Dose-Escalation Study Evaluating the Safety and Pharmacokinetics of Artesunate in Patients With Hepatocellular Carcinoma (DESPARTH)

• ClinicalTrials.gov Identifier: NCT02304289
• Recruitment Status: Terminated
• First Posted: December 1, 2014
• Last Update Posted: October 27, 2021
• Sponsor: University Hospital, Ghent
• Collaborators: University Ghent; Anticancer Fund, Belgium
• Information provided by (Responsible Party): University Hospital, Ghent

Tracking Information

• First Submitted Date: November 20, 2014
• First Posted Date: December 1, 2014
• Last Update Posted Date: October 27, 2021
• Study Start Date: November 2014
• Actual Primary Completion Date: December 2016 (Final data collection date for primary outcome measure)

Current Primary Outcome Measures (submitted: November 25, 2014)

• Number of Participants with Adverse Events as a Measure of Safety and Tolerability [ Time Frame: 14 days ]
• Maximum tolerated dose (MTD) [ Time Frame: 14 days ]
• Pharmacokinetic analysis of Cmax, Cmin, Tmax, and AUC. [ Time Frame: 2 days ]

• Original Primary Outcome Measures: Same as current

Current Secondary Outcome Measures (submitted: November 25, 2014)

• Time to tumor progression (TTP) [ Time Frame: Time from the first intake of Artesunate to radiological progression ]
• Overall survival (OS) [ Time Frame: ime from the first intake of Artesunate to death ]
• Quality of life based on the "Functional Assessment of Cancer Therapy Hep-30 scale" (FACT-Hep-30) [ Time Frame: 14 days ]

• Original Secondary Outcome Measures: Same as current
• Current Other Pre-specified Outcome Measures: Not Provided
• Original Other Pre-specified Outcome Measures: Not Provided

Descriptive Information

• Brief Title: Dose-Escalation Study Evaluating the Safety and Pharmacokinetics of Artesunate in Patients With Hepatocellular Carcinoma
• Official Title: Phase I Dose-Escalation Study Evaluating the Safety and Pharmacokinetics of Oral Artesunate (ART) in Patients With Advanced Hepatocellular Carcinoma (HCC).
• Brief Summary: The purpose of this study is to evaluate the Safety and Pharmacokinetics of Oral Artesunate in patients with advanced hepatocellular carcinoma (HCC)

Detailed Description

Artemisinins, compounds extracted from the herb Artemisia annua, are safe and effective FDA-approved antimalarial drugs. Recent studies have suggested that artemisinins also exert anti-angiogenic and cytotoxic effects on human cancer cells. Artesunate (ART) is a water soluble semisynthetic artemisinin with improved pharmacokinetic properties.

A single-center phase I dose-escalation study evaluating the safety and pharmacokinetics of oral Artesunate in patients with Advanced HCC.

Approximately 15 patients will be enrolled in this trial. Dose-escalation protocol: The first patient will receive 200 mg Artesunate once-daily for 14 days. If no dose-limiting toxicity (DLT) is observed after 14 days, the next patient will start at a daily dose of 300 mg Artesunate. If no DLT is observed after 14 days, a cohort of 3 patients will receive 400 mg once-daily for 14 days. For each subsequent cohort of 3 patients 200 mg will be added to the dose, until the maximum tolerated dose (MTD) is determined.

• Study Type: Interventional
• Study Phase: Phase 1
• Study Design: Allocation: N/A; Intervention Model: Single Group Assignment; Masking: None (Open Label); Primary Purpose: Treatment
• Condition: Hepatocellular Carcinoma

Intervention

Drug: Artesunate

Oral Artesunate once-daily for 14 days, dose-escalation

Study Arms

Experimental: Oral Artesunate

The first patient will receive 200 mg Artesunate once-daily for 14 days. If no dose-limiting toxicity (DLT) is observed after 14 days, the next patient will start at a daily dose of 300 mg Artesunate. If no DLT is observed after 14 days, a cohort of 3 patients will receive 400 mg once-daily for 14 days. For each subsequent cohort of 3 patients 200 mg will be added to the dose, until the maximum tolerated dose (MTD) is determined.

