E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Hepatocellular Carcinoma (HCC) |
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MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 9.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10019828 |
E.1.2 | Term | Hepatocellular carcinoma non-resectable |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To evaluate the overall response rate [ie, proportion of subjects with complete response (CR) and partial response (PR)] to treatment with Prolarix at the MTD determined in a previous Phase 1 study (26.6 mg/m2 tretazicar co-administered with 200 mg/m2 caricotamide). |
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E.2.2 | Secondary objectives of the trial |
Secondary Objectives:
To evaluate the disease control rate defined as the proportion of subjects with either CR or PR or stable disease (SD) at tumour assessment performed approximately 12 weeks or more after first treatment with Prolarix.
To evaluate time to tumour progression (TTP).
To evaluate indications of anti-tumour activity as supported by post-treatment changes in the amount of contrast-enhancing and non-contrast-enhancing tumour and by changes in alpha fetoprotein.
To evaluate the toxicity profile of Prolarix in subjects with HCC.
To evaluate the pharmacokinetic profiles of tretazicar and caricotamide in subjects with HCC.
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Subjects must meet all of the following criteria to be eligible for enrolment into the study:
1) Subject must be ≥18 years of age.
2) Subject must have a histologic or cytologic diagnosis of HCC and be considered unsuitable for resection or other potentially curative options (eg, liver transplant, curative radiofrequency ablation). [Note: Subjects who have not yet had a tissue diagnosis may enter the Screening phase of the study if a) their clinical presentation is considered highly suggestive of HCC by the principal investigator and b) a tissue diagnosis is considered necessary for their management (subjects whom a tissue diagnosis is not considered essential for their management should not be enrolled on this study). A tissue diagnosis must be obtained prior to the entry of any subject into the treatment phase of the study. Subjects whom the principal investigator deems core biopsy to be indicated (as opposed to fine needle aspiration), will be requested to provide informed consent for a second pass biopsy (ie, in addition to the first pass biopsy for tissue diagnosis) for quantification of enzyme DT- diaphorase (NQO2) activity. The second pass biopsy is optional and subjects refusing a second pass biopsy may be enrolled in the study and will be treated identically to those accepting the second pass biopsy].
3) Subject must have a measurable lesion by Response Evaluation Criteria in Solid Tumors (RECIST) on CT scan in at least one site which has not received radiation or any other local therapy [eg, transcatheter arterial chemoembolisation (TACE), radiofrequency ablation, local injection]. (Note: Subjects who have received local therapies will be allowed to participate provided that they have a target lesion which has not been subjected to local therapy. Subjects who have received TACE must have a target lesion outside of the vascular territory subjected to chemoembolisation).
4) Subject has an Eastern Cooperative Oncology Group (ECOG) Performance status of 0 or 1.
5) Subject has had no other active malignancy within the past three years [other than non melanomatous skin cancer or carcinoma in situ (CIS) of the breast, bladder or uterine cervix. Subjects with Ta (non-invasive papillary carcinoma) or Tis (sessile carcinoma in situ) bladder cancer are allowed].
6) Subject has a minimum life expectancy of at least three months as determined by the investigator.
7) Subject has adequate bone marrow function (ie, haemoglobin ≥9 g/dL, granulocytes ≥1500/mm3, platelets ≥75,000/mm3).
8) Prothrombin time (PT)-international normalised ratio (INR) ≤2.3 or PT ≤ equal to 6 seconds above control. (Note: Subjects who are being therapeutically anticoagulated with an agent such as warfarin or heparin will be allowed to participate provided that their INR is between 2.0 and 3.0).
9) Subject has adequate renal function (ie, serum creatinine clearance is normal or calculated creatinine clearance is ≥60 mL/min).
10) Subject has adequate hepatic function (ie, bilirubin ≤2x upper limit of normal (ULN); aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase ≤5xULN). (Also see exclusion for Child-Pugh class C below).
11) Male subjects and females of childbearing potential must agree to use an adequate method of contraception from the time of initiation of treatment through study participation and for 3 months after release from the study.
12) Subject is able to give informed consent.
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E.4 | Principal exclusion criteria |
Subjects meeting any of the following exclusion criteria will not be eligible for enrolment:
1) Any prior or current systemic pharmacotherapy for HCC (cytotoxic, targeted or biologic). (Note: TACE is not considered to be systemic pharmacotherapy for the purpose of this study.)
2) Subject has an absolute contraindication to receiving CT contrast media. (Note: Subjects with a history of minor contrast reactions may be pre-medicated prior to contrast administration in accordance with local or institutional practice).
3) Subject has Child-Pugh Class C hepatic impairment.
4) Subject has received an investigational drug within 30 days of enrolment in the study.
5) Females of childbearing potential unless using adequate contraception.
6) Pregnant or lactating females.
7) Major variceal bleeding in the last 30 days.
8) Subjects with a known history of human immunodeficiency virus (HIV) infection
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E.5 End points |
E.5.1 | Primary end point(s) |
Overall tumour response will be based on the best tumour response in all subjects. Tumour responses for targeted and non-targeted tumours are defined using modified RECIST criteria with the modification that confirmatory CT is not required to define tumour response
Evaluation of target lesions
1) Complete Response (CR): Disappearance of all target lesions
2) Partial Response (PR): At least a 30% decrease in the sum of the longest diameter (LD) of target lesions, taking as reference the baseline sum LD.
3) Stable Disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum LD since the treatment started.
4) Progressive Disease (PD): At least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of 1 or more new lesions
Evaluation of non-target lesions
1) Complete Response (CR): Disappearance of all non-target lesions and normalisation of tumour marker level.
2) Incomplete Response/ Stable Disease (SD): Persistence of one or more non-target lesion(s) or/and maintenance of tumour marker level above the normal limits
3) Progressive Disease (PD): Appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions.
The primary efficacy variable is overall best response rate (proportion of subjects with CR or PR as defined by modified RECIST). Other secondary variables of clinical interest include disease control rate, TTP, indications of anti-tumour effect as evidenced by post treatment changes in the amount of contrast-enhancing and non-contrast-enhancing tumour and by changes in alpha-fetoprotein, duration of best response, and time to best response.
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | Information not present in EudraCT |
E.7.1.1 | First administration to humans | Information not present in EudraCT |
E.7.1.2 | Bioequivalence study | Information not present in EudraCT |
E.7.1.3 | Other | Information not present in EudraCT |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | Information not present in EudraCT |
E.7.4 | Therapeutic use (Phase IV) | Information not present in EudraCT |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | Information not present in EudraCT |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | Information not present in EudraCT |
E.8.1.4 | Double blind | Information not present in EudraCT |
E.8.1.5 | Parallel group | Information not present in EudraCT |
E.8.1.6 | Cross over | Information not present in EudraCT |
E.8.1.7 | Other | Information not present in EudraCT |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Information not present in EudraCT |
E.8.2.2 | Placebo | Information not present in EudraCT |
E.8.2.3 | Other | Information not present in EudraCT |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.4.1 | Number of sites anticipated in Member State concerned | 1 |
E.8.5 | The trial involves multiple Member States | No |
E.8.5.1 | Number of sites anticipated in the EEA | 1 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
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E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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End of the trial will be the last patient last visit |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 0 |
E.8.9.1 | In the Member State concerned months | 10 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 0 |
E.8.9.2 | In all countries concerned by the trial months | 10 |
E.8.9.2 | In all countries concerned by the trial days | 0 |