Nexavar-Tarceva Combination Therapy for First Line Treatment of Patients Diagnosed With Hepatocellular Carcinoma (SEARCH)

A Phase III Randomized, Placebo Controlled, Double Blind Trial of Sorafenib Plus Erlotinib vs. Sorafenib Plus Placebo as First Line Systemic Treatment for Hepatocellular Carcinoma (HCC)

This is a randomized trial to evaluate the clinical benefit of sorafenib 400 mg twice daily and erlotinib 150 mg once a day versus sorafenib 400 mg twice daily and placebo erlotinib once daily in subjects with unresectable advanced or metastatic Child-Pugh A HCC. Patients who are candidates for potentially curative intervention (i.e. surgical resection or local ablation) are not eligible for this study.

Study Overview

• Status: Completed
• Conditions: Carcinoma, Hepatocellular
• Intervention / Treatment: Drug: Sorafenib (Nexavar, BAY43-9006); Drug: Erlotinib (Tarceva); Drug: Placebo

Detailed Description

European quality of life scale (5 dimensions) (EQ-5D)

• Study Type: Interventional
• Enrollment (Actual): 732
• Phase: Phase 3

Contacts and Locations

Study Locations

• Australia
  • New South Wales
    • Randwick, New South Wales, Australia, 2031
  • Queensland
    • Brisbane, Queensland, Australia, 4120
    • Herston, Queensland, Australia, 4029
  • Victoria
    • Clayton, Victoria, Australia, 3168
    • Melbourne, Victoria, Australia, 3004
  • Western Australia
    • Nedlands, Western Australia, Australia, 6009
• Austria
  • Wien, Austria, 1090
• Belgium
  • Bruxelles - Brussel, Belgium, 1200
  • Edegem, Belgium, 2650
  • Gent, Belgium, 9000
  • Kortrijk, Belgium, 8500
  • La Louviere, Belgium, 7100
  • Leuven, Belgium, 3000
  • Liege, Belgium, 4000
• Brazil
  • Rio de Janeiro, Brazil, 21941-913
  • Sao Paulo, Brazil, 01509-900
  • Sao Paulo, Brazil, 05403-000
  • Minas Gerais
    • Belo Horizonte, Minas Gerais, Brazil, 30110-090
  • Rio Grande Do Sul
    • Porto Alegre, Rio Grande Do Sul, Brazil, 90020-090
  • Sao Paulo
    • São Paulo, Sao Paulo, Brazil, 05651-900
• Bulgaria
  • Plovdiv, Bulgaria, 4002
  • Sofia, Bulgaria, 1784
  • Varna, Bulgaria, 9002
  • Varna, Bulgaria, 9010
• Canada
  • Alberta
    • Edmonton, Alberta, Canada, T6G 1Z2
  • Quebec
    • Montreal, Quebec, Canada, H3A 1A1
• Chile
  • Santiago, Chile, 7601003
  • Santiago, Chile, 838-0455
• China
  • Beijing, China, 100021
  • Beijing, China, 100071
  • Guangdong
    • Guangzhou, Guangdong, China, 510060
  • Jiangsu
    • Nanjing, Jiangsu, China, 210002
  • Zhejiang
    • Hangzhou, Zhejiang, China, 310016
• Colombia
  • Floridablanca, Colombia
  • Medellín, Colombia
• France
  • Bordeaux, France, 33000
  • Clichy, France, 92110
  • Creteil, France, 94010
  • La Roche Sur Yon, France, 85925
  • Lille, France, 59037
  • Lyon, France, 69004
  • Marseille, France, 13005
  • Paris, France, 75012
  • Pessac, France, 33604
  • Vandoeuvre-les-nancy, France, 54511
  • Villejuif, France, 94800
• Germany
  • Berlin, Germany, 12200
  • Baden-Württemberg
    • Freiburg, Baden-Württemberg, Germany, 79106
    • Tübingen, Baden-Württemberg, Germany, 72076
  • Bayern
    • München, Bayern, Germany, 81675
    • Regensburg, Bayern, Germany, 93042
  • Hessen
    • Frankfurt, Hessen, Germany, 60590
  • Niedersachsen
    • Hannover, Niedersachsen, Germany, 30625
  • Nordrhein-Westfalen
    • Essen, Nordrhein-Westfalen, Germany, 45147
    • Köln, Nordrhein-Westfalen, Germany, 50937
