- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01005199
Sorafenib Tosylate With or Without Everolimus in Treating Patients With Localized, Unresectable, or Metastatic Liver Cancer
Sorafenib Alone or in Combination With Everolimus in Patients With Unresectable Hepatocellular Carcinoma. A Randomized Multicenter Phase II Trial.
RATIONALE: Sorafenib tosylate and everolimus may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor.
PURPOSE: This randomized phase II trial is studying giving sorafenib tosylate together with everolimus to see how well it works compared with sorafenib tosylate alone in treating patients with localized, unresectable, or metastatic liver cancer.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
OBJECTIVES:
- To determine if sorafenib tosylate with versus without everolimus can stop tumor progression in patients with localized, unresectable, or metastatic hepatocellular carcinoma.
- To evaluate changes in symptom-related and global quality of life (QL) and QL benefit over the course of trial treatment in these patients.
- To compare the primary endpoint (i.e., progression-free survival at week 12) to the QL benefit within 12 weeks from baseline.
- To evaluate how symptom-related and global QL indicators map on the single summary index derived from a standardized measure of health status for utility cost analysis.
OUTLINE: This is a multicenter study. Patients are stratified according to WHO performance status (0 vs 1), disease spread (extrahepatic spread vs non-extrahepatic spread), and center. Patients are randomized to 1 of 2 treatment arms.
- Arm A (standard treatment): Patients receive oral sorafenib tosylate twice daily for 4 weeks. Courses repeat every 4 weeks in the absence of disease progression or unacceptable toxicity.
- Arm B (investigational treatment): Patients receive oral sorafenib tosylate twice daily and oral everolimus once daily for 4 weeks. Courses repeat every 4 weeks in the absence of disease progression or unacceptable toxicity.
Some patients may undergo CT scan or MRI at baseline and at 6 and 12 weeks during study to assess tumor response, tumor size, and tumor density.
Patients complete quality of life questionnaires at baseline and every 2 weeks for 12 weeks during study treatment.
After completion of study treatment, patients are followed every 2 months for 3 years.
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
-
Wien, Austria, 1090
- Medizinische Universität Wien
-
-
-
-
-
Budapest, Hungary, 1097
- Szent Laszlo Korhaz
-
-
-
-
-
Basel, Switzerland, CH-4016
- Saint Claraspital AG
-
Basel, Switzerland, CH-4031
- Clinical Cancer Research Center at University Hospital Basel
-
Bellinzona, Switzerland, 6500
- Istituto Oncologico della Svizzera Italiana - Ospedale Regionale Bellinzona e Valli
-
Bern, Switzerland, CH-3010
- Inselspital Bern
-
Bruderholz, Switzerland, CH-4101
- Kantonsspital Bruderholz
-
Geneva, Switzerland, CH-1211
- Hôpital Cantonal Universitaire de Genève
-
Lausanne, Switzerland, CH-1011
- Centre Hospitalier Universitaire Vaudois
-
Liestal, Switzerland, CH-4410
- Kantonsspital Liestal
-
Sion, Switzerland, 1950
- CHCVS - Hôpital de Sion
-
St. Gallen, Switzerland, CH-9007
- Kantonsspital - St. Gallen
-
Thun, Switzerland, 3600
- Regionalspital
-
Zurich, Switzerland, CH-8063
- City Hospital Triemli
-
Zurich, Switzerland, CH-8091
- Universitaetsspital Zuerich
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
DISEASE CHARACTERISTICS:
Histologically, cytologically, or radiologically confirmed hepatocellular carcinoma (HCC)
- Localized, unresectable, or metastatic disease
- Child-Pugh class A or mildly decompensated Child-Pugh class B liver dysfunction (Child-Pugh score ≤ 7)
- Stage B or C disease according to the Barcelona Clinic Liver Cancer (BCLC) staging classification
Measurable disease
- At least 1 unidimensionally measurable site of disease (≥ 10 mm in case of a non-nodal lesion or with a short axis ≥ 15 mm in case of a lymph node) by spiral/multi-slice CT/MRI scan according to revised RECIST criteria
- No locally advanced disease AND a candidate for radical surgery
