Hepatic Arterial Infusion Chemotherapy (HAIC) Plus Tremelimumab, Durvalumab and Bevacizumab as Conversion Therapy for Potentially Resectable Hepatocellular Carcinoma (HCC): a Single Center, Open Label, Single Arm, Phase II Trial
To evaluate the efficacy and safety of HAIC combined with Durvalumab, Tremelimumab and Bevacizumab as first-line therapy in Unresectable hepatocellular carcinoma
• Provide a written informed consent form (ICF) signed and dated by the patient/legal representative before conducting any research specific procedures, sampling, and analysis specified in the protocol.
• Before collecting genetic analysis samples (optional), provide a signed and dated written informed consent form for genetic research.
• At the time of screening, the age should be ≥ 18 years old. For patients under the age of 20 who are enrolled in China, written informed consent from the patient and their legal representative should be obtained.
• Based on the histopathology results of tumor tissue, a patient with stage C hepatocellular carcinoma complicated with portal vein tumor thrombus BCLC was diagnosed, with portal vein tumor thrombus type I to III. (Cheng's classification indicates that the tumor thrombus is mainly located at the level of the liver segment (secondary branch of the portal vein); Type II refers to the spread of cancer thrombi invading the left or right branch of the portal vein (primary branch of the portal vein); Type III refers to cancer thrombus invading the main portal vein; Type IV refers to tumor thrombus invading superior mesenteric vein or inferior vena cava.
• No evidence of extrahepatic diseases was found in baseline chest/abdominal/pelvic imaging
• The disease is not suitable for radical surgery, transplantation, or radical ablation
• The disease must be suitable for TACE and HAIC treatment, and it is expected that TACE treatment for local lesions will not exceed 4 times within 16 weeks \[DEB-TACE\]
• The Child Pugh grading of liver function is Grade A,the Eastern Oncology Collaborative Group (ECOG) physical fitness score was 0 or 1
• Patients with HBV infection \[showing positive hepatitis B B virus surface antigen (HBsAg), and/or positive hepatitis B core antibody (anti HBcAb)\] and detectable HBV DNA (≥ 10IU/mL or higher than the detection limit according to the local experimental standard) must receive antiviral treatment according to the institutional diagnosis and treatment routine to ensure adequate virus suppression (HBV DNA ≤ 2000IU/mL) before enrollment. Patients must maintain antiviral treatment during the study period and within 6 months after the last administration of the study drug. For patients who are positive for hepatitis B core antibody (HBc) but have not detected HBV DNA (\<10 IU/ml or below the detection limit of local laboratory standards), antiviral treatment is not required before enrollment. These patients need to monitor HBV DNA levels during each course of treatment, and once HBV DNA is tested (≥ 10 IU/mL or below the detection limit of local laboratory standards), antiviral treatment begins. Patients who can detect HBV DNA must begin and maintain antiviral therapy during the study period and within 6 months after the last administration of the study drug.
⁃ According to the following mRECIST criteria, at least one measurable intrahepatic lesion is suitable for repeated evaluation: in intravenous contrast-enhanced CT or MRI scans, the liver lesion shows typical features of HCC, namely arterial phase vascular enhancement, venous phase or delayed phase enhancement rapidly disappears in the non necrotic part at baseline (arterial phase IV contrast agent enhancement), and its longest diameter can be accurately measured to be ≥ 10 mm
⁃ The definition of good organ and bone marrow function is as follows. Within 14 days before the start of the first dose, standards a, b, c, and f cannot be met through blood transfusion, infusion, or receiving supportive therapies such as growth factors
∙ Hemoglobin ≥ 9.0 g/dL
‣ Absolute neutrophil count ≥ 1000/µ L
‣ Platelet count ≥ 75000/ μ L
‣ Total bilirubin ≤ 2.0 × Upper limit of normal value (ULN)
‣ Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 5 × ULN
‣ Albumin ≥ 2.8 g/dL
‣ International normalized ratio (INR) ≤ 1.6
‣ 2+or lower urine test strip reading
‣ Calculate creatinine clearance rate (CL) ≥ 30mL/min, and measure male creatinine CL=weight (kg) using Cockcroft Fault (using actual body weight) or 24-hour urine creatinine CL × (140 Age) (mL/min) 72 × Serum creatinine (mg/dL) Female: creatinine CL=weight (kg) × (140- Age) × 0.85(mL/min)72 × Serum creatinine (mg/dL)
⁃ Must have an expected lifespan of at least 12 weeks
⁃ Weight\>30 kg
⁃ No gender limit