Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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TERMINATED
PHASE2
7 participants
INTERVENTIONAL
2021-01-21
2021-12-10
Brief Summary
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Detailed Description
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Arm B, the comparative arm, will include a standard dose/schedule regorafenib of a 160 mg/day starting on Cycle 1, Day 1. The primary goal of this Arm is compare whether, or not, an 80 mg/day starting dose of regorafenib that escalates weekly by 40 mg until 160 mg/day is non-inferior to the FDA approved labeling 160 mg starting dose of regorafenib in terms of Overall Survival (OS) in HCC subjects. The investigators will also compare the proportions of patients in each arm who complete two cycles of treatment and who intend to continue to a third cycle if no tumor progression is noted on the 8-week disease scan. Other outcomes such as Quality of Life measures, and toxicity profile with a focus on regorafenib related toxicities such as hand-foot skin reaction will also be assessed.
Patients will be randomized 1:1 to either Arm A receiving the Cycle 1 Week-1 80 mg daily dose or Arm B the standard FDA labeling 160 mg daily starting dose, with subsequent dose adjustments as needed. Patients with unacceptable toxicities at the 80 mg dose may be considered for further dose reduction but will no longer be included in the overall survival analysis. After the conclusion of Cycle 2 (Week 8 of treatment), if toxicities have sufficiently resolved, re-escalation is allowed 40 mg at a time every four weeks to a maximum of 160 mg/day at the discretion of the treating investigator.
Patients will continue treatment until progression, unacceptable adverse events, or patient refusal. Treatment will then be discontinued, and the patient will go to event monitoring.
Additionally, a site-optional and subject-optional sub-study collecting blood serum samples at the Screening Visit for "hold and store" for future analysis of CD14, CD15, and CD16 cells as well as other potential biomarkers to be determined.
Conditions
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Keywords
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Study Design
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RANDOMIZED
PARALLEL
Arm B will initiate Cycle 1 treatment at 160mg daily of regorafenib.
TREATMENT
NONE
Study Groups
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A
Arm A: Regorafenib Cycle 1:
* 80 mg daily Week 1
* 120 mg daily Week 2
* 160 mg daily week 3 then 1 week off followed by Cycle 2+ (160 mg for 21 days/1 week off) Subsequent Treatment Cycles
* 160 mg daily for 21 days, then 1 week off.
Regorafenib 40 MG
Regorafenib (BAY 73-4506) is an oral small molecule tyrosine kinase inhibitor (TKI) that potently blocks multiple protein kinases, including kinases involved in tumor angiogenesis (vascular endothelial growth factor receptor \[VEGFR\] 1, 2, 3, Tyrosine kinase with immunoglobulin-like and epidermal growth factor-like domains 2 \[TIE2\]), stem cell growth factor receptor (KIT, rearranged during transfection \[RET\], p38-alpha, a member of the mitogen activated protein kinase \[MAPK\] family, proto-oncogene c-RAF \[c-RAF\], proto-oncogene BRAF \[BRAF\], BRAFV600E), metastasis (VEGFR3, platelet-derived growth factor receptor \[PDGFR\], fibroblast growth factor receptor1 \[FGFR1\]) and tumor immunity (colony stimulating factor 1 receptor \[CSF1R\]).
B
Arm B: Regorafenib Cycle 1:
* 160 mg daily for 21 days/then 1 week off Subsequent Treatment Cycles
* 160 mg daily for 21 days, then 1 week off
Regorafenib 40 MG
Regorafenib (BAY 73-4506) is an oral small molecule tyrosine kinase inhibitor (TKI) that potently blocks multiple protein kinases, including kinases involved in tumor angiogenesis (vascular endothelial growth factor receptor \[VEGFR\] 1, 2, 3, Tyrosine kinase with immunoglobulin-like and epidermal growth factor-like domains 2 \[TIE2\]), stem cell growth factor receptor (KIT, rearranged during transfection \[RET\], p38-alpha, a member of the mitogen activated protein kinase \[MAPK\] family, proto-oncogene c-RAF \[c-RAF\], proto-oncogene BRAF \[BRAF\], BRAFV600E), metastasis (VEGFR3, platelet-derived growth factor receptor \[PDGFR\], fibroblast growth factor receptor1 \[FGFR1\]) and tumor immunity (colony stimulating factor 1 receptor \[CSF1R\]).
