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Axitinib Plus Toripalimab as Second-line Treatment in Hepatobiliary Malignant Tumors

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ClinicalTrials.gov Identifier: NCT04010071
Recruitment Status : Not yet recruiting
First Posted : July 8, 2019
Last Update Posted : July 8, 2019
Sponsor:
Collaborator:
Shanghai Junshi Biosciences Co., LTD
Information provided by (Responsible Party):
Peking Union Medical College Hospital

Brief Summary:
The investigators design a phase II clinical study to explore the efficacy and safety of axitinib plus toripalimab as a second-line treatment in patients with hepatobiliary malignant tumors and to analyze potential biomarkers of therapeutic response.

Condition or disease Intervention/treatment Phase
Hepatobiliary Neoplasm Liver Neoplasm Biliary Tract Neoplasms Drug: axitinib plus toripalimab Phase 2

Detailed Description:

This phase II trial is a single-arm, non-randomized and single-center clinical study.

It is estimated that 60 patients who met the study criteria will be enrolled in PUMCH and treated with axitinib plus toripalimab. The investigators will follow up and collect subjects' data each month to evaluate the efficacy and safety of treatment, including overall survival and time to progression, until disease progression or death. Histopathology and multi-omics data analysis will be used to explore potential biomarkers of treatment response.

Study Type: Interventional. Masking: Open Label.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 60 participants
Intervention Model: Single Group Assignment
Intervention Model Description: Patients were confirmed with advanced hepatobiliary malignancies by imaging and histological examination and meet with the inclusive criteria, including hepatocellular carcinoma, cholangiocarcinoma, ampullary carcinoma, gallbladder carcinoma, and mixed cancer).
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Axitinib Plus Toripalimab as Second-line Treatment in Hepatobiliary Malignant Tumors: a Single-arm, Non-randomized, Single-center Phase II Trial
Estimated Study Start Date : July 1, 2019
Estimated Primary Completion Date : January 1, 2020
Estimated Study Completion Date : June 30, 2020

Resource links provided by the National Library of Medicine

Drug Information available for: Axitinib

Arm Intervention/treatment
Experimental: axitinib plus toripalimab

Axitinib (Inlyta, Pfizer Inc.) is a novel oral angiogenesis inhibitor that selectively targets vascular endothelial growth factor (VEGFR) 1, 2 and 3.

Toripalimab (Shanghai Junshi Biosciences Co., Ltd.) is a recombinant anti-human PD-1 IgG4 monoclonal antibody.

Drug: axitinib plus toripalimab

Axitinib 5mg, twice a day, orally, 4 weeks a cycle. Dose reduction from 5mg twice a day to 3mg twice a day should be considered according to adverse events.

Toripalimab 240mg, every 3 weeks, intravenous infused, 6 weeks a cycle. Number of cycle: until disease progression or unacceptable toxicity events.





Primary Outcome Measures :
  1. objective response rate (ORR) [ Time Frame: one year ]
    Proportion of patients whose tumor volume has reached a predetermined value and can maintain a minimum time limit, including complete response and partial response patients.

  2. Progression-free Survival (PFS) [ Time Frame: six months ]
    A duration from the date of initial treatment with axitinib plus toripalimab to disease progression (defined by RECIST 1.1) or death of any cause.


Secondary Outcome Measures :
  1. Disease Control Rate (DCR) [ Time Frame: one year ]
    Proportion of patients whose tumor volume control (reduced or enlarged) reaches a predetermined value and can maintain a minimum time limit.

  2. Overall Survival (OS) [ Time Frame: two years ]
    Duration from the date of initial treatment with axitinib plus toripalimab to the date of death due to any cause.

  3. Duration of Response (DOR) [ Time Frame: one year ]
    Duration from the first time reported partial response or complete response to the first time of disease progression or death.

  4. Stable Disease (SD) [ Time Frame: one year ]
    Proportion of patients with stable disease status more than 4 months.

  5. Progression free survival rate [ Time Frame: six months ]
    Portion of patients who do not experience disease progression (defined by RECIST 1.1) or death of any cause after treated with axitinib plus toripalimab for 3 months and 6 months, respectively.

  6. Rate of 6-months and 1-year overall survival [ Time Frame: one year ]
    Portion of patients who die of any cause after treated with axitinib plus toripalimab for 6 months and 12 months, respectively.