  • Rheinland-Pfalz
    • Mainz, Rheinland-Pfalz, Germany, 55131
  • Saarland
    • Homburg, Saarland, Germany, 66421
• Greece
  • Athens, Greece, 115 27
  • Larissa, Greece, 41100
  • Thessaloniki, Greece, 54642
  • Thessaloniki, Greece, 546 36
• Hong Kong
  • Hong Kong, Hong Kong
  • Shatin, Hong Kong
• Israel
  • Beer Sheva, Israel, 8410101
  • Haifa, Israel, 3109601
  • Petah Tikva, Israel, 4941492
  • Rehovot, Israel, 7610001
  • Zrifin, Israel, 70300
• Italy
  • Lombardia
    • Milano, Lombardia, Italy, 20089
• Korea, Republic of
  • Seoul, Korea, Republic of, 03080
  • Seoul, Korea, Republic of, 05505
  • Seoul, Korea, Republic of, 06351
  • Seoul, Korea, Republic of, 152-703
  • Gyeonggido
    • Goyang-si, Gyeonggido, Korea, Republic of, 410-769
• New Zealand
  • Auckland, New Zealand, 1023
  • Christchurch, New Zealand, 8011
  • Wellington South, New Zealand, 6021
• Peru
  • Lima, Peru, Lima 1
  • Lima, Peru, LIMA 34
• Poland
  • Bydgoszcz, Poland, 85-796
  • Gdansk, Poland, 80-952
  • Gliwice, Poland, 44-101
  • Warszawa, Poland, 02-781
• Russian Federation
  • Barnaul, Russian Federation, 656049
  • Moscow, Russian Federation, 115478
  • Nizhny Novgorod, Russian Federation, 603001
• Singapore
  • Singapore, Singapore, 308433
  • Singapore, Singapore, 169610
• South Africa
  • Gauteng
    • Johannesburg, Gauteng, South Africa, 2193
  • Western Cape
    • Cape Town, Western Cape, South Africa, 7500
• Spain
  • Barcelona, Spain, 08036
  • Lugo, Spain, 27003
  • Madrid, Spain, 28040
  • Santander, Spain, 39008
  • Valencia, Spain, 46026
  • Valencia, Spain, 46010
  • Barcelona
    • Hospitalet de Llobregat, Barcelona, Spain, 08907
• Taiwan
  • Tainan, Taiwan, 736
  • Taipei, Taiwan, 112
  • Taoyuan, Taiwan, 333
• United Kingdom
  • Glasgow, United Kingdom, G12 0YN
  • London, United Kingdom, SE5 9RS
  • Newcastle Upon Tyne, United Kingdom, NE7 7DN
  • South Yorkshire
    • Sheffield, South Yorkshire, United Kingdom, S10 2SJ
• United States
  • California
    • San Francisco, California, United States, 94115
  • District of Columbia
    • Washington, District of Columbia, United States, 20007
  • Florida
    • Gainesville, Florida, United States, 32610
    • Miami, Florida, United States, 33136
  • Georgia
    • Atlanta, Georgia, United States, 30318
  • Hawaii
    • Honolulu, Hawaii, United States, 96817
  • Illinois
    • Maywood, Illinois, United States, 60153-5585
  • Kansas
    • Westwood, Kansas, United States, 66205
  • Kentucky
    • Louisville, Kentucky, United States, 40202
  • Louisiana
    • New Orleans, Louisiana, United States, 70112
  • Maryland
    • Baltimore, Maryland, United States, 21202
  • Massachusetts
    • Boston, Massachusetts, United States, 02114
    • Boston, Massachusetts, United States, 02215-5450
    • Worcester, Massachusetts, United States, 01655
  • Michigan
    • Detroit, Michigan, United States, 48202
  • Minnesota
    • Minneapolis, Minnesota, United States, 55455
  • New York
    • New York, New York, United States, 10029
    • Rochester, New York, United States, 14642
    • Valhalla, New York, United States, 10595
  • North Carolina
    • Charlotte, North Carolina, United States, 28203
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19107
  • Texas
    • Houston, Texas, United States, 77030
  • Washington
    • Seattle, Washington, United States, 98109-1023

