HAIC Combined With Second-line "Target Immunity" for HCC With TACE Standard Treatment Low Response or Failure

NCT05233358 | Unknown

• 1 other identifier: ZJLS-KLDMIR-22001
• Study Type: interventional
• Target: 176
• Locations: 0 countries
• Sites: N/A

Brief Summary

This study is a prospective, randomized controlled, multicenter clinical study. The purpose of this study is to explore the efficacy and safety of hepatic artery infusion chemotherapy (HAIC) combined with second-line regorafenib and immune checkpoint inhibitors in the treatment of transarterial chemoembolization (TACE) combined with first-line molecular targeted drugs and immune checkpoint inhibitors with low response or failure in advanced hepatocellular carcinoma.

Conditions

Hepatocellular Carcinoma

Keywords

Hepatocellular Carcinoma; Hepatic Artery Infusion Chemotherapy; Transarterial Chemoembolization; Target Immunity; Advanced

Outcome Measures

Primary Outcomes (1)

• Progression Free Survival

  The 6-month, 1-year and 2-year progression-free survival rates were evaluated.

  The time from enrollment to tumor progression or death from any cause, whichever came first, measured in "months", assessed up to 2 years.

Secondary Outcomes (6)

• Overall Survival

  Time from enrollment to death from any cause, in "months", assessed up to 2 years. For patients who are still alive at the time of data analysis, overall survival is calculated based on the date when the patient is last known to be alive.

• To Tumor Untreatable Progression

  The time interval between receiving HAIC or TACE and the patient's inability to receive further intra-arterial treatment, assessed up to 12 months.

• Objective Response Rate

  Proportion of patients who achieved complete remission (CR) or partial remission (PR) according to mRECIST criteria, assessed up to 12 months.

• Disease Control Rate

  Proportion of patients with complete remission (CR), partial remission (PR), and stable disease (SD) according to mRECIST criteria, assessed up to 12 months.

• Duration of Overall Response

  The time from the first assessment of the tumor as complete remission or partial remission to the first assessment as disease progression or death from any cause, assessed up to 12 months.

Study Arms (2)

HAIC combined with regorafenib and immune checkpoint inhibitors

EXPERIMENTAL

Subjects received FOLFOX regimen HAIC treatment, within 2 weeks of regorafenib (28 days as a cycle, 80-160 mg qd regorafenib orally on days 1-21) and immune checkpoint inhibitors (continue treatment according to the original plan, 1 cycle every 3 weeks) treatment. HAIC treatment was repeated every 3 weeks for a maximum of six cycles.

Procedure: Hepatic Artery Infusion Chemotherapy; Drug: Regorafenib; Drug: Immune Checkpoint Inhibitors

TACE combined with regorafenib and immune checkpoint inhibitors

ACTIVE COMPARATOR

Choose traditional precise cTACE or dTACE treatment, and receive regorafenib within 2 weeks (28 days as a cycle, 80-160mg qd regorafenib orally on d1-21) and immune checkpoint inhibitors (continue treatment according to the original plan, every 3 weeks as a cycle) treatment. CT or MRI examination was repeated 4-6 weeks after the operation to evaluate whether there were active lesions. If there were still active lesions, one repeat TACE could be performed, and the number of TACE was less than 3 times.

Procedure: Transarterial Chemoembolization; Drug: Regorafenib; Drug: Immune Checkpoint Inhibitors

Interventions

Hepatic Artery Infusion Chemotherapy PROCEDURE

HAIC adopts FOLFOX chemotherapy regimen, hepatic arteriography through a radial artery or femoral artery cannulation, routine hepatic artery cannulation, imaging, infusion of chemotherapy drugs into hepatic artery: oxaliplatin 85 mg/m2 on the first day for 0-3 hours, folinic acid 400 mg/m2 for 3-4.5 hours on day 1, fluorouracil 400 mg/m2 for 4.5-6.5 hours on day 1, and fluorouracil 2500 mg/m2 for 46 hours on days 1-3.

