Investigation of Antitumor Immune Response in Patients With Unresectable Hepatocellular Carcinoma Undergoing Photon Radiotherapy Combined With Atezolizumab and Bevacizumab

Status: Recruiting
Location: See location...
Intervention Type: Drug, Radiation
Study Type: Interventional
Study Phase: Phase 2
SUMMARY

Atezolizumab (anti-programmed death-ligand 1; anti-PD-L1) in conjunction with bevacizumab (anti-vascular endothelial growth factor; anti-VEGF) has become the established standard first-line systemic treatment for unresectable hepatocellular carcinoma (HCC). Despite an improved objective response rate (ORR) of 27%, the majority of patients face HCC progression and liver failure \[Finn et al., N Engl J Med 2020\]. Developing a new combined treatment strategy to overcome resistance to anti-PD-L1 and anti-VEGF is essential to improve patient outcomes. Radiation treatment (RT) is highly efficacious in controlling localized solid tumors and has become an integral component of the treatment algorithm for unresectable HCC. Importantly, a recent retrospective cohort described that RT combined with atezolizumab plus bevacizumab was associated with favorable median overall survival of 16.1 months (Manzar et al, Cancers 2022). Our preclinical study (Hsieh et al., Science Immunology 2022) revealed that RT combined with PD-L1/PD-1 blockade induces immunogenic cell death and tumor antigen cross-presentation in antigen-presenting cells, thereby potentiating the systemic antitumor T cell responses in murine tumor models. However, whether the combinatorial therapy with RT, atezolizumab, and bevacizumab can trigger synergistic antitumor effects and systemic immune mobilization has not yet been validated in clinical trials for unresectable HCC. Both atezolizumab/bevacizumab and X-ray RT are approved treatment methods for unresectable HCC by the U.S. and Taiwan Food and Drug Administration (FDA). The present phase II non-randomized trial aims to prospectively document the therapeutic efficacy, safety, and immunological responses in patients with unresectable HCC treated with atezolizumab/bevacizumab combined with conventional photon radiotherapy.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Healthy Volunteers: f
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• Participants must have a diagnosis of HCC that is deemed unsuitable for surgical resection or transplant. Participants may have multiple lesions with a total maximal tumor dimension of \< 20 cm, and no one lesion \> 15 cm. Diagnosis should be confirmed by at least 1 criterion listed below:

‣ Histologically or cytologically proven diagnosis of HCC.

⁃ Typical arterial enhancement and delayed washout on multiphasic CT or MRI.

• Age ≥18 years at the time of signing the informed consent document.

• ECOG performance status 0-1.

• Barcelona Clinic Liver Cancer (BCLC) stages Intermediate (B) or Advanced (C).

• Child-Pugh score 5-6 liver function within 28 days of study registration.

• Documented virology status of hepatitis B virus (HBV), as confirmed by screening HBV serology test.

• Documented virology status of hepatitis C virus (HCV), as confirmed by screening HCV serology test.

• Ability to understand and the willingness to sign a written informed consent document

• Adequate bone marrow, liver, and renal function within 4 weeks before study registration

‣ Hemoglobin ≥ 9.0 g/dL

⁃ Absolute neutrophil count (ANC) ≥ 1,000/mm3

⁃ Platelet count ≥ 50,000/μL

⁃ Total bilirubin \< 2.5 mg/dL

⁃ Serum albumin \>2.8 g/dL

⁃ Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 3 × upper limit of normal (ULN)

⁃ Prothrombin time ≤ 6 seconds prolonged

⁃ Serum creatinine ≤ 1.5 mg/dL

Locations
Other Locations
Taiwan
Chang Gung Memorial Hospital at Linkou
RECRUITING
Taoyuan
Contact Information
Primary
Rodney Cheng-En Hsieh, MD, PhD
rodney445@gmail.com
+886-3-3281200
Time Frame
Start Date: 2024-03-30
Estimated Completion Date: 2031-03-30
Participants
Target number of participants: 45
Treatments
Experimental: Atezolizumab and bevacizumab with photon radiotherapy
Patients undergo Atezolizumab and Bevacizumab with photon radiotherapy.
Related Therapeutic Areas
Sponsors
Leads: Chang Gung Memorial Hospital

This content was sourced from clinicaltrials.gov