Intervention: Drug: Artesunate

• Publications *: Not Provided

Recruitment Information

• Recruitment Status: Terminated
• Actual Enrollment (submitted: January 3, 2017): 2
• Original Estimated Enrollment (submitted: November 25, 2014): 15
• Actual Study Completion Date: December 2016
• Actual Primary Completion Date: December 2016 (Final data collection date for primary outcome measure)

Eligibility Criteria

Inclusion Criteria:

• Histologically confirmed advanced HCC, based on the report of the department of pathology, excluding fibrolamellar carcinoma.
• Liver mass measuring at least 2 cm with characteristic vascularization seen on either triphasic computed tomography (CT) scan or magnetic resonance imaging (MRI) with gadolinium
• Patients must have refused treatment with sorafenib or must have had treatment with sorafenib, which was either stopped due to intolerance or therapeutic failure.
• ECOG PS of 0-2.
• Child Pugh class ≤ B7
• Life expectancy greater than 3 months in the Investigator's opinion
• Adequate bone marrow function
• Adequate hepatic function
• Women of childbearing potential must have a negative serum (beta-human chorionic gonadotropin (β-hCG) or urine pregnancy test at screening. Women who are pregnant or breast feeding are ineligible for this study.
• For women who are not postmenopausal (12 months of amenorrhea) or surgically sterile (absence of ovaries and/or uterus): agreement to use adequate methods of contraception (e.g., hormonal implants, combined oral contraceptives, vasectomized partner), during the treatment period and for at least 3 months after the last dose of study treatment
• For men: agreement to use a barrier method of contraception during the treatment period and for at least 3 months after the last dose of the study treatment.
• Adequate renal function
• Each subject (or their legally acceptable representative) must be able and willing to provide an written informed consent form (ICF) indicating that he or she understands the purpose of and procedures required for the study and are willing to participate in the study.
• Able to swallow capsules
• Adequate coagulation tests: international normalized ratio (INR) ≤1.5 x ULN
• Recovery to Grade 1 from the effects (excluding alopecia) of any prior therapy for their malignancies
• At least 4 weeks since any major surgery or open biopsy and 7 days since a core biopsy before first study treatment
• The following time must have elapsed between previous therapy for cancer and first administration of ART:
• At least 2 weeks since previous systemic targeted therapy with small molecule inhibitors, which includes any tyrosine-kinase inhibitor
• At least 4 weeks since the last dose of systemic anti-cancer therapy other than targeted therapy, which includes cytotoxic agents, monoclonal antibody therapy, immunotherapy and prior radiotherapy

Exclusion Criteria:

• Patients with Child-Pugh classification > B7
• Major debilitating disease limiting survival prognosis (incl. heart failure, uncontrolled diabetes, psychiatric disease, hemodialysis, and respiratory insufficiency)
• Any mental deficiency preventing proper understanding of trial protocol requirements
• Remaining toxicities from previous sorafenib treatment will be individually evaluated and well documented by the PI.
• QTc≥440 msec
• Patients suffering from sinus bradycardia, bradyarrythmia, AV-block I or III.
• Known allergy to ART or to other artemisinin derivatives
• Malabsorption or intestinal obstruction
• History of venous thromboembolic disease within 3 months prior to first administration of study treatment
• The patient has current, severe and uncontrolled medical condition such as infection, diabetes mellitus or other systemic disease
• Any condition or illness that, in the opinion of the Investigator or the medical monitor, would compromise patient safety or interfere with the evaluation of the safety of the drug
• The patient has known positive serology for human immunodeficiency virus
• Essential medications that are known potent inhibitors or inducers of CYP2B6 and/or CYP3A4
• Fibrolamellar carcinoma

Sex/Gender

• Sexes Eligible for Study: All

• Ages: 18 Years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Contacts: Contact information is only displayed when the study is recruiting subjects
• Listed Location Countries: Belgium

Administrative Information

• NCT Number: NCT02304289
• Other Study ID Numbers: AGO/2014/003; 2014-002503-16 ( EudraCT Number )
• Has Data Monitoring Committee: No
• U.S. FDA-regulated Product: Not Provided
• IPD Sharing Statement: Not Provided
• Current Responsible Party: University Hospital, Ghent
• Original Responsible Party: Same as current
• Current Study Sponsor: University Hospital, Ghent
• Original Study Sponsor: Same as current

Collaborators

• University Ghent
• Anticancer Fund, Belgium

Investigators

• Principal Investigator: Hans Van Vlierberghe, MD, PhD; University Ghent

• PRS Account: University Hospital, Ghent
• Verification Date: January 2017