NP-101 before Y-90 Radioembolization for the Treatment of Unresectable Hepatocellular Carcinoma

Inclusion Criteria

• Must provide written informed consent prior to initiating any trial related procedures
• Adults ≥ 18 years of age
• Patient has histologically or radiographically confirmed HCC. Initial HCC diagnosis during study screening can also be made based on characteristic imaging pattern per the AASLD (American Association for the Study of Liver Diseases) guidelines. Per AASLD guidelines: “arterial phase hyperenhancement (APHE) and washout on portal venous or delayed phases of contrast-enhanced multiphase CT or MRI are considered radiological hallmarks of HCC given high specificity and positive predictive value in lesions ≥ 1 cm in size.”
• Unresectable HCC or not eligible for surgical resection or liver transplantation at the time of screening
• At least one untreated target lesion that could be measured in one dimension, according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST)
• Must have a Child-Turcotte-Pugh score of Class A (5-6) or B7
• Eastern Cooperative Oncology Group (ECOG) of 0 or 1
• Hemoglobin ≥ 9 g/dL
• Absolute neutrophil count ≥ 1,500/mm^3
• Platelet count ≥ 75,000/mm^3
• Creatinine clearance ≥ 30 mL/min
• International normalized ratio (INR) ≤ 1.5 or prothrombin time ≤ 3 seconds above control
• Total bilirubin level of ≤ 2.0 mg/dL
• Subjects of childbearing potential (SOCBP) must be using an adequate method of contraception to avoid pregnancy throughout the study and for at least 12 weeks after the last dose of study drug to minimize the risk of pregnancy. Prior to study enrollment, subjects of childbearing potential must be advised of the importance of avoiding pregnancy during trial participation and the potential risk factors for an unintentional pregnancy * SOCBP includes any subject who has experienced menarche and who has not undergone successful surgical sterilization (hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or who is not post-menopausal. Post-menopause is defined as: ** Amenorrhea that has lasted for ≥ 12 consecutive months without another cause, or ** For subjects with irregular menstrual periods who are taking hormone replacement therapy (HRT), a documented serum follicle-stimulating hormone (FSH) level of greater than 35 mIU/mL
• Subjects with partners of child-bearing potential must agree to use physician-approved contraceptive methods (e.g., abstinence, condoms, vasectomy) throughout the study and should avoid conceiving children for 12 weeks following the last dose of study drug

Exclusion Criteria

• Patient has another active malignancy; has had an active malignancy within the last two years; or has been treated with any systemic therapy for cancer in the past two years
• Patient has received prior Y90 radioembolization to the lesion(s) intended for treatment on this study
• Evidence of macrovascular invasion or extrahepatic metastases
• Patient has fibrolamellar HCC, sarcomatoid HCC, or mixed cholangiocarcinoma and HCC where HCC is not the majority histology
• Patients who experienced any of the following within the last 12 weeks: Severe gastrointestinal (GI) bleeding, intracranial bleeding, stroke, uncontrolled blood pressure, or a history of organ rupture or perforation * Severe GI bleeding is defined as bleeding that requires hospitalization, blood transfusion, endoscopic or surgical intervention, or results in a drop in hemoglobin of ≥ 2 g/dL within 24 hours
• Prior liver transplantation
• Subjects of childbearing potential who are unwilling or unable to use an acceptable method to avoid pregnancy for the entire study period and for at least 12 weeks after the last dose of study drug
• Subjects who are confirmed to be pregnant or breastfeeding
• History of any other disease, metabolic dysfunction, clinical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of protocol therapy or that might affect the interpretation of the results of the study or that puts the subject at high risk for treatment complications, in the opinion of the treating physician
• Administration of a vaccine containing live virus within 30 days prior to the first dose of trial treatment. Note: Most flu vaccines are killed viruses, with the exception of the intra-nasal vainer (Flu-Mist) which is an attenuated live virus and therefore prohibited for 30 days prior to first dose. Non-live versions of the coronavirus disease (COVID) vaccine are allowed
• Prisoners or subjects who are involuntarily incarcerated, or subjects who are compulsorily detained for treatment of either a psychiatric or physical illness
• Use of immunosuppressive drugs, such as steroids, and any herbs, which cannot be discontinued prior to study entry