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Sorafenib Induced Autophagy Using Hydroxychloroquine in Hepatocellular Cancer

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ClinicalTrials.gov Identifier: NCT03037437
Recruitment Status : Recruiting
First Posted : January 31, 2017
Last Update Posted : January 29, 2019
Sponsor:
Information provided by (Responsible Party):
Sukeshi Patel, The University of Texas Health Science Center at San Antonio

Brief Summary:
The PI is studying if sorafenib/hydroxychloroquine (HCQ) will have improved efficacy when compared to sorafenib alone and in patients progressing of sorafenib the addition of HCQ would lead to disease stability in patients with advanced hepatocellular cancer (HCC).

Condition or disease Intervention/treatment Phase
Hepatocellular Cancer Drug: Sorafenib (SOR) Drug: Hydroxychloroquine (HCQ) Phase 2

Detailed Description:

Phase 2 study with two cohorts:

Cohort 1: As second-line treatment, we will add HCQ to SOR dose the patient was tolerating at the time of progression.

Cohort 2: SOR-naïve patients receive SOR 400 mg by PO twice daily on Cycle1 Day1 (C1D1). On Cycle 1 Day 15, HCQ 400 mg PO daily will be started. In clinical practice, dose reduction of SOR may be required. On C1D15 SOR maybe kept as starting dose or reduced for toxicity. On Cycle 2 Day 1 of toxicity of HCQ and SOR will be assessed.

Each cycle is 28 days.

Blood samples will be collected at Cycle 1 Day 1, Cycle 1 Day 15 and Cycle 2 Day 1 to assess for biomarkers.

Disease evaluation every 2 cycles.

Dose reductions due to adverse events are allowed for both sorafenib per standard of care and/or HCQ for grade 3 or more adverse event was related to study medication. Dose reductions are also permitted based on investigator clinical decision.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 68 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Modulation of Sorafenib Induced Autophagy Using Hydroxychloroquine in Hepatocellular Cancer
Actual Study Start Date : February 16, 2017
Estimated Primary Completion Date : December 2019
Estimated Study Completion Date : December 2020

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Liver Cancer

Arm Intervention/treatment
Experimental: No prior systemic treatment
Sorafenib (SOR)-naïve patients receive SOR 400 mg by PO twice daily on Cycle1/Day1 (C1D1). In clinical practice, dose reduction of SOR is often required. Therefore, on C1D15, the clinician will dose-reduce sorafenib based on toxicity and hydroxychloroquine (HCQ) 400 mg PO daily will be started. C2D1 of each cohort, toxicity of HCQ will be assessed. Dose reductions due to adverse events (AEs) to each agent are allowed for SOR per standard of care and/or HCQ for grade 3+ AE.
Drug: Sorafenib (SOR)
Patients will receive SOR 400 mg by PO twice daily on Cycle1/Day1 (C1D1).
Other Name: Nexavar

Drug: Hydroxychloroquine (HCQ)
400mg by mouth daily
Other Name: Plaquenil

Experimental: Progress on sorafenib
As second-line treatment, we will add hydroxychloroquine (HCQ) to sorafenib (SOR) dose the patient was tolerating at the time of progression.
Drug: Sorafenib (SOR)
Patients will receive SOR 400 mg by PO twice daily on Cycle1/Day1 (C1D1).
Other Name: Nexavar

Drug: Hydroxychloroquine (HCQ)
400mg by mouth daily
Other Name: Plaquenil




Primary Outcome Measures :
  1. Time to tumor progression evaluated via tumor imaging [ Time Frame: Through study completion, an average of 1 year ]
    Computerized axial tomography (CAT) Scan or Magnetic resonance imaging (MRI) will be done at Screening, then every other cycle and evaluated using RECIST version 1.1



