Cabozantinib in patients previously treated with immune checkpoint inhibitors
- Conditions
- Neoplasms
- Registration Number
- KCT0005238
- Lead Sponsor
- Asan Medical Center
- Brief Summary
Not available
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Active, not recruiting
- Sex
- All
- Target Recruitment
- 48
1.Diagnosis of HCC according to AASLD guidelines
2.Disease that is not amenable to a curative treatment (e.g. surgery, transplant, radiofrequency ablation)
3.Prior treatment with immune check-point inhibitor (including anti-PD1, anti-CTLA4, anti-PD1 plus anti-CTLA4, or above agents plus other targeted agents)
4.For patients who stop immune check-point inhibitor due to progressive disease, the duration of immune check-point inhibitor must be 8 weeks or longer
5.Recovery to = Grade 1 from toxicities related to any prior treatments, unless the adverse events are clinically nonsignificant and/or stable on supportive therapy
6.Life expectancy of 12 weeks or longer
7.Age = 19 years old
8.ECOG performance status of 0, 1 or 2
9.Adequate hematological function
a.Absolute neutrophil count (ANC) = 1.2 x109/L
b.Platelets = 60 x 109/L
c.Hemoglobin = 8g/dL
10.Adequate renal function
a.serum creatinine = 1.5 × upper limit of normal or calculated creatinine clearance = 40 mL/min (using the Cockroft-Gault equation) AND
b.urine protein/creatinine ratio (UPCR) = 1 mg/mg (= 113.1 mg/mmol) or 24-hour urine protein < 1 g
11.Child-Pugh Score of A5 or 6
12.Total bilirubin = 2 mg/dL (= 34.2 µmol/L)
13.Serum albumin > 2 g/dL (> 20 g/L)
14.Alanine aminotransferase (ALT) < 3.0 upper limit of normal (ULN)
15.Hemoglobin A1c (HbA1c) = 8%
16.Antiviral therapy per local standard of care if active hepatitis B (HBV) infection
17.Capable of understanding and complying with the protocol requirements and signed informed consent
18.Sexually active fertile subjects and their partners must agree to use medically accepted methods of contraception (e.g., barrier methods, including male condom, female condom, or diaphragm with spermicidal gel) during the course of the study and for 4 months after the last dose of study treatment
19.Female subjects of childbearing potential must not be pregnant at screening.
1.Fibrolamellar carcinoma or mixed hepatocellular cholangiocarcinoma
2.Prior cabozantinib treatment
3.More than two lines of systemic therapy (i.e. cabozantinib must be either 2nd line or 3rd line systemic treatment)
4.Known brain metastases or cranial epidural disease unless adequately treated with radiotherapy and/or surgery (including radiosurgery) and stable for at least 3 months before randomization.
5.Concurrent steroid use of prednisolone >10mg once daily
6.Presence of thrombosis or tumor invasion in inferior vena cava
7.Concomitant anticoagulation, at therapeutic doses, with anticoagulants such as warfarin or warfarin-related agents, low molecular weight heparin (LMWH), thrombin or coagulation factor X (FXa) inhibitors, or antiplatelet agents (eg, clopidogrel). Low dose aspirin for cardioprotection (per local applicable guidelines), low-dose warfarin (= 1 mg/day), and low dose LMWH are permitted.
8.The subject has uncontrolled, significant intercurrent or recent illness including, but not limited to, the following conditions:
a.Cardiovascular disorders including
i.Symptomatic congestive heart failure, unstable angina pectoris, or serious cardiac arrhythmias
ii.Uncontrolled hypertension defined as sustained BP > 150 mm Hg systolic, or > 100 mm Hg diastolic despite optimal antihypertensive treatment
iii.Stroke (including TIA), myocardial infarction, or other ischemic event within 6 months
iv.Thromboembolic event within 3 months. Subjects with thromboses of portal/hepatic vasculature attributed to underlying liver disease and/or liver tumour are eligible
b.Gastrointestinal (GI) disorders including those associated with a high risk of perforation or fistula formation/bleeding:
i.Tumours invading the GI tract, active peptic ulcer disease, inflammatory bowel disease, diverticulitis, cholecystitis, symptomatic cholangitis or appendicitis, acute pancreatitis or acute obstruction of the pancreatic duct or common bile duct, or gastric outlet obstruction
ii.Abdominal fistula, GI perforation, bowel obstruction, intra-abdominal abscess within 6 months
9.Major surgery within 2 months before randomization. Complete healing from major surgery must have occurred 1 month before randomization. Complete healing from minor surgery (eg, simple excision, tooth extraction) must have occurred at least 7 days before registration. Subjects with clinically relevant co d. Cavitating pulmonary lesion(s) or endobronchial disease
10.Lesion invading a major blood vessel (eg, pulmonary artery or aorta)
11.Clinically significant bleeding risk including the following within 3 months of registration: hematuria, hematemesis, hemoptysis of >0.5 teaspoon (>2.5 mL) of red blood, or other signs indicative of pulmonary hemorrhage, or history of other significant bleeding if not due to reversible external factors
12.Subjects with untreated or incompletely treated varices with bleeding or high risk for bleeding are excluded with the following clarification: subjects with history of prior variceal bleeding must have been treated with adequate endoscopic therapy without any evidence of recurrent bleeding for at least 6 months prior to study entry and must be stable on optimal medical management (e.g. non-selective beta blocker, proton pump inhibitor) at study entry.
13.Moderate or severe ascites (Radiologically detected but clinically insignificant ascites is allowed)
14.Corrected QT interval calculated by the Fridericia fo
Study & Design
- Study Type
- Interventional Study
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Progression-free survival
- Secondary Outcome Measures
Name Time Method Response rate;Overall survival;Time to progression;Adverse events