Chemoembolization With or Without Sorafenib Tosylate in Treating Patients With Liver Cancer That Cannot Be Removed By Surgery
Trial Purpose and Description
This randomized phase III trial is studying chemoembolization and sorafenib tosylate to see how well they work compared with chemoembolization alone in treating patients with liver cancer that cannot be removed by surgery. Drugs used in chemotherapy, such as doxorubicin hydrochloride, mitomycin, and cisplatin, 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 the blood flow to the tumor. Sorafenib tosylate may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. It is not yet known whether giving chemoembolization together with sorafenib tosylate is more effective than chemoembolization alone in treating patients with liver cancer
I. To compare the progression-free survival of patients with unresectable hepatocellular carcinoma treated with chemoembolization with versus without sorafenib tosylate.
I. To compare the overall survival of patients treated with these regimens. II. To compare extra-hepatic versus intra-hepatic patterns of failure in patients treated with these regimens.
III. To determine the rates of toxicity related to these regimens in these patients.
IV. To analyze the pharmacogenetic and pharmacokinetic properties of sorafenib tosylate, including angiogenesis, monooxygenases, polymorphisms, and MDR.
V. To determine the inter-reader imaging concordance for response characterization at 4 and 8 months by the European Association for the Study of Liver (EASL) criteria.
VI. To determine the value of objective tumor response at 4 and 8 months by the EASL criteria to predict PFS and OS.
VII. To evaluate the effects of intra-hepatic vs. extra-hepatic progression on OS.
OUTLINE: This is a multicenter study. Patients are stratified according to macrovascular intrahepatic portal vein invasion (present vs absent), Child Pugh score (A vs B7), and chemoembolization method (doxorubicin-eluting bead vs conventional). Patients are randomized to 1 of 2 treatment arms.
ARM I: Patients receive oral sorafenib tosylate twice daily in the absence of disease progression or unacceptable toxicity. Beginning within 2 weeks after a stable dose of sorafenib tosylate is reached, patients undergo transarterial chemoembolization (TACE) comprising doxorubicin hydrochloride, mitomycin C, and cisplatin (closed to accrual as of 10/1/2010); conventional chemoembolization comprising doxorubicin hydrochloride only; or chemoembolization comprising doxorubicin-eluting beads. Treatment with TACE repeats approximately every 4 weeks for up to 4 courses in the absence of disease progression or unacceptable toxicity.
ARM II: Patients receive oral placebo twice daily in the absence of disease progression or unacceptable toxicity. Beginning within 2 weeks after a stable dose of placebo is reached, patients undergo TACE as in arm I.
MAINTENANCE THERAPY: After completion of chemoembolization, patients receive sorafenib or placebo as in arm I and II in the absence of disease progression or unacceptable toxicity. Patients undergo chest, abdomen, and/or pelvis CT scans or MRI at baseline, at 4 and 8 months, and every 2 months thereafter.
Blood and tissue samples may be collected at baseline and periodically during study for pharmacogenetic and pharmacokinetic studies. After completion of study therapy, patients are followed up periodically for 4 years.
- 18 Years and older
- Diagnosis of hepatocellular carcinoma (HCC) according to 1 of the following criteria:
- Histologically confirmed disease
- Liver cirrhosis AND = 1 solid liver lesion > 2 cm with early enhancement and
delayed enhancement washout on CT scan or MRI regardless of alpha-fetoprotein
- AFP > 400 ng/mL AND = 1 solid liver lesion > 2 cm regardless of specific imaging
characteristics on CT scan or MRI
- Disease must be limited to the liver
- No clinical or radiographic evidence of extra hepatic HCC
- Portal vein lymphadenopathy is allowed for patients with hepatitis B or C
- Branch portal vein invasion by tumor allowed
- No main portal vein invasion by tumor
- Measurable disease constituting < 50% of liver parenchyma within the past 4 weeks
- Child Pugh score of A or B7 within the past 4 weeks
- No ascites detectable on physical evaluation
- Not a candidate for curative resection, orthotopic liver transplantation, or
radiofrequency ablation (RFA)
- ECOG performance status 0-1
- Life expectancy = 3 months
- Platelet count = 50,000/µL
- Total bilirubin = 2.0 mg/dL
- Alkaline phosphatase < 5 times upper limit of normal (ULN)
- AST and ALT < 5 times ULN
- Serum creatinine = 1.5 mg/dL
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- Able to swallow pills
- No clinical signs of heart failure
- No NYHA class III or IV heart disease
- No evidence of bleeding diathesis or active gastrointestinal bleeding
- No known HIV positivity
- No other concurrent uncontrolled illness (except hepatitis B or C) including, but not
limited to, any of the following:
- Uncontrolled hypertension (i.e., optimally treated baseline BP > 150/90 mm Hg)
- Symptomatic congestive heart failure
- Unstable angina pectoris
- Cardiac arrhythmia
- Psychiatric illness and/or addictive disorder that would limit compliance with
- No allergy to iodine or gadolinium contrast that cannot be safely controlled with
- No prior brachytherapy (e.g., yttrium-90 microspheres)
- No prior sorafenib tosylate, chemoembolization, or systemic chemotherapy, including
cytotoxic agents or molecularly targeted agents
- Prior attempted curative liver resection allowed
- More than 4 weeks since prior RFA
- No concurrent cytochrome P450 enzyme-inducing drugs
- No concurrent prophylactic G-CSF or GM-CSF
- National Cancer Institute (NCI)
- October 2009
- Last Updated:
- January 16, 2013
- Study HIC#:
Clinicaltrials.gov ID: NCT01004978