Sorafenib Tosylate and Yttrium Y 90 Glass Microspheres in Treating Patients With Liver Cancer That Cannot Be Removed by Surgery
Condition: Advanced Adult Hepatocellular Carcinoma; BCLC Stage C Hepatocellular Carcinoma; Recurrent Adult Hepatocellular Carcinoma; Stage III Hepatocellular Carcinoma AJCC v7; Stage IIIA Hepatocellular Carcinoma AJCC v7; Stage IIIB Hepatocellular Carcinoma AJCC v7; Stage IIIC Hepatocellular Carcinoma AJCC v7; Stage IV Hepatocellular Carcinoma AJCC v7; Stage IVA Hepatocellular Carcinoma AJCC v7; Stage IVB Hepatocellular Carcinoma AJCC v7; Unresectable Hepatocellular Carcinoma
MeSH terms: Carcinoma; Carcinoma, Hepatocellular
Intervention: Laboratory Biomarker Analysis; Quality-of-Life Assessment; Sorafenib; Sorafenib Tosylate; Yttrium Y 90 Glass Microspheres
Intervention description: Correlative studies; Ancillary studies; Given PO; Given PO; Given IA
Intervention MeSH terms: Sorafenib
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 40.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      This phase II trial studies how well sorafenib tosylate and yttrium Y 90 glass microspheres
      work in treating patients with liver cancer that cannot be removed by surgery. Sorafenib
      tosylate may stop the growth of tumor cells by blocking some of the enzymes needed for cell
      growth. Yttrium Y 90 glass microspheres use glass beads to carry radiation directly to tumor
      cells without harming normal cells. Giving sorafenib tosylate with yttrium Y 90 glass
      microspheres may be an effective treatment for liver cancer.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Subjects must be able to understand and be willing to sign the written informed
             consent form; a signed informed consent form must be appropriately obtained prior to
             the conduct of any trial-specific procedure

          -  Life expectancy of at least 12 weeks (3 months)

          -  Patients with histological or cytologically documented hepatocellular carcinoma (HCC)
             (documentation of original biopsy for diagnosis is acceptable if tumor tissue is
             unavailable) or clinical diagnosis by American Association for the Study of Liver
             Diseases (AASLD) criteria in cirrhotic subjects is required; for subjects without
             cirrhosis histological confirmation is mandatory

          -  Patients must have at least one tumor lesion that meets the following criteria: the
             lesion can be accurately measured in at least one dimension according to Response
             Evaluation Criteria in Solid Tumor (RECIST)

          -  The target lesion(s) has not been previously treated with local therapy (such as
             surgery, radiation therapy, hepatic arterial therapy, chemoembolization,
             radiofrequency ablation, percutaneous ethanol injection or cryoablation)

          -  Patients who have received local therapy, such as surgery, radiation therapy, hepatic
             arterial embolization, chemoembolization, radiofrequency ablation, percutaneous
             ethanol injection or cryoablation are eligible if the previously treated lesions have
             progressed or recurred can be identified as target lesions; local therapy must have
             been completed at least 4 weeks prior to the baseline scan

          -  Patients who have received yttrium-90 microspheres are not eligible

          -  Patients who have an Eastern Cooperative Oncology Group (ECOG) performance status (PS)
             =< 1

          -  Patients who are categorized under Barcelona-Clınic Liver Cancer (BCLC)-C stage

          -  Cirrhosis grade of Child-Pugh class A; Child-Pugh status should be calculated based on
             clinical findings and laboratory results during the screening period

          -  Platelet count >= 60 x 10^9/L

          -  Hemoglobin >= 8.5 g/dL

          -  Total bilirubin =< 2.5 mg/dl

          -  Alanine transaminase (ALT) and aspartate aminotransferase (AST) =< 5 x upper limit of
             normal

          -  Serum creatinine =< 1.5 x the upper limit of normal

          -  Prothrombin time (PT)-international normalized ratio (INR) =< 2.3 or PT =< 6 seconds
             above control

          -  All acute toxic effects of any prior treatment have resolved to National Cancer
             Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAE) v4.0 grade 1 or
             less at the time of signing the informed consent form (ICF)

