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Hepatocellular Carcinoma (HCC)Phase 2REVIVENCT07495579

Lenvatinib or Regorafenib for Advanced Hepatocellular Carcinoma After Immunotherapy (REVIVE)

A Phase 2 study testing Lenvatinib and regorafenib in people with Hepatocellular Carcinoma (HCC), run by Asan Medical Center at 1 site in South Korea.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

The goal of this clinical trial is to learn if lenvatinib or regorafenib can help treat people with advanced liver cancer (hepatocellular carcinoma, HCC) that cannot be removed with surgery after first treatment with immunotherapy-based drug combinations. It will also look at the safety of these treatments. Read more about this study

Who is it for?
Ages 19 years and older
Conditions the study is for
Hepatocellular Carcinoma (HCC)
What is being tested?
Lenvatinib and regorafenib
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
146 participants
Where
1 siteSouth Korea
Study dates
Apr 2026to Dec 2028
Phase
Phase 2
Are there results?
Not yet: the study is under way

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

Who may be able to join

  • Age 19 years or older
  • Diagnosis of hepatocellular carcinoma according to the American Association for the Study of Liver Diseases (AASLD) guidelines
  • Unresectable or metastatic hepatocellular carcinoma not amenable to curative treatments such as surgical resection, liver transplantation, or local ablation
  • Prior first-line systemic treatment with an immune checkpoint inhibitor-based combination regimen, defined as dual immune checkpoint inhibitor therapy (e.g., nivolumab plus ipilimumab or durvalumab plus tremelimumab) for the REVIVE-1 cohort, and immune checkpoint inhibitor-based combination therapy (e.g., atezolizumab plus bevacizumab, durvalumab plus tremelimumab, nivolumab plus ipilimumab, camrelizumab plus rivoceranib, or similar regimens) for the REVIVE-2 cohort; prior participation in clinical trials using these regimens is allowed
  • Radiologic disease progression after at least 2 cycles of first-line treatment
  • At least one measurable lesion according to RECIST v1.1
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  • Recovery from toxicities related to prior therapy to grade 1 or lower, except for clinically stable or non-clinically significant toxicities
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
  • Life expectancy of at least 12 weeks
  • Absolute neutrophil count ≥ 1.0 × 10⁹/L
  • Platelet count ≥ 75 × 10⁹/L for REVIVE-1 or ≥ 50 × 10⁹/L for REVIVE-2
  • Hemoglobin ≥ 9 g/dL
  • Serum creatinine ≤ 1.5 × ULN or creatinine clearance ≥ 40 mL/min
  • Proteinuria <3 g in 24-hour urine collection or urine protein-to-creatinine ratio <3 mg/mg
  • Child-Pugh A (score 5-6) for REVIVE-1 cohort or Child-Pugh B (score 7-8) for REVIVE-2 cohort
  • Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 3 × upper limit of normal (ULN)
  • Patients with chronic hepatitis B infection receiving appropriate antiviral therapy if HBV DNA positive
  • QTcF ≤ 480 ms on electrocardiogram obtained within 21 days prior to enrollment
  • Ability to understand and willingness to sign written informed consent
  • Women of childbearing potential must have a negative pregnancy test and agree to use effective contraception during the study and for 4 months after the last dose

Who cannot join

  • Known fibrolamellar hepatocellular carcinoma or mixed hepatocellular-cholangiocarcinoma
  • Prior treatment with lenvatinib or regorafenib
  • Receipt of two or more prior systemic treatment regimens for advanced hepatocellular carcinoma
  • Known brain metastases or epidural disease unless adequately treated and clinically stable for at least 3 months
  • Congestive heart failure greater than New York Heart Association class II
  • Unstable angina, myocardial infarction, or stroke within 6 months
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  • Clinically significant cardiac arrhythmia requiring treatment
  • Uncontrolled hypertension despite optimal medical therapy (systolic blood pressure >150 mmHg or diastolic blood pressure >90 mmHg)
  • Active bleeding disorders or high risk of severe bleeding
  • Tumor invasion of major blood vessels with high risk of bleeding
  • Gastrointestinal conditions with high risk of perforation or fistula, including active peptic ulcer disease, inflammatory bowel disease, diverticulitis, cholecystitis, symptomatic cholangitis, or recent gastrointestinal perforation
  • Major surgery within 2 months before enrollment or incomplete recovery from surgery
  • Moderate to severe ascites
  • Known hypersensitivity to study drugs or their components
  • Pregnancy or breastfeeding
  • Diagnosis of another active malignancy requiring treatment within the past 2 years, except for adequately treated low-risk cancers
  • Uncorrected electrolyte abnormalities
  • Any medical condition that, in the investigator's judgment, would make the participant unsuitable for the study

