- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05199285
A Phase II Study of Nivolumab + Ipilimumab in Advanced HCC Patients Who Have Progressed on First Line Atezolizumab + Bevacizumab
Study Overview
Status
Conditions
- Unresectable Hepatocellular Carcinoma
- Stage III Hepatocellular Carcinoma AJCC v8
- Stage IIIA Hepatocellular Carcinoma AJCC v8
- Stage IV Hepatocellular Carcinoma AJCC v8
- Stage IVA Hepatocellular Carcinoma AJCC v8
- Stage IVB Hepatocellular Carcinoma AJCC v8
- BCLC Stage B Hepatocellular Carcinoma
- BCLC Stage C Hepatocellular Carcinoma
- Stage IIIB Hepatocellular Carcinoma AJCC v8
- Metastatic Hepatocellular Carcinoma
- Locally Advanced Hepatocellular Carcinoma
Intervention / Treatment
Detailed Description
PRIMARY OBJECTIVE:
I. To investigate the confirmed objective response rate (ORR) of nivolumab and ipilimumab in patients with hepatocellular carcinoma (HCC) who have progressed radiographically on atezolizumab/bevacizumab that necessitates change in treatment.
SECONDARY OBJECTIVES:
I. To determine the overall survival (OS) in hepatocellular carcinoma (HCC) patients treated with nivolumab and ipilimumab who have progressed radiographically on atezolizumab / bevacizumab that necessitates change in treatment.
II. To determine the progression free survival (PFS) in hepatocellular carcinoma (HCC) patients treated with nivolumab and ipilimumab who have progressed radiographically on atezolizumab/bevacizumab that necessitates change in treatment.
III. To determine the disease control rate in hepatocellular carcinoma (HCC) patients treated with nivolumab and ipilimumab who have progressed radiographically on atezolizumab/bevacizumab that necessitates change in treatment.
IV. To assess the frequency and severity of adverse events in hepatocellular carcinoma (HCC) patients treated with nivolumab and ipilimumab who have progressed radiographically on atezolizumab/bevacizumab that necessitates change in treatment.
OUTLINE:
Patients receive nivolumab intravenously (IV) over 30 minutes and ipilimumab IV over 90 minutes on day 1. Treatment repeats every 21 days for 4 cycles in the absence of disease progression or unacceptable toxicity. Patients then receive nivolumab IV over 30 minutes on day 1. Treatment repeats every 28 days for up to 24 cycles in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at 30 days and then every 3 months for up to 2 years from registration.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
Alabama
-
Birmingham, Alabama, United States, 35233
- Recruiting
- University of Alabama- Birmingham
-
Principal Investigator:
- Mehmet Akce, M.D.
-
Contact:
- University of Alabama at Birmingham/O'Neal Comprehensive Cancer Center
- Phone Number: 205-934-2992
-
-
Florida
-
Miami, Florida, United States, 33136
- Recruiting
- University of Miami Miller School of Medicine-Sylvester Cancer Center
-
Principal Investigator:
- Lynn Feun
-
Contact:
- Carla Montoya
- Phone Number: 305-243-1139
- Email: ccm162@miami.edu
-
-
Georgia
-
Atlanta, Georgia, United States, 30322
- Not yet recruiting
- Emory University Hospital/Winship Cancer Institute
-
Principal Investigator:
- Maria Diab
-
Contact:
- Maria Diab
- Phone Number: 444-778-8025
- Email: maria.diab@emory.edu
-
-
Minnesota
-
Rochester, Minnesota, United States, 55905
- Not yet recruiting
- Mayo Clinic in Rochester
-
Principal Investigator:
- Mehmet Akce
-
Contact:
- Mehmet Akce
- Phone Number: 444-778-8025
- Email: accru@mayo.edu
-
-
New Jersey
-
New Brunswick, New Jersey, United States, 08903
- Recruiting
- Rutgers Cancer Institute of New Jersey
-
Contact:
- Simbiat Ajao
- Phone Number: 732-235-7530
- Email: ajao@cinj.rutgers.edu
-
Principal Investigator:
- Sharon Li, M.D.
-
-
Tennessee
-
Nashville, Tennessee, United States, 37232
- Recruiting
- Vanderbilt University/Ingram Cancer Center
-
Contact:
- Thatcher Heumann
- Phone Number: 615-936-8422
- Email: thatcher.heumann@vumc.org 615-936-8422 NA
-
Principal Investigator:
- Thatcher Heumann
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age >= 18 years.
- HCC diagnosis confirmed by histology/cytology or clinically by American Association for Study of Liver Diseases (AASLD) criteria in cirrhotic patients.
