A Phase II Trial of Durvalumab (MEDI4736) and Tremelimumab and Radiation Therapy in Hepatocellular Carcinoma and Biliary Tract Cancer
This research study is studying a combination of drugs as a possible treatment for Hepatocellular Carcinoma or Biliary Tract Cancer. The interventions involved in this study are: * Durvalumab * Tremelimumab * Radiation Therapy
• Histologically or cytologically confirmed hepatocellular carcinoma or biliary tract cancer
• Locally advanced/unresectable or metastatic disease
• Age ≥ 18 years at time of study entry
• ECOG Performance Status ≤ 1
• One previously unirradiated lesion amenable to 8 Gy x 3 radiotherapy based on dosimetric organ tolerance AND another unirradiated measurable lesion (per irRECIST) outside of the radiation field
• Immunotherapy-naïve
• Progressed on, be intolerant of, or refused sorafenib \[for HCC\], second line treatment and beyond for cholangiocarcinoma or gemcitabine-based chemotherapy for biliary tract cancer
• The benefits of sorafenib have been discussed with the patient and the patient has refused treatment with sorafenib.
• Viral status (Hepatitis B and C) must be known. All HBV-positive patients must be on antiviral medication for viral suppression.
‣ Patients with concomitant HBV infection must have a confirmed diagnosis of HBV characterized by the presence of hepatitis B core antibodies, and be sufficiently suppressed with active antiviral treatment (per local institutional practice) prior to enrollment to ensure adequate viral suppression (HBV deoxyribonucleic acid \[DNA\] \<2000 IU/mL).
⁃ Patients with concomitant HCV infection must have confirmed diagnosis of HCV characterized by the presence of detectable HCV ribonucleic acid (RNA or anti-HCV antibody upon enrollment.
• Body weight ≥ 30 kg
• Child-Pugh Score of A. A score of B7 is allowed without severe ascites or without hepatic encephalopathy.
• Adequate organ and marrow function, defined as:
‣ Hemoglobin ≥ 9 g/dL
⁃ ANC ≥ 1.5 x 10\^9/L
⁃ Platelet count ≥75×109/L
⁃ Serum bilirubin ≤2.0× the upper limit of normal (ULN).
⁃ ALT and AST ≤ 3 x institutional ULN
⁃ Albumin \> 2.8 g/dL
⁃ INR \< 2.0
⁃ Calculated creatinine clearance \> 40 mL/min as determined by Cockcroft-Gault (using actual body weight)
• Males:
⁃ -Creatinine CL (mL/min) = Weight (kg) x (140 - Age) 72 x serum creatinine (mg/dL)
• Females:
⁃ -Creatinine CL (mL/min) = Weight (kg) x (140 - Age) x 0.85 72 x serum creatinine (mg/dL)
• Ability to understand and the willingness to sign a written informed consent document
• Female subjects must be either of non-reproductive potential (i.e., post-menopausal by history: ≥ 50 years old and no menses for ≥1 year without an alternative medical cause; OR history of hysterectomy, OR history of bilateral tubal ligation, OR history of bilateral oophorectomy) or must have a negative serum pregnancy test upon study entry.
• Willing and able to comply with the protocol for the duration of the study including undergoing treatment and scheduled visits and examinations with follow up