Other Outcome Measures:
  1. Any adverse events related with treatment with axitinib plus toripalimab. [ Time Frame: one year ]
    Safety and tolerability of the treatment

  2. PD-L1 expression [ Time Frame: six months ]
    PD-L1 expression in tumor tissues.

  3. Tumor mutation burden [ Time Frame: six months ]
    Tumor mutation burden assessed by whole exome sequencing.



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

Inclusion Criteria: Subjects must meet all of the following criteria

  • Subjects volunteer to participate in the study and agree to sign the informed consent with good compliance and follow-up.
  • Subjects are 18 years old or older when signing the informed consent and gender is not limited.
  • Subjects were diagnosed with advanced hepatobiliary malignant tumors (clinical stage IV) by imaging and histological examination, including hepatocellular carcinoma, cholangiocarcinoma, ampullary carcinoma, gallbladder carcinoma and mixed carcinoma.
  • The disease is not suitable for radical surgery and/or topical treatment, or disease progression occurs after surgery and/or local treatment.
  • At least one measurable lesion (according to RECIST version 1.1): the measurable lesion has a long diameter ≥ 10 mm or lymphadenopathy has a short diameter ≥ 15 mm in spiral CT scan.
  • Patients fail after at least one systemic failure, including surgery, intervention, radiotherapy, chemotherapy and targeted therapy and require palliative treatment.

Definition of treatment failure: Disease progression during treatment or relapse after treatment, such as after at least once radical or palliative resection surgery, revenue recurrence or progression after intervention therapy or radiotherapy. Intervention therapy or oxaliplatin treatment must be more than 1 cycle, and molecular targeted therapy must more than ≥14 days.

Definition of intolerance: Grade ≥IV hematologic toxicity, or grade ≥III non- hematologic toxicity, or grade ≥ II damage of heart, liver and kidney during treatment.

  • The ECOG score is 0-1 within 1 week before enrollment.
  • Liver function assessment: Child-Pugh Grade A or mild Grade B (score ≤ 7), BCLC stage B-C.
  • More than 2 weeks from first-line system treatment failure to sign informed consent for this study, and adverse events returned to normal (NCI-CTCAE ≤ I).
  • Estimated survival time ≥ 6 months.
  • HBV DNA <2000 IU/ml (10^4 copies/ml).
  • Hematology and organ function are sufficient based on the following laboratory results within 14 days prior to the treatment of this study:

Whole blood cell examination (no blood transfusion within 14 days, no G-CSF use and no drugs use): Hb≥100g/L, ANC≥1.5×10*9/L, PLT≥75×10*9/L.

Biochemical examination (no ALB infused within 14 days): ALB≥35g/L, ALT and AST<3×ULN, TBIL≤2×ULN, creatinine≤1.5×ULN, PT≤ULN+4S, INR≤2.2 (note: only one of albumin and bilirubin is permitted Child-Pugh score 2).

  • There are no active autoimmune diseases that require systemic therapy in the past 2 years (note: active state means requiring disease modulators, corticosteroids or immunosuppressive drugs use). Alternative therapies, such as thyroxine, insulin or a physiological corticosteroid replacement therapy are not considered as systemic therapy.
  • Women with fertility agree to abstinence during the treatment period and at least 6 months after the last dose (avoiding heterosexual intercourse) or using a contraceptive method with an annual contraceptive failure rate <1%.

If a female patient has menstruation and not reached the postmenopausal state (continuously no menstruation ≥ 12 months and no other causes), and has not undergone sterilization by removing the ovaries and/or uterus), then the patient has fertility.

Contraceptive methods with a contraceptive failure rate <1% include bilateral tubal ligation, male sterilization, hormonal contraceptives that inhibit ovulation, hormone-releasing intrauterine devices and copper intrauterine devices.

The reliability of sexual desire should be evaluated relative to the duration of the clinical trial and lifestyle of patient. Periodic abstinence (eg. calendar days, ovulation, symptomatic body temperature or post-ovulation methods) and in vitro ejaculation are unacceptable methods of contraception.

  • Male patients agree to abstinence (no heterosexual intercourse) or use of contraceptive measures and no sperm donation, as defined below:

When a female partner has fertility, male patients must abstinence from sex during treatment and at least 6 months after the last dose of treatment, or use condoms and other contraceptive methods with contraceptive failure rate <1%. At the same time, male patients must also agree not to donate sperm.

When a female partner is pregnant, the male patient must abstinence or using a condom during the treatment period and at least 6 months after the last dose of treatment to prevent the fetus from being affected by the study.

The reliability of sexual desire should be evaluated relative to the duration of the clinical trial and lifestyle of patient. Periodic abstinence (eg. calendar days, ovulation, symptomatic body temperature or post-ovulation methods) and in vitro ejaculation are unacceptable methods of contraception.

  • Tumor tissue must be available for biomarker analysis prior to the first dose of treatment, If not available, participants can consult the investigator for enrollment agreement. (Note: If an unstained section is submitted, the new section should be submitted to the laboratory within 14 days.)

