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Lenvatinib + TACE for Liver Cancer

Phase 2

Waitlist Available

Led By Maen Abdelrahim, MD

Research Sponsored by The Methodist Hospital Research Institute

Eligibility Criteria Checklist

Specific guidelines that determine who can or cannot participate in a clinical trial

Must have

Adequate organ and marrow function criteria must be met

Adults (≥18 years old) with histologically or cytologically confirmed HCC beyond Milan Criteria

Must not have

Uncontrolled blood pressure despite optimized regimen of antihypertensive medication

Bleeding or thrombotic disorders or subjects at risk for severe hemorrhage

Timeline

Screening 3 weeks

Treatment Varies

Follow Up at eligibility screening; within 14 days prior to the administration of the first dose of lenvatinib; at time of administration of first dose of lenvatinib; 1, 2, 3, 4, 5, 6, 7, 8 months after first dose

Awards & highlights

Summary

This trial will study if adding the drug lenvatinib to transcatheter arterial chemoembolization (TACE) before liver transplantation will improve outcomes in patients with hepatocellular carcinoma (HCC) beyond Milan Criteria.

Who is the study for?

This trial is for adults with advanced liver cancer (HCC) who haven't had previous cancer treatments, are on the liver transplant list, and can perform daily activities with little to no assistance. They must have well-managed hepatitis if present, good organ function, not be pregnant or breastfeeding, and agree to use effective contraception.

What is being tested?

The study tests a combination of Lenvatinib medication and TACE procedure over six months before a liver transplant in patients with large HCC tumors. It aims to compare these patients' outcomes against those from past records who didn't receive this treatment.

What are the potential side effects?

Lenvatinib may cause high blood pressure, fatigue, loss of appetite, weight loss, nausea, diarrhea or constipation. The TACE procedure could lead to abdominal pain, fever or infection. Both interventions carry risks like bleeding or allergic reactions.

Eligibility Criteria

Inclusion Criteria

You may be eligible if you check “Yes” for the criteria below

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My organs and bone marrow are functioning well.

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I am an adult with liver cancer that has progressed beyond early stages.

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I have not received any treatments and am eligible for a TACE procedure.

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I am fully active or restricted in physically strenuous activity but can do light work.

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I can take pills by mouth.

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I am on antiviral therapy for my hepatitis B to control the virus.

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I am on the liver transplant list and do not need any other organ transplant.

Exclusion Criteria

You may be eligible for the trial if you check “No” for criteria below:

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My high blood pressure is not controlled despite taking medication.

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I have a bleeding or clotting disorder, or I'm at high risk for severe bleeding.

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I have had chemotherapy or immunotherapy for liver cancer.

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My liver function is moderately to severely impaired.

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I have a serious heart condition.

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I have had cancer before, but it was a type that is allowed in this study.

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My liver cancer fits within specific size and number limits.

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I have a blood clot in the liver's vein that prevents a specific liver cancer treatment.

Timeline

Screening ~ 3 weeks3 visits

Treatment ~ Varies

Follow Up ~ at eligibility screening; within 14 days prior to the administration of the first dose of lenvatinib; at time of administration of first dose of lenvatinib; 1, 2, 3, 4, 5, 6, 7, 8 months after first dose

Screening ~ 3 weeks

Treatment ~ Varies

Follow Up ~at eligibility screening; within 14 days prior to the administration of the first dose of lenvatinib; at time of administration of first dose of lenvatinib; 1, 2, 3, 4, 5, 6, 7, 8 months after first dose

This trial's timeline: 3 weeks for screening, Varies for treatment, and at eligibility screening; within 14 days prior to the administration of the first dose of lenvatinib; at time of administration of first dose of lenvatinib; 1, 2, 3, 4, 5, 6, 7, 8 months after first dose for reporting.

Treatment Details

Study Objectives

Study objectives can provide a clearer picture of what you can expect from a treatment.

