Sorafenib Tosylate Before and After Hepatic Arterial Chemoembolization With Doxorubicin Hydrochloride and Mitomycin C in Treating Patients With Localized Liver Cancer That Cannot Be Removed by Surgery

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00949182
Recruitment Status : Completed
First Posted : July 30, 2009
Last Update Posted : January 14, 2014
Information provided by (Responsible Party):
Andrew de la Torre, Rutgers, The State University of New Jersey

Brief Summary:

RATIONALE: Sorafenib tosylate 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. Drugs used in chemotherapy, such as doxorubicin hydrochloride and mitomycin C, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Chemoembolization kills tumor cells by carrying drugs directly into the tumor and blocking blood flow to the tumor. Giving sorafenib tosylate before and after chemoembolization may kill more tumor cells.

PURPOSE: This phase II trial is studying the side effects and how well giving sorafenib tosylate before and after hepatic arterial chemoembolization with doxorubicin hydrochloride and mitomycin C works in treating patients with localized liver cancer that cannot be removed by surgery.

Condition or disease Intervention/treatment Phase
Liver Cancer Drug: sorafenib tosylate, HACE : Doxorubicin Hydrochloride and Mitomycin C Other: laboratory biomarker analysis Phase 2

Detailed Description:



  • To evaluate the safety and tolerability of sorafenib tosylate therapy when administered before and after doxorubicin hydrochloride-based hepatic arterial chemoembolization (HACE) as assessed by NCI CTCAE v3.0 in patients with localized unresectable hepatocellular carcinoma.


  • To determine if sorafenib tosylate decreases the number of HACE treatments required to achieve radiologic tumor kill.
  • To assess improvement in progression-free survival.
  • To assess changes in monthly AFP levels in patients with AFP-producing tumors.
  • To measure VEGF levels.

OUTLINE: Patients receive oral sorafenib tosylate twice daily on days 1-14. Beginning ≥ 3 days later, patients undergo hepatic arterial chemoembolization (HACE)* with doxorubicin hydrochloride and mitomycin C. Beginning ≥ 3 days after the completion of HACE and/or once liver function returns to baseline, patients resume sorafenib tosylate twice daily for up to 6 months in the absence of disease progression or unacceptable toxicity.

NOTE: *Patients may undergo more than one HACE treatment.

Blood samples are collected periodically for further laboratory analysis.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 20 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Micro and Macro Arteriolar Blockade of Hepatocellular Carcinoma (HCC): Treatment With Sorafenib Before and After Hepatic Arterial Embolization (HAE) Therapy for Liver Cancer.
Study Start Date : July 2009
Actual Primary Completion Date : June 2013
Actual Study Completion Date : June 2013

Arm Intervention/treatment
Experimental: Sorafenib Tosylate, Doxorubicin, Mytomicin C
Micro and Macro arteriolar blockade of hepatocellular carcinoma (HCC): Treatment with Sorafenib 400mg two weeks prior to embolization HACE which includes the use of agents such as Doxorubicin Hydrochloride and Mytomicin C, continuing same Sorafenib dose after the procedure (dose adjustment according to tolerance).
Drug: sorafenib tosylate, HACE : Doxorubicin Hydrochloride and Mitomycin C
After Sorafenib Tosylate has been administered the actual HACE procedure is performed using Doxorubicin Hydrochloride or Mitomycin C
Other Name: Doxorubicin brand name Adriamycin.

Other: laboratory biomarker analysis

Primary Outcome Measures :
  1. Safety and tolerability as assessed by NCI CTCAE v3.0 [ Time Frame: 06/2009 to 12/2010 ]

Secondary Outcome Measures :
  1. Number of hepatic arterial chemoembolization (HACE) treatments required to achieve objective complete response [ Time Frame: 06/2009 to 12/2010 ]
  2. Progression-free survival and time to radiologic progression as assessed by CT scan [ Time Frame: 06/2009 to 12/2010 ]
  3. Overall survival at 6, 12, and 24 months [ Time Frame: 06/2009 to 12/2011 ]
  4. AFP and VEGF serum levels as assessed at baseline, prior to each HACE treatment, and then every 3 months thereafter [ Time Frame: 06/2009 to 12/2011 ]

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria

  • Age > 18 years old
  • Confirmed HCC diagnosis by Biopsy or Radiologic parameters. Following NCCN guidelines for HACE, including subjects within the University of San Francisco transplant listing criteria.
  • ECOG Performance Status 0 or 1
  • Adequate bone marrow, liver and renal function as .assessed by the following:

    • Hemoglobin > 9.0 g/dl
    • Absolute neutrophil count (ANC) > 1,500/mm3
    • Platelet count > 75,000/mm3
    • Total bilirubin < 2 mg/dl
    • ALT and AST < 2.5 times the ULN ( < 5 x ULN for patients with liver involvement)
    • Creatinine < 1.5 times mg/dl
  • Women of childbearing potential must have a negative serum pregnancy test performed within 7 days prior to the start of treatment
  • Women of childbearing potential and men must agree to use adequate contraception (barrier method of birth control) prior to study entry and for the duration of study participation. Men should use adequate birth control for at least three months after the last administration of sorafenib.
  • Ability to understand and the willingness to sign a written informed consent. A signed informed consent must be obtained prior to any study specific procedures.
  • INR < 1.5 or a PT/PTT within normal limits. Patients receiving anti-coagulation treatment with an agent such as warfarin or heparin may be allowed to participate. For patients on warfarin, the INR should be measured prior to initiation of sorafenib and monitored at least weekly, or as defined by the local standard of care, until INR is stable.
  • BCLC Stage B (Intermediate)

