TRC105 for Liver Cancer That Has Not Responded to Sorafenib
Condition: Hepatocellular Carcinoma; Hepatocellular Cancer; Carcinoma, Hepatocellular
MeSH terms: Carcinoma; Carcinoma, Hepatocellular; Liver Neoplasms
Study type: Interventional
Phase: Phase 2

Summary: 
      Background:

      - TRC105 is an experimental cancer drug. It is designed to slow or stop the growth of tumors.
      It does this by preventing the growth of new blood vessels that feed these tumors. People
      with hepatocellular carcinoma (or liver cancer) sometimes do not respond to standard
      treatments. This includes the cancer drug sorafenib.

      Objectives:

      - To test the safety and effectiveness of TRC105 to treat liver cancer that has not responded
      to standard therapy.

      Eligibility:

        -  People at least 18 years of age who have hepatocellular carcinoma (or liver cancer) that
           has not responded to standard therapy. Participants also will not be eligible for a
           liver transplant.

        -  No anticoagulation therapy is allowed with the exception of low-dose aspirin.

        -  No history of bleeding disorders, peptic ulcer disease or gastritis.

      Design:

        -  Participants will have a physical exam and medical history. They will also have blood
           and urine tests, and imaging studies.

        -  Participants will receive TRC105 once a week. They will also have two daily doses of a
           steroid the day before each treatment. This will help prevent known side effects.

        -  Participants will be monitored with blood and urine tests. They will also have imaging
           studies every two months to study the effect of the drug on tumor growth.

        -  Participants will continue to have TRC105 as long as they do not have severe side
           effects and their liver cancer stops growing or shrinks. After stopping TRC105, they
           will have yearly visits with physical exams and blood tests.
    

Detailed description: 
      Background:

        -  Worldwide, hepatocellular carcinoma (HCC) is the fifth most common malignancy with a
           median survival of 6-9 months. The Study of Heart and Renal Protection (SHARP) study
           established Sorafenib as a standard consideration in this disease and set the bar for
           future studies of systemic therapy. There is no standard therapy for patients whose
           disease has progressed despite Sorafenib therapy.

        -  TRC105 is a chimeric, anti-angiogenic monoclonal antibody that binds CD105, a
           transmembrane receptor overexpressed by proliferating endothelial cells. TRC105 binds to
           CD105-expressing endothelial cells and mediates growth inhibition, apoptosis and
           antibody-dependent cell-mediated cytotoxicity (ADCC).

      Objectives:

      Primary:

      -To evaluate time to tumor progression (TTP) for TRC105 in HCC.

      Secondary:

        -  To evaluate safety of TRC105 in HCC.

        -  To evaluate the immunogenicity of TRC105 as measured by human antichimeric antibody
           (HACA) and human antimouse antibody formation.

        -  To evaluate anti-tumor response as determined by standard and European Association for
           the Study of the Liver (EASL) -modified Response Evaluation Criteria in Solid Tumors
           (RECIST) response criteria.

        -  To perform correlative studies assessing potential biomarkers of response to TRC105.

      Eligibility:

        -  Histologically or cytologically confirmed diagnosis of HCC.

        -  Childs-Pugh A or B (7 points) cirrhosis only is allowed.

        -  Patients must have disease that is not amenable to potentially curative resection.

        -  Patients must have progressed on or been intolerant of prior sorafenib therapy.

        -  No history of bleeding varices (unless subsequent liver transplant). All patients must
           have had endoscopic evaluation within 6 months of starting study.

        -  No history of bleeding varices in previous 1 year (unless subsequent liver transplant).
           No anti-coagulation (except low-dose aspirin).

      Design:

        -  This is a single-arm phase II study of TRC105 in patients with HCC.

        -  TRC105 will be administered as an intravenous infusion every two weeks. Patients will be
           re-staged every 8 weeks.

        -  The primary endpoint of the study will be Time to Tumor Progression (TTP). The primary
           purpose of this study is to evaluate the ability of TRC105 as a second line treatment to
           improve upon the time to progression (TTP) of patients with refractory HCC.
    

Intervention name(s): TRC105
Intervention type(s): Drug
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: CD105; Monoclonal Antibody; Anti-Angiogenic; Chimeric; Apoptosis; Liver Cancer