          -  Women of childbearing potential must have a negative serum pregnancy test performed
             within 7 days prior to the start of study drug; post-menopausal women (defined as no
             menses for at least 1 year) and surgically sterilized women are not required to
             undergo a pregnancy test

          -  Subjects (men and women) of childbearing potential must agree to use adequate
             contraception beginning at the signing of the ICF until at least 30 days after the
             last dose of study drug; the definition of adequate contraception will be based on the
             judgment of the principal investigator or a designated associate

          -  Subject must be able to swallow and retain oral medication

        Exclusion Criteria:

          -  Main portal vein thrombosis (PVT)

          -  Patients who are eligible for curative treatment (ablation or resection or
             transplantation)

          -  Previous or concurrent cancer other than HCC unless without evidence of disease for 5
             or more years prior to entry, except cervical cancer in-situ, treated basal cell
             carcinoma, or superficial bladder tumor

          -  Tumor replacement > 70% of total liver volume based on visual estimation by the
             investigator OR tumor replacement > 50% of total liver volume in the presence of
             albumin < 3 mg/dL

          -  Contraindications to angiography and selective visceral arterial catheterization

          -  Any known contraindications to sorafenib including allergic reaction, pill-swallowing
             difficulty, uncontrolled hypertension or history of cardiac disease, significant
             gastrointestinal (GI) bleed within 30 days, metastatic brain disease, renal failure
             requiring dialysis

          -  Concomitant treatment or within 28 days of one of the following:

               -  Any other systemic anticancer agent other than agents used for cancer prevention

               -  Subjects who have used strong cytochrome P450 3A4 (CYP3A4) inducers (e.g.,
                  phenytoin, carbamazepine, phenobarbital, St. John's Wort [hypericum perforatum],
                  dexamethasone at a dose of greater than 16 mg daily, or rifampin [rifampicin],
                  and/or rifabutin) within 28 days before treatment

               -  UDP glycosyltransferase 1 family, polypeptide A1 (UGT 1A1) and UDP
                  glycosyltransferase 1 family, polypeptide A9 (UGT 1A9) substrates (e.g.,
                  irinotecan)

               -  P-glycoprotein (Gp) substrates (e.g., Digoxin)

          -  Prior radiation therapy to the liver

          -  Prior systemic therapy for the treatment of HCC, including sorafenib

          -  Any history of symptomatic pulmonary compromise, such as chronic obstructive pulmonary
             disease

          -  Any prior intervention for, or ongoing compromise of, the ampulla of Vater or
             biliary-enteric anastomosis

          -  Clinically evident ascites (trace ascites on imaging is acceptable)

          -  Pregnant or breast-feeding patients

          -  A positive serum pregnancy test within 14 days prior to treatment in women of
             childbearing potential

          -  Uncontrolled hypertension (systolic pressure > 140 mm Hg or diastolic pressure > 90 mm
             Hg [NCI-CTCAE v4.0] on repeated measurement) despite optimal medical management

          -  Active or clinically significant cardiac disease including:

               -  Congestive heart failure-New York Heart Association (NYHA) > class II

               -  Active coronary artery disease

               -  Cardiac arrhythmias requiring anti-arrhythmic therapy other than beta blockers or
                  digoxin

               -  Unstable angina (anginal symptoms at rest), new-onset angina within 3 months
                  before treatment, or myocardial infarction within 6 months before treatment

          -  Evidence or history of bleeding diathesis or uncontrolled coagulopathy

          -  Subject with any pulmonary hemorrhage/bleeding event of NCI-CTCAE v4.0 grade 2 or
             higher within 4 weeks before treatment; any other hemorrhage/bleeding event of
             NCI-CTCAE v4.0 grade 3 or higher within 4 weeks before treatment

          -  Subjects with thrombotic, embolic, venous, or arterial events, such as cerebrovascular
             accident (including transient ischemic attacks) within 6 months of informed consent

          -  Presence of a non-healing wound, non-healing ulcer, or bone fracture

          -  History of organ allograft. (Including corneal transplant)

          -  Known or suspected allergy or hypersensitivity to any of the study drugs, study drug
             classes, or excipients of the formulations given during the course of this trial

          -  Any malabsorption condition

          -  Inability to comply with the protocol and/or not willing or not available for
             follow-up assessments