Exclusion Criteria: Subjects with one or more than one of the following criteria should be excluded

  • Clinical stage I-III, and/or with any of the following: Suitable for radical surgery; Or, without an assessment lesion after radical surgery; Or, never receive any first line treatment; Or, liver transplantation history or ready for liver transplantation.
  • Already known to be allergic to recombinant humanized PD-1 monoclonal antibody drugs and components; known to be allergic to axitinib and components.
  • ECOG score ≥ 2 points.
  • Received any topical treatment within 4 weeks prior to the study, including but not limited to surgery, radiotherapy, hepatic artery embolization, TACE, hepatic artery perfusion, radiofrequency ablation, cryoablation or percutaneous ethanol injection.
  • Received any systemic anti-tumor treatment within 3 months prior to participation in the study, including but not limited to intravenous infused and/or oral chemotherapy, targeted drugs, antibody drugs, and traditional Chinese medicines known to have anticancer effects.
  • Ascites with clinical symptoms which requires abdominal puncture or drainage therapy, or Child-Pugh score >2 points.
  • With serious systemic diseases such as heart disease and cerebrovascular disease, and the condition is unstable or uncontrollable.
  • Already known active central nervous system metastasis and/or cancerous meningitis. Subjects with stable brain metastases after previous treatment may participate as long as no radiologic evidence of progression lasts for at least four weeks prior to this trial and any neurological symptoms have returned to baseline, and no new or enlarged metastatic evidence in brain and no steroids use for at least 7 days prior to trial treatment. Cancer meningitis should be excluded regardless of clinical stability.
  • Surgery was performed within 4 weeks prior to the trial and patients must be evaluated after wound healing.
  • Hepatic and renal dysfunction evidence: jaundice, ascites, and/or bilirubin ≥ 2 × ULN, and/or alkaline phosphatase ≥ 3 × ULN, and/or ≥ 3 grade (CTC-AE 5.0) proteinuria (> 3.5g /24 hours), or renal failure requiring blood dialysis or peritoneal dialysis.
  • Urine examination shows urinary protein ≥ ++ or 24 hours urine protein >1.0g.
  • Persistent >2 grade (CTC-AE5.0) infection.
  • History of allogeneic tissue transplantation or solid organ transplantation.
  • History of active tuberculosis, such as mycobacterium tuberculosis.
  • Intolerant of any drug (or any excipient) in this trial.
  • Female patients who are pregnant, breastfeeding or refuse contraception.
  • Known or untreated brain metastases, or patients with epilepsy who need medication treatment.
  • Patients with bone metastases received palliative radiotherapy (radiation area > 5% bone marrow area) within 4 weeks prior to this study, or there were wounds, ulcers or fractures that could not be healed, or patients have organ transplantation history.
  • Gastrointestinal bleeding history in the past 6 months or tendency to gastrointestinal bleeding, such as esophageal varices, local active ulceration lesions, fecal occult blood ≥ (++) (gastroscopy is required when fecal occult blood is (+)).
  • Evidence or history of ≥3 grade (CTC-AE5.0) bleeding events.
  • History of human immunodeficiency virus infection.
  • History of hepatitis B virus or hepatitis C virus infection, and not receive regular treatment.
  • Severe non-healing wounds, ulcers or fractures.
  • Prior treatment with either axitinib or any kind of anti-PD-1, anti-PD-L1 or anti-PD-L2 drugs.
  • Diagnosis of immunodeficiency or systemic steroid therapy or any form of immunosuppressants therapy within 7 days prior to this study. A physiological dose of corticosteroids (no more than 7.5 mg/d prednisone or equivalent) can be approved after clinical evaluation.
  • There exists drug abuse, or any medical, psychological or social condition which might affect the study, the compliance or even the safety of patients.
  • Variable factors which significantly affect drug use and absorption, such as inability to swallow, chronic diarrhea and intestinal obstruction.
  • Any >1 grade (CTC-AE5.0) unresolved toxicity due to previous treatment or operation, except for hair loss, anemia, and hypothyroidism.
  • Vaccination of any live virus vaccine within 30 days prior to this study, except for seasonal flu vaccines without live virus.
  • Previous and current evidence of pulmonary fibrosis, interstitial pneumonia, pneumoconiosis, radiation pneumonitis, drug-associated pneumonia and severe impairment of lung function.
  • Received a potent CYP3A4 inhibitor treatment within 7 days prior to the study, or received a potent CYP3A4 inducer within 12 days prior to the study.
  • Patients participate in another clinical study at the same time.
  • Patients are unsuitable for participation in this research after comprehensive assessment by the researchers.

