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Advanced Hepatocellular CarcinomaPhase 2NCT04442581

Cabozantinib and Pembrolizumab for the First-Line Treatment of Advanced Liver Cancer

A Phase 2 study testing Cabozantinib S-malate and Pembrolizumab in people with Advanced Hepatocellular Carcinoma and BCLC Stage B Hepatocellular Carcinoma, run by University of Washington at 1 site in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
Search all trials

Trial summary

This phase II trial studies how well cabozantinib and pembrolizumab work for the first-line treatment of patients with liver cancer who are not eligible for local therapy (i.e. advanced stage). Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Cabozantinib S-malate and Pembrolizumab
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
2 participants
Where
1 siteUnited States
Study dates
20 Apr 2021to 8 Mar 2022
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Must have a histologically confirmed diagnosis of HCC or a non-invasive diagnosis of HCC as per the American Association for the Study of Liver Diseases (AASLD) criteria
  • If available, archival tissue must be submitted
  • Mixed HCC-cholangiocarcinoma is not allowed
  • Patient has Barcelona Clinic Liver Cancer (BCLC) stage C disease, or BCLC stage B disease that is not amenable to locoregional therapy or refractory to locoregional therapy, and not amenable to curative treatment
  • Previous locoregional therapy is allowed (e.g. surgical resection, external beam radiation, catheter-based therapy), and patients must have evidence of disease progression from locoregional therapy
  • Must have measurable disease by RECIST v1.1
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  • Lesions that were previously radiated or ablated cannot be target lesions unless there was subsequent radiographic progression at those sites
  • No prior systemic therapy for HCC. Prior chemotherapy given locally into the liver (e.g. transarterial chemoembolization [TACE]) is allowed
  • Must have Child-Pugh class A hepatic function within 7 days prior to first dose of study intervention
  • Eastern Cooperative Oncology Group (ECOG) performance status 0-1
  • Life expectancy of at least 12 weeks
  • Recovery to baseline or =< grade 1 toxicities (CTCAE v5) related to any prior treatments, unless adverse events (AEs) are clinically nonsignificant and/or stable on supportive therapy
  • Absolute neutrophil count (ANC) >= 1500/mm^3 without granulocyte colony-stimulating factor support (within 14 days before first dose of study treatment)
  • Platelets >= 60,000/mm^3 without transfusion (within 14 days before first dose of study treatment)
  • Hemoglobin >= 9 g/dL (>= 90 g/L) without transfusion or erythropoietin (EPO) dependency (within 14 days before first dose of study treatment)
  • Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 5 x upper limit of normal (ULN) (within 14 days before first dose of study treatment)