Interventions
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Regorafenib 40 MG
Regorafenib (BAY 73-4506) is an oral small molecule tyrosine kinase inhibitor (TKI) that potently blocks multiple protein kinases, including kinases involved in tumor angiogenesis (vascular endothelial growth factor receptor \[VEGFR\] 1, 2, 3, Tyrosine kinase with immunoglobulin-like and epidermal growth factor-like domains 2 \[TIE2\]), stem cell growth factor receptor (KIT, rearranged during transfection \[RET\], p38-alpha, a member of the mitogen activated protein kinase \[MAPK\] family, proto-oncogene c-RAF \[c-RAF\], proto-oncogene BRAF \[BRAF\], BRAFV600E), metastasis (VEGFR3, platelet-derived growth factor receptor \[PDGFR\], fibroblast growth factor receptor1 \[FGFR1\]) and tumor immunity (colony stimulating factor 1 receptor \[CSF1R\]).
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
2. Histological, cytological confirmation of hepatocellular carcinoma or non-invasive diagnosis of HCC as per American Association for the Study of Liver Diseases (AASLD) criteria in patients with a confirmed diagnosis of cirrhosis.
3. Locally advanced or metastatic and/or unresectable HCC that is not amenable or progressed after curative surgical and/or locoregional therapies.
4. Patients who received one prior systemic treatment and for whom the treating physician has decided to treat with regorafenib.
5. Life expectancy of ≥ 3 months.
6. The following laboratory values obtained ≤ 7 days prior to randomization.
* Absolute neutrophil count (ANC) \> 1500/mm3
* Platelet count \> 60,000/mm3
* Hemoglobin \> 9.0 g/dL
* Albumin \> 2.7 gm/dL
* Total bilirubin \< 2 mg/dl (Mildly elevated total bilirubin (\< 6 mg/dL) is allowed if Gilbert's syndrome is documented)
* Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) \< 5 x ULN
* Serum creatinine ≤ 1.5 x ULN or creatinine clearance \> 50 mL/min (calculated using the Cockcroft-Gault formula)
* INR/PTT ≤ 1.5 x ULN
* Alkaline phosphatase limit ≤ 2.5 x ULN
7. At least one measurable (per RECIST 1.1) lesion. Patients who received prior local therapy (e.g., radiofrequency ablation or transarterial chemoembolization, etc.) are eligible provided the target lesion(s) have not been previously treated with local therapy or the target lesion(s) within the field of local therapy have subsequently progressed in accordance with RECIST 1.1.
8. Eastern Cooperative Oncology Group (ECOG) = 0 or 1
9. Negative serum pregnancy test done ≤ 7 days prior to randomization, for females of childbearing potential only.
10. Provide written informed consent.
11. Patients with a prior liver transplant may be included if they have no history of graft rejection within the previous 6 months and stable graft function.
Exclusion Criteria
2. Major surgical procedure, open biopsy, or significant traumatic injury ≤28 days prior to randomization.
3. Congestive heart failure \> New York Heart Association (NYHA) class 2.
4. Unstable angina (angina symptoms at rest), new-onset angina (begun within the last 3 months) or myocardial infarction less than 6 months prior to randomization.
5. Cardiac arrhythmias requiring anti-arrhythmic therapy. Note: beta blockers or digoxin are permitted.
6. Uncontrolled hypertension. (Systolic blood pressure \> 150 mmHg or diastolic pressure \> 90 mmHg despite optimal medical management).
7. History of or current pheochromocytoma.
8. Arterial or venous thrombotic or embolic events such as cerebrovascular accident (including transient ischemic attacks), deep vein thrombosis or pulmonary embolism ≤ 6 months prior to randomization.