    • multinodular asymptomatic tumors
    • without vascular invasion
    • without extrahepatic spread
  • Child Pugh A through B7
  • Male or female patients > 18 years of age
  • Life expectancy of at least 12 weeks. Patients with unresectable, multinodular asymptomatic tumor (no vascular invasion or extrahepatic spread)
  • Patients with histologically or cytologically documented HCC. Documentation of original biopsy for diagnosis is acceptable if tumor tissue is unavailable
  • Prior informed consent.
  • At least one tumor lesion that meets both of the following criteria:

    • The lesion can be accurately measured in at least one dimension according to RECIST
    • The lesion has not been previously treated with local therapy (such as surgery, radiation therapy, RFA, PEI, or cryoablation)

Exclusion Criteria

  • Cardiac disease: Congestive heart failure > class II NYHA. Patients must not have unstable angina (anginal symptoms at rest) or new onset angina (began within the last 3 months) or myocardial infarction within the past 6 months.
  • Known brain metastasis or CNS disease. Patients with neurological symptoms must undergo a CT scan/MRI of the brain to exclude brain metastasis.
  • Cardiac ventricular arrhythmias requiring anti-arrhythmic therapy.
  • Uncontrolled hypertension defined as systolic blood pressure > 150 mmHg or diastolic pressure > 90 mmHg, despite optimal medical management.
  • Known human immunodeficiency virus (HIV) infection
  • Active clinically serious infection > CTCAE Grade 2 except hepatitis B or C.
  • Thrombolic or embolic events such as a cerebrovascular accident including transient ischemic attacks within the past 6 months.
  • Pulmonary hemorrhage/bleeding event > CTCAE Grade 2 within 4 weeks of first dose of study drug.
  • Any other hemorrhage/bleeding event > CTCAE Grade 3 within 4 weeks of first dose of study drug.
  • Serious non-healing wound, ulcer, or bone fracture.
  • Evidence or history of bleeding diathesis or coagulopathy
  • Major surgery, open biopsy or significant traumatic injury within 4 weeks of first study drug.
  • Use of St. John's Wort or rifampin (rifampicin).
  • Known or suspected allergy to sorafenib or any agent given in the course of this trial.
  • Any condition that impairs patient's ability to swallow whole pills.
  • Any malabsorption problem.
  • Use of any prior systemic chemotherapy or targeted agents.
  • Diffuse HCC or presence of vascular invasion (including segmental portal obstruction), extrahepatic spread
  • Advanced liver disease: unstable ascites or >Child-Pugh B7
  • Porto-systemic shunt
  • Any contraindication for an arterial procedure such as impaired clotting tests (platelet count < 50.000/mm3 or prothrombin activity < 50 percent), 1
  • Renal failure
  • Severe atheromatosis
  • Any contraindication for systemic chemotherapy administration (serum bilirubin > 5mg/dL, leukocyte count < 3.000 cells/mm3)
  • Any contraindication for sorafenib administration
  • Patients with clinically significant gastrointestinal bleeding within 30 days prior to study entry
  • Substance abuse, medical, psychological or social conditions that may interfere with the patient's participation in the study or evaluation of the study results
  • Pregnant or breast-feeding patients
  • Previous or concurrent cancer that is distinct in primary site or histology from HCC, EXCEPT cervical carcinoma in situ, treated basal cell carcinoma, superficial bladder tumors (Ta, Tis & T1). Any cancer curatively treated > 3 years prior to entry is permitted
  • Patients receiving therapy for Hepatitis A, B or C
  • Encephalopathy ≥ Grade 1.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00949182

United States, New Jersey
Rutgers University Hospital
Newark, New Jersey, United States, 07101
Sponsors and Collaborators
Rutgers, The State University of New Jersey
Principal Investigator: Andrew N. de la Torre, MD Rutgers University Hospital / St Joseph Medical Center

Responsible Party: Andrew de la Torre, M.D, Rutgers, The State University of New Jersey Identifier: NCT00949182     History of Changes
Other Study ID Numbers: CDR0000649008
UMDNJ-20090859 ( Other Identifier: WIRB )
BAYER-IST000477 ( Other Grant/Funding Number: Bayer Health Care Pharmaceuticals )
First Posted: July 30, 2009    Key Record Dates
Last Update Posted: January 14, 2014
Last Verified: January 2014

Keywords provided by Andrew de la Torre, Rutgers, The State University of New Jersey:
localized unresectable adult primary liver cancer
adult primary hepatocellular carcinoma

Additional relevant MeSH terms:
Liver Neoplasms
Carcinoma, Hepatocellular
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Digestive System Neoplasms
Neoplasms by Site
Digestive System Diseases
Liver Diseases
Liposomal doxorubicin
Antibiotics, Antineoplastic
Antineoplastic Agents
Topoisomerase II Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Protein Kinase Inhibitors
Vitamin B Complex
Growth Substances
Physiological Effects of Drugs
Alkylating Agents