Primary study objectives

Percent Tumor Necrosis

Secondary study objectives

Adverse Event Occurrence

Explant Biomarkers

Microvessel Density

+3 more

Side effects data

From 2019 Phase 3 trial • 392 Patients • NCT01321554

70%

Diarrhoea

69%

Hypertension

57%

Decreased appetite

54%

Weight decreased

49%

Nausea

44%

Fatigue

40%

Headache

38%

Proteinuria

38%

Vomiting

38%

Stomatitis

33%

Palmar-plantar erythrodysaesthesia syndrome

33%

Arthralgia

33%

Dysphonia

32%

Constipation

30%

Cough

26%

Asthenia

25%

Oedema peripheral

21%

Rash

20%

Back pain

20%

Myalgia

19%

Abdominal pain

18%

Dysgeusia

18%

Pain in extremity

18%

Abdominal pain upper

18%

Musculoskeletal pain

18%

Dry mouth

18%

Dyspnoea

17%

Dizziness

16%

Pyrexia

16%

Oropharyngeal pain

16%

Hypokalaemia

15%

Dyspepsia

15%

Hypocalcaemia

14%

Epistaxis

13%

Dysphagia

13%

Alopecia

12%

Anaemia

12%

Musculoskeletal chest pain

12%

Dry skin

11%

Urinary tract infection

11%

Nasopharyngitis

10%

Thrombocytopenia

10%

Hypoalbuminaemia

10%

Oral pain

10%

Blood creatinine increased

10%

Electrocardiogram QT prolonged

10%

Upper respiratory tract infection

Dehydration

Neck pain

Hypomagnesaemia

Depression

Influenza like illness

Muscle spasms

Lymphopenia

Alanine aminotransferase increased

Muscular weakness

Haematuria

Malaise

Pruritus

Ejection fraction decreased

Hyponatraemia

Blood thyroid stimulating hormone increased

Platelet count decreased

Aspartate aminotransferase increased

Toothache

Glossodynia

Blood alkaline phosphatase increased

Hyperkeratosis

Bronchitis

Flatulence

Dysuria

Influenza

Anxiety

Hyperglycaemia

Leukopenia

Productive cough

Non-cardiac chest pain

Paraesthesia

Hypothyroidism

Haemoptysis

White blood cell count decreased

Pneumonia

General physical health deterioration

Cholecystitis

Malignant pleural effusion

Sepsis

Pulmonary embolism

seizure

Acute myocardial infarction

Atrial fibrillation

Lower respiratory tract infection

Hypotension

Lung infection

Spinal cord compression

Acute kidney injury

Hypercalcaemia

Respiratory failure

Appendicitis

Acute respiratory failure

Intracranial tumour haemorrhage

Acute coronary syndrome

Death

Hepatic failure

Osteoarthritis

Blood uric acid increased

Intestinal obstruction

Monoparesis

Small intestinal obstruction

Colitis

Transient ischaemic attack

Pancreatitis

Atrial flutter

Cardio-respiratory arrest

Uterine prolapse

Coronary artery stenosis

Pneumatosis intestinalis

Cerebrovascular accident

Confusional state

Liver injury

Diverticulitis

Bacteraemia

Gastroenteritis

Perineal abscess

Wound infection

Malignant neoplasm progression

Bone pain

Cancer pain

Syncope

Vocal cord paralysis

Nephrotic syndrome

100%

80%

60%

40%

20%

Study treatment Arm

Randomization Phase: Lenvatinib 24 mg

Randomization Phase: Placebo

OOL, Treatment Period: Lenvatinib 24 mg

OOL, Treatment Period: Lenvatinib 20 mg

Trial Design

2Treatment groups

Experimental Treatment

Group I: Matched Historical Control PatientsExperimental Treatment1 Intervention

Historical controls will be liver transplant recipients matched on age, etiology of liver disease (viral vs. non-viral), listing tumor size, and number of TACE procedures to cases in the intervention group who receive a transplant.

Group II: Lenvatinib in Combination with TACE Prior to Liver TransplantationExperimental Treatment2 Interventions

Regimen of six months neoadjuvant lenvatinib in combination with TACE prior to liver transplantation in patients with hepatocellular carcinoma (HCC) beyond Milan Criteria.

Treatment

First Studied

Drug Approval Stage

How many patients have taken this drug

Lenvatinib

FDA approved

0 / 15Eligibility criteria met