A Randomized Phase II Trial Evaluating Chemotherapy Plus Atezolizumab vs Chemotherapy Plus Bevacizumab and Atezolizumab in Advanced Combined Hepatocellular Carcinoma-Cholangiocarcinoma
Overview
- Phase
- Phase 2
- Intervention
- Atezolizumab
- Conditions
- Combined Hepatocellular Carcinoma and Cholangiocarcinoma
- Sponsor
- National Cancer Institute (NCI)
- Enrollment
- 88
- Locations
- 73
- Primary Endpoint
- Progression free survival (PFS)
- Status
- Active, not recruiting
- Last Updated
- 19 days ago
Overview
Brief Summary
This phase II trial compares the effect of adding bevacizumab and atezolizumab to gemcitabine and cisplatin (chemotherapy) versus chemotherapy and atezolizumab in treating patients with liver cancer that cannot be removed by surgery (unresectable) or that may have spread from where it first started to nearby tissue, lymph nodes, or distant parts of the body (advanced). Immunotherapy with monoclonal antibodies, such as atezolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Bevacizumab is in a class of medications called antiangiogenic agents. It works by stopping the formation of blood vessels that bring oxygen and nutrients to tumor. This may slow the growth and spread of tumor. Chemotherapy drugs, such as gemcitabine and cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving bevacizumab and atezolizumab with chemotherapy may kill more tumor cells in patients liver cancer than chemotherapy and atezolizumab.
Detailed Description
PRIMARY OBJECTIVE: I. To evaluate whether a quadruplet combined chemotherapy, immunotherapy, and anti-VEGF therapy improves progression-free survival (PFS), defined as time to progressive disease or death due to any cause as determined by the investigator using Response Evaluation Criteria in Solid Tumors (RECIST) version (v)1.1, compared to chemotherapy plus immunotherapy in patients with advanced combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC). SECONDARY OBJECTIVES: I. To evaluate whether a quadruplet combined chemotherapy, immunotherapy, and anti-VEGF therapy improves objective response (OR), defined as a complete or partial response as determined by the investigator according to RECIST v1.1, compared to chemotherapy plus immunotherapy in patients with advanced cHCC-CC. II. To evaluate whether a quadruplet combined chemotherapy, immunotherapy, and anti-VEGF therapy improves overall response (OS), and disease control rate as determined by the investigator using RECIST v1.1, compared to chemotherapy plus immunotherapy in patients with advanced cHCC-CC. OUTLINE: Patients are randomized to 1 of 2 arms. ARM A: Patients receive atezolizumab intravenously (IV) over 30-60 minutes on day 1, bevacizumab IV over 30-90 minutes on day 1, gemcitabine IV over 30 minutes on days 1 and 8, and cisplatin IV on days 1 and 8. Cycles repeats every 21 days in the absence of disease progression or unacceptable toxicity. Patients undergo computed tomography (CT) or magnetic resonance imaging (MRI) throughout the trial. Patients undergo blood specimen collection on study. ARM B: Patients receive atezolizumab IV over 30-60 minutes on day 1, and gemcitabine IV over 30 minutes and cisplatin IV on days 1 and 8. Cycles repeats every 21 days in the absence of disease progression or unacceptable toxicity. Patients undergo CT or magnetic resonance imaging MRI throughout the trial. Patients undergo blood specimen collection on study. After completion of study treatment, patients are followed up for 3 years.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Patient must be \>= 18 years of age
- •Patient must have a histologically confirmed diagnosis of combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CC) at the local laboratory based on the 2019 World Health Organization (WHO) classification, including the classical type and intermediate cell carcinoma
- •The classical type defines primary liver carcinoma with unequivocal features of both HCC and CC differentiation within the same tumors on routine histopathology with hematoxylin and eosin stains regardless of the proportion of each histology observed
