Sorafenib Tosylate and Hypoxia-Activated Prodrug TH-302 in Treating Patients with Advanced Kidney Cancer or Liver Cancer That Cannot Be Removed by Surgery

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Basic Trial Information

PhaseTypeStatusAgeTrial IDs
Phase II, Phase IBiomarker/Laboratory analysis, TreatmentTemporarily closed18 and overN1153
NCI-2012-00095, CDR0000720022, NCCTG-N1153, NCT01497444

Trial Description

Summary

This phase I/II trial studies the side effects and best dose of giving sorafenib tosylate together with hypoxia-activated prodrug TH-302 and to see how well they work in treating patients with advanced kidney cancer or liver cancer that cannot be removed by surgery. Sorafenib tosylate may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth by blocking blood flow to the tumor. Drugs used in chemotherapy, such as hypoxia-activated prodrug TH-302, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving sorafenib tosylate together with hypoxia-activated prodrug TH-302 may kill more tumor cells.

Further Study Information

PRIMARY OBJECTIVES:

I. To determine the maximum tolerated dose (MTD) and recommended Phase II dosing (RP2D) for the combination of sorafenib (sorafenib tosylate) and hypoxia-activated prodrug TH-302 (TH-302) in patients with hepatocellular carcinoma (HCC) and renal cell carcinoma (RCC; non-HCC) advanced solid tumors. (Phase I)

II. To evaluate the overall response rate (RR) determined based on modified Response Evaluation Criteria in Solid Tumors (RECIST) criteria in patients with advanced HCC receiving sorafenib tosylate with TH-302. (Phase II)

SECONDARY OBJECTIVES:

I. To characterize overall toxicity profile of sorafenib + TH-302 within patients with HCC and RCC (non-HCC) advanced solid tumors. (Phase I)

II. To characterize the responses of sorafenib + TH-302 within patients with HCC and RCC (non-HCC) advanced solid tumors. (Phase I)

III. To assess the adverse events (AEs) profile and safety profile of sorafenib in combination with TH-302 in patients with advanced HCC. (Phase II)

IV. To estimate the overall response rate based on standard RECIST criteria in the study population. (Phase II)

V. To estimate the duration of response based on modified (standard) RECIST criteria in the study population. (Phase II)

VI. To estimate the progression free survival (PFS) in the study population. (Phase II)

VII. To estimate the overall survival (OS) in the study population. (Phase II)

VIII. To estimate the alpha-fetoprotein (AFP) response rate (defined as > 20% decrease of AFP from baseline) in the study population. (Phase II)

OUTLINE: This is a phase I, dose-escalation study followed by a phase II study.

Patients receive sorafenib tosylate orally (PO) twice daily (BID) on days 1-28 and hypoxia-activated prodrug TH-302 intravenously (IV) over 30 minutes on days 8, 15, and 22. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up for 3 years.

Eligibility Criteria

Inclusion Criteria:

Cytological or histological confirmed diagnosis of advanced hepatocellular or renal cell carcinoma; HCC patients should not be amenable to treatment with surgery or to orthotopic liver transplant (Phase I)

Patients must have measurable disease (Phase I)

RCC patients only: Tumor progression after receiving standard/approved chemotherapy and/or targeted agent, where there is no approved therapy or for tumors where sorafenib based therapy would be standard therapy (Phase I)

HCC patients only:

First line (i.e., no prior systemic therapy) or second-line (with prior first-line sorafenib therapy only) advanced HCC

Child Pugh class A or B7 liver disease

Prior chemoembolization, radioembolization, radiofrequency ablation (RFA), or other local ablative therapies are permissible if >= 6 weeks from procedure with evidence of progression or new metastatic disease, if applicable (Phase I)

Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1

Absolute neutrophil count (ANC) >= 1200/mm^3

Peripheral platelet count (PLT) >= 75,000/mm^3

Hemoglobin (HgB) > 8.5 g/dL

Bilirubin =< 3.0 x upper limit of normal (ULN)

Serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) and serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 2.5 x ULN

If subject has HCC or liver metastases =< 5 x ULN) (Phase I); AST and ALT =< 5 x ULN (Phase II)

