Carcinoma, Hepatocellular
Conditions
Keywords
Hepatocellular carcinoma, Sorafenib, Adjuvant, Surgical resection, Ablation, Nexavar, Adjuvant therapy, Liver cancer, HCC, STORM
Brief summary
To evaluate efficacy and safety of sorafenib versus placebo in the adjuvant treatment of Hepatocellular Carcinoma (HCC) after potentially curative treatment (surgical resection or local ablation).
Interventions
Sorafenib 400 mg twice daily (BID)
Placebo 2 tablets twice daily (BID)
Sponsors
Study design
Eligibility
Inclusion criteria
* Subjects who have undergone surgical resection or local ablation (PEI or percutaneous or intraoperative RFA) for treatment of HCC with curative intent within 4 months from staging to potentially curative treatment. A maximum of 2 local ablation courses may be administered during this time period. * At least 3 weeks (21 days) but no more than 7 weeks (49 days), from resection or last local ablation course, to CT/MRI scan date * Male or female subjects \>/= 18 years of age * Confirmation of CR (absence of residual tumor after curative treatment), on the eligibility scan by independent radiological review. * For subjects undergoing surgical resection pathology proven complete removal of tumor. * Intermediate or High Risk of recurrence as assessed by tumor characteristics. * Child-Pugh score 5 -7 points. A Child-Pugh score of 7 points is allowed only in the absence of ascites. * ECOG Performance Status of 0. * Adequate bone marrow, liver and renal function
Exclusion criteria
* Recurrent HCC * Child-Pugh score 7 points with presence of ascites. * Low risk of recurrence after curative treatment * History of cardiovascular disease * History of HIV infection * Active clinically serious infections (\> grade 2 NCI-CTCAE version 3.0) * Subjects with seizure disorder requiring medication (such as steroids or anti-epileptics) * Subjects with evidence or history of bleeding diathesis * Subjects undergoing renal dialysis * Previous or concurrent cancer that is distinct in primary site or histology from the cancer being evaluated in this study EXCEPT cervical carcinoma in situ, treated basal cell carcinoma, superficial bladder tumors \[Ta, Tis & T1\] or any cancer curatively treated \> 3 years prior to study entry as defined by the signing of informed consent.. * Uncontrolled ascites (defined as not easily controlled with diuretic treatment) * Encephalopathy * History of GI bleeding within 30 days of randomization. * Subjects with a history of esophageal varices bleeding which has not been followed by effective therapy and/or treatment to prevent bleeding recurrence. * Prior anti cancer therapy for treatment of HCC (including sorafenib or any other molecular therapy) is excluded. * Major surgery within 4 weeks of start of study as defined by the signing of informed consent, except for surgical resection or local ablation of HCC. * Investigational drug therapy outside of this trial during or within 4 weeks of study entry, as defined by the signing of informed consent. * Liver transplantation, this includes patients on a transplant list with the intention to transplant
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Recurrence Free Survival (RFS) by Independent Assessment | From randomization up to 4 years or until disease recurrence whichever came first | Disease recurrence of HCC (intra or extra hepatic) was defined as the appearance of a new intrahepatic lesions fulfilling the American Association for the Study of Liver Diseases (AASLD) criteria of diagnosis of HCC or a new extra-hepatic lesions according to the Response Evaluation Criteria in Solid Tumors (RECIST) criteria version 1.0. In addition to investigator assessment, all images were reviewed by an independent panel of radiologists. The calculation of the RFS was based on the independent evaluation of the scans. RFS was defined as the time from randomization to the first documented disease recurrence by independent radiological assessment or death due to any cause whichever occurred first. For subjects who had not recurred or died at the time of analysis, RFS was censored at their last date of evaluable scan before drop-out for any other reason than recurrence or death. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to Recurrence (TTR) by Independent Assessment | From randomization up to 4 years or until disease recurrence whichever came first | TTR was defined as the time from randomization to the first documented disease recurrence by independent radiological assessment. For subjects who had not recurred at the time of analysis, TTR was censored at their last date of evaluable scan before withdrawal for any other reason than recurrence. NA in the reported data indicates values could not be estimated due to censored data. |
