Bevacizumab in Treating Patients With Unresectable Nonmetastatic Liver Cancer
Condition: Adult Primary Hepatocellular Carcinoma; Localized Unresectable Adult Primary Liver Cancer; Recurrent Adult Primary Liver Cancer
MeSH terms: Carcinoma, Hepatocellular; Liver Neoplasms
Intervention: bevacizumab
Intervention description: Given orally
Intervention MeSH terms: Bevacizumab; Antineoplastic Agents, Immunological; Antibodies; Immunoglobulins; Antibodies, Monoclonal
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 46.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      This phase II trial is to see if bevacizumab works in treating patients who have unresectable
      nonmetastatic liver cancer that has not spread to the main portal vein. Monoclonal
      antibodies, such as bevacizumab, can block cancer growth in different ways. Some block the
      ability of cancer cells to grow and spread. Others find cancer cells and help kill them or
      deliver cancer-killing substances to them.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Histologically confirmed hepatocellular carcinoma

               -  Confirmed by needle aspirate, biopsy, or prior surgical resection specimen

          -  Clinically confirmed hepatocellular carcinoma defined as follows:

               -  Cirrhosis or chronic hepatitis B or C virus infection, with 1 or more
                  hypervascular liver masses more than 2 cm

               -  Alpha-fetoprotein (AFP) greater than 400 ng/mL OR greater than 3 times normal and
                  doubling in value during the past 3 months

          -  Deemed unresectable

               -  Prior surgical resection allowed

               -  Recurrence after hepatic resection or other procedure allowed

               -  Tumor that extends into branches of the portal or hepatic veins allowed

               -  No tumor invading the main portal vein (portal trunk) or inferior vena cava

               -  No tumor occupying more than 50% of the liver volume

          -  Enlargement/involvement of regional lymph nodes allowed

          -  At least 1 unidimensionally measurable lesion at least 20 mm

               -  No poorly defined lesions

               -  No vague hypervascular patches

          -  Child-Pugh class A or compensated Child-Pugh class B liver dysfunction

               -  No Child-Pugh class C or uncompensated class B indicated by active
                  encephalopathy, persistent ascites, or prothrombin time greater than 1.5 times
                  normal

               -  Prior ascites allowed if manageable with diuretics alone

               -  No repeated paracentesis (more than 1 per month)

          -  No extrahepatic metastasis

          -  No documented brain metastases

          -  No history or clinical evidence of CNS disease (e.g., primary brain tumor, seizures
             uncontrolled with standard medical therapy, or history of stroke)

          -  Performance status - ECOG 0-2

          -  Absolute neutrophil count greater than 1,500/mm^3

          -  Hemoglobin at least 8 g/dL

          -  Platelet count at least 75,000/mm^3

          -  No prior serious bleeding event (unrelated to liver disease)

          -  No bleeding diathesis

          -  No coagulopathy

          -  Bilirubin no greater than 3 mg/dL

          -  Transaminases less than 5 times upper limit of normal (ULN)

          -  Albumin at least 2.5 mg/dL

          -  PTT less than 4 seconds above ULN

          -  INR less than 1.5 (for patients receiving warfarin)

          -  Creatinine less than 1.5 g/dL

          -  Urine protein less than 500 mg/24hrs*

        Exclusion criteria:

          -  No thromboembolic event within the past 12 months

          -  No clinically significant cardiovascular disease

          -  Not pregnant or nursing

          -  Negative pregnancy test

          -  Fertile patients must use effective contraception

          -  No active infection requiring parenteral antibiotics

          -  No serious non-healing wound/ulcer or bone fracture

          -  No variceal bleeding within the past 6 months

          -  No malignancy within the past 5 years except localized nonmelanoma skin cancer

          -  No ongoing psychiatric or social situation that would preclude study compliance

          -  No known hypersensitivity to Chinese hamster ovary cell products

          -  No known hypersensitivity to other recombinant human antibodies

          -  No more than 1 prior biologic therapy

          -  No concurrent interferon

          -  No concurrent interleukin-2

          -  No more than 1 prior antineoplastic chemotherapy

          -  At least 4 weeks since prior invasive surgery, including open biopsy

          -  At least 2 weeks since prior needle biopsy (core or fine-needle aspirate)

          -  No concurrent hepatic transplant

          -  At least 4 weeks since prior anticancer therapy

          -  No concurrent platelet-stimulating factors (e.g., oprelvekin)

          -  No concurrent full-dose anticoagulants or thrombolytic agents (except as required to
             maintain patency of pre-existing, permanent indwelling IV catheters)

          -  No chronic daily antiplatelet drugs (e.g., aspirin doses of 325 mg/day or higher or
             non-steroidal anti-inflammatory drugs)