  • Total bilirubin =< 2 mg/dL OR direct bilirubin =< ULN for participants with total bilirubin levels > 2 mg/dL (within 14 days before first dose of study treatment)
  • Serum albumin >= 2.8 g/dl (>= 28 g/L) without albumin infusion (within 14 days before first dose of study treatment)
  • Prothrombin time (PT)/international normalized ratio (INR) or partial thromboplastin time (PTT) test =< 1.5 x ULN (within 14 days before first dose of study treatment)
  • Serum creatinine =< 1.5 x ULN or calculated creatinine clearance >= 40 mL/min using the Cockcroft-Gault equation (within 14 days before first dose of study treatment)
  • Urine protein/creatinine ratio (UPCR) =< 1 mg/mg (=< 113.2 mg/mmol) or 24 hour(h) urine protein =< 1 g (within 14 days before first dose of study treatment)
  • Hemoglobin A1c (HbA1c) =< 8% within 28 days before randomization or fasting serum glucose =< 160 mg/dL (within 14 days before first dose of study treatment)
  • Patients with positive hepatitis B surface antigen (HBsAg) and/or hepatitis B virus (HBV) viral load > 100 IU/mL at the time of enrollment are eligible to enroll on study if they meet the following criteria:
  • Anti-HBV therapy as per institutional practice must be given at least 4 weeks and HBV viral load must be < 100 IU/mL prior to initiating study treatment. Patients on active HBV therapy with viral loads < 100 IU/mL should remain on the same therapy throughout study treatment
  • Note: Patients with positive anti-hepatitis B core antibody (HBcAb), negative HBsAg, and negative or positive anti-hepatitis B surface antibody, and who have an HBV viral load < 100 IU/mL do not require anti-viral prophylaxis
  • Patients with past or ongoing hepatitis C infection (HCV) are eligible to enroll on study, with or without prior anti-viral treatment, as long as the other eligibility criteria are met. Treated patients must have completed their anti-viral treatment at least 1 month prior to initiating study treatment
  • Sexually active fertile subjects and their partners must agree to use effective methods of contraception during the course of the study and for at least 4 months after the last dose cabozantinib. They must also refrain from donating sperm during this time period
  • Female subjects of childbearing potential must not be pregnant at screening and not breastfeeding. Females of childbearing potential are defined as premenopausal females capable of becoming pregnant (i.e. females who have had any evidence of menses in the past 12 months, with the exception of those who had prior hysterectomy)
  • Women who have been amenorrheic for 12 or more months are still considered to be of childbearing potential if the amenorrhea is possibly due to prior chemotherapy, antiestrogens, low body weight, ovarian suppression or other reasons
  • Capable of understanding and complying with the protocol requirements and must provide written informed consent/assent for the study