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Patients > 18 years of age
• Patients who have a life expectancy of at least 12 weeks
• Patients with histological or cytologically documented HCC

• Patients must have at least one tumor lesion that meets both of the following criteria:

  • The lesion can be accurately measured in at least one dimension according to response evaluation criteria in solid tumors (RECIST)
  • The lesion has not been previously treated with local therapy
• Patients who have an ECOG PS (Eastern Cooperative Oncology Group Performance Status) of 0 or 1
• Cirrhotic status of Child-Pugh class A.
• Patients who give written informed consent prior to any study specific screening procedures with the understanding that the patient has the right to withdraw from the study at any time.

Exclusion Criteria:

• History of cardiac disease: congestive heart failure > New York Heart Association (NYHA) class 2; active coronary artery disease (CAD); cardiac arrhythmias requiring anti-arrhythmic therapy other than beta blockers or digoxin), or uncontrolled hypertension. Myocardial infarction more than 6 months prior to study entry is permitted.
• Abnormalities of the cornea based on history (e.g. dry eye syndrome, Sogren's syndrome) including congenital abnormality (e.g. Fuch's dystrophy), abnormal slit-lamp examination using a vital dye (e.g. fluorescein, Bengal-Rose), and/or an abnormal corneal sensitivity test (Schirmer test or similar tear production test).
• History of interstitial lung disease (ILD).
• Patients with clinically significant gastrointestinal bleeding within 30 days prior to study entry.
• Previous treatment with yttrium-90 spheres
• Any condition that is unstable or which could jeopardize the safety of the patient and his/her compliance in the study.
• Uncontrolled ascites (defined as not easily controlled with diuretic treatment)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: DOUBLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Sorafenib (Nexavar, BAY43-9006) + Erlotinib (Tarceva); Participants received sorafenib 400 mg twice daily (bid) and erlotinib 150 mg tablet once daily (qd)	Drug: Sorafenib (Nexavar, BAY43-9006); Sorafenib 400 mg twice daily; Drug: Erlotinib (Tarceva); Erlotinib 150 mg once daily
ACTIVE_COMPARATOR: Sorafenib (Nexavar, BAY43-9006) + Placebo; Participants received sorafenib 400 mg twice daily (bid) and matching erlotinib placebo 150 mg tablet once daily (qd)	Drug: Sorafenib (Nexavar, BAY43-9006); Sorafenib 400 mg twice daily; Drug: Placebo; Matching erlotinib placebo 150 mg once daily

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall Survival	Overall Survival (OS) was defined as the time from date of randomization to death due to any cause.	From randomization of the first patient until 34 months or date of death of any cause whichever came first

