Sorafenib Tosylate and Yttrium Y 90 Bead Therapy in Treating Patients with Advanced Liver Cancer

Inclusion Criteria

• Histologically or cytologically confirmed hepatocellular carcinoma (HCC) or clinical diagnosis by American Association for the Study of Liver Diseases (AASLD) criteria in cirrhotic subjects is required
• Barcelona Clinic Liver Cancer stage B or C; segmental and subsegmental portal vein thrombosis is allowed
• Metastatic disease is allowed if investigator feels liver directed therapy could offer palliative benefit (i.e., minimal extrahepatic tumor burden)
• No evidence of cirrhosis or cirrhosis grade of Child-Pugh class A or B7
• Have at least one tumor lesion that can be accurately measured according to Response Evaluation Criteria in Solid Tumors (RECIST version [v]1.1)
• Consultation with interventional radiologist and deemed an appropriate candidate for TARE
• Prior local therapy, such as surgery, hepatic arterial embolization, chemoembolization, radiofrequency ablation, percutaneous ethanol injection or cryoablation is allowed if the index lesion(s) remains outside of the treatment field or has progressed since prior treatment; local therapy must have been completed at least 4 weeks prior to the baseline scan
• Prior 90Y TARE or sorafenib is not allowed
• Patient must be informed of the investigational nature of this study and must sign and give written informed consent in accordance with institutional and federal guidelines
• Eastern Cooperative Oncology Group (ECOG) performance status =< 1
• Absolute neutrophil count (ANC) >= 1000/ucl obtained within 28 days prior to registration
• Platelet count >= 60,000/ucl obtained within 28 days prior to registration
• Hemoglobin >= 8.5 mg/dl obtained within 28 days prior to registration
• Serum bilirubin =< 2 x upper limit of normal (ULN)
• Serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) or serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 5 x the institutional upper limit of normal (IULN)
• Serum creatinine =< 1.5 x ULN OR a measured creatinine clearance or calculated creatinine clearance >= 50 mL/min
• Have a life expectancy of >= 12 weeks
• Must be able to swallow oral medications
• Negative pregnancy test done =< 7 days prior to registration, for women of childbearing potential only

Exclusion Criteria

• Known or suspected allergy or hypersensitivity to sorafenib
• Any malabsorption condition
• Must not have known brain metastases
• No concurrent anticancer chemotherapy or local therapy
• No concurrent herbal or unconventional therapy (e.g., St. John's wort)
• Pregnant or nursing women
• No prior radiation therapy to the liver
• Inability to perform y90 TARE due to: (1) inability to catheterize the hepatic artery, (2) portal vein thrombosis/occlusion without the ability to perform selective infusion, (3) technetium Tc 99m-labeled macroaggregated albumin (Tc-99m MAA) hepatic artery perfusion scintigraphy shows unfavorable shunt fraction between the liver and the pulmonary parenchyma as determined by the interventional radiologist, or (4) other contraindication to TARE identified by interventional radiologist
• Women/men of reproductive potential unwilling or unable to use an effective contraceptive method
• No other prior malignancy is allowed except for the following: adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated stage I or II cancer from which the patient is currently in complete remission, or any other cancer from which the patient has been disease-free for 3 years
• History of myocardial infarction, stroke, ventricular arrhythmia, or symptomatic conduction abnormality within 6 months
• Concurrent severe or uncontrolled medical disease (i.e., active systemic infection, diabetes, coronary artery disease, congestive heart failure) that, in the opinion of the investigator, would compromise the safety of the patient or compromise the ability of the patient to complete the study