Sorafenib + mFOLFOX for Hepatocellular Carcinoma
Brief description of study
This research study is a Phase II clinical trial. Phase II clinical trials test the
effectiveness of an investigational combination of drugs to learn whether the drug
combination works in treating a specific cancer. "Investigational" means that the modified
FOLFOX and sorafenib combination is still being studied and that research doctors are trying
find out more about it-such as the safest dose to use, the side effects it may cause, and if
the combination is effective for treating different types of cancer. It also means that the
FDA has not yet approved the modified FOLFOX and sorafenib combination that will be used in
this study for liver cancer.
FOLFOX is a combination of three drugs: folinic acid (leucovorin), fluorouracil (5-FU), and
oxaliplatin. The dosage amounts for some of these FDA approved drugs will be modified
slightly in this study. The FOLFOX combination is approved by the FDA and is a standard
treatment of colorectal cancer. However, it is not approved for the treatment of liver
Sorafenib is a new drug, which is approved under the brand name Nexavar for the treatment of
liver cancer. It is also currently being tested in various other cancers. Sorafenib works by
slowing down and/or stopping the development of new cancer cells and new blood vessels. By
slowing down and/or stopping the growth of new blood vessels around a tumor, it is believed
that sorafenib prevents or slows down the growth of tumors.
In this research study, sorafenib, the standard treatment, is being combined with modified
FOLFOX, which has shown some antitumor activity in liver cancer.
Clinical Study Identifier: NCT01775501
Detailed Study Description
After agreeing to participate in this study, the patient will be asked to undergo some
screening tests or procedures to find out if he/she is eligible. Many of these tests and
procedures are likely to be part of regular cancer care and may be done even if it turns out
that the patient does not take part in the research study. If the patient has had some of
these tests or procedures recently, they may or may not have to be repeated. These tests and
procedures include: a medical history, physical exam, performance status, electrocardiogram,
assessment of tumor, blood tests, urine test, pregnancy test and optional research biopsy.
If these tests show that the patient is eligible to participate in the research study,
he/she will begin the study treatment. If the patient does not meet the eligibility
criteria, he/she will not be able to participate.
If the patient takes part in this research study, he/she will be given a sorafenib study
drug-dosing diary for each treatment cycle. Each treatment cycle lasts 28 days (4 weeks),
during which time the patient will be taking the study drug twice daily. The diary will also
include special instructions for sorafenib.
There will be a 2-week Lead-in period, in which the patient will receive sorafenib alone for
the first two weeks of the study. Cycle 1 will begin once the patient receives the
combination sorafenib and FOLFOX.
For FOLFOX, all three chemotherapy drugs will be injected through a central vein in the
patient's chest (portacath) and will be given once every two weeks (14 days), starting on
Day 15 of Cycle 1. The patient will receive oxaliplatin first as a 2-hour infusion, followed
by leucovorin, and then 5-FU. The 5-FU infusion can last up to 46 hours and will be given
through a small portable pump. The investigator will ask the patient to come back to the
clinic on day 3 (46 hours after begin 5-FU dose) for pump discontinuance.
During all cycles the patient will have a physical exam and the patient will be asked
questions about his/her general health and specific questions about any problems that he/she
might be having and any medication he/she may be taking.
As part of the research study the patient will undergo research blood tests that will
measure certain proteins in the blood to learn what affect the study treatment may have on
you and your disease. About 1 teaspoon of blood will be drawn on Days 3 and 14 during your
first two weeks of sorafenib alone, again on Days 14 and 28 post-treatment with
FOLFOX-sorafenib and, if available, at the time of progression (if the patient's disease
The patient's blood pressure will be monitored once every week for the first 6 weeks of the
study (once a week during sorafenib lead-in period and Cycle 1). The investigator will asses
the patient's tumor by chest, abdominal and pelvic CT or MRI scan once every 8 weeks
throughout the study.
After the final dose of the study drug the investigator will ask the patient to come back to
the clinic to repeat the following procedures: medical review, physical examination, blood
tests, pregnancy test and tumor assessment by CT or MRI. The investigator would like to keep
track of patient's medical condition for the rest of his/her life. The investigator would
like to do this by calling the patient on the telephone once a year to see how the patient
is doing. Keeping in touch with the patient and checking his/her condition every year helps
the investigator look at the long-term effects of the research study.