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to Radiological Tumor Progression (TTP)	TTP was the time from randomization to radiological tumor progression. Participants without radiological tumor progression at the time of analysis were censored at their last date of tumor evaluation. Progressive disease (PD) was defined using Response Evaluation Criteria in Solid Tumors (RECIST version 1.0), as at least a 20% increase in the sum of longest diameter (LD) of measured lesions taking as references the smallest sum LD recorded since the treatment started or the appearance of 1 or more new lesions. Appearance of new lesions also constituted PD.	From randomization of the first participant until 34 months later (cut-off date), assessed every 6 weeks
Disease Control	Disease control was defined as the number of participants who had a best response rating of complete response (CR), partial response (PR), or stable disease (SD) according to RECIST assessed by magnetic resonance imaging (MRI) that was confirmed at least 28 days from the first demonstration of that rating. CR: disappearance of all clinical and radiological evidence of target and non-target tumors. PR: at least a 30% decrease in the sum of LD of target lesions taking as reference the baseline sum LD. SD: steady state of disease. Neither sufficient shrinkage for PR nor sufficient increase for PD.	From randomization of the first participant until 34 months later (cut-off date), assessed every 6 weeks
Health-related Quality of Life and Utility Values as Measured by EQ-5D - Index	The European quality of life scale (5 dimensions) (EQ-5D) questionnaire was given to the participants at each visit. The EQ-5D questionnaire consisted of 5 ordinal categorical responses (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). The scores for the EQ-5D dimensions are assigned according to the level of problems reported (1 'no problems'; 2 'some problems'; 3 'extreme problems'). The 5 health dimensions are summarized into a single score, the EQ-5D index score. The EQ-5D index score has a range of 0 and 1 with 0 representing death and 1 representing perfect health.	The EQ-5D was administered at the beginning of the visit prior to seeing the investigator. Questionnaires were to be completed every 6 weeks (Day 1 of each cycle) for subsequent cycles and at the end of treatment visit.
Health-related Quality of Life and Utility Values as Measured by EQ-5D - VAS	Participants indicated on a scale of 0 (worst) to 100 (best) how good or bad their health state was on that particular day.	The EQ-5D VAS was administered at the beginning of the visit prior to seeing the investigator. Questionnaires were to be completed every 6 weeks (Day 1 of each cycle) for subsequent cycles and at the end of treatment visit.

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Duration of Response	Duration of response - RECIST: number of days from the date that CR or PR is first documented to date that PD is first objectively documented or to death before progression. Note: the relevant date is that of the first documentation, not the confirmation date (if participant progressed or died then censored=no) or to last observation if participant did not progress or die then censored=yes note: this last observation date should be the same as that used for time to progression.	From randomization of the first participant until 34 months later (cut-off date), assessed every 6 weeks
Time to Response	Time to response was the number of days from randomization to the date the CR or PR was documented (with confirmation) (Note: the relevant date is that of the first documentation, not the confirmation date).	From randomization of the first participant until 34 months later (cut-off date), assessed every 6 weeks
Tumor Response	Tumor response was the proportion of participants with the best tumor response (ie, achieving either a confirmed complete response [CR] or partial response [PR], according to Response Evaluation Criteria in Solid Tumors [RECIST] criteria).	From randomization of the first participant until 34 months later (cut-off date), assessed every 6 weeks

Collaborators and Investigators

• Sponsor: Bayer

Publications and helpful links

Helpful Links

• Click here to find information about studies related to Bayer Healthcare products conducted in Europe.

Study record dates

Study Major Dates

• Study Start (ACTUAL): May 21, 2009
• Primary Completion (ACTUAL): April 17, 2012
• Study Completion (ACTUAL): May 23, 2018

Study Registration Dates

• First Submitted: May 13, 2009
• First Submitted That Met QC Criteria: May 13, 2009
• First Posted (ESTIMATE): May 14, 2009

Study Record Updates

• Last Update Posted (ACTUAL): May 30, 2019
• Last Update Submitted That Met QC Criteria: May 16, 2019
• Last Verified: May 1, 2019

More Information

Terms related to this study

• Keywords: HCC; First Line; Sorafenib (Nexavar); Erlotinib (Tarceva)
• Additional Relevant MeSH Terms: Digestive System Diseases; Neoplasms by Histologic Type; Neoplasms; Neoplasms by Site; Adenocarcinoma; Neoplasms, Glandular and Epithelial; Digestive System Neoplasms; Liver Diseases; Liver Neoplasms; Carcinoma; Carcinoma, Hepatocellular; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antineoplastic Agents; Protein Kinase Inhibitors; Erlotinib Hydrochloride; Sorafenib
• Other Study ID Numbers: 12917; 2008-006021-14 (EUDRACT_NUMBER)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No