Phase 2 Study of Cabozantinib Combined With Ipilimumab/Nivolumab and Transarterial Chemoembolization (TACE) in Patients With Hepatocellular Carcinoma (HCC) Who Are Not Candidates for Curative Intent Treatment
This is a phase 2 single-arm, open-label clinical trial determining efficacy of cabozantinib in combination with ipilimumab/nivolumab and transarterial chemoembolization (TACE) in subjects with hepatocellular carcinoma (HCC). These are subjects who are not candidates for curative intent treatment.
• Histologic or radiographic diagnosis of hepatocellular carcinoma
• At least one lesion amenable to TACE treatment
• Child-Pugh A-B7 (B7 based on Albumin allowed)
• Not a candidate for resection or transplantation
• Age ≥ 18 years.
• Performance status: ECOG performance status ≤2
• Must have at least one measurable lesion (either untreated or progressed after previous locoregional treatment)
• Adequate organ and marrow function as defined below:
∙ Leukocytes ≥ 2,000/mcL
‣ absolute neutrophil count ≥ 1000/mcL
‣ platelets ≥ 60,000/mcl
‣ total bilirubin within normal institutional limits
‣ AST(SGOT)/ALT(SPGT) ≤ 3 X institutional upper limit of normal or ≤ 5 X if liver metastases are present
‣ creatinine \<1.5ULN
‣ hemoglobin ≥ 8 g/dL
‣ Serum albumin ≥ 2.8 g/dL
‣ Urine protein/creatinine ration (UPCR) ≤ 1 mg/mg
• The effects of cabozantinib on the developing human fetus at the recommended therapeutic dose are unknown. For this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 4 months following completion of therapy. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
• Based on its mechanism of action, ipilimumab can cause fetal harm when administered to a pregnant woman. Females of reproductive potential must use effective contraception during treatment with ipilimumab and for 3 months following the last dose of ipilimumab.
• Based on its mechanism of action, nivolumab can cause fetal harm when administered to a pregnant woman. Females of reproductive potential must use effective contraception during treatment with nivolumab and for 5 months following the last dose of nivolumab.
• 1\. A female of child-bearing potential is any woman (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria:
⁃ Has not undergone a hysterectomy or bilateral oophorectomy; or
⁃ Has not been naturally postmenopausal for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months).
∙ Life expectancy of greater than 3 months
‣ Ability to swallow tablets
‣ Ability to understand and the willingness to sign a written informed consent.