| Overall Survival (OS) | From randomization of the first subject until 4 years later. | OS was defined as the time from randomization to date of death due to any cause. OS for subjects alive at the time of analysis was censored at their last date of contact. NA in the reported data indicates values could not be estimated due to censored data. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Patient Reported Outcomes: Functional Assessment of Cancer Therapy (FACT)- General (G) Total Score | Cycle (C) Day (D)1, C2D1, C3D1 and subsequent cycles up to C18, end of intervention visit | The PWB, FWB, SWB and EWB were summed to form the FACT-G total score. Subjects responded to each item on a 5-point Likert-type scale ranging from 0 (not at all) to 4 (very much). FACT-G scores ranged from 0 to 108 and the higher scores represented a better quality of life. The MID for the FACT-G total score was in the range of 6 to 7. The results on the ANCOVA analysis of time-adjusted AUC for the FACT-G score were reported. |
| The Correlation Between Plasma Biomarker Levels at Baseline With RFS to Determine Prognostic Value of Biomarkers - ANG-2 | At Baseline | Biomarker was analyzed at baseline \[i.e., before treatment\] as a dichotomized variable based on median biomarker levels, and dichotomized into high and low groups using an optimal max chi cut-off approach - not per intervention. As such, results were analyzed according to this stratification. Max-chi square methodology was used to search for the optimal cut point for dichotomization of each plasma biomarker and Kaplan-Meier curves were generated using the optimal cut point for each possible association examined. These biomarker analyses were retrospective and exploratory and of signal generating nature only. |
| Patient Reported Outcomes: Euroqol-5 Dimensions (EQ-5D) - Index Score | Cycle (C) Day (D)1, C2D1, C3D1 and subsequent cycles up to C18, end of intervention visit | The EQ-5D is a generic quality of life preference based on a validated instrument used in cancer and in general population, with 2 parts: Index and Visual Analogue Scale. The EQ-5D Index is a descriptive system of the following health dimensions: mobility, selfcare, usual activities, pain/discomfort, and anxiety/depression. Subjects were asked to choose any one of the 3 response levels for each dimension: no problems, some problems, and severe problems. The 5 health dimensions were summarized into a single score, the EQ-5D Index score which ranged from -0.59 to 1 with higher scores representing better health states (0=death, 1= perfect health, and -0.59=a health state worse than death). A change of at least 0.10 to 0.12 points was considered a minimally important difference using Eastern Cooperative Oncology Group Performance Status as the anchor. The results on the Analysis of covariance of timeadjusted Area under curve for the EQ-5D index score were reported. |
| The Correlation Between Plasma Biomarker Levels at Baseline With RFS to Determine Prognostic Value of Biomarkers - MET | At Baseline | Biomarker was analyzed at baseline \[i.e., before treatment\] as a dichotomized variable based on median biomarker levels, and dichotomized into high and low groups using an optimal max chi cut-off approach - not per intervention. As such, results were analyzed according to this stratification. Max-chi square methodology was used to search for the optimal cut point for dichotomization of each plasma biomarker and Kaplan-Meier curves were generated using the optimal cut point for each possible association examined. These biomarker analyses were retrospective and exploratory and of signal generating nature only. |
| The Correlation Between Plasma Biomarker Levels at Baseline With RFS to Determine Prognostic Value of Biomarkers - AFP | At Baseline | Biomarker was analyzed at baseline \[i.e., before treatment\] as a dichotomized variable based on median biomarker levels, and dichotomized into high and low groups using an optimal max chi cut-off approach - not per intervention. As such, results were analyzed according to this stratification. Max-chi square methodology was used to search for the optimal cut point for dichotomization of each plasma biomarker and Kaplan-Meier curves were generated using the optimal cut point for each possible association examined. These biomarker analyses were retrospective and exploratory and of signal generating nature only. |