Who cannot join

  • Prior treatment with any systemic therapy for HCC, including anti-VEGF therapy or any systemic investigational agent
  • If the patient previously received systemic treatment for reasons other than HCC: small molecule kinase inhibitors are not allowed within 2 weeks and cytotoxic/biologic agents are not allowed within 4 weeks of study treatment
  • Prior exposure to immune checkpoint inhibitors or other immunotherapeutic agents
  • Currently participating in or has participated in a study of an investigational agent or device within 4 weeks prior to the first dose of study treatment
  • Major surgery within 6 weeks or minor surgery (e.g. dental extraction) within 10 days prior to first dose of study treatment
  • Complete wound healing from major surgery must have occurred at least 1 month before first dose and from minor surgery (e.g. simple excision, tooth extraction) at least 7 days before first dose. Subjects with clinically relevant ongoing complications from prior surgery are not eligible
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  • Local liver-directed therapy within 4 weeks of initiating study treatment
  • Palliative radiation for the purpose of symptomatic relief to non-liver and non-central nervous system (CNS) disease within 2 weeks of starting treatment. Other radiation treatments within 4 weeks of starting treatment
  • Patients must have recovered from all radiation-related toxicities, not require corticosteroids, and have not had radiation pneumonitis
  • Prior liver or other allogenic tissue/organ transplantation
  • History of primary immunodeficiency
  • Active autoimmune or inflammatory disease that has required systemic treatment in the past 2 years (i.e. with use of disease-modifying agents, corticosteroids or immunosuppressive drugs). This includes, but is not limited to, inflammatory bowel disease, celiac disease, systemic lupus erythematosus, rheumatoid arthritis, myasthenia gravis, Graves' disease, etc.
  • The following autoimmune conditions are allowed: vitiligo or alopecia; hypothyroidism on stable hormone replacement therapy; psoriasis/eczema not requiring systemic treatment
  • Replacement therapy (e.g. thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency) is not considered a form of systemic treatment and is allowed
  • Chronic use of systemic steroid (in dosing exceeding 10 mg daily of prednisone equivalent) or immunosuppressive therapy or use within 14 days prior to enrollment
  • The following treatments are allowed: intranasal, inhaled, topical or local steroid injections; systemic corticosteroids at physiologic doses equivalent to no more than prednisone 10 mg/day; steroids as premedication for contrast dye allergy
  • History of (non-infectious) pneumonitis that required steroids or has current pneumonitis
  • History of hepatic encephalopathy or treatment to prevent or control encephalopathy within the past 12 months. Subjects on lactulose and/or rifaximin to control hepatic encephalopathy are not allowed
  • Esophageal or gastric variceal bleeding within the past 6 months. All subjects will be screened for esophageal varices unless performed in the last 6 months before study treatment. If varices are present, they should be treated according to institutional standards before starting study treatment
  • Uncontrolled ascites, clinically significant or symptomatic ascites requiring paracenteses or increasing doses of diuretics within the past 3 months
  • Patients who are on stable diuretic doses for at least 3 months are eligible if they meet other eligibility criteria
  • Asymptomatic ascites detected on imaging are allowed
  • Has known history or any evidence of CNS metastases and/or carcinomatous meningitis. Subjects with previously treated brain metastases may participate provided they are asymptomatic and radiologically stable (i.e. without progression for at least 4 weeks by repeat imaging [which must be performed during study screening], clinically stable, and without the need steroids for at least 4 weeks prior to first dose of study treatment)
  • Concomitant anticoagulation with oral anticoagulants (e.g. warfarin, direct thrombin and factor Xa inhibitors) or platelet inhibitors (e.g. clopidogrel). Allowed anticoagulants are the following:
  • Low-dose aspirin for cardioprotection (per local applicable guidelines) is permitted
  • Low molecular weight heparin (LMWH) is permitted
  • Anticoagulation with therapeutic doses of LMWH is allowed in subjects without known brain metastases who are on a stable dose of LMWH for at least 4 weeks before first dose of study treatment, and who have had no clinically significant hemorrhagic complications from the anticoagulation regimen or the tumor
  • The subject has uncontrolled, significant intercurrent or recent illness including, but not limited to, the following conditions:
  • Cardiovascular disorders:
  • Congestive heart failure New York Heart Association class 3 or 4, unstable angina pectoris, serious cardiac arrhythmias with risk of hemodynamic instability within 12 months before the first dose of study treatment
  • Uncontrolled hypertension defined as sustained blood pressure (BP) > 150 mm Hg systolic or > 95 mm Hg diastolic despite optimal antihypertensive treatment, and/or change in antihypertensive medications within 1 week before starting treatment. Note: eligibility of a subject receiving 4 or more antihypertensive medications prior to study entry will require approval from the principal investigator (PI)
  • Stroke (including transient ischemic attack [TIA]), myocardial infarction (MI), or other ischemic event, or arterial thromboembolic within 12 months before the first dose
  • Asymptomatic venous thromboembolic event (e.g. deep venous thrombosis, pulmonary embolism) is allowed if the patient has been stable on anticoagulation with LMWH for at least 4 weeks
  • Gastrointestinal (GI) disorders including those associated with a high risk of perforation or fistula formation:
  • The subject has evidence of tumor invading the GI tract, active peptic ulcer disease, inflammatory bowel disease (e.g. Crohn's disease), GI malabsorption, diverticulitis, cholecystitis, symptomatic cholangitis or appendicitis, acute pancreatitis, acute obstruction of the pancreatic duct or common bile duct, or gastric outlet obstruction
  • Abdominal fistula, GI perforation, bowel obstruction, or intra-abdominal abscess within 6 months before first dose
  • Note: Complete healing of an intra-abdominal abscess must be confirmed before first dose
  • Clinically significant hematuria, hematemesis, or hemoptysis of > 0.5 teaspoon (2.5 ml) of red blood, other history of significant bleeding (e.g. pulmonary hemorrhage) within 12 weeks before first dose, or known thrombotic disorder
  • Cavitating pulmonary lesion(s) or known endotracheal or endobronchial disease manifestation
  • Lesions invading any major blood vessels, including main portal vein, inferior vena cava, or cardiac involvement of HCC based on imaging
  • Note: Main and branch portal vein and hepatic vein invasion is allowed
  • Ongoing active infection requiring antibiotics. Antibiotics must be completed at least 7 days before initiating study treatment
  • Known active tuberculosis
  • Serious non-healing wound, ulcer, or bone fracture
  • Patients with proteinuria > 1+ on urine dipstick testing will undergo 24-hour urine collection for quantitative assessment of proteinuria. Participants with urine protein >= 1 g/24 hours will be ineligible
  • Corrected QT interval calculated by the Fridericia formula (QTcF) > 480 ms per electrocardiogram (EKG) within 28 days before first dose of study treatment
  • Note: If a single EKG shows a QTcF with an absolute value > 500 ms, two additional EKGs at intervals of approximately 3 min must be performed within 30 min after the initial EKG, and the average of these three consecutive results for QTcF will be used to determine eligibility
  • Inability to swallow tablets or any other condition that might interfere with oral absorption of medications
  • Previously identified allergy or hypersensitivity to study drugs and/or any of their excipients
  • Ongoing secondary malignancy that is progressing and/or has required active treatment within the past year. Adjuvant treatment for resected breast cancer is allowed
  • Subjects with basal cell carcinoma of the skin, squamous cell carcinoma or the skin, or carcinoma in situ (e.g. breast carcinoma, cervical cancer in situ) that have undergone potentially therapy are allowed
  • Has a known history of human immunodeficiency virus (HIV) infection. Note: HIV testing is not mandated for screening
  • Co-infection with HBV (HBsAg [+] and /or detectable HBV DNA) and HCV (anti-HCV Ab [+] and detectable HCV ribonucleic acid [RNA]) at study entry
  • Co-infection with HBV and hepatitis D virus (HDV) at study entry
  • Live attenuated vaccine within 30 days prior to first dose of study treatment. Examples of live vaccines include, but are not limited to, the following: measles, mumps, rubella, varicella/zoster (chicken pox), yellow fever, rabies, Bacillus Calmette-Guerin (BCG), and typhoid vaccine. Seasonal influenza vaccines for injection are generally killed virus vaccines and are allowed; however, intranasal influenza vaccines (e.g. FluMist) are live attenuated vaccines and are not allowed
  • Pregnant or lactating females
  • Known psychiatric illness, substance abuse disorder, or other condition that would interfere with the ability to comply with the requirements of the study
  • Has history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the subject's participation for the full duration of the study, or is not in the best interest of the subject to participate, in the opinion of the treating investigator