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): NCT04010071


Contacts
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Contact: Jianzhen Lin, MD +86 18800158133 jzlin816@126.com
Contact: Haitao Haitao, Prof

Locations
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China, Beijing
Peking Union Medical College Hospital Not yet recruiting
Beijing, Beijing, China, 100730
Contact: Jianzhen Lin, MD    +86-18800158133    drlinjz@163.com   
Contact: Xiao-Bo Yang, MD    +86-138-1167-5126    yangxiaobo67@pumch.cn   
Principal Investigator: Hai-Tao Zhao, MD         
Sponsors and Collaborators
Peking Union Medical College Hospital
Shanghai Junshi Biosciences Co., LTD
Investigators
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Study Chair: Haitao Haitao, Prof Peking Union Medical College Hospital (PUMCH)

Publications of Results:
Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Akinyemiju TF, Al Lami FH, Alam T, Alizadeh-Navaei R, Allen C, Alsharif U, Alvis-Guzman N, Amini E, Anderson BO, Aremu O, Artaman A, Asgedom SW, Assadi R, Atey TM, Avila-Burgos L, Awasthi A, Ba Saleem HO, Barac A, Bennett JR, Bensenor IM, Bhakta N, Brenner H, Cahuana-Hurtado L, Castañeda-Orjuela CA, Catalá-López F, Choi JJ, Christopher DJ, Chung SC, Curado MP, Dandona L, Dandona R, das Neves J, Dey S, Dharmaratne SD, Doku DT, Driscoll TR, Dubey M, Ebrahimi H, Edessa D, El-Khatib Z, Endries AY, Fischer F, Force LM, Foreman KJ, Gebrehiwot SW, Gopalani SV, Grosso G, Gupta R, Gyawali B, Hamadeh RR, Hamidi S, Harvey J, Hassen HY, Hay RJ, Hay SI, Heibati B, Hiluf MK, Horita N, Hosgood HD, Ilesanmi OS, Innos K, Islami F, Jakovljevic MB, Johnson SC, Jonas JB, Kasaeian A, Kassa TD, Khader YS, Khan EA, Khan G, Khang YH, Khosravi MH, Khubchandani J, Kopec JA, Kumar GA, Kutz M, Lad DP, Lafranconi A, Lan Q, Legesse Y, Leigh J, Linn S, Lunevicius R, Majeed A, Malekzadeh R, Malta DC, Mantovani LG, McMahon BJ, Meier T, Melaku YA, Melku M, Memiah P, Mendoza W, Meretoja TJ, Mezgebe HB, Miller TR, Mohammed S, Mokdad AH, Moosazadeh M, Moraga P, Mousavi SM, Nangia V, Nguyen CT, Nong VM, Ogbo FA, Olagunju AT, Pa M, Park EK, Patel T, Pereira DM, Pishgar F, Postma MJ, Pourmalek F, Qorbani M, Rafay A, Rawaf S, Rawaf DL, Roshandel G, Safiri S, Salimzadeh H, Sanabria JR, Santric Milicevic MM, Sartorius B, Satpathy M, Sepanlou SG, Shackelford KA, Shaikh MA, Sharif-Alhoseini M, She J, Shin MJ, Shiue I, Shrime MG, Sinke AH, Sisay M, Sligar A, Sufiyan MB, Sykes BL, Tabarés-Seisdedos R, Tessema GA, Topor-Madry R, Tran TT, Tran BX, Ukwaja KN, Vlassov VV, Vollset SE, Weiderpass E, Williams HC, Yimer NB, Yonemoto N, Younis MZ, Murray CJL, Naghavi M. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2016: A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncol. 2018 Nov 1;4(11):1553-1568. doi: 10.1001/jamaoncol.2018.2706.

Other Publications:
Xu R, Wang FH, Feng FJ, et al. Recombinant humanized anti-PD-1 monoclonal antibody (JS001) in patients with refractory/metastatic nasopharyngeal carcinoma: Preliminary results of an open-label phase II clinical study. Annals of Oncology 2018;29.
Guo J, Sheng X, Si L, et al. A phase Ib study of JS001, a humanized IgG4 mAb against programmed death-1 (PD-1) combination with axitinib in patients with metastatic mucosal melanoma. Journal of Clinical Oncology 2018 36:15_suppl, 9528-9528.

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Responsible Party: Peking Union Medical College Hospital
ClinicalTrials.gov Identifier: NCT04010071     History of Changes
Other Study ID Numbers: JS-1964
First Posted: July 8, 2019    Key Record Dates
Last Update Posted: July 8, 2019
Last Verified: July 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Peking Union Medical College Hospital:
Hepatobiliary Neoplasm
axitinib
toripalimab
biomarker
Additional relevant MeSH terms:
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Liver Neoplasms
Biliary Tract Neoplasms
Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Digestive System Diseases
Liver Diseases
Biliary Tract Diseases
Axitinib
Antineoplastic Agents
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action