| Patient Reported Outcomes: Euroqol-5 Dimensions (EQ-5D) - Visual Analogue Scale (VAS) Score | Cycle (C) Day (D)1, C2D1, C3D1 and subsequent cycles up to C18, end of intervention visit | The EQ-5D is a generic quality of life preference based on a validated instrument used in cancer and in general population, with 2 parts: Index and Visual Analogue Scale. The EQ-5D VAS is a measure that represents health status as a single value. It is a 20-centimetre vertical graduated visual analogue scale with scores that ranged from 0 (worst imaginable health state) to 100 (best imaginable health state). The respondent rated his/her current health state by drawing a line from the box marked 'your own health state today' to the appropriate point on the EQ-5D VAS. A 3-digit number (including leading zeros) was read off the scale from the point where the respondent's line crossed the scale, which was the EQ-5D VAS score. A change of at least 7 points on the VAS was considered as minimally important. The results on the ANCOVA analysis of time-adjusted AUC for the EQ-5D VAS score were reported. |
| Patient Reported Outcomes: Functional Assessment of Cancer Therapy (FACT)- Hepatobiliary Subscale (HEP) Score | Cycle (C) Day (D)1, C2D1, C3D1 and subsequent cycles up to C18, end of intervention visit | The FACT-HEP is a 45 item, self-administered, multi-dimensional, psychometrically sound questionnaire used extensively in oncology clinical trials. FACT-HEP consisted of five subscales: Physical Well-Being (PWB), Social Well-Being (SWB), Emotional Well-Being (EWB), Functional Well-Being (FWB), and Hepatobiliary Cancer Subscale (HCS). The PWB, FWB, SWB and EWB were summed to form the FACTGeneral (FACT-G) total score. The FACT-G and HCS scores were summed to form the FACT-HEP total score. FACT-HEP scores ranged from 0 to 180 and the higher scores represented a better quality of life. Subjects responded to each item on a 5-point Likert-type scale ranging from 0 (not at all) to 4 (very much). The minimally important difference (MID) for the FACT-Hep total score was in the range of 8 to 9. The results on the ANCOVA analysis of time-adjusted AUC for the FACT-HEP score were reported. |
Countries
Argentina, Australia, Austria, Belgium, Brazil, Bulgaria, Canada, Chile, China, France, Germany, Greece, Hong Kong, Italy, Japan, Mexico, New Zealand, Portugal, Romania, Russia, Singapore, South Korea, Spain, Sweden, Switzerland, Taiwan, United Kingdom, United States
Participant flow
Recruitment details
Participant recruitment period was between 15 August 2008 to 12 November 2010.
Pre-assignment details
Of 1602 participants who were screened for inclusion in the study, 1114 were enrolled, and 1107 received treatment.
Participants by arm
| Arm | Count |
|---|---|
| Sorafenib (Nexavar, BAY43-9006) Participants received 2 tablets of Sorafenib (2×200 mg) orally twice daily (BID) | 556 |
| Placebo Participants received 2 tablets of placebo orally twice daily (BID) | 558 |
| Total | 1,114 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 136 | 41 |
| Overall Study | Clinical endpoint reached | 16 | 43 |
| Overall Study | Completed all planned assessments | 79 | 101 |
| Overall Study | Death | 10 | 5 |
| Overall Study | Disease progression, recurrence/relapse | 170 | 279 |
| Overall Study | Lost to Follow-up | 7 | 3 |
| Overall Study | Non-compliant with study medication | 11 | 5 |
| Overall Study | Physician decision not protocol driven | 10 | 14 |
| Overall Study | Progression by clinical judgment | 2 | 3 |
| Overall Study | Protocol driven decision point | 3 | 7 |
| Overall Study | Protocol Violation | 2 | 7 |
| Overall Study | Radiological and clinical progression | 8 | 8 |
| Overall Study | Randomized but not treated | 3 | 4 |
| Overall Study | Study terminated by sponsor | 2 | 2 |
| Overall Study | Withdrawal by Subject | 97 | 36 |
Baseline characteristics
| Characteristic | Sorafenib (Nexavar, BAY43-9006) | Placebo | Total |
|---|---|---|---|
| Age, Continuous | 58.1 Years STANDARD_DEVIATION 11.7 | 58.7 Years STANDARD_DEVIATION 12.2 | 58.4 Years STANDARD_DEVIATION 12 |
