A Multicenter Phase Ib/II Clinical Study on the Safety and Efficacy of Selective Internal Radiation Therapy (SIRT) With Yttrium-90 Microspheres in Combination With Nivolumab, Ipilimumab, and Lenvatinib in Patients With Unresectable Hepatocellular Carcinoma
This clinical trial was designed to evaluate the safety and efficacy of Y90-SIRT combined with nivolumab, ipilimumab, and lenvatinib in patients with unresectable HCC. In addition to assessing short-term efficacy endpoints, such as ORR and PFS, this trial places particular emphasis on the OS benefit for patients. This study is therefore both novel and innovative.
• HCC confirmed as unresectable by imaging or histology, or patients who refuse surgery. Eligible for Y90-SIRT, with no evidence of extrahepatic disease on any available imaging. Lymph node involvement is permitted. The term unresectable hepatocellular carcinoma refers to a clinical state in which radical surgical resection is precluded because the tumor extent or an inadequate anticipated future liver remnant would prevent R0 removal, or because the procedural risk is prohibitively high, and where surgical intervention is not expected to yield a survival advantage over non-surgical therapies.
• Aged between 18 and 80 years at the time of enrollment
• Participants with Child-Pugh class A.
• Participants with an ECOG performance status of 0 or 1 at the time of enrollment
• Participants with a lung dose threshold of 30 Gy for yttrium-90 microspheres (each treatment dose ≤ 30 Gy), and an anticipated future liver remnant volume (FLRV) ≥ 30% of the total liver volume.
• Participants with one or more measurable lesions; for those with segmental or right anterior/posterior portal vein invasion (Vp1/Vp2), the disease is confined to a single lobe and suitable for Y90 microsphere treatment.
• If the patient is co-infected with hepatitis B virus (HBV) or hepatitis C virus (HCV), the following criteria must be met: HBV or HCV viral levels should be monitored during study participation. Patients with detectable hepatitis B surface antigen (HBsAg) or HBV DNA should have HBV DNA \< 100 IU/ml and be managed according to local treatment guidelines. Most patients with advanced HCC and HCV have not received treatment for HCV infection. However, if antiviral therapy has been completed prior to the first administration of study drugs, these patients are considered eligible for inclusion.
• No prior systemic therapy or transarterial radioembolization (Y90 glass microsphere TARE).
• No active autoimmune disease and no history of chronic or recurrent autoimmune disease.
⁃ Adequate hematological, liver, and renal function as follows: (1) Absolute neutrophil count ≥ 1,500/mm³ (2) Hemoglobin level ≥ 9.0 g/dL (3) Platelet count ≥ 75,000/mm³ (4) Total bilirubin ≤ 1.5 × ULN (5) AST ≤ 2.5 × ULN (6) ALT ≤ 2.5 × ULN (7) International normalized ratio (INR) ≤ 1.25 (8) Albumin ≥ 31 g/L (9) 24-hour urine collection creatinine clearance (CL) \> 40 mL/min or calculated creatinine clearance (CL) \> 40 mL/min.
⁃ Not pregnant and no intention to conceive before or during treatment.
⁃ Written informed consent from the patient.
⁃ Expected survival of at least 12 weeks.