- No known fibrolamellar HCC or mixed cholangiocarcinoma/HCC
- No clinical symptoms or history of CNS metastases or leptomeningeal disease (no imaging required)
PATIENT CHARACTERISTICS:
- WHO performance status 0-1
- Hemoglobin ≥ 90 g/L
- Neutrophil count ≥ 1.5 x 10^9/L
- Platelet count ≥ 75 x 10^9/L
- Creatinine clearance ≥ 40 mL/min
- ALT ≤ 5 times upper limit of normal
- INR ≤ 2
- Urine dipstick for proteinuria ≤ 1+ OR protein spot urine < 0.6 g/L
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception during and for 12 months after completion of study therapy
- No prior malignancy within the past 5 years except adequately treated carcinoma in situ of the cervix or localized nonmelanoma skin cancer
- No history of hemorrhagic or thrombotic cerebrovascular event within the past 12 months
- No documented variceal hemorrhage within the past 3 months
- No requirement for anticoagulant therapy except for low-dose anticoagulants for maintenance of patency of central venous access or prevention of deep vein thrombosis
- No history or presence of clinically significant acute or unstable cardiovascular, cerebrovascular, renal, gastrointestinal, pulmonary, endocrine, central nervous system, or immunological disorders (except for the presence of hepatitis B or C virus or cirrhosis) within the past 6 months
- No encephalopathy
- No known HIV infection
- No active infection requiring IV antibiotics
- No arterial hypertension ≥ 150/100 mm Hg despite therapy
- No ongoing cardiac dysrhythmias of NCI CTCAE grade ≥ 2, atrial fibrillation of any grade, prolongation of QTc > 500 msec on screening electrocardiogram (ECG), or history of familial long QT syndrome
- No repeated paracentesis (more than 1 per month)
- No psychiatric disorder precluding understanding of information of trial-related topics, giving informed consent, or interfering with compliance for oral drug intake
- No concurrent grapefruit, grapefruit juice, or products containing bitter oranges
- Able to take oral medications
- Completed baseline quality of life questionnaire
- Must be compliant and geographically proximal for follow-up
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
No prior systemic anticancer treatment for this disease
The following prior therapies are allowed provided previously treated lesions remain separate from those to be measured in the current trial and prior treatment is completed within the past 4 weeks
- Surgery
- Liver-directed therapy (e.g., transarterial embolization/chemoembolization [limited to 5 treatments], radiofrequency ablation, cryoablation, radiotherapy, or percutaneous ethanol injection)
- No prior organ transplantation
- No concurrent estrogen-containing supplementary therapy
- No concurrent full-dose anticoagulation with coumarin derivatives
- No concurrent elective major surgery
- No concurrent radiotherapy (concurrent analgesic radiotherapy of non-target lesions allowed)
No concurrent or anticipated need for CYP3A4 inhibitors or inducers, unless the drugs are medically necessary and no substitutes are available, including any of the following:
- Ketoconazole
- Itraconazole
- Voriconazole
- Erythromycin
- Clarithromycin
- Diltiazem
- Verapamil
- Protease inhibitors
No concurrent strong CYP3A4 inducers*, including any of the following:
- Carbamazepine
- Continuous dexamethasone (> 2 mg/day for > 7 days)
- Phenobarbital
- Phenytoin
- Rifampicin
- St. John's wort NOTE: *Concurrent antacids allowed provided they are administered > 1 hour before or > 1 hour after trial drug administration.
- No other concurrent experimental drugs or anticancer therapy or treatment in another clinical trial within the past 30 days
- No other concurrent investigational drugs
- No chronic systemic steroids or other immunosuppressive agents
- No concurrent angiotension converting enzyme inhibitors (ACE-I)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Arm A: Sorafenib standard
• Arm A (standard treatment): Sorafenib 2 x 400 mg daily until progressive disease, unacceptable toxicity, or consent withdrawal.