| Age, Customized <18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Customized >=65 years | 173 Participants | 197 Participants | 370 Participants |
| Age, Customized Between 18 and 65 years | 383 Participants | 361 Participants | 744 Participants |
| Sex: Female, Male Female | 105 Participants | 97 Participants | 202 Participants |
| Sex: Female, Male Male | 451 Participants | 461 Participants | 912 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 360 / — | 522 / — |
| serious Total, serious adverse events | 230 / 548 | 228 / 559 |
Outcome results
Recurrence Free Survival (RFS) by Independent Assessment
Disease recurrence of HCC (intra or extra hepatic) was defined as the appearance of a new intrahepatic lesions fulfilling the American Association for the Study of Liver Diseases (AASLD) criteria of diagnosis of HCC or a new extra-hepatic lesions according to the Response Evaluation Criteria in Solid Tumors (RECIST) criteria version 1.0. In addition to investigator assessment, all images were reviewed by an independent panel of radiologists. The calculation of the RFS was based on the independent evaluation of the scans. RFS was defined as the time from randomization to the first documented disease recurrence by independent radiological assessment or death due to any cause whichever occurred first. For subjects who had not recurred or died at the time of analysis, RFS was censored at their last date of evaluable scan before drop-out for any other reason than recurrence or death.
Time frame: From randomization up to 4 years or until disease recurrence whichever came first
Population: Full analysis set (FAS) included participants who were randomized to study treatments.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sorafenib (Nexavar, BAY43-9006) | Recurrence Free Survival (RFS) by Independent Assessment | 1014 Days |
| Placebo | Recurrence Free Survival (RFS) by Independent Assessment | 1026 Days |
Overall Survival (OS)
OS was defined as the time from randomization to date of death due to any cause. OS for subjects alive at the time of analysis was censored at their last date of contact. NA in the reported data indicates values could not be estimated due to censored data.
Time frame: From randomization of the first subject until 4 years later.
Population: FAS included participants who were randomized to study treatments.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sorafenib (Nexavar, BAY43-9006) | Overall Survival (OS) | NA Days |
| Placebo | Overall Survival (OS) | NA Days |
Time to Recurrence (TTR) by Independent Assessment
TTR was defined as the time from randomization to the first documented disease recurrence by independent radiological assessment. For subjects who had not recurred at the time of analysis, TTR was censored at their last date of evaluable scan before withdrawal for any other reason than recurrence. NA in the reported data indicates values could not be estimated due to censored data.
Time frame: From randomization up to 4 years or until disease recurrence whichever came first
Population: FAS included participants who were randomized to study treatments.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sorafenib (Nexavar, BAY43-9006) | Time to Recurrence (TTR) by Independent Assessment | 1172 Days |
| Placebo | Time to Recurrence (TTR) by Independent Assessment | 1089 Days |
Patient Reported Outcomes: Euroqol-5 Dimensions (EQ-5D) - Index Score
The EQ-5D is a generic quality of life preference based on a validated instrument used in cancer and in general population, with 2 parts: Index and Visual Analogue Scale. The EQ-5D Index is a descriptive system of the following health dimensions: mobility, selfcare, usual activities, pain/discomfort, and anxiety/depression. Subjects were asked to choose any one of the 3 response levels for each dimension: no problems, some problems, and severe problems. The 5 health dimensions were summarized into a single score, the EQ-5D Index score which ranged from -0.59 to 1 with higher scores representing better health states (0=death, 1= perfect health, and -0.59=a health state worse than death). A change of at least 0.10 to 0.12 points was considered a minimally important difference using Eastern Cooperative Oncology Group Performance Status as the anchor. The results on the Analysis of covariance of timeadjusted Area under curve for the EQ-5D index score were reported.