Also known as: HAIC

HAIC combined with regorafenib and immune checkpoint inhibitors

Transarterial Chemoembolization PROCEDURE

Treatment regimens have chosen "lipiodol-based" hepatic arterial chemoembolization, with lipiodol dosage varying from 5-20ml depending on tumor size. The chemotherapy drug is gemcitabine 1.0 combined with 100mg oxaliplatin, combined with 1/3 to 1 dose of solid embolic agent (the dosage is determined by the investigator based on the tumor size). After uniform emulsification, the drug is injected into the supplying blood vessels and stops when the intravascular blood flow is slow. Later, angiography is performed again, and the tumor staining disappears and the supplying artery is occlusions. CT or MRI scans are performed 4 to 6 weeks postoperatively to assess the presence of active lesions. Repeat TACE if active lesions are still present. The frequency of TACE treatment is determined by the investigator and is given according to the patient's condition, generally 2-4 times. The interval between TACE treatments is 30-45 days, with a maximum of six cycles.

Also known as: TACE

TACE combined with regorafenib and immune checkpoint inhibitors

Regorafenib DRUG

Regorafenib is administered for 28 days per treatment cycle, with oral regorafenib on days 1-21, 80-160 mg once daily. The dose is adjusted according to adverse reactions, with a minimum of 80 mg.

Also known as: second-line target drug

HAIC combined with regorafenib and immune checkpoint inhibitors; TACE combined with regorafenib and immune checkpoint inhibitors

Immune Checkpoint Inhibitors DRUG

Optional immune checkpoint inhibitors include Camrelizumab, Sintilimab, Nivolumab, Pembrolizumab, and Toripalimab. Treatment is based on the immune checkpoint inhibitor before the patients are randomized into the group, and it is not recommended to replace the immune checkpoint inhibitor. The dosage is 200 mg, intravenous infusion, D1, once every 21 days (Q3W). Dosing interruption or dose reduction may be necessary based on individual safety and tolerability considerations; dosing with immune checkpoint inhibitors should not be suspended for more than 4 weeks.

Also known as: Camrelizumab, Sintilimab, Nivolumab, Pembrolizumab, Toripalimab

HAIC combined with regorafenib and immune checkpoint inhibitors; TACE combined with regorafenib and immune checkpoint inhibitors

Eligibility Criteria

• Age: 18 Years - 70 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Voluntarily participate in this study and sign the informed consent;
• Age ≥18 years old to 70 years old;
• Patients diagnosed with primary liver cancer by histopathology, cytology or imaging;
• The China liver cancer staging is IIb-IIIa;
• Patients with intermediate and advanced liver cancer who must receive at least one cycle of TACE combined with first-line "target immune" therapy and are assessed as partial remission (PR), stable disease (SD）(low response), and progressive disease (PD) (failure) according to mRECIST criteria;
• At least one measurable (based on RECIST 1.1 criteria and mRECIST criteria) lesions, tumor lesions located at the local treatment site, if progressed, considered measurable;
• Local treatment (surgery, radiotherapy, radiofrequency/microwave ablation, cryoablation, percutaneous ethanol injection) can be used in the past, but it must be completed before 3 months;
• ECOG PS score ≤ 2;
• Child-Pugh liver function classification: grade A/B (≤9 points);
• Expected survival \> 3 months;
• Patients with active hepatitis B virus (HBV) infection: HBV DNA ≤2000 IU/mL (104 cps/ml) obtained within 28 days prior to initiation of study treatment, and receiving anti-HBV treatment for at least 14 days prior to study entry (based on local standard treatment) and willing to continue to receive treatment during the study;

You may not qualify if:

• Have received HAIC treatment in the past;
• Known allergy to possible therapeutic drugs;
• Previously received regorafenib treatment;
• According to the Common Terminology Criteria for Adverse Events Version 5.0 (CTCAE v5.0), the toxicity grade caused by TACE combined with first-line "target immunity" treatment is \> grade 3;
• Patients with liver decompensation, including esophageal or gastric variceal bleeding or hepatic encephalopathy, pregnancy or breastfeeding and other aggressive malignant diseases;
• Use immunosuppressive drugs and high-dose hormone therapy within 2 weeks before randomization to achieve the purpose of immunosuppression (dose\>10mg/day prednisone or other hormones with equivalent efficacy);
• CART treatment within 3 months before randomization;
• Laboratory test values 1 week before randomization: blood routine: ① leukocyte \<3.0×109/L; ② absolute neutrophil count \<1.5×109/L; ③ platelets \<75×109/L; ④ hemoglobin \< 90g/L; liver function: ①serum albumin\<30g/L; ②ALT and AST\>5×ULN; renal function: ①serum creatinine\>1.5×ULN; ②Cr clearance rate\<50ml/min; ③estimated renal small Globular filtration rate (eGFR) \<30 mL/min/1.73 m2; coagulation function: ① international normalized ratio (INR)\> 2; ② prothrombin time (PT) exceeding the range of normal control\> 6 seconds;
• Uncontrolled hypertension (systolic blood pressure \> 180 mmHg, diastolic blood pressure \> 110 mmHg);
• Uncontrollable diabetes;
• Active heart disease, including myocardial infarction, unstable angina pectoris, NYHA class II and above heart failure, and poorly controlled arrhythmias (including QTcF interval \>450 ms in men and \>470 ms in women);
• Women are pregnant or breastfeeding;
• History of any active autoimmune disease or autoimmune disease, including but not limited to: autoimmune hepatitis, interstitial pneumonia, uveitis, vasculitis, glomerulonephritis, hyperthyroidism, or hypothyroidism, asthma requiring bronchodilator treatment, etc;
• Uncontrolled clinically significant ascites (uncontrolled with diuretics or paracentesis);
• Combined with active infection, except HBV and HCV;

Sponsors & Collaborators

• The Central Hospital of Lishui City: lead

Related Publications (8)

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  PMID: 33538338 BACKGROUND

• Finn RS, Ikeda M, Zhu AX, Sung MW, Baron AD, Kudo M, Okusaka T, Kobayashi M, Kumada H, Kaneko S, Pracht M, Mamontov K, Meyer T, Kubota T, Dutcus CE, Saito K, Siegel AB, Dubrovsky L, Mody K, Llovet JM. Phase Ib Study of Lenvatinib Plus Pembrolizumab in Patients With Unresectable Hepatocellular Carcinoma. J Clin Oncol. 2020 Sep 10;38(26):2960-2970. doi: 10.1200/JCO.20.00808. Epub 2020 Jul 27.

  PMID: 32716739 BACKGROUND

• Zhu AX, Finn RS, Edeline J, Cattan S, Ogasawara S, Palmer D, Verslype C, Zagonel V, Fartoux L, Vogel A, Sarker D, Verset G, Chan SL, Knox J, Daniele B, Webber AL, Ebbinghaus SW, Ma J, Siegel AB, Cheng AL, Kudo M; KEYNOTE-224 investigators. Pembrolizumab in patients with advanced hepatocellular carcinoma previously treated with sorafenib (KEYNOTE-224): a non-randomised, open-label phase 2 trial. Lancet Oncol. 2018 Jul;19(7):940-952. doi: 10.1016/S1470-2045(18)30351-6. Epub 2018 Jun 3.

  PMID: 29875066 BACKGROUND

• Odagiri N, Hai H, Thuy LTT, Dong MP, Suoh M, Kotani K, Hagihara A, Uchida-Kobayashi S, Tamori A, Enomoto M, Kawada N. Early Change in the Plasma Levels of Circulating Soluble Immune Checkpoint Proteins in Patients with Unresectable Hepatocellular Carcinoma Treated by Lenvatinib or Transcatheter Arterial Chemoembolization. Cancers (Basel). 2020 Jul 24;12(8):2045. doi: 10.3390/cancers12082045.