(46 patients).
|
Sorafenib 2 x 400 mg daily
Other Names:
|
Experimental: Arm B: Sorafenib + everolimus
• Arm B (investigational treatment): Sorafenib 2 x 400 mg daily plus everolimus 1 x 5 mg daily until progressive disease, unacceptable toxicity, or consent withdrawal.
(60 patients)
|
Sorafenib 2 x 400 mg daily
Other Names:
Sorafenib 2 x 400 mg daily plus everolimus 1 x 5 mg daily
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Progression-free survival
Time Frame: at 12 weeks
|
at 12 weeks
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Objective response
Time Frame: during trial treatment and follow-up (max. 3 years)
|
during trial treatment and follow-up (max. 3 years)
|
Disease stabilization (DS)
Time Frame: under trial treatment
|
under trial treatment
|
Duration of disease stabilization
Time Frame: Duration of DS (CR, PR or SD) will be calculated from the time that measurement criteria are met for the first time until documented tumor progression.
|
Duration of DS (CR, PR or SD) will be calculated from the time that measurement criteria are met for the first time until documented tumor progression.
|
Progression-free survival (PFS)
Time Frame: PFS will be calculated from randomization until documented tumor progression or death, whichever occurs first
|
PFS will be calculated from randomization until documented tumor progression or death, whichever occurs first
|
Time to progression (TTP)
Time Frame: TTP will be calculated from randomization until documented tumor progression or tumor-related death
|
TTP will be calculated from randomization until documented tumor progression or tumor-related death
|
Overall survival
Time Frame: from randomization until death
|
from randomization until death
|
Adverse events at baseline and during trial treatment
Time Frame: All AEs will be assessed according to NCI CTCAE v3.0.
|
All AEs will be assessed according to NCI CTCAE v3.0.
|
Serum alpha fetoprotein (AFP) level
Time Frame: Serum AFP levels will be measured during the therapy, if AFP is ≥ 1.5 x ULN at baseline.
|
Serum AFP levels will be measured during the therapy, if AFP is ≥ 1.5 x ULN at baseline.
|
Viral reactivation in patients with chronic hepatitis B or C virus infection
Time Frame: Number of patients with HCV/HBV (re)-activation during trial treatment
|
Number of patients with HCV/HBV (re)-activation during trial treatment
|
Correlation between vitamin B12 and overall survival
Time Frame: The baseline vitamin B12 value, collected at trial randomization, is correlated to overall survival when dichotomized by the cut-point of 600 ng/L.
|
The baseline vitamin B12 value, collected at trial randomization, is correlated to overall survival when dichotomized by the cut-point of 600 ng/L.
|
Collaborators and Investigators
Investigators
- Study Chair: Jean-Francois Dufour, MD, University Hospital Inselspital, Berne
- Study Chair: Gyorgy Bodoky, MD, PhD, Szent Laszlo Korhaz
- Study Chair: Michael Montemurro, MD, CHUV Lausanne
Publications and helpful links
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Digestive System Diseases
- Neoplasms
- Neoplasms by Site
- Digestive System Neoplasms
- Liver Diseases
- Liver Neoplasms
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Enzyme Inhibitors
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Protein Kinase Inhibitors
- Sorafenib
- Everolimus
Other Study ID Numbers
- SAKK 77/08 and SASL 29
- SWS-SAKK-77/08 (Other Identifier: SAKK)
- SWS-SASL-29
- 2009-011884-35 (EudraCT Number)
- EU-20983
- CDR0000657702
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Liver Cancer
-
Slawa CwajnaNova Scotia Health AuthorityWithdrawnPrimary Liver Cancer | Metastatic Liver CancerCanada
-
Duke UniversityCompletedPrimary Liver Cancer | Metastatic Liver Cancer From Any Cancer SiteUnited States
