Atezolizumab/Bevacizumab Followed by On-demand TACE or Initial Synchronous Treatment With TACE and Atezolizumab/Bevacizumab

Hepatocellular Carcinoma Non-resectable Clinical Trial

— DEMAND  

Official title:

A Randomized, 2-arm Non-comparative Phase II Study on the Efficacy of Atezolizumab and Roche Bevacizumab (Atezo/Bev) Followed by On-demand Selective TACE (sdTACE) Upon Detection of Disease Progression or of Initial Synchronous Treatment With TACE and Atezo/Bev on 24-months Survival Rate in the Treatment of Unresectable Hepatocellular Carcinoma Patients

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04224636
• Other study ID #: AIO-HEP-0418
• Secondary ID: 2019-002430-36
• Status: Recruiting
• Phase: Phase 2
• Start date: June 10, 2020
• Est. completion date: March 1, 2025

Study information

• Verified date: June 2024
• Source: Ludwig-Maximilians - University of Munich
• Contact: Enrico De Toni, MD
• Phone: +49 89 4400 0
• Email: enrico.detoni[@]med.uni-muenchen.de
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Aim of the study is to evaluate the efficacy of up-front atezolizumab/ bevacizumab (Atezo/Bev) followed by on-demand selective transarterial chemoembolization (sdTACE) and of initial synchronous treatment with TACE and Atezo/Bev in the treatment of unresectable HCC patients.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 106
• Est. completion date: March 1, 2025
• Est. primary completion date: March 1, 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Key Inclusion Criteria

1. Patient's signed informed consent

2. Age =18 years at time of signing Informed Consent Form

3. Ability to comply with the study protocol, according to investigator's judgement

4. Life expectancy of at least 12 weeks

5. HCC with histologically confirmed diagnosis

6. Disease that is not amenable to curative surgical and/or local ablation but eligible for TACE

7. ECOG Performance Status of 0 or 1

8. Child-Pugh class A or B7

9. Adequate hematologic and end-organ function

10. Negative HIV test at screening

Key Exclusion Criteria

1. Diffuse HCC or presence of vascular invasion or extrahepatic spread or more than 7 lesions or at least one lesion >= 7 cm

2. Clinically relevant ascites

3. Uncontrolled pleural effusion or pericardial effusion

4. History or presence of hepatic encephalopathy

5. Co-infection of HBV and HCV

6. Patients on a liver transplantation list.

7. Prior systemic therapy for HCC

8. Prior treatment with TACE or selective internal radiation treatment (SIRT)

9. Any condition representing a contraindication to TACE

10. Major gastrointestinal bleeding within 4 weeks prior to randomization, untreated or incompletely treated varices with bleeding or high-risk for bleeding.

11. Active or history of autoimmune disease or immune deficiency

12. Prior allogeneic stem cell or solid organ transplantation

13. History of idiopathic pulmonary fibrosis, organizing pneumonia (e.g., bronchiolitis obliterans), drug-induced pneumonitis, or idiopathic pneumonitis, or evidence of active pneumonitis on screening chest computed tomography (CT) scan

14. Active tuberculosis

15. Severe infection requiring antibiotics within 4 weeks prior to randomization

16. Significant cardiovascular disease

17. History of congenital long QT syndrome or corrected QT interval >500 ms at screening ECG

18. Inadequately controlled arterial hypertension or prior history of hypertensive crisis or hypertensive encephalopathy

19. Significant vascular disease including aortic aneurysm requiring surgical repair or peripheral arterial thrombosis with 6 months prior to randomization

20. History of abdominal or tracheoesophageal fistula or gastrointestinal perforation, or intra-abdominal abscess within 6 months prior to randomization.

21. History or clinical signs of gastrointestinal obstruction or requirement for routine parenteral hydration, parenteral nutrition, or tube feeding. Evidence of abdominal free air that is not explained by paracentesis or recent surgical procedure

22. History of intra-abdominal inflammatory process within 6 months prior to randomization, including but not limited to peptic ulcer disease, diverticulitis, or colitis

23. Evidence of bleeding diathesis or significant coagulopathy

24. Any other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding that contraindicates the use of an investigational drug, may affect the interpretation of the results, or may render the patient at high risk from treatment complications.

25. Uncontrolled tumor-related pain. Patients requiring pain medication must be on a stable regimen at enrollment.

26. Severe, non healing or dehisced wound, active ulcer, or untreated bone fracture

27. History of malignancy other than HCC, with the exception of patients who have been disease-free for at least five years before enrollment or patients with adequately treated and completely resected basal cell or squamous cell skin cancer, in situ cervical, breast or prostate cancer, stage I uterine cancer

28. Current or recent (within 10 days of randomization) use of acetylsalicyclic acid or treatment with dipyramidole, ticlopidine, clopidogrel, and cilostazol

29. Current or recent (within 10 days prior to randomization) use of full dose oral or parenteral anticoagulants or thrombolytic agents for therapeutic purpose.

30. Chronic daily treatment with a nonsteroidal anti-inflammatory drug (NSAID). Occasional use of NSAIDs for the symptomatic relief of medical conditions such as headache or fever is allowed.