Time frame: Cycle (C) Day (D)1, C2D1, C3D1 and subsequent cycles up to C18, end of intervention visit
Population: FAS included participants who were randomized to study treatments.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Sorafenib (Nexavar, BAY43-9006) | Patient Reported Outcomes: Euroqol-5 Dimensions (EQ-5D) - Index Score | 0.827 Unit on a scale |
| Placebo | Patient Reported Outcomes: Euroqol-5 Dimensions (EQ-5D) - Index Score | 0.866 Unit on a scale |
Patient Reported Outcomes: Euroqol-5 Dimensions (EQ-5D) - Visual Analogue Scale (VAS) Score
The EQ-5D is a generic quality of life preference based on a validated instrument used in cancer and in general population, with 2 parts: Index and Visual Analogue Scale. The EQ-5D VAS is a measure that represents health status as a single value. It is a 20-centimetre vertical graduated visual analogue scale with scores that ranged from 0 (worst imaginable health state) to 100 (best imaginable health state). The respondent rated his/her current health state by drawing a line from the box marked 'your own health state today' to the appropriate point on the EQ-5D VAS. A 3-digit number (including leading zeros) was read off the scale from the point where the respondent's line crossed the scale, which was the EQ-5D VAS score. A change of at least 7 points on the VAS was considered as minimally important. The results on the ANCOVA analysis of time-adjusted AUC for the EQ-5D VAS score were reported.
Time frame: Cycle (C) Day (D)1, C2D1, C3D1 and subsequent cycles up to C18, end of intervention visit
Population: FAS included participants who were randomized to study treatments.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Sorafenib (Nexavar, BAY43-9006) | Patient Reported Outcomes: Euroqol-5 Dimensions (EQ-5D) - Visual Analogue Scale (VAS) Score | 77.203 Unit on a scale |
| Placebo | Patient Reported Outcomes: Euroqol-5 Dimensions (EQ-5D) - Visual Analogue Scale (VAS) Score | 80.181 Unit on a scale |
Patient Reported Outcomes: Functional Assessment of Cancer Therapy (FACT)- General (G) Total Score
The PWB, FWB, SWB and EWB were summed to form the FACT-G total score. Subjects responded to each item on a 5-point Likert-type scale ranging from 0 (not at all) to 4 (very much). FACT-G scores ranged from 0 to 108 and the higher scores represented a better quality of life. The MID for the FACT-G total score was in the range of 6 to 7. The results on the ANCOVA analysis of time-adjusted AUC for the FACT-G score were reported.
Time frame: Cycle (C) Day (D)1, C2D1, C3D1 and subsequent cycles up to C18, end of intervention visit
Population: FAS included participants who were randomized to study treatments.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Sorafenib (Nexavar, BAY43-9006) | Patient Reported Outcomes: Functional Assessment of Cancer Therapy (FACT)- General (G) Total Score | 80.46 Unit on a scale |
| Placebo | Patient Reported Outcomes: Functional Assessment of Cancer Therapy (FACT)- General (G) Total Score | 82.95 Unit on a scale |
Patient Reported Outcomes: Functional Assessment of Cancer Therapy (FACT)- Hepatobiliary Subscale (HEP) Score
The FACT-HEP is a 45 item, self-administered, multi-dimensional, psychometrically sound questionnaire used extensively in oncology clinical trials. FACT-HEP consisted of five subscales: Physical Well-Being (PWB), Social Well-Being (SWB), Emotional Well-Being (EWB), Functional Well-Being (FWB), and Hepatobiliary Cancer Subscale (HCS). The PWB, FWB, SWB and EWB were summed to form the FACTGeneral (FACT-G) total score. The FACT-G and HCS scores were summed to form the FACT-HEP total score. FACT-HEP scores ranged from 0 to 180 and the higher scores represented a better quality of life. Subjects responded to each item on a 5-point Likert-type scale ranging from 0 (not at all) to 4 (very much). The minimally important difference (MID) for the FACT-Hep total score was in the range of 8 to 9. The results on the ANCOVA analysis of time-adjusted AUC for the FACT-HEP score were reported.