Trial locations and contacts

1 site in 1 country.

United States1 site

  • Fred Hutch/University of Washington Cancer Consortium

    Seattle, Washington, 98109

Other trials in United States

About this study

Official title: A Phase 2 Trial of Cabozantinib and Pembrolizumab in the First-Line Treatment of Advanced Hepatocellular Carcinoma

This phase II trial studies how well cabozantinib and pembrolizumab work for the first-line treatment of patients with liver cancer who are not eligible for local therapy (i.e. advanced stage). Cabozantinib may stop the growth of tumor cells by blocking some cell surface receptors and signaling pathways inside the tumor cells. Immunotherapy with monoclonal antibodies, such as pembrolizumab, may help the body's immune system attack the cancer. Giving cabozantinib and pembrolizumab together may work better in treating patients with advanced liver cancer compared to cabozantinib or pembrolizumab alone.

Read the detailed description

OUTLINE:

Patients receive cabozantinib S-malate orally (PO) once daily (QD) on days 1-21 and pembrolizumab intravenously (IV) over 30 minutes on day 1. Cycles repeat every 21 days for up to 2 years in the absence of disease progression or unacceptable toxicity. Disease assessment by imaging will be performed every 9 weeks.

Being tested
Cabozantinib S-malate, Pembrolizumab

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Cabozantinib S-malateDrug

    Also called BMS-907351, Cabometyx, Cometriq, XL-184

    Given PO

  • PembrolizumabBiological

    Also called Keytruda, Lambrolizumab, MK-3475, SCH 900475

    Given IV

Study groups in NCT04442581
Study groupRoleWhat they receive
Treatment (cabozantinib S-malate, pembrolizumab)ExperimentalPatients receive cabozantinib S-malate PO QD on days 1-21 and pembrolizumab IV over 30 minutes on day 1. Cycles repeat every 21 days for up to 2 years in the absence of disease progression or unacceptable toxicity.
Receives: Drug: Cabozantinib S-malate; Biological: Pembrolizumab

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of Participants With Objective Response (Complete or Partial Response)

    Will be assessed per Response Evaluation Criteria in Solid Tumors (RECIST) version (v)1.1 (by blinded central review). Assessment of objective response per Response Evaluation Criteria in Solid Tumors version 1.1 of target lesions by cross sectional imaging (either CT or MRI), defined as the following: 1.) Complete Response (CR): Disappearance of all target lesions, Partial Response (PR): At least a 30% decrease in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD, Progressive Disease (PD): At least a 20% increase in the sum of the LD of target lesions, Stable Disease (SD): neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD. Overall Response Rate is defined as percentage of CR + PR.

    Measured: Assessed at baseline, every 2 cycles until cycle 4, then every 3 cycles until disease progression, up to 10 months 16 days.

Secondary outcomes (4)

  1. Number of Participants With Disease Control (Complete + Partial Response + Stable Disease)

    Will be assessed per RECIST v1.1 and iRECIST. Assessment of objective response per Response Evaluation Criteria in Solid Tumors version 1.1 of target lesions by cross sectional imaging (either CT or MRI), defined as the following: 1.) Complete Response (CR): Disappearance of all target lesions, Partial Response (PR): At least a 30% decrease in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD, Progressive Disease (PD): At least a 20% increase in the sum of the LD of target lesions, Stable Disease (SD): neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD. Overall Response Rate is defined as percentage of CR + PR.

    Measured: Assessed at baseline, every 2 cycles until cycle 4, then every 3 cycles until disease progression, up to 10 months 16 days.

  2. Time in Months With Progression-free Survival

    Defined as time from study registration to radiographic progression per RECIST v1.1 (blinded central assessment), clinical progression, or death of any cause.

    Measured: Assessed at baseline, every 2 cycles until cycle 4, then every 3 cycles until disease progression, up to 10 months 16 days.

  3. Overall Survival Time in Months

    Defined as time from study registration to death of any cause.

    Measured: Survival assessed from study registration through study completion, 10 months 16 days.

  4. Number of Participants With Adverse Events

    Will be evaluated according to National Cancer Institute Common Terminology Criteria for Adverse Events v5.

    Measured: Adverse events monitored from time of informed consent through the last follow-up visit or 30 days after the date of the last dose of cabozantinib or pembrolizumab treatment, whichever occurs last, up to 10 months 16 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 Jun 2020
  2. Study start20 Apr 2021
  3. Primary completion13 Dec 2021
  4. Study completion8 Mar 2022

Why it stopped: Terminated due to slow accrual

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
2 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04442581
Sponsor's protocol ID
RG1007034
Other IDs
NCI-2020-03968, 10548
Status last verified
Mar 2023
First submitted
18 Jun 2020
Last updated
5 Apr 2023
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Cabozantinib S-malate and Pembrolizumab in people with Advanced Hepatocellular Carcinoma and BCLC Stage B Hepatocellular Carcinoma, run by University of Washington at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 30 inclusion and 58 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 5 Apr 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 5 Apr 2023). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of Participants With Objective Response (Complete or Partial Response) (time frame: Assessed at baseline, every 2 cycles until cycle 4, then every 3 cycles until disease progression, up to 10 months 16 days.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04442581.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 5 Apr 2023; AzTrials last refreshed its copy on 8 Nov 2026.

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