9. Ongoing infection \> grade 2 NCI-CTCAE version 5.0.
10. Patients with seizure disorder requiring medication.
11. Symptomatic metastatic brain or meningeal tumors unless the patient is \> 6 months from definitive therapy, has a negative imaging study within 4 weeks of randomization and is clinically stable with respect to the tumor at the time of randomization.
NOTE: Patient must not be undergoing acute steroid therapy or taper (chronic steroid therapy is acceptable provided that the dose is stable for one month prior to and following screening radiographic studies).
12. History of organ allograft (including corneal transplant), except prior liver transplant.
13. Hepatic Encephalopathy requiring hospital admission within six (6) months prior to randomization.
14. Ascites requiring paracentesis within four (4) weeks of randomization.
15. Evidence or history of bleeding diathesis or any hemorrhage or bleeding event \> CTCAE grade 3 ≤4 weeks prior to randomization.
16. Non-healing wound, ulcer, or bone fracture.
17. Renal failure requiring hemo-or peritoneal dialysis.
18. Substance abuse, medical, psychological, or social conditions that may interfere with the patient's participation in the study or evaluation of the study results.
19. Known hypersensitivity to any of the study drugs, study drug classes, or excipients in the formulation.
20. Interstitial lung disease with ongoing signs and symptoms at the time of informed consent.
21. Persistent proteinuria of CTC Grade 3 or higher (\> 3.5 g/24 hrs, measured by urine protein: creatinine ratio on a random urine sample).
22. Patients unable to swallow oral medications.
23. Any malabsorption conditions that will affect that absorption of regorafenib.
24. Unresolved toxicity greater than CTCAE (version 5.0) Grade 1 attributed to any prior therapy/procedure excluding alopecia and oxaliplatin induced neurotoxicity ≤ Grade 2.
25. Pregnant or nursing women and men or women of childbearing potential who are unwilling to employ adequate contraception because regorafenib is a chemotherapeutic agent that has known genotoxic, mutagenic, and teratogenic effects.
NOTE: Men and women of childbearing potential must agree to use adequate contraception beginning at the signing of the ICF until at least 2 months after the last dose of study drug. The definition of adequate contraception will be based on the judgment of the principal investigator or a designated associate.
26. Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens.
27. Immunocompromised patients and patients known to be HIV positive and currently receiving antiretroviral therapy.
NOTE: Patients known to be HIV positive, but without clinical evidence of an immunocompromised state, are eligible for this trial. Active infection requiring systemic treatment, known infection with human immunodeficiency virus (HIV), or known acquired immunodeficiency syndrome (AIDS)-related illness 29. Pleural effusion or ascites that causes respiratory compromise (≥ CTCAE version 4.0 Grade 2 dyspnea).
30\. Concurrent anti-cancer therapy (chemotherapy, radiation therapy, surgery, immunotherapy, biologic therapy, or tumor embolization) other than study treatment (regorafenib, other agents being investigated in combination with regorafenib).
31\. Use of any herbal remedies known to have interference with liver or other major organ functions. Patients must notify the investigator of all herbal remedies used during the study.
18 Years
ALL
No
Sponsors
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Bayer
INDUSTRY
SC Liver Research Consortium, LLC
OTHER
Responsible Party
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Principal Investigators
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Catherine T Frenette, MD
Role: PRINCIPAL_INVESTIGATOR
Scripps MD Anderson Cancer Center
Madappa Kundranda, MD
Role: PRINCIPAL_INVESTIGATOR
Banner MD Andersen Cancer Center
Locations
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Banner MD Anderson Cancer Center
Gilbert, Arizona, United States
VA Long Beach Health System
Long Beach, California, United States
Tulane University
New Orleans, Louisiana, United States
Henry Ford Health Systems
Detroit, Michigan, United States
Cancer and Hematology Centers of Western Michigan
Grand Rapids, Michigan, United States
Saint Louis University
St Louis, Missouri, United States
Comprehensive Cancer Centers of Nevada
Henderson, Nevada, United States
University of Cincinnati Medical Center
Cincinnati, Ohio, United States
Albert Einstein Medical Center
Philadelphia, Pennsylvania, United States
Countries
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Other Identifiers
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21305
Identifier Type: -
Identifier Source: org_study_id