Creatinine =< 1.5 x ULN

International normalized ratio (INR) =< 1.5 x ULN; patients receiving anti-coagulation therapy are permitted as long as they have a stable INR =< 3.0

Negative pregnancy test done =< 7 days prior to registration, for women of childbearing potential only

Provide informed written consent

Willing to return to Alliance enrolling institution for follow-up

Life expectancy >= 3 months

PHASE II REGISTRATION - INCLUSION CRITERIA

Cytological or histological confirmed diagnosis of hepatocellular carcinoma that is locally advanced or metastatic and is not amenable to treatment with surgery or to orthotopic liver transplant (Phase II)

Patients must have measurable disease; must have at least one non-nodal lesion

First line advanced HCC (i.e., no prior systemic therapy)

Child Pugh class A or B7 liver disease

Prior chemoembolization, radioembolization, radiofrequency ablation (RFA) or other local ablative therapies are permissible if >= 6 weeks from procedure with evidence of progression or new metastatic disease, if applicable

Ability to receive intravenous contrast for the purpose of imaging

Exclusion Criteria:

Any of the following:

Pregnant women

Nursing women

Men or women of childbearing potential who are unwilling to employ adequate contraception for the duration of study participation; men and women should continue to use adequate birth control after the last administration of sorafenib and TH-302 under the guidance of their treating physician

Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens

Receiving any other investigational agent

Other active malignancy =< 3 years prior to registration; EXCEPTIONS: non-melanotic skin cancer or carcinoma-in-situ of the cervix; NOTE: if there is a history or prior malignancy, they must not be receiving other specific treatment (other than hormonal therapy) for their cancer

Inadequately controlled hypertension (systolic blood pressure of > 150 mmHg or diastolic pressure > 100 mmHg on anti-hypertensive medications)

Major surgical procedures, or significant traumatic injury =< 14 days prior to registration or anticipation of need for elective or planned major surgical procedure during the course of the study

New York Heart Association (NYHA) classification III or IV congestive heart failure

Received treatment with radiation therapy or investigational therapy =< 28 days prior to registration

RCC patients only: Having received chemotherapy prior to study entry within 5 half-lives of the agent (as described in the package insert), or 4 weeks prior to registration (whichever is shorter) with resolution of side effects from therapy to =< grade 1

Known central nervous system (CNS) or brain metastasis that are either symptomatic or untreated; Note: patients with neurological symptoms must undergo a computed tomography (CT) scan/magnetic resonance imaging (MRI) of the brain to exclude brain metastasis

Note: patients with CNS metastases that have been treated and are stable without symptoms for >= 4 weeks after completion of treatment are eligible

HCC patients only: Cancer potentially amenable to local modalities of therapy or surgical resection (phase I)

Known or suspected allergy or hypersensitivity to any component of TH-302, sorafenib, or any of the sorafenib excipients

Any condition that severely impairs patient’s ability to swallow whole pills

Corrected QT (QTc) interval > 500 msec on baseline electrocardiogram (EKG)

Documented history of prolonged QTc interval =< 6 months prior to registration

Receiving any medication that has documented data or is generally accepted as having increased risk of QT prolongation and/or Torsades de Pointes

Receiving any medications or substances that are inducers or strong or moderate inhibitors of cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP3A4) =< 7 days prior to registration

Use of CYP3A4 inducers are prohibited =< 7 days prior to registration

Use of CYP3A4 strong or moderate inhibitors are prohibited =< 7 days prior to registration

Fibrolamellar histology HCC, mixed hepatocholangiocarcinoma, hepatic sarcomas and other non-HCC primary liver tumors

History of lobectomy involving > 50% of lobe

Radioembolization within 8 weeks of day 1 dosing of sorafenib

PHASE II REGISTRATION: EXCLUSION CRITERIA:

Cancer potentially amenable to local modalities of therapy or surgical resection

Trial Contact Information

Trial Lead Organizations / Sponsors / Collaborators

Alliance for Clinical Trials in Oncology

  • National Cancer Institute
  • Threshold Pharmaceuticals
Mitesh Jivraj Borad, Principal Investigator

Link to the current ClinicalTrials.gov record.
NLM Identifier NCT01497444

Note: Information about participating sites on pharmaceutical industry trials may be incomplete. Please visit the ClinicalTrials.gov record via the link above for more information about participating sites.