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

South Korea1 site
  • Asan Medical Center

    Seoul, 05505

    Changhoon Yoo, 82-2-3010-1727, cyoo.amc@gmail.com

Other trials in South Korea

About this study

Official title: A Multicenter Phase 2 Study of Lenvatinib or Regorafenib in Patients With Unresectable or Metastatic Hepatocellular Carcinoma Who Progressed After First-Line Immunotherapy-Based Combination Therapy (REVIVE)

The goal of this clinical trial is to learn if lenvatinib or regorafenib can help treat people with advanced liver cancer (hepatocellular carcinoma, HCC) that cannot be removed with surgery after first treatment with immunotherapy-based drug combinations. It will also look at the safety of these treatments.

The main questions this study aims to answer are:

Read more
  • How long lenvatinib can delay cancer growth in people with good liver function (Child-Pugh)A after dual immunotherapy
  • How long people with reduced liver function (Child-Pugh B7-B8) live after treatment with lenvatinib or regorafenib after first-line immunotherapy-based combination treatment
  • What side effects people experience during treatment
  • How many people have their tumors shrink or disappear

The study has two parts:

In REVIVE-1, participants with Child-Pugh A liver function will receive lenvatinib.

In REVIVE-2, participants with Child-Pugh B7 to B8 liver function will receive either lenvatinib or regorafenib.

Participants will:

  • take lenvatinib or regorafenib by mouth
  • visit the clinic regularly for physical exams, blood and urine tests, and safety checks
  • have computed tomography (CT) scans every 8 weeks to check their cancer
  • be followed during and after treatment to assess outcomes and side effects
Read the detailed description

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide. Immune checkpoint inhibitor (ICI)-based combination therapies have become standard first-line treatments for patients with unresectable or metastatic HCC. Several clinical trials have demonstrated survival benefits with these regimens, including atezolizumab plus bevacizumab (IMbrave150), durvalumab plus tremelimumab (HIMALAYA), and nivolumab plus ipilimumab (CheckMate 9DW). As a result, immunotherapy-based combinations are widely used as first-line systemic treatment for advanced HCC.

Despite these advances, most patients eventually experience disease progression and require subsequent systemic therapy. However, prospective evidence regarding optimal second-line treatment after progression on ICI-based therapy remains limited. Multikinase inhibitors such as sorafenib, lenvatinib, and regorafenib were originally approved based on studies conducted before the widespread use of immunotherapy. Therefore, their role after failure of modern ICI-based regimens remains unclear.

In addition, most clinical trials in advanced HCC have primarily enrolled patients with preserved liver function (Child-Pugh A). Evidence for patients with Child-Pugh B liver function is limited, and prospective studies evaluating systemic therapies in this population are scarce.

The REVIVE study is a multicenter phase 2 clinical trial designed to evaluate the efficacy and safety of lenvatinib or regorafenib in patients with unresectable or metastatic hepatocellular carcinoma who have progressed after first-line immunotherapy-based combination therapy.

The study consists of two cohorts.

REVIVE-1 is a prospective, multicenter, single-arm phase 2 cohort evaluating lenvatinib in participants with Child-Pugh A liver function whose disease has progressed after first-line dual immune checkpoint inhibitor therapy.

REVIVE-2 is a multicenter, randomized, non-comparative phase 2 cohort evaluating lenvatinib or regorafenib in participants with Child-Pugh B7 to B8 liver function whose disease has progressed after first-line immunotherapy-based combination therapy.

This study aims to generate prospective evidence regarding the efficacy and safety of lenvatinib and regorafenib as second-line treatments after failure of immunotherapy-based therapy in advanced hepatocellular carcinoma, , particularly in settings where evidence remains limited, such as after dual ICI therapy and in patients with Child-Pugh B liver function.

Being tested
Lenvatinib, regorafenib
Keywords
Hepatocellular Carcinoma, Lenvatinib, Regorafenib, Second-line Therapy, Dual Immune Checkpoint Inhibitor, Child-Pugh B
Medical subject headings
Carcinoma, Hepatocellular

What participants receive

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

  • LenvatinibDrug

    Lenvatinib is an oral multikinase inhibitor targeting vascular endothelial growth factor receptors (VEGFR), fibroblast growth factor receptors (FGFR), platelet-derived growth factor receptor alpha (PDGFR-α), RET, and KIT. In this study, lenvatinib is administered orally as second-line treatment according to protocol-defined dosing based on liver function and body weight.

