, PhD         
Sub-Investigator: Andrew H Ko, MD         
Sub-Investigator: Katherine Van Loon, MD         
Sub-Investigator: Alan P Venook, MD         
Sub-Investigator: Thomas Eaton Weber, NP         
United States, Illinois
Robert H Lurie Comprehensive Cancer Center Recruiting
Chicago, Illinois, United States, 60611
Contact: Erin Alonso, CCRC    312-695-4168    erin.alonso@northwestern.edu   
Principal Investigator: Halla Nimeiri, M.D.         
Sponsors and Collaborators
University of California, San Francisco
Robert H. Lurie Cancer Center
Pfizer
Investigators
Study Chair: Kate Kelley, MD University of California, San Francisco
Principal Investigator: Kate Kelley, MD University of California, San Francisco
  More Information

No publications provided

Responsible Party: University of California, San Francisco
ClinicalTrials.gov Identifier: NCT01687673     History of Changes
Other Study ID Numbers: UCSF CC# 124511
Study First Received: September 11, 2012
Last Updated: November 5, 2014
Health Authority: United States: Food and Drug Administration

Keywords provided by University of California, San Francisco:
Advanced HCC
Temsirolimus
TORISEL
Sorafenib

Additional relevant MeSH terms:
Carcinoma
Carcinoma, Hepatocellular
Adenocarcinoma
Digestive System Diseases
Digestive System Neoplasms
Liver Diseases
Liver Neoplasms
Neoplasms
Neoplasms by Histologic Type
Neoplasms by Site
Neoplasms, Glandular and Epithelial
Everolimus
Sirolimus
Sorafenib
Anti-Bacterial Agents
Anti-Infective Agents
Antibiotics, Antineoplastic
Antifungal Agents
Antineoplastic Agents
Enzyme Inhibitors
Immunologic Factors
Immunosuppressive Agents
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Physiological Effects of Drugs
Protein Kinase Inhibitors
Therapeutic Uses

ClinicalTrials.gov processed this record on November 20, 2014