  PMID: 32722224 BACKGROUND

• Wang Y, Zhou C, Liu J, Shi Q, Huang S, Yang C, Li T, Chen Y, Xiong B. Increased Liquefactive Necrosis Formation After Transarterial Chemoembolization Combined with Molecular Targeted Agents Plus Immune Checkpoint Inhibitors for Hepatocellular Carcinoma. Cancer Manag Res. 2021 Sep 7;13:6935-6941. doi: 10.2147/CMAR.S328812. eCollection 2021.

  PMID: 34522136 BACKGROUND

• Li J, Qin S, Xu R, Yau TC, Ma B, Pan H, Xu J, Bai Y, Chi Y, Wang L, Yeh KH, Bi F, Cheng Y, Le AT, Lin JK, Liu T, Ma D, Kappeler C, Kalmus J, Kim TW; CONCUR Investigators. Regorafenib plus best supportive care versus placebo plus best supportive care in Asian patients with previously treated metastatic colorectal cancer (CONCUR): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2015 Jun;16(6):619-29. doi: 10.1016/S1470-2045(15)70156-7. Epub 2015 May 13.

  PMID: 25981818 BACKGROUND

• Bruix J, Qin S, Merle P, Granito A, Huang YH, Bodoky G, Pracht M, Yokosuka O, Rosmorduc O, Breder V, Gerolami R, Masi G, Ross PJ, Song T, Bronowicki JP, Ollivier-Hourmand I, Kudo M, Cheng AL, Llovet JM, Finn RS, LeBerre MA, Baumhauer A, Meinhardt G, Han G; RESORCE Investigators. Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2017 Jan 7;389(10064):56-66. doi: 10.1016/S0140-6736(16)32453-9. Epub 2016 Dec 6.

  PMID: 27932229 BACKGROUND

• Ikeda M, Shimizu S, Sato T, Morimoto M, Kojima Y, Inaba Y, Hagihara A, Kudo M, Nakamori S, Kaneko S, Sugimoto R, Tahara T, Ohmura T, Yasui K, Sato K, Ishii H, Furuse J, Okusaka T. Sorafenib plus hepatic arterial infusion chemotherapy with cisplatin versus sorafenib for advanced hepatocellular carcinoma: randomized phase II trial. Ann Oncol. 2016 Nov;27(11):2090-2096. doi: 10.1093/annonc/mdw323. Epub 2016 Aug 29.

  PMID: 27573564 BACKGROUND

MeSH Terms

Conditions

Carcinoma, Hepatocellular

Interventions

regorafenib; Immune Checkpoint Inhibitors; camrelizumab; sintilimab; Nivolumab; pembrolizumab; toripalimab

Condition Hierarchy (Ancestors)

Adenocarcinoma; Carcinoma; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type; Neoplasms; Liver Neoplasms; Digestive System Neoplasms; Neoplasms by Site; Digestive System Diseases; Liver Diseases

Intervention Hierarchy (Ancestors)

Molecular Mechanisms of Pharmacological Action; Pharmacologic Actions; Chemical Actions and Uses; Antineoplastic Agents, Immunological; Antineoplastic Agents; Therapeutic Uses; Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal; Antibodies; Immunoglobulins; Immunoproteins; Blood Proteins; Proteins; Amino Acids, Peptides, and Proteins; Serum Globulins; Globulins

Study Officials

• Liyun Zheng, MD.

  The Central Hospital of Lishui City

  STUDY DIRECTOR

Central Study Contacts

Zhongwei Zhao, Dr.

CONTACT

+8615925728781; zhaozw79@163.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 24, 2022
• First Posted: February 10, 2022
• Study Start: February 1, 2022
• Primary Completion: February 1, 2023
• Study Completion: February 1, 2025
• Last Updated: February 10, 2022

Record last verified: 2022-02

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, CSR
• Time Frame: Within six months after the trial is completed.
• Access Criteria: Shared data is not available for downloading, but can only be browsed. To download the data, you must contact the researchers. Shared data does not provide any private information of the participants.