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Ages Eligible for Study:   18 Years to 100 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Cytologically or histologically confirmed advanced or metastatic HCC. If no histological diagnosis, patient must have imaging studies compatible with HCC.
  • Age 18 years and above
  • ECOG performance status of 0 or 1
  • Not a candidate for curative treatments (i.e., resection, transplantation)
  • Child-Pugh class A or B7 liver function
  • Measurable disease as defined by RECIST 1.1
  • Patients who received prior local therapy (e.g., TACE) are eligible.
  • Documented virology status of hepatitis, as confirmed by screening HBsAg, anti-HBc, and/or anti-HCV
  • Life expectancy> 3 months
  • For women who are not postmenopausal (12 months of amenorrhea) or surgically sterile (absence of ovaries and/or uterus): agreement to use two adequate methods of contraception. For men: agreement to use a barrier method of contraception during the treatment period
  • Hematologic, Biochemical, and Organ Function within 7 days prior to Cycle 1 Day 1: Granulocyte count > 1500/mm3, Platelet count > 75,000/ mm3, Hemoglobin > 8 g/dL; Total bilirubin < 2.0; Albumin > 2.8g/dl; AST (SGOT) and ALT (SGPT) < 5 x ULN; Serum creatinine< 1.5 x ULN
  • Cohort 1 (with sorafenib): No previous systemic therapy including sorafenib or chemotherapy treatment. Previous TACE and local treatments are permitted.
  • Cohort 2 (on progression of sorafenib): Patients who have received prior sorafenib therapy for at least 4 weeks and has confirmation of disease progression on CT/MRI. Prior surgery or local therapy within 4 weeks prior to Cycle 1 Day 1, with the exception of palliative radiation therapy to the bone

Exclusion Criteria:

  • Patients receiving prior therapy with HCQ.
  • Patients with uncontrolled brain metastases. Patients with brain metastases must be asymptomatic and off corticosteroids for at least one week.
  • Due to risk of disease exacerbation, patients with psoriasis are ineligible unless the disease is well controlled, and they are under the care of a specialist for the disorder who agrees to monitor the patient for exacerbations.
  • Patients with previously documented macular degeneration or or untreated diabetic retinopathy (stable retinopathy is allowed).
  • Patients may not be receiving any other investigational agents.
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to HCQ.
  • Patients requiring the use of enzyme-inducing anti-epileptic medication (phenytoin, carbamazepine, phenobarbital, primidone or oxcarbazepine) are not eligible for entry into the study.
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
  • QTc > 500 milliseconds (ms) at baseline.
  • Gastrointestinal tract disease resulting in an inability to take oral medication or a requirement for IV alimentation, prior surgical procedures affecting absorption, or active peptic ulcer disease. Patients with NG-tube, J-tube, or G-tube will not be allowed to participate.
  • Pregnant women are excluded from this study because sorafenib has the potential for teratogenic or abortifacient effects. For this reason, women of childbearing potential and men must also agree to use adequate contraception (hormonal or barrier method of birth control) prior to study entry and for the duration of study participation.
  • Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with sorafenib, breastfeeding should be discontinued.
  • Informed Consent - No study specific procedures will be performed without a written and signed informed consent document. Patients who do not demonstrate the ability to understand or the willingness to sign the written informed consent document will be excluded from study entry.

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 ClinicalTrials.gov identifier (NCT number): NCT03037437


Contacts
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Contact: Epp Goodwin 210-450-5798 ctrcreferral@uthscsa.edu
Contact: Sukeshi Patel Arora, MD 210-450-1015 aroras@uthscsa.edu

Locations
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United States, Texas
University of Texas Health Cancer Center Recruiting
San Antonio, Texas, United States, 78229
Contact: Epp Goodwin    210-450-5798    goodwine@uthscsa.edu   
Sponsors and Collaborators
The University of Texas Health Science Center at San Antonio
Investigators
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Principal Investigator: Sukeshi Patel Arora, MD Cancer Therapy & Research Center University of Texas Health Science Center San Antonio

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Responsible Party: Sukeshi Patel, Principal Investigator, The University of Texas Health Science Center at San Antonio
ClinicalTrials.gov Identifier: NCT03037437     History of Changes
Other Study ID Numbers: CTMS 16-0076
HSC20160515H ( Other Identifier: University of Texas Health Science Center- San Antonio )
First Posted: January 31, 2017    Key Record Dates
Last Update Posted: January 29, 2019
Last Verified: January 2019

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Sukeshi Patel, The University of Texas Health Science Center at San Antonio:
Hepatocellular Cancer
Sorafenib
Hydroxychloroquine

Additional relevant MeSH terms:
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Liver Neoplasms
Carcinoma, Hepatocellular
Digestive System Neoplasms
Neoplasms by Site
Neoplasms
Digestive System Diseases
Liver Diseases
Adenocarcinoma
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Sorafenib
Hydroxychloroquine
Antineoplastic Agents
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Antimalarials
Antiprotozoal Agents
Antiparasitic Agents
Anti-Infective Agents
Antirheumatic Agents