-
University of HawaiiGlaxoSmithKlineRecruitingAdvanced Adult Primary Liver Cancer | Localized Unresectable Adult Primary Liver Cancer | Adult Primary Liver CancerUnited States
-
Célia TurcoCompletedPrimary Liver Cancer | Liver Metastases | Secondary Liver CancerFrance
-
University of CincinnatiActive, not recruitingLiver Metastases | Advanced Adult Primary Liver Cancer | Localized Unresectable Adult Primary Liver Cancer | Recurrent Adult Primary Liver CancerUnited States
-
Lisa H. Butterfield, Ph.D.National Cancer Institute (NCI)TerminatedHepatocellular Carcinoma | Liver Cancer | Cancer of Liver | Hepatoma | Hepatocellular Cancer | Hepatic Cancer | Liver Cell Carcinoma | Cancer, Hepatocellular | Liver Cancer, Adult | Liver Cell Carcinoma, Adult | Cancer of the Liver | Neoplasms, Liver | Hepatic Neoplasms | Neoplasms, HepaticUnited States
-
Radboud University Medical CenterTerumo Medical CorporationCompletedPrimary Liver Cancer | Liver Cancer | Liver Metastasis Colon CancerNetherlands
-
Cardiovascular and Interventional Radiological...RecruitingPrimary Liver Cancer | Secondary Liver CancerGermany
-
Shanghai Huihe Medical Technology Co., LtdEnrolling by invitation
-
Burzynski Research InstituteTerminatedPrimary Liver CancerUnited States
Clinical Trials on sorafenib tosylate
-
National Cancer Institute (NCI)CompletedMultiple Endocrine Neoplasia Type 2A | Multiple Endocrine Neoplasia Type 2B | Recurrent Thyroid Gland Medullary Carcinoma | Hereditary Thyroid Gland Medullary Carcinoma | Locally Advanced Thyroid Gland Medullary Carcinoma | Sporadic Thyroid Gland Medullary Carcinoma | Stage III Thyroid Gland Medullary... and other conditionsUnited States
-
National Cancer Institute (NCI)Active, not recruitingGastrointestinal Stromal TumorUnited States
-
National Cancer Institute (NCI)CompletedPreviously Treated Myelodysplastic Syndrome | Recurrent Adult Acute Myeloid Leukemia | Secondary Acute Myeloid Leukemia | Recurrent Adult Acute Lymphoblastic Leukemia | Secondary Myelodysplastic Syndrome | de Novo Myelodysplastic Syndrome | Adult Acute Monoblastic Leukemia | Adult Acute Monocytic... and other conditionsUnited States
-
National Cancer Institute (NCI)Gynecologic Oncology GroupCompletedRecurrent Ovarian Carcinoma | Primary Peritoneal CarcinomaUnited States
-
Roswell Park Cancer InstituteNational Comprehensive Cancer NetworkCompletedAdvanced Adult Hepatocellular Carcinoma | Localized Non-Resectable Adult Hepatocellular Carcinoma | Stage IIIA Hepatocellular Carcinoma | Stage IIIB Hepatocellular Carcinoma | Stage IIIC Hepatocellular Carcinoma | Stage IVA Hepatocellular Carcinoma | Stage IVB Hepatocellular Carcinoma | Stage III... and other conditionsUnited States
-
Ohio State University Comprehensive Cancer CenterBayerTerminated
-
National Cancer Institute (NCI)CompletedJuvenile Myelomonocytic Leukemia | Recurrent Disease | Recurrent Childhood Acute Lymphoblastic Leukemia | Recurrent Childhood Acute Myeloid Leukemia | Childhood Chronic Myelogenous Leukemia, BCR-ABL1 Positive | Childhood Solid Neoplasm | Chronic Myelogenous Leukemia, BCR-ABL1 Positive | Philadelphia... and other conditionsUnited States, Canada
-
National Cancer Institute (NCI)CompletedAdvanced Malignant NeoplasmUnited States
-
National Cancer Institute (NCI)CompletedHilar Cholangiocarcinoma | Recurrent Gallbladder Carcinoma | Unresectable Extrahepatic Bile Duct Carcinoma | Unresectable Gallbladder Carcinoma | Gallbladder Adenocarcinoma | Recurrent Extrahepatic Bile Duct Carcinoma | Extrahepatic Bile Duct Adenocarcinoma | Gallbladder Adenocarcinoma With Squamous... and other conditionsUnited States
-
National Cancer Institute (NCI)CompletedNon-Small-Cell Lung CarcinomaUnited States