Atezolizumab and Bevacizumab Pre-Liver Transplantation for Patients With Hepatocellular Carcinoma Beyond Milan Criteria: A Feasibility Study

Who is this study for? Patients with hepatocellular carcinoma
What treatments are being studied? Atezolizumab+Bevacizumab
Status: Recruiting
Location: See location...
Intervention Type: Drug
Study Type: Interventional
Study Phase: Phase 4
SUMMARY

Patients with hepatocellular carcinoma (HCC) beyond Milan Criteria (MC) who are transplant-eligible will be treated with 6 months of neoadjuvant/downstaging atezolizumab plus bevacizumab while receiving standard of care transarterial chemoembolization (TACE). We hypothesize that atezolizumab and bevacizumab can appropriately bridge patients with HCC beyond MC to transplantation and not increase the risk of 1-year post-transplant rejection.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Healthy Volunteers: f
View:

• Male or female, aged ≥18 years old at the time of signing Informed Consent Form

• Measurable or evaluable disease per RECIST v1.1 or mRECIST of unresectable HCC outside of Milan criteria

• Histologically proven HCC, without extrahepatic disease. Patients who consent to a fresh tissue biopsy, and under the discretion of the Investigators, will provide a baseline biopsy sample for diagnosis and correlative studies. Archival tumor tissue may be used to confirm HCC in patients who do not consent to a fresh tissue biopsy.

• Prior remote LRT is allowed if new lesions or local disease recurrence are present

• Must be eligible for liver transplantation, defined in Section 10.4

• Eligible and suited to receive TACE procedure(s)

• Child-Pugh score ≤A6

• Eastern Cooperative Oncology Group (ECOG) score 0-1

• Life expectancy of ≥ 6 months

⁃ Adequate hematological and end-organ function, defined by the following laboratory test results obtained within 14 days prior to study initiation:

∙ Absolute neutrophil count (ANC) ≥ 1.5 x 109/L

‣ Lymphocyte count ≥ 0.5 x 10\^9/L (500/uL)

‣ Platelet count \> 75 x 109/L

‣ Hemoglobin \> 9 g/dL

‣ Total bilirubin \< 1.5 x upper limit of normal (ULN)

‣ Aspartate transaminase (AST),alanine aminotransferase (ALT), and alkaline phosphatase (ALP) \< 2.5 x ULN

‣ Serum albumin \> 2.7 g/dL

‣ Serum creatinine \< 1.5x ULN or calculated creatinine clearance \< 50 ml/min

‣ Urine dipstick for proteinuria ≥ 2+ unless a 24-hour urine protein \< 1 g of protein is demonstrated

∙ International normalized ratio (INR) ≤ 1.5 or partial thromboplastin time (PTT) ≤ 1.5 x ULN for patients not receiving anti-coagulation. The use of full-dose oral or parenteral anticoagulants is permitted as long as the INR or PTT is within therapeutic limits (according to the medical standard of the enrolling institution) and the patient has been on a stable dose of anticoagulants for at least two weeks prior to the first study treatment.

⁃ No evidence of a Grade 2 or higher esophageal and/or gastric varices. Patients must have an esophagogastroduodenoscopy (EGD) within 6 months prior to initiating the study treatment. See Section 8.7.1.2.

⁃ No history of hemoptysis (≥ 1/2 teaspoon of bright red blood per episode) within 1 month of study enrollment

⁃ Negative HIV test at screening or transplant workup

⁃ Negative hepatitis B surface antigen (HBsAg) test at screening or transplant workup

⁃ Negative total hepatitis B core antibody (HBcAb) test at screening or transplant workup, or positive total HBcAb test followed by a negative hepatitis B virus (HBV) DNA test at screening or transplant workup. The HBV DNA test will be performed only for patients who have a negative HBsAg test and a positive total HBcAb test.

⁃ For women of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive methods, as defined below:

∙ Women must remain abstinent or use contraceptive methods with a failure rate of \<1% per year during the treatment period and for 6 months after the final dose of atezolizumab/bevacizumab Females who receive a LT are required to maintain abstinence or contraception until the End of Study.

‣ A woman is considered to be of childbearing potential if she is postmenarchal, has not reached a postmenopausal state (≥12 continuous months of amenorrhea with no identified cause other than menopause), and has not undergone surgical sterilization (removal of ovaries and/or uterus). The definition of childbearing potential may be adapted for alignment with local guidelines or requirements.

‣ Examples of contraceptive methods with a failure rate of \<1% per year include bilateral tubal ligation, male sterilization, hormonal contraceptives that inhibit ovulation, hormone-releasing intrauterine devices, and copper intrauterine devices.

‣ The reliability of sexual abstinence should be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the patient. Periodic abstinence (eg, calendar, ovulation, symptothermal, or postovulation methods) and withdrawal are not adequate methods of contraception.

⁃ For men: agreement to remain abstinent (refrain from heterosexual intercourse) or use a condom, and agreement to refrain from donating sperm, as defined below:

∙ With a female partner of childbearing potential or pregnant female partner, men must remain abstinent or use a condom during the treatment period and for 6 months after the final dose of atezolizumab/bevacizumab to avoid exposing the embryo. Men must refrain from donating sperm during this same period. Males who receive a LT are required to maintain these criteria until the End of Study.

‣ The reliability of sexual abstinence should be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the patient. Periodic abstinence (eg, calendar, ovulation, symptothermal, or postovulation methods) and withdrawal are not adequate methods of preventing drug exposure.

⁃ Stated willingness to comply with all study procedures and availability for the duration of the study

⁃ Women of childbearing potential must have a negative serum or urine pregnancy test result within 14 days prior to initiation of study treatment.

Locations
United States
Texas
Houston Methodist Research Institute
RECRUITING
Houston
Contact Information
Primary
Darrel Cleere, BSN
dwcleere@houstonmethodist.org
713-441-6232
Backup
Shondra Word
sword@houstonmethodist.org
713-441-5122
Time Frame
Start Date: 2023-01-30
Estimated Completion Date: 2027-10-31
Participants
Target number of participants: 24
Treatments
Experimental: Atezolizumab + Bevacizumab
Patients will receive transarterial chemoembolization (TACE) every 3 months, with a maximum of 4 treatments, plus atezolizumab combined with bevacizumab.
Related Therapeutic Areas
Sponsors
Collaborators: Genentech, Inc.
Leads: The Methodist Hospital Research Institute

This content was sourced from clinicaltrials.gov