- Measurable disease as defined by Response Evaluation Criteria in Solid Tumors (RECIST) version (v)1.1
- Locally advanced, metastatic, or unresectable disease.
- Child Pugh class A.
- Barcelona clinic liver cancer (BCLC) stage B (not amenable to liver directed therapy) or stage C.
- Prior treatment with atezolizumab and bevacizumab combination with radiographic progression that necessitates change in treatment per treating physician. Patients with rapid progression on atezolizumab and bevacizumab (defined as patients who progressed radiographically in the first restaging scan that necessitates change in treatment) are excluded.
- Washout period >= 4 weeks prior to registration is required since last atezolizumab and bevacizumab dose.
- Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1. (Form is available on the Academic and Community Cancer Research United [ACCRU] website).
- Absolute neutrophil count (ANC) >= 1000/mm ^ 3 (obtained =< 28 days prior to registration).
- Platelet count >= 60,000/mm^3 (obtained =< 28 days prior to registration).
- Hemoglobin >= 8.5 g/dL (obtained =< 28 days prior to registration).
- Total bilirubin =< 3 x upper limit of normal (ULN) (obtained =< 28 days prior to registration).
- Alanine aminotransferase (ALT) and aspartate transaminase (AST) =< 5 x ULN (obtained =< 28 days prior to registration).
- International normalized ratio (INR) =< 2.3 or Prothrombin time (PT) =< 6 seconds above control OR if patient is receiving anticoagulant therapy and INR is within target range of therapy creatinine =< 1.5x ULN (obtained =< 28 days prior to registration).
Negative pregnancy test done =< 7 days prior to registration, for women of childbearing potential only.
- Note: If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required.
- Provide informed written consent =< 28 days prior to registration.
Willing to return to enrolling institution for follow-up (during the active monitoring phase of the study).
- Note: During the active monitoring phase of a study (i.e., active treatment), participants must be willing to return to the consenting institution for follow-up.
- Willing to provide mandatory tissue specimens and blood specimens for correlative research purposes.
Exclusion Criteria:
Any of the following because this study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown
- Pregnant persons
- Nursing persons
- Persons of childbearing potential who are unwilling to employ adequate contraception.
- Major surgery =< 4 weeks prior to registration.
- Liver directed therapy (transarterial chemoembolization [TACE], Y-90, liver directed radiation) =< 28 days prior to registration. Prior liver directed therapy > 28 days prior to registration is allowed as long as patient has at least one measurable untreated lesion by RECIST v1.1.
- Patients with rapid progression on atezolizumab and bevacizumab (who progressed radiographically in the first restaging scan that necessitates change in treatment) are excluded.
- Prior treatment =< 4 weeks prior to registration with anti-CTLA-4 antibody for HCC.
- Comorbid 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.
Immunocompromised patients and patients known to be human immunodeficiency virus (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.
Uncontrolled intercurrent illness including, but not limited to:
- Ongoing or active infection excluding hepatitis C virus (HCV)
- Symptomatic congestive heart failure
- Unstable angina pectoris
- Unstable cardiac arrhythmia
- Psychiatric illness/social situations that would limit compliance with study requirements.
- Active infection including tuberculosis (clinical evaluation that includes clinical history, physical examination and radiographic findings, and tuberculosis [TB] testing in line with local practice), hepatitis B (known positive hepatitis B virus [HBV] surface antigen [HBsAg] result). Patients with a past or resolved HBV infection (defined as the presence of hepatitis B core antibody [anti-HBc] and absence of HBsAg) are eligible. Patients with chronic HBV infection as evidenced by detectable HBV surface antigen or HBV deoxyribonucleic acid (DNA) are eligible if on antiviral therapy and have HBV DNA < 100 IU/mL. Patients with active or resolved hepatitis C (HCV) infection as evidenced by detectable HCV ribonucleic acid (RNA) or antibody are eligible.
- Receiving any other investigational agent which would be considered as a treatment for the primary neoplasm =< 4 weeks prior to registration.
- Other active malignancy =< 2 years prior to registration. Exceptions: Non-melanotic skin cancer or carcinoma-in-situ of the cervix.
- History of myocardial infarction =< 6 months, or congestive heart failure requiring use of ongoing maintenance therapy for life-threatening ventricular arrhythmias.
- History of allogenic organ transplantation.