  • regorafenibDrug

    Regorafenib is an oral multikinase inhibitor targeting angiogenic, stromal, and oncogenic receptor tyrosine kinases including VEGFR, FGFR, PDGFR, KIT, RET, and RAF kinases. In this study, regorafenib is administered orally as second-line treatment according to protocol-defined dosing.

Study groups in NCT07495579
Study groupRoleWhat they receive
REVIVE-1: LenvatinibExperimentalLenvatinib orally once daily at a dose based on body weight (12 mg for ≥60 kg or 8 mg for <60 kg)
Receives: Drug: Lenvatinib
REVIVE-2: LenvatinibExperimentalLenvatinib orally once daily at a starting dose of 4 mg or 8 mg based on body weight, with step-up to 8 mg or 12 mg after 2 weeks if tolerated
Receives: Drug: Lenvatinib
REVIVE-2: RegorafenibExperimentalRegorafenib administered orally at a starting dose of 80 mg once daily for 3 weeks followed by 1 week off in each 4-week cycle, with step-up to 120 mg after 2 weeks if tolerated.
Receives: Drug: regorafenib

What is being measured

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

  1. Progression-Free Survival (PFS) in REVIVE-1

    Progression-free survival is defined as the time from first dose of study treatment to disease progression according to RECIST v1.1 or death from any cause, whichever occurs first, in the REVIVE-1 cohort.

    Measured: Up to 24 months

  2. Overall Survival (OS) in REVIVE-2

    Overall survival is defined as the time from first dose of study treatment to death from any cause in the REVIVE-2 cohort.

    Measured: Up to 30 months

Secondary outcomes (5)
  1. Overall Survival (OS) in REVIVE-1

    Overall survival is defined as the time from first dose of study treatment to death from any cause in the REVIVE-1 cohort.

    Measured: Up to 24 months

  2. Progression-Free Survival (PFS) in REVIVE-2

    Progression-free survival is defined as the time from first dose of study treatment (lenvatinib or regorafenib) to the first documented disease progression according to RECIST v1.1 or death from any cause, whichever occurs first, in the REVIVE-2 cohort.

    Measured: Up to 30 months

  3. Objective Response Rate (ORR)

    Objective response rate is defined as the proportion of participants who achieve a confirmed complete response or partial response according to RECIST v1.1. in both REVIVE-1 and REVIVE-2 cohorts.

    Measured: Up to 24 months

  4. Incidence of Treatment-Emergent Adverse Events

    The incidence and severity of treatment-emergent adverse events will be assessed and graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 in both REVIVE-1 and REVIVE-2 cohorts.

    Measured: Up to 30 months

  5. Time to Liver Function Deterioration in REVIVE-2

    Time to liver function deterioration is defined as the time from first dose of study treatment to worsening of liver function, such as progression from Child-Pugh B7 to B8-9 or C, from Child-Pugh B8 to B9 or C, or worsening of albumin-bilirubin (ALBI) grade from 2 to 3.

    Measured: Up to 30 months

Timeline

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

  1. First posted27 Mar 2026
  2. Study startApr 2026 (estimated)
  3. Primary completionApr 2028 (estimated)
  4. Study completionDec 2028 (estimated)

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
Randomised
Intervention model
Parallel groups
Model description
This study includes two cohorts. REVIVE-1 is a single-arm phase 2 cohort evaluating lenvatinib in participants with Child-Pugh A liver function after progression on dual immune checkpoint inhibitor therapy. REVIVE-2 is a randomized, non-comparative phase 2 cohort evaluating lenvatinib or regorafenib in participants with Child-Pugh B7-8 liver function after progression on immunotherapy-based combination therapy.
Masking
None (open label)
Enrolment
146 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07495579
Sponsor's protocol ID
KCSG HB25-15
Other IDs
HB25-15
Acronym
REVIVE
Status last verified
May 2026
First submitted
22 Mar 2026
Last updated
27 May 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Lenvatinib and regorafenib in people with Hepatocellular Carcinoma (HCC), run by Asan Medical Center at 1 site in South Korea.

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 20 inclusion and 18 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: opening soon, as of the sponsor's last update on 27 May 2026. 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 South Korea. 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?

This study is still under way. Results are not available in the source record yet.

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

Contact Changhoon Yoo (82-2-3010-1727, cyoo.amc@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Progression-Free Survival (PFS) in REVIVE-1 (time frame: Up to 24 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 27 May 2026.

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