- •The intermediate cell carcinoma defines cancers with biphenotypic differentiation in which cells have a morphology intermediate between hepatocytes and cholangiocytes. Intermediate cell carcinoma may be associated with expression of both hepatocyte and cholangiocytic markers. Distinct HCC and CC arising in the same liver, fibrolamellar HCC, morphologically typical HCCs with only immunohistochemical expression of keratin or other cholangiocytic markers, or morphologically typical CCs with only immunohistochemical expression of hepatocytic markers will be excluded
- •NOTE: Local pathology review constitutes adequate documentation of histology for initial study enrollment and treatment
- •Patient must have Eastern Cooperative Oncology Group (ECOG) performance status of 0-1
- •Patient must have disease which is unresectable or metastatic
- •Patient must not have any prior history of systemic therapy for advanced cHCC-CC. Prior adjuvant treatment composed of chemotherapy agents such as capecitabine or gemcitabine-based treatments are allowed if adjuvant treatment if at least 6 months have elapsed since completing chemotherapy at the time of enrollment
- •Patient must be Child Pugh class A
- •Patients with prior locoregional therapy are eligible provided the following are met:
Exclusion Criteria
- Not provided
Arms & Interventions
Arm A (atezolizumab, bevacizumab, gemcitabine, cisplatin)
Patients receive atezolizumab IV over 30-60 minutes on day 1, bevacizumab IV over 30-90 minutes on day 1, gemcitabine IV over 30 minutes on days 1 and 8, and cisplatin IV on days 1 and 8. Cycles repeats every 21 days in the absence of disease progression or unacceptable toxicity. Patients undergo CT or MRI throughout the trial. Patients undergo blood specimen collection on study.
Intervention: Atezolizumab
Arm A (atezolizumab, bevacizumab, gemcitabine, cisplatin)
Patients receive atezolizumab IV over 30-60 minutes on day 1, bevacizumab IV over 30-90 minutes on day 1, gemcitabine IV over 30 minutes on days 1 and 8, and cisplatin IV on days 1 and 8. Cycles repeats every 21 days in the absence of disease progression or unacceptable toxicity. Patients undergo CT or MRI throughout the trial. Patients undergo blood specimen collection on study.
Intervention: Bevacizumab
Arm A (atezolizumab, bevacizumab, gemcitabine, cisplatin)
Patients receive atezolizumab IV over 30-60 minutes on day 1, bevacizumab IV over 30-90 minutes on day 1, gemcitabine IV over 30 minutes on days 1 and 8, and cisplatin IV on days 1 and 8. Cycles repeats every 21 days in the absence of disease progression or unacceptable toxicity. Patients undergo CT or MRI throughout the trial. Patients undergo blood specimen collection on study.
Intervention: Cisplatin
Arm A (atezolizumab, bevacizumab, gemcitabine, cisplatin)
Patients receive atezolizumab IV over 30-60 minutes on day 1, bevacizumab IV over 30-90 minutes on day 1, gemcitabine IV over 30 minutes on days 1 and 8, and cisplatin IV on days 1 and 8. Cycles repeats every 21 days in the absence of disease progression or unacceptable toxicity. Patients undergo CT or MRI throughout the trial. Patients undergo blood specimen collection on study.
Intervention: Gemcitabine Hydrochloride
Arm B (atezolizumab, gemcitabine, cisplatin)
Patients receive atezolizumab IV over 30-60 minutes on day 1, and gemcitabine IV over 30 minutes and cisplatin IV on days 1 and 8. Cycles repeats every 21 days in the absence of disease progression or unacceptable toxicity. Patients undergo CT or magnetic resonance imaging MRI throughout the trial. Patients undergo blood specimen collection on study.
Intervention: Atezolizumab
Arm B (atezolizumab, gemcitabine, cisplatin)
Patients receive atezolizumab IV over 30-60 minutes on day 1, and gemcitabine IV over 30 minutes and cisplatin IV on days 1 and 8. Cycles repeats every 21 days in the absence of disease progression or unacceptable toxicity. Patients undergo CT or magnetic resonance imaging MRI throughout the trial. Patients undergo blood specimen collection on study.
