Phase I study of lenalidomide and sorafenib inpatients with advanced hepatocellular carcinoma

Safi Shahda, Patrick Loehrer, Romnee Clark, A. John Spittler, Sandra K. Althouse, E. Gabriella Chiorean

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background. Sorafenib is the standard treatment for advanced hepatocellular carcinoma (HCC), and to date, no combination therapy has demonstrated superior survival compared with sorafenib alone. The immunosuppressive microenvironment in HCC is a negative predictor for survival. Lenalidomide is an immunomodulator and antiangiogenic agent, with limited single-agent efficacy in HCC. Based on these data, we designed a phase I study of sorafenib plus lenalidomide to determine the safety and preliminary antitumor activity of this combination. Methods. This was an open-label, phase I study with a 3+3 dose escalation/de-escalation design. The starting dose of sorafenib was 400mgp.o. b.i.d. and of lenalidomide was 15mg p.o. daily with a planned dose escalation by 5mgper cohort up to 25 mg daily. Dose de-escalation was planned to a sorafenib dose of 400 mg p.o. daily combined with two doses of lenalidomide: 10mgp.o. daily for a 28-day cycle (cohort 1) and 10 mg p.o. daily for a 21- or 28-day cycle (cohort 2). Patients with cirrhosis, a Child-Pugh score of A-B7, and no previous systemic therapy were eligible. Results. Five patients were enrolled. Their median age was 56 years (range 39–61), and the ECOG status was 0–2. Four patients were treated at dose level (DL) 1. Because of the poor tolerance to the combination associated with grade 2 toxicities, one more patient was treated at DL 21. No doselimiting toxicity was observed as specified per protocol. The most common toxicities were nausea, anorexia, pruritus, elevated liver enzymes, and elevated bilirubin. Three patients experienced one or more of the following grade 3 toxicities: fatigue (DL 1), increased bilirubin (DL 1), skin desquamation (DL21), and elevated transaminase levels (DL 1). The median duration of therapy was 1 cycle (range 1–3). All patients discontinued the study, 4 because of progressive disease and 1 by patient preference. The best confirmed response was progressive disease. The median progression-free survival was 1.0 month (95% confidence interval 0.9–2.8), and the median overall survival was 5.9 months (95% confidence interval 3.68–23.4). Conclusion. In our small study, the combination of lenalidomide and sorafenib was poorly tolerated and showed no clinical activity. Although the study was closed early because of toxicity concerns, future studies assessing combinations of sorafenib with new-generation immunomodulator drugs or other immunomodulatory agents, should consider lower starting doses of sorafenib to avoid excessive toxicity.

Original languageEnglish (US)
Pages (from-to)664-665
Number of pages2
JournalOncologist
Volume21
Issue number6
DOIs
StatePublished - Jun 1 2016

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Inpatients
Hepatocellular Carcinoma
Immunologic Factors
Bilirubin
Survival
Confidence Intervals
Angiogenesis Inhibitors
sorafenib
lenalidomide
Patient Preference
Anorexia
Therapeutics
Pruritus
Immunosuppressive Agents
Transaminases
Nausea
Disease-Free Survival
Fatigue
Fibrosis
Safety

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Phase I study of lenalidomide and sorafenib inpatients with advanced hepatocellular carcinoma. / Shahda, Safi; Loehrer, Patrick; Clark, Romnee; Spittler, A. John; Althouse, Sandra K.; Chiorean, E. Gabriella.

In: Oncologist, Vol. 21, No. 6, 01.06.2016, p. 664-665.

Research output: Contribution to journalArticle

Shahda, Safi ; Loehrer, Patrick ; Clark, Romnee ; Spittler, A. John ; Althouse, Sandra K. ; Chiorean, E. Gabriella. / Phase I study of lenalidomide and sorafenib inpatients with advanced hepatocellular carcinoma. In: Oncologist. 2016 ; Vol. 21, No. 6. pp. 664-665.
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abstract = "Background. Sorafenib is the standard treatment for advanced hepatocellular carcinoma (HCC), and to date, no combination therapy has demonstrated superior survival compared with sorafenib alone. The immunosuppressive microenvironment in HCC is a negative predictor for survival. Lenalidomide is an immunomodulator and antiangiogenic agent, with limited single-agent efficacy in HCC. Based on these data, we designed a phase I study of sorafenib plus lenalidomide to determine the safety and preliminary antitumor activity of this combination. Methods. This was an open-label, phase I study with a 3+3 dose escalation/de-escalation design. The starting dose of sorafenib was 400mgp.o. b.i.d. and of lenalidomide was 15mg p.o. daily with a planned dose escalation by 5mgper cohort up to 25 mg daily. Dose de-escalation was planned to a sorafenib dose of 400 mg p.o. daily combined with two doses of lenalidomide: 10mgp.o. daily for a 28-day cycle (cohort 1) and 10 mg p.o. daily for a 21- or 28-day cycle (cohort 2). Patients with cirrhosis, a Child-Pugh score of A-B7, and no previous systemic therapy were eligible. Results. Five patients were enrolled. Their median age was 56 years (range 39–61), and the ECOG status was 0–2. Four patients were treated at dose level (DL) 1. Because of the poor tolerance to the combination associated with grade 2 toxicities, one more patient was treated at DL 21. No doselimiting toxicity was observed as specified per protocol. The most common toxicities were nausea, anorexia, pruritus, elevated liver enzymes, and elevated bilirubin. Three patients experienced one or more of the following grade 3 toxicities: fatigue (DL 1), increased bilirubin (DL 1), skin desquamation (DL21), and elevated transaminase levels (DL 1). The median duration of therapy was 1 cycle (range 1–3). All patients discontinued the study, 4 because of progressive disease and 1 by patient preference. The best confirmed response was progressive disease. The median progression-free survival was 1.0 month (95{\%} confidence interval 0.9–2.8), and the median overall survival was 5.9 months (95{\%} confidence interval 3.68–23.4). Conclusion. In our small study, the combination of lenalidomide and sorafenib was poorly tolerated and showed no clinical activity. Although the study was closed early because of toxicity concerns, future studies assessing combinations of sorafenib with new-generation immunomodulator drugs or other immunomodulatory agents, should consider lower starting doses of sorafenib to avoid excessive toxicity.",
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