Time frame: Cycle (C) Day (D)1, C2D1, C3D1 and subsequent cycles up to C18, end of intervention visit
Population: FAS included participants who were randomized to study treatments.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Sorafenib (Nexavar, BAY43-9006) | Patient Reported Outcomes: Functional Assessment of Cancer Therapy (FACT)- Hepatobiliary Subscale (HEP) Score | 138.7 Unit on a scale |
| Placebo | Patient Reported Outcomes: Functional Assessment of Cancer Therapy (FACT)- Hepatobiliary Subscale (HEP) Score | 143.79 Unit on a scale |
The Correlation Between Plasma Biomarker Levels at Baseline With RFS to Determine Prognostic Value of Biomarkers - AFP
Biomarker was analyzed at baseline \[i.e., before treatment\] as a dichotomized variable based on median biomarker levels, and dichotomized into high and low groups using an optimal max chi cut-off approach - not per intervention. As such, results were analyzed according to this stratification. Max-chi square methodology was used to search for the optimal cut point for dichotomization of each plasma biomarker and Kaplan-Meier curves were generated using the optimal cut point for each possible association examined. These biomarker analyses were retrospective and exploratory and of signal generating nature only.
Time frame: At Baseline
Population: Plasma biomarker analysis was done in 858 (77%) of the all enrolled subjects.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sorafenib (Nexavar, BAY43-9006) | The Correlation Between Plasma Biomarker Levels at Baseline With RFS to Determine Prognostic Value of Biomarkers - AFP | 668 Days |
| Placebo | The Correlation Between Plasma Biomarker Levels at Baseline With RFS to Determine Prognostic Value of Biomarkers - AFP | 1267 Days |
The Correlation Between Plasma Biomarker Levels at Baseline With RFS to Determine Prognostic Value of Biomarkers - ANG-2
Biomarker was analyzed at baseline \[i.e., before treatment\] as a dichotomized variable based on median biomarker levels, and dichotomized into high and low groups using an optimal max chi cut-off approach - not per intervention. As such, results were analyzed according to this stratification. Max-chi square methodology was used to search for the optimal cut point for dichotomization of each plasma biomarker and Kaplan-Meier curves were generated using the optimal cut point for each possible association examined. These biomarker analyses were retrospective and exploratory and of signal generating nature only.
Time frame: At Baseline
Population: Plasma biomarker analysis was done in 858 (77%) of the all enrolled subjects.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sorafenib (Nexavar, BAY43-9006) | The Correlation Between Plasma Biomarker Levels at Baseline With RFS to Determine Prognostic Value of Biomarkers - ANG-2 | 588 Days |
| Placebo | The Correlation Between Plasma Biomarker Levels at Baseline With RFS to Determine Prognostic Value of Biomarkers - ANG-2 | 1260 Days |
The Correlation Between Plasma Biomarker Levels at Baseline With RFS to Determine Prognostic Value of Biomarkers - MET
Biomarker was analyzed at baseline \[i.e., before treatment\] as a dichotomized variable based on median biomarker levels, and dichotomized into high and low groups using an optimal max chi cut-off approach - not per intervention. As such, results were analyzed according to this stratification. Max-chi square methodology was used to search for the optimal cut point for dichotomization of each plasma biomarker and Kaplan-Meier curves were generated using the optimal cut point for each possible association examined. These biomarker analyses were retrospective and exploratory and of signal generating nature only.
Time frame: At Baseline
Population: Plasma biomarker analysis was done in 858 (77%) of the all enrolled subjects.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Sorafenib (Nexavar, BAY43-9006) | The Correlation Between Plasma Biomarker Levels at Baseline With RFS to Determine Prognostic Value of Biomarkers - MET | 841 Days |
| Placebo | The Correlation Between Plasma Biomarker Levels at Baseline With RFS to Determine Prognostic Value of Biomarkers - MET | NA Days |