Active or prior documented autoimmune or inflammatory disorders (including inflammatory bowel disease [e.g., colitis or Crohn's disease], diverticulitis [with the exception of diverticulosis], systemic lupus erythematosus, sarcoidosis syndrome, or Wegener syndrome [granulomatosis with polyangiitis, graves' disease, rheumatoid arthritis, hypophysitis, uveitis, etc]). The following are exceptions to this criterion:
- Patients with vitiligo or alopecia
- Patients with hypothyroidism (e.g., following Hashimoto syndrome) stable on hormone replacement
- Any chronic skin condition that does not require systemic therapy
- Patients without active disease in the last 5 years may be included but only after consultation with the study physician
- Patients with celiac disease controlled by diet alone
- History of leptomeningeal carcinomatosis.
- Known allergy or hypersensitivity to any of the study drugs or any of the study drug excipients.
Current or prior use of immunosuppressive medication =< 14 days prior to registration. The following are exceptions to this criterion:
- Intranasal, inhaled, topical steroids, or local steroid injections (e.g., intra articular injection)
- Systemic corticosteroids at physiologic doses not to exceed 10 mg/day of prednisone or its equivalent
- Steroids as premedication for hypersensitivity reactions (e.g., computed tomography [CT] scan premedication).
- Receipt of live attenuated vaccine =< 30 days prior to registration; Note: Patients, if enrolled, should not receive live vaccine whilst on study treatment and up to 30 days after the last dose of study treatment.
- Any unresolved toxicity National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v5.0 grade >= 2 from previous anticancer therapy with the exception of alopecia, vitiligo, and the laboratory values defined in the inclusion criteria.
- History of grade 3 or 4 immunotherapy related toxicity NCI CTCAE v5.0 due to prior regimen attributed to atezolizumab.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Treatment (nivolumab, ipilimumab)
Patients receive nivolumab IV over 30 minutes and ipilimumab IV over 90 minutes on day 1.
Treatment repeats every 21 days for 4 cycles in the absence of disease progression or unacceptable toxicity.
Patients then receive nivolumab IV over 30 minutes on day 1.
Treatment repeats every 28 days for up to 24 cycles in the absence of disease progression or unacceptable toxicity.
|
Given IV
Other Names:
Given IV
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Confirmed objective response rate (ORR)
Time Frame: Up to 6 months
|
A confirmed response is defined to be either a complete response (CR) or partial response (PR) noted as the objective status on 2 consecutive evaluations at least 4 weeks apart.
Disease status will be assessed using response evaluation criteria in solid tumors (RECIST) version (v.) 1.1 criteria.
Overall Response Rate (ORR) is defined as the proportion of evaluable patients who achieve confirmed response (CR or PR) while on treatment.
The final ORR point estimate and corresponding 95% confidence interval will be reported according to the method of Clopper-Pearson.
|
Up to 6 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Overall survival (OS)
Time Frame: Assessed up to 2 years
|
Overall survival (OS) is defined as the time from registration to death from any cause.
OS will be estimated using the Kaplan-Meier method.
Patients who are alive will be censored at the last follow-up date.
The median OS and corresponding 95% confidence interval will be reported.
|
Assessed up to 2 years
|
Progression-free survival (PFS)
Time Frame: Assessed up to 2 years
|
Progression-free survival (PFS) is defined as the time from registration to the first disease progression or death from any cause, where disease progression is determined based on RECIST 1.1 criteria.
PFS will be estimated using the Kaplan-Meier method.
Patients who do not experience disease progression or death while on protocol will be censored at the last disease assessment date.
The median PFS and corresponding 95% confidence interval will be reported.
|
Assessed up to 2 years
|
Disease control
Time Frame: Up to 2 years
|
Disease control is defined as achieving CR, PR, or maintaining SD for at least 6 months while on treatment.
Objective status will be assessed using RECIST v. 1.1 criteria.
Disease control rate will be calculated as the proportion of evaluable patients who achieve disease control.
Confidence intervals for the true success proportion will be calculated according to the approach of Clopper Pearson.
|
Up to 2 years
|
Incidence of adverse events
Time Frame: Up to 2 years
|
All patients who have initiated treatment will be considered evaluable for adverse event analyses.
