A Study of Ramucirumab (LY3009806) Versus Placebo in Participants With Hepatocellular Carcinoma and Elevated Baseline Alpha-Fetoprotein
Trial Status: Closed to Accrual
The purpose of this study is to evaluate the safety and efficacy of ramucirumab in participants with hepatocellular carcinoma (HCC) and elevated baseline alpha-fetoprotein. Participants will be randomized to ramucirumab or placebo in a 2:1 ratio (Main Global Cohort and China Maximized Extended Enrollment [ME2] Cohort). Participants may also receive ramucirumab if eligible to be enrolled in Open-Label Expansion (OLE) Cohort.
- A diagnosis of HCC based on histopathologic findings, or a diagnosis of cirrhosis and a tumor with classical HCC imaging characteristics.
- Sorafenib was the only systemic therapy for HCC and was discontinued for disease progression or intolerance (Main Global and ME2 Cohorts only).
- The participant received ≤2 prior systemic therapy regimen, excluding prior sorafenib or chemotherapy, for the treatment of HCC (OLE Cohort only).
- ≥1 measurable lesion per Response Evaluation Criteria In Solid Tumors (RECIST) Version 1.1 that has not been previously treated with locoregional therapy. A participant with a lesion(s) that has previously been treated with locoregional therapy is also eligible, if the lesion has documented progression after locoregional treatment and is measureable.
- Child-Pugh score <7 (Child-Pugh Class A).
- Barcelona Clinic Liver Cancer (BCLC) Stage C disease or BCLC Stage B disease not amenable to locoregional therapy or refractory to locoregional therapy.
- Baseline AFP ≥400 nanograms/milliliter.
- Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
- Resolution of all clinically significant toxic effects of prior therapy.
- Total bilirubin ≤1.5 times upper limit of normal value (ULN), aspartate transaminase (AST) and alanine transaminase (ALT) ≤5 × ULN.
- Creatinine clearance ≥60 milliliters/minute.
- Urinary protein is ≤1+ on dipstick or routine urinalysis or 24-hour urine demonstrating <1 gram of protein.
- Absolute neutrophil count ≥1.0 × 10^9/Liter, hemoglobin ≥9 grams/deciliter, and platelets ≥75 × 10^9/Liter.
- International Normalized Ratio (INR) ≤1.5 and a partial thromboplastin time (PTT) ≤5 seconds above the ULN.
- Surgically sterile, postmenopausal, or compliant with a highly effective contraceptive method.
- If a woman of childbearing potential, a negative serum pregnancy test prior to randomization.
- Willing to provide blood for research. The participant has provided signed informed consent prior to any study specific procedures and is amenable to compliance with protocol schedules and testing.
- Fibrolamellar carcinoma or mixed hepatocellular cholangiocarcinoma.
- Concurrent malignancy. Participants with carcinoma in situ of any origin and participants with prior malignancies in remission may be eligible with sponsor approval.
- Previous brain metastases, leptomeningeal disease, or uncontrolled spinal cord compression.
- History of or current hepatic encephalopathy or clinically meaningful ascites.
- Ongoing or recent hepatorenal syndrome.
- Liver transplant (Main Global and ME2 cohorts only; Participants with prior liver transplant may be eligible for OLE cohort).
- Hepatic locoregional therapy following prior systemic therapy or within 28 days prior to randomization.
- Major surgical procedure, traumatic injury, non-healing wound, or peptic ulcer ≤28 days prior to randomization.
- Received radiation to any nonhepatic (for example, bone) site within 14 days prior to randomization.
- Placement of a subcutaneous venous access device within 7 days prior to the first dose of study treatment unless the procedure is judged of low risk of bleeding.
- Enrolled in a clinical trial involving an investigational product or unapproved use of a drug or in medical research judged not to be scientifically or medically compatible with this study.
- Discontinued from study treatment from another clinical trial within 28 days prior to randomization.
- Known allergy to any of the treatment components.
- Uncontrolled hypertension.
- Any arterial thrombotic event, including myocardial infarction, unstable angina, cerebrovascular accident, or transient ischemic attack, <6 months prior to randomization.
- Any bleeding episode considered life-threatening, or any Grade 3 or 4 gastrointestinal bleeding episode in the 3 months prior to randomization requiring intervention.
- Esophageal or gastric varices that require intervention or represent high bleeding risk. Participants with evidence of portal hypertension or prior bleeding must have had endoscopic evaluation within 3 months prior to randomization.
- Gastrointestinal perforation or fistulae within 6 months prior to randomization.
- Symptomatic congestive heart failure (New York Heart Association II-IV), unstable angina pectoris, or symptomatic or poorly controlled cardiac arrhythmia.
- Pregnant or breast-feeding.
- Any medical or psychiatric condition that may increase the risk associated with study participation or may interfere with the interpretation of study results. Conditions include but are not limited to:
- Human immunodeficiency virus infection or acquired immunodeficiency syndrome-related illness.
- Active or uncontrolled clinically serious infection. (Participants with chronic viral hepatitis are eligible.)
- Ongoing or recent history of drug abuse.
- Uncontrolled hereditary or acquired thrombotic or bleeding disorder.
- Bowel obstruction, history or presence of inflammatory enteropathy or extensive intestinal resection.
- Therapeutic dose anticoagulation with warfarin, low molecular-weight heparin, or similar agents.
- Chronic therapy with nonsteroidal anti-inflammatory agents or other anti-platelet agents. Aspirin at doses up to 100 milligrams/day is permitted.
- The participant received prior immunotherapy and is experiencing or has experienced any of the following (OLE cohort only):
- Any clinically significant Grade ≥3 immune-related adverse event (irAE)
- Any grade neurologic or ocular irAE
- Any grade immune-related pneumonitis, cardiomyopathy, or hepatitis
- The participant received prior immunotherapy and at the time of study enrollment, requires steroids or other immunosuppressive agents (OLE cohort only).
UCLA / Jonsson Comprehensive Cancer Center
Contact: Lia Etheridge
District of Columbia
MedStar Georgetown University Hospital
University of Iowa / Holden Comprehensive Cancer Center
Contact: Mark W. Karwal
Brigham and Women's Hospital
Dana-Farber Cancer Institute
Massachusetts General Hospital Cancer Center
Contact: Andrew Xiuxuan Zhu
Wake Forest University Health Sciences
OHSU Knight Cancer Institute
Contact: Gina Maria Vaccaro
Trial Phase Phase III
Trial Type Treatment
Eli Lilly and Company
- Primary ID 15755
- Secondary IDs NCI-2016-00158, 2014-005068-13, I4T-MC-JVDE
- Clinicaltrials.gov ID NCT02435433