Intervention: Gemcitabine Hydrochloride
Arm B (atezolizumab, gemcitabine, cisplatin)
Patients receive atezolizumab IV over 30-60 minutes on day 1, and gemcitabine IV over 30 minutes and cisplatin IV on days 1 and 8. Cycles repeats every 21 days in the absence of disease progression or unacceptable toxicity. Patients undergo CT or magnetic resonance imaging MRI throughout the trial. Patients undergo blood specimen collection on study.
Intervention: Computed Tomography
Arm B (atezolizumab, gemcitabine, cisplatin)
Patients receive atezolizumab IV over 30-60 minutes on day 1, and gemcitabine IV over 30 minutes and cisplatin IV on days 1 and 8. Cycles repeats every 21 days in the absence of disease progression or unacceptable toxicity. Patients undergo CT or magnetic resonance imaging MRI throughout the trial. Patients undergo blood specimen collection on study.
Intervention: Conventional Magnetic Resonance Imaging
Arm B (atezolizumab, gemcitabine, cisplatin)
Patients receive atezolizumab IV over 30-60 minutes on day 1, and gemcitabine IV over 30 minutes and cisplatin IV on days 1 and 8. Cycles repeats every 21 days in the absence of disease progression or unacceptable toxicity. Patients undergo CT or magnetic resonance imaging MRI throughout the trial. Patients undergo blood specimen collection on study.
Intervention: Cisplatin
Arm A (atezolizumab, bevacizumab, gemcitabine, cisplatin)
Patients receive atezolizumab IV over 30-60 minutes on day 1, bevacizumab IV over 30-90 minutes on day 1, gemcitabine IV over 30 minutes on days 1 and 8, and cisplatin IV on days 1 and 8. Cycles repeats every 21 days in the absence of disease progression or unacceptable toxicity. Patients undergo CT or MRI throughout the trial. Patients undergo blood specimen collection on study.
Intervention: Biospecimen Collection
Arm A (atezolizumab, bevacizumab, gemcitabine, cisplatin)
Patients receive atezolizumab IV over 30-60 minutes on day 1, bevacizumab IV over 30-90 minutes on day 1, gemcitabine IV over 30 minutes on days 1 and 8, and cisplatin IV on days 1 and 8. Cycles repeats every 21 days in the absence of disease progression or unacceptable toxicity. Patients undergo CT or MRI throughout the trial. Patients undergo blood specimen collection on study.
Intervention: Computed Tomography
Arm A (atezolizumab, bevacizumab, gemcitabine, cisplatin)
Patients receive atezolizumab IV over 30-60 minutes on day 1, bevacizumab IV over 30-90 minutes on day 1, gemcitabine IV over 30 minutes on days 1 and 8, and cisplatin IV on days 1 and 8. Cycles repeats every 21 days in the absence of disease progression or unacceptable toxicity. Patients undergo CT or MRI throughout the trial. Patients undergo blood specimen collection on study.
Intervention: Conventional Magnetic Resonance Imaging
Arm B (atezolizumab, gemcitabine, cisplatin)
Patients receive atezolizumab IV over 30-60 minutes on day 1, and gemcitabine IV over 30 minutes and cisplatin IV on days 1 and 8. Cycles repeats every 21 days in the absence of disease progression or unacceptable toxicity. Patients undergo CT or magnetic resonance imaging MRI throughout the trial. Patients undergo blood specimen collection on study.
Intervention: Biospecimen Collection
Outcomes
Primary Outcomes
Progression free survival (PFS)
Time Frame: From start of treatment until progression, assessed up to 3 years
Defined as time to progressive disease or death due to any cause as determined by the investigator using Response Evaluation Criteria in Solid Tumors (RECIST) version (v)1.1. The null hypothesis of equality of PFS will be tested using a one-sided alternative favoring the quadruplet arm. The primary comparison will be via a one-sided log rank test.
Secondary Outcomes
- Objective response rate(Up to 3 years)
- Overall response rate(Up to 3 years)