The rate of patients experiencing a grade 3+ adverse event will be reported using Common Terminology Criteria for Adverse Events (CTCAE) v5.0.
|
Up to 2 years
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Mehmet Akce, Academic and Community Cancer Research United
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
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 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
- Antineoplastic Agents
- Antineoplastic Agents, Immunological
- Immune Checkpoint Inhibitors
- Nivolumab
- Ipilimumab
Other Study ID Numbers
- ACCRU-GI-2017 (Other Identifier: Academic and Community Cancer Research United)
- P30CA015083 (U.S. NIH Grant/Contract)
- NCI-2021-13335 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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 Unresectable Hepatocellular Carcinoma
-
National Cancer Institute (NCI)Active, not recruitingStage III Intrahepatic Cholangiocarcinoma AJCC v8 | Stage IIIA Intrahepatic Cholangiocarcinoma AJCC v8 | Stage IIIB Intrahepatic Cholangiocarcinoma AJCC v8 | Unresectable Hepatocellular Carcinoma | Metastatic Cholangiocarcinoma | Stage III Hepatocellular Carcinoma AJCC v8 | Stage IIIA Hepatocellular... and other conditionsUnited States
-
Sun Yat-sen UniversityXiangya Hospital of Central South University; Nanfang Hospital of Southern... and other collaboratorsRecruitingUnresectable Hepatocellular Carcinoma | Hepatocellular Carcinoma by BCLC StageChina
-
Mayo ClinicRecruitingAdvanced Hepatocellular Carcinoma | Unresectable Hepatocellular Carcinoma | Stage III Hepatocellular Carcinoma AJCC v8 | Stage IV Hepatocellular Carcinoma AJCC v8United States
-
Sirtex MedicalBright Research PartnersRecruitingUnresectable Hepatocellular Carcinoma | BCLC Stage B Hepatocellular Carcinoma | BCLC Stage C Hepatocellular Carcinoma | BCLC Stage A Hepatocellular CarcinomaUnited States
-
H. Lee Moffitt Cancer Center and Research InstituteNational Comprehensive Cancer NetworkWithdrawnLiver Cancer | HepatoCellular Carcinoma | Unresectable HepatoCellular CarcinomaUnited States
-
BeiGeneCompletedHepatocellular Carcinoma | Unresectable Hepatocellular Carcinoma | Metastatic Hepatocellular CarcinomaChina
-
Mayo ClinicNational Cancer Institute (NCI)RecruitingStage III Intrahepatic Cholangiocarcinoma AJCC v8 | Unresectable Hepatocellular Carcinoma | Stage III Hepatocellular Carcinoma AJCC v8 | Stage IV Hepatocellular Carcinoma AJCC v8 | Stage IV Intrahepatic Cholangiocarcinoma AJCC v8 | Unresectable Intrahepatic CholangiocarcinomaUnited States
-
Chengdu New Radiomedicine Technology Co. LTD.RecruitingUnresectable Hepatocellular CarcinomaChina
-
BayerRecruitingUnresectable Hepatocellular CarcinomaGreece, Spain, Brazil, China, Colombia, Italy, Saudi Arabia, Taiwan, Thailand, United States, Korea, Republic of, Argentina, France, Mexico, Turkey
-
Zhongda HospitalRecruitingUnresectable Hepatocellular CarcinomaChina
Clinical Trials on Nivolumab
-
Universitair Ziekenhuis BrusselNot yet recruiting
-
Brown UniversityBristol-Myers Squibb; The Miriam Hospital; Rhode Island Hospital; Women and Infants...Terminated
-
Bristol-Myers SquibbRecruitingMelanomaSpain, United States, Italy, Chile, Greece, Argentina
-
Baptist Health South FloridaBristol-Myers Squibb; NovoCure Ltd.TerminatedRecurrent GlioblastomaUnited States
-
Jason J. Luke, MDArray BioPharmaActive, not recruitingMelanoma | Renal Cell Carcinoma | Solid Tumor | Non-small Cell Lung Cancer | Head and Neck Squamous Cell CarcinomaUnited States
-
HUYABIO International, LLC.Bristol-Myers SquibbActive, not recruitingUnresectable or Metastatic Melanoma | Progressive Brain MetastasisNew Zealand, Spain, United States, Belgium, France, Japan, Germany, Korea, Republic of, Singapore, Australia, Brazil, South Africa, Italy, Czechia, Austria, Puerto Rico, United Kingdom
-
Michael B. Atkins, MDBristol-Myers Squibb; Hoosier Cancer Research NetworkActive, not recruitingAdvanced Renal Cell CarcinomaUnited States
-
Bristol-Myers SquibbCompletedLung CancerItaly, United States, France, Russian Federation, Spain, Argentina, Belgium, Brazil, Canada, Chile, Czechia, Germany, Greece, Hungary, Mexico, Netherlands, Poland, Romania, Switzerland, Turkey, United Kingdom
-
Universitätsklinikum Hamburg-EppendorfCharite University, Berlin, Germany; University Hospital, Essen; Westpfalz-Clinical...Active, not recruiting
-
National Health Research Institutes, TaiwanNational Taiwan University Hospital; Mackay Memorial Hospital; China Medical... and other collaboratorsRecruitingHepatocellular Carcinoma (HCC)Taiwan