New treatment for liver cancer using targeted therapy

CSR02-Fab-TF as Hepatic Intra-arterial Therapy in Intermediate Stage B or Limited Advanced Stage C Hepatocellular Carcinoma (HCC): Dose-Escalation Study to Assess Safety and Tolerability

This study is testing a new treatment for liver cancer that uses a special therapy to target the tumor's blood vessels while leaving healthy tissue alone, to see if it can help shrink the tumors and improve patient outcomes.

Quick facts

• Phase: Early Phase 1
• Study type: Interventional
• Enrollment: 43 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Koo Foundation Sun Yat-Sen Cancer Center (Academic / other)
• Drugs / interventions: radiation
• Locations: 4 sites (Tainan, North Dist. and 3 other locations)
• Trial ID: NCT04601428 on ClinicalTrials.gov

What this trial studies

This clinical trial investigates a novel intra-arterial therapy for patients with hepatocellular carcinoma (HCC) that is not amenable to surgical intervention. The approach utilizes a specially designed protein, CSR02-Fab-TF, which targets blood vessels specific to HCC tumors while sparing normal liver tissue. The study aims to determine the safety and optimal dosing of this therapy, as well as its effectiveness in inducing tumor response. By blocking the blood supply to the tumor, the therapy seeks to induce necrosis and improve patient outcomes.

Who should consider this trial

Good fit: Ideal candidates include adults aged 18 and older with intermediate to limited advanced stage HCC who have not responded adequately to previous therapies.

Not a fit: Patients with curable liver cancer through resection, transplantation, or ablation may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could provide a more effective and targeted option for patients with advanced liver cancer.

How similar studies have performed: While similar approaches have been explored, this specific targeting method using CSR02-Fab-TF is novel and has not been extensively tested in prior studies.

Eligibility criteria

Inclusion Criteria:

* Age ≥ 18 years
* Diagnosis of HCC by at least one of the following criteria:

  * Histological confirmation;
  * Magnetic resonance imaging (MRI) or computerized tomography (CT) consistent with liver cirrhosis AND at least one solid liver lesion \> 1 cm with intense contrast uptake during the arterial phase followed by contrast washout during the venous phase regardless of alpha-fetal protein (AFP) level
* Barcelona Clinic Liver Cancer (BCLC) Intermediate Stage B or limited Advanced Stage C (see Protocol Section 3.1). Patients with Stage C disease should have received or been offered and chosen not to receive systemic therapy
* Inadequate response to prior liver-directed therapy (e.g., TACE, bland embolization, Y90, ablation, radiation therapy) to the same targeted area or progressive disease after prior liver-directed therapy) or to one or more systemic therapies
* Not a candidate for curative resection, liver transplantation, or percutaneous ablation (See Protocol Appendix 3)
* Eastern Collective Oncology Group (ECOG) performance status ≤1 (See Protocol Appendix 5)
* Adequate laboratory parameters, including:

  * Serum total bilirubin ≤ 2x ULN
  * Alkaline phosphatase, aspartate aminotransferase (AST) and aspartate aminotransferase (ALT) \< 5 x ULN;
  * Serum creatinine ≤ 1.5 mg/dL;
  * Prothrombin time (international normalized ratio; INR) ≤ 1.5;
  * Absolute neutrophil count \> 1000/μL;
  * Platelet count \> 75,000/μL;
  * Hgb \> 8 g/dL
* Acceptable pulmonary status, including room air O2 saturation \> 90%
* Child-Pugh A-B7 without clinically significant ascites (See Protocol Appendix 4)
* Signed informed consent
* All subjects must be surgically sterile, at least two years post-menopausal (if female), or agree to use adequate, effective contraception approved by the Investigator until two (2) months after receiving a final dose of CSR02-Fab-TF

Exclusion Criteria:

* Eligible for transplantation by Milan criteria (Protocol Appendix 3) or potentially eligible if successfully "down staged" by pre-transplant therapy
* Prior organ transplantation
* Any small molecule drug treatment for HCC (including TACE) within the previous 30 days, treatment with biological agents or any investigational therapy within the previous 60 days, or treatment with Y90 within the previous 90 days.
* Previously treated malignancies from which the subject has not been disease-free for at least 2 years, except for adequately treated non-melanoma skin cancer, in situ cancer, or low-grade prostate or bladder cancer
* Severe chronic obstructive or other pulmonary disease with hypoxemia that requires supplementary oxygen or clinically significant pleural effusions
* New York Heart Association (NYHA) Class III or IV, cardiac disease, myocardial infarction within 3 months prior to therapy, unstable arrhythmia, symptomatic peripheral arterial vascular disease, or presence of an artificial or other vascular device requiring chronic anticoagulation (See Protocol Appendix 6)
* Any of the following risks related to QT/QTc interval:

  * Baseline prolongation of QT/QTc interval (repeated interval \> 480 milliseconds using Frederica's QT correction formula);
  * History of additional risk factors for Torsades de Pointes (e.g. heart failure, hypokalemia, family history of Long QT syndrome);
  * Concomitant medications that have a known risk for prolongation of the QT/QTc interval (see https://crediblemeds.org/new-drug-list/)
* Major surgery, vascular injury, or serious illness within the previous 60 days
* Known inherited thrombophilia (hypercoagulable state) or history of unprovoked venous or arterial thrombosis
* Active, uncontrolled bacterial, viral, or fungal infections, requiring systemic therapy at screening. Subjects with prior HBV (positive HBSAg) must have HBV viral load \< 2000 IU/mL or be receiving concurrent anti-HBV therapy to be eligible. Subjects on anti-HBV therapy must have been on treatment with a viral load maintained at \< 2000 IU/mL for at least 4 weeks prior to first dose and continue on this same therapy throughout study treatment. Subjects with HCV infection are eligible if other eligibility criteria are met
* Females who are breast-feeding
* Allergy to iodinated contrast medium that is uncontrolled or refractory to medical therapy
* Therapeutic anticoagulation that cannot be stopped 24-72 hours before treatment (per Section 4.5) and reinstituted no sooner than 72 hours after therapy
* Any concomitant disease or condition that could interfere with the conduct of the study, or that would, in the opinion of the Investigator, pose an unacceptable risk to the subject in this study
* Unwillingness or inability to comply with the study protocol for any reason

Where this trial is running

Tainan, North Dist. and 3 other locations

• National Cheng Kung University Hospital (NCKUH) — Tainan, North Dist., Taiwan (Recruiting)
• Koo Foundation Sun Yat-Sen Cancer Center (KFSYSCC) — Taipei, Pei-Tou Dist., Taiwan (Recruiting)
• National Taiwan University Hospital (NTUH) — Taipei, Zhongzheng Dist., Taiwan (Recruiting)
• Kfsyscc — Taipei, Taiwan (Recruiting)

Study contacts

• Study coordinator: Gabriela Sanchez

Conditions Hepatocellular Carcinoma; Hepatocellular carcinoma; HCC; hepatoma; IA therapy; PLVAP; CSR02-Fab-TF