31. Treatment with a live, attenuated vaccine within 4 weeks prior to randomization, or anticipation of need for such a vaccine during atezolizumab treatment or within 5 months after the last dose of atezolizumab

32. Prior treatment with CD137 agonists or immune checkpoint blockade therapies, including anti-CTLA-4, anti-PD-1, and antiPD-L1 therapeutic antibodies

33. Hypersensitivity to atezolizumab or bevacizumab or any of the excipients, known hypersensitivity to Chinese hamster ovary cell products, known hypersensitivity to human or humanized antibodies

34. Treatment with systemic immunostimulatory agents (including, but not limited to, interferon and interleukin 2 [IL-2]) within 4 weeks or 5 half-lives of the drug (whichever is longer) prior to randomization

35. Treatment with systemic immunosuppressive medication within 2 weeks prior to randomization, or anticipation of need for systemic immunosuppressive medication during study treatment, with the following exceptions:

Patients who received acute, low-dose systemic immunosuppressant medication or a one-time pulse dose of systemic immunosuppressant medication (e.g., 48 hours of corticosteroids for a contrast allergy) are eligible.

Inhaled corticosteroids for chronic obstructive pulmonary disease or bronchial asthma, supplemental mineralocorticosteroids or low-dose corticosteroids for adrenalcortical insufficiency are allowed.

36. Major surgical procedure other than for diagnosis, open biopsy, or significant traumatic injury within 28 days prior to randomization, or abdominal surgery, abdominal interventions or significant abdominal traumatic injury within 60 days prior to randomization or anticipation of need for major surgical procedure during the course of the study or non-recovery from side effects of any such procedure

37. Core biopsy or other minor surgical procedure, excluding placement of a vascular access device, within 3 days prior to the first dose of bevacizumab

38. Pregnant or breastfeeding females

39. Participation in a clinical trial or experimental drug treatment within 28 days prior to inclusion in the clinical trial or within a period of 5 half-lives of the substances administered in a clinical trial or during an experimental drug treatment prior to inclusion in the clinical trial, depending on which period is longest, or simultaneous participation in another clinical trial while taking part in this clinical trial.

40. Patient committed to an institution by virtue of an order issued either by the judicial or the administrative authorities

41. Patient possibly dependent from the investigator including the spouse, children and close relatives of any investigator

Related Conditions & MeSH terms

• Carcinoma
• Carcinoma, Hepatocellular
• Hepatocellular Carcinoma Non-resectable

Intervention

Combination Product:
• Atezolizumab Injection, Bevacizumab Injection
Atezolizumab and Bevacizumab will be administered prior to or in combination with TACE

Locations

Country	Name	City	State
Germany	University of Bonn	Bonn
Germany	University Hospital Cologne	Köln
Germany	Hospital of the University of Munich	Munich
Germany	Klinikum Rechts der Isar of the Technical University Munich	Munich
Germany	University Hospital Regensburg	Regensburg
Germany	University Hospital Tübingen	Tübingen
Germany	Würzburg University Hospital	Würzburg

Sponsors (1)

Lead Sponsor	Collaborator
Ludwig-Maximilians - University of Munich

Country where clinical trial is conducted

Germany, 

References & Publications (1)

De Toni EN. Immune checkpoint inhibitors: use them early, combined and instead of TACE? Gut. 2020 Oct;69(10):1887-1888. doi: 10.1136/gutjnl-2019-319658. Epub 2019 Oct 14. No abstract available. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Overall response rate (ORR)	Response is defined by RECIST 1.1 and mRECIST	24 months
Secondary	Median overall survival (mOS)	Defined as the time from treatment initiation until death	24 months
Secondary	Progression-free survival (PFS)	Progression is defined according RECIST 1.1 and mRECIST	24 months
Secondary	24-months survival rate	Percentage of patients alive after 24 months since randomization	24 months
Secondary	Complete response rate (CRR)	Defined by the percentage of patients with disappearance of tumor manifestation at radiological evaluation	24 months
Secondary	Disease control rate (DCR)	Defined as the percentage of patients who have achieved complete response, partial response and stable disease	24 months
Secondary	Time to deterioration of liver function	Defined as time from randomization to worsening of CTCAE grade for any of these parameters: aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, albumin, and international normalized ratio (INR)	24 months
Secondary	Time to untreatable progression	defined as time from randomization to progression not amenable to local treatment as per protocol, occurrence of vascular invasion or of extrahepatic spread, worsening of liver function to Child-Pugh score 8 or higher	24 months
Secondary	Time to stage-progression	Defined as time from randomization to disease progression to BCLC C stage	24 months
Secondary	Time to first TACE (arm A)	Defined as time from randomization to disease to the first TACE	24 months
Secondary	Quality of life (QOL)	Standardized assessment will be performed by using EORTC QLQ-C30 - European Organisation for Research and Treatment of Cancer - Quality of Life Core Questionnaire 30 items	24 months
Secondary	Quality of life (QOL)	Standardized assessment will be performed by using EORTC QLQ-HCC18 - European Organisation for Research and Treatment of Cancer - Quality of Life Core Questionnaire - Hepatocellular carcinoma module 18	24 months
Secondary	Adverse Events	Number of Participants With Treatment-Related Adverse Events as Assessed by CTCAE v5.0	24 months

External Links

•   https://demand-study.com/
•   https://demand-study.de/