Description:
This research will assess the effects of Itacitinib as a second line treatment for patients
with advanced inflammatory hepatocellular carcinoma (HCC), a type of liver cancer. Itacinib
is a protein inhibitor of the tyrosine kinase, JAK1, which is believed to enable cancer cells
to metastasise to other parts of the body.
Title
- Brief Title: Itacitinib in Advanced Hepatocellular Carcinoma
- Official Title: A Phase Ib Study of Itacitinib, a JAK1 Inhibitor, in Advanced Hepatocellular Carcinoma
Clinical Trial IDs
- ORG STUDY ID:
237279
- SECONDARY ID:
2017-004437-81
- NCT ID:
NCT04358185
Conditions
- Advanced Hepatocellular Carcinoma
Interventions
Drug | Synonyms | Arms |
---|
Itacitinib (INCB039110) | | Itacitinib |
Purpose
This research will assess the effects of Itacitinib as a second line treatment for patients
with advanced inflammatory hepatocellular carcinoma (HCC), a type of liver cancer. Itacinib
is a protein inhibitor of the tyrosine kinase, JAK1, which is believed to enable cancer cells
to metastasise to other parts of the body.
Detailed Description
JAKaL is a single arm phase Ib study evaluating the effect of Itacitinib in 25 patients with
advanced HCC.
Many patients diagnosed with HCC will have advanced disease where only palliative care is
offered to them, this could account for the relatively low reported 5-year survival rate of
approximately 10%. There are a number of epidemiological and pre-clinical studies that have
investigated the role of chronic inflammatory conditions in the development of HCC and these
provide evidence that inflammation promotes malignant transformation. The production of
tumour-promoting cytokines by inflammatory cells can activate transcription factors, such as
STAT3 via the JAK/STAT pathway in premalignant cells. STAT3, once activated, can cause the
expression of further genes necessary for cell activation, localisation, survival and
proliferation. Inhibition of JAK could therefore be a way of directly affecting malignant
cell proliferation, as STAT3 in most malignancies are persistently phosphorylated and thereby
stimulated to carry out its function; to sustain cell proliferation and block apoptosis.
For reference, STAT3 is a member of the STAT protein family and is switched on, via
phosphorylation, by receptor-associated Janus kinases (JAK), a type of tyrosine kinase, and
together they form homo-/heterodimers that translocate to the cell nucleus and act as
transcription activators. STAT3 mediates the expression of a variety of genes and therefore
is integral to many cellular processes, as mentioned above, such as cell growth and
apoptosis, and thus they can promote oncogenesis by being over-active in the different
signalling pathways it is involved in.
Itacitinib has not yet been approved by the U.S. Food and Drug Administration (FDA) for any
clinical indication but has been developed as potential treatments for myelofibrosis (MF),
rheumatoid arthritis (RA), psoriasis, graft-versus-host disease (GVHD), B cell malignancies
and solid tumours like HCC. It is a small molecule selective inhibitor of JAK1 thereby
preventing its phosphorylation of STAT proteins, particularly STAT3, resulting in a decrease
in the expression of genes responsible for cell activation, localisation, survival and
proliferation
Trial Arms
Name | Type | Description | Interventions |
---|
Itacitinib | Experimental | Itacitinib (INCB039110) - novel and small molecule selective inhibitor of JAK1 | |
Eligibility Criteria
Inclusion Criteria:
1. Aged 18 or over
2. Diagnosis of hepatocellular carcinoma. If primary diagnosis of HCC: diagnosis based on
the following criteria:
- cyto-histological criteria, OR
- radiological criteria: Focal lesion >1 cm with arterial hypervascularization in 2
coincident imaging techniques (CT, MRI, or US), OR
- combined criteria: one imaging technique showing a focal lesion 1-2 cm with
arterial hypervascularization AND AFP levels >400 ng/mL, OR
- combined criteria: one imaging technique showing a focal lesion >2 cm with
arterial hypervascularization AND AFP levels >200 ng/mL
3. Child-Pugh A and B up to 7 points (in patients receiving anticoagulant therapy;
Child-Pugh score up to 5 points; INR category not regarded for calculation of the
Child-Pugh score)
4. Progression or intolerance to first line therapy - N.B: Date of patients last dose of
therapy must be more than 28 days before enrolment into this study.
5. ECOG Performance status 0, 1 or 2.
6. Adequate organ function as defined by:
- Adequate hematologic function (ANC 1.0x109/l, platelet count 50x109/l, and
hemoglobin 9g/dl).
- Serum creatinine concentration < 1.5 times the upper limit of normal (ULN) and/or
creatinine clearance >60 ml/min
- Bilirubin level < 1.5 X ULN
- PT-INR/PTT<1.5 x ULN
7. For women of child-bearing potential (defined as women who have not undergone surgical
sterilization with a hysterectomy, and/or bilateral oophorectomy, and are not
postmenopausal, defined as ≥12 months of amenorrhea) must have a negative serum
pregnancy test within 14 days prior to the first study drug administration Effective
contraception must be used throughout the duration of the study and up to 30 days
following the last dose of the investigational medicinal product (IMP). Effective
forms of contraception include complete abstinence from sexual intercourse, double
barrier methods (condom with spermicide in conjunction with use of an intrauterine
device or condom with spermicide in conjunction with use of a diaphragm), birth
control patch or vaginal ring, oral, injectable, or implanted contraceptives and
surgical sterilization (tubal ligation or vasectomy). Sperm and ova donation are
prohibited during the duration of the study and 30days after the last dose. 8. Written
informed consent prior to initiation of any study procedures and willing and able to
comply with the study schedule
Exclusion Criteria:
1. Previous treatment with:
- Study medication, any other JAK1 inhibitor and/or known hypersensitivity to the
study medication
- An investigational agent within 28 days prior to start of study treatment
2. Serious concurrent medical or psychiatric illness, including serious active infection
3. Uncontrolled ascites
4. Uncontrolled hypertension
5. History of organ transplant (including prior liver transplant)
6. Diagnosis of HIV, congenital immune defect, any immunosuppressive therapy for
autoimmune disease or inflammatory bowel disease
7. Patients with active or latent tuberculosis
8. Patients with active hepatitis C or active hepatitis B that requires treatment
9. Patients who have received a live vaccine 30 days or fewer prior to enrolment as well
as patients who intend to receive live vaccination during study participation or for
three months after last dose administration
8. Patients who have a history of unprovoked venous thromboembolism (VTE) prior to the
diagnosis of malignancy 9. Pregnant or breast feeding women Other clinically significant
co-morbidities that could compromise the subject's participating in the study
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | To assess the safety and tolerability of Itacitinib in patients with HCC: adverse events |
Time Frame: | Throughout study completion, up to 1 year |
Safety Issue: | |
Description: | Assessment of adverse events relating to experimental drug intake according to the Common Terminology Criteria for Adverse Events (CTCAE) V4.03 |
Secondary Outcome Measures
Measure: | Efficacy of Itacitinib by progression free survival |
Time Frame: | Throughout study completion, up to 1 year |
Safety Issue: | |
Description: | Progression free survival (PFS), defined as time from study entry to first evidence of disease progression assessed by mRECIST v1.1 or death due to any cause |
Measure: | Efficacy of Itacitinib by overall survival |
Time Frame: | Throughout study completion, up to 1 year |
Safety Issue: | |
Description: | Overall survival (OS), defined as time from study entry to death due to any cause |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Imperial College London |
Last Updated
April 24, 2020