Regorafenib + Pembrolizumab vs. Loco-Regional Therapy for Liver Cancer

(REPLACE Trial)

Recruiting at76 trial locations

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 3

Waitlist Available

Sponsor: Translational Research in Oncology

No Placebo Group

Pivotal Trial (Near Approval)

Prior Safety Data

Breakthrough Therapy

Trial Summary

What is the purpose of this trial?

This trial compares a drug combination (Regorafenib and Pembrolizumab) with localized treatments for liver cancer. It targets patients with intermediate-stage liver cancer that can't be cured with surgery. The drug combination works by stopping cancer growth and boosting the immune system, while the localized treatments directly target the liver cancer.

Do I have to stop taking my current medications for this trial?

The trial protocol does not specify if you need to stop taking your current medications. However, you cannot be on systemic corticosteroids or other immunosuppressive medications within 14 days before randomization. It's best to discuss your current medications with the trial team.

What data supports the idea that Regorafenib + Pembrolizumab vs. Loco-Regional Therapy for Liver Cancer is an effective treatment?

The available research shows that combining Regorafenib with transarterial chemoembolization (TACE) can be beneficial for patients with advanced liver cancer, especially after other treatments have failed. Studies indicate that this combination can be effective in controlling the disease. Although specific data on Regorafenib combined with Pembrolizumab is not provided, the combination of Regorafenib with TACE has shown positive results, suggesting potential effectiveness when combined with other treatments like Pembrolizumab. ^{1 2 3 4 5}

What safety data exists for Regorafenib and Pembrolizumab in liver cancer treatment?

The safety data for Regorafenib, often used in combination with Transarterial Chemoembolization (TACE), indicates common grade 3-4 adverse reactions such as hand-foot skin reactions, diarrhea, hypertension, and fatigue. Studies have evaluated the safety of Regorafenib combined with TACE in hepatocellular carcinoma (HCC) patients, showing it as a second-line therapy after the failure of first-line treatments. However, specific safety data for the combination of Regorafenib and Pembrolizumab in liver cancer is not directly addressed in the provided studies. ^{1 3 4 5 6}

Is the treatment with the drugs Nivolumab, Regorafenib, and TACE promising for liver cancer?

Yes, the combination of Nivolumab, Regorafenib, and TACE is promising for liver cancer. Studies show that using Regorafenib with TACE and immune checkpoint inhibitors like Nivolumab can be effective in treating advanced liver cancer, especially when other treatments have failed. ^{3 4 5 7 8}

Research Team

Peter R Galle, MD

Principal Investigator

University Medical Center, Mainz, Germany

Richard S Finn, MD

Principal Investigator

UCLA Department of Medicine, Division of Hematology-Oncology

Eligibility Criteria

This trial is for adults with confirmed intermediate-stage hepatocellular carcinoma (HCC) who haven't had prior systemic or loco-regional therapy. They should be in good physical condition, have liver cancer that's not curable by surgery, and can't have certain autoimmune diseases or recent major surgeries. Women must not be pregnant and participants must agree to use effective contraception.

Inclusion Criteria

No evidence of MVI or EHS

My liver cancer is at an intermediate stage.

My blood counts and organ functions are within normal ranges.

Exclusion Criteria

My liver cancer is not the widespread type that can be measured.

My heart condition fits the study's specific requirements.

I do not have serious lung conditions like fibrosis or uncontrolled lung disease.

Treatment Details

Interventions

• Nivolumab (Checkpoint Inhibitor)
• Regorafenib (Tyrosine Kinase Inhibitor)
• Transarterial Chemoembolization (TACE) (Procedure)

Trial Overview The REPLACE trial compares Regorafenib with pembrolizumab (Rego-Pembro) against transarterial chemoembolization (TACE) or radioembolization (TARE). It aims to find out which treatment is better as a first-line option for liver cancer. Patients will continue treatments until disease progression or unacceptable side effects occur.

Participant Groups

Group I: Regorafenib + Pembrolizumab Experimental Treatment 1 Intervention

Investigational arm: regorafenib at a dose of 90 mg orally once per day (on days 1 to 21 of a 28-day cycle), in combination with pembrolizumab 400 mg using a 30-minute intravenous infusion, on day 1 of a 6-week cycle.

Group II: Loco-regional therapy Active Control 1 Intervention

Control arm: Patients will be treated with TACE or TARE "on-demand" according to site's standard of practice.

Nivolumab is already approved in Canada, Switzerland for the following indications:

Approved in Canada as Opdivo for:

• Melanoma
• Non-small cell lung cancer
• Renal cell carcinoma
• Hodgkin lymphoma
• Head and neck squamous cell carcinoma
• Urothelial carcinoma
• Colorectal cancer
• Gastric cancer
• Gastroesophageal junction cancer
• Esophageal adenocarcinoma

Approved in Switzerland as Opdivo for:

• Melanoma
• Non-small cell lung cancer
• Renal cell carcinoma
• Hodgkin lymphoma
• Head and neck squamous cell carcinoma
• Urothelial carcinoma
• Colorectal cancer
• Gastric cancer
• Gastroesophageal junction cancer
• Esophageal adenocarcinoma

Who Is Running the Clinical Trial?

Translational Research in Oncology

Lead Sponsor

Trials

22

Recruited

6,700+

Bayer

Industry Sponsor

Trials

2,291

Recruited

25,560,000+

Founded

1863

Headquarters

Leverkusen, Germany

Known For

Pharmaceutical Innovations

Top Products

Aspirin, Aleve, Yaz, Nexavar

Bill Anderson

Bayer

Chief Executive Officer since 2023

BSc in Chemical Engineering from the University of Texas, MSc in Chemical Engineering and Management from MIT

Michael Devoy

Bayer

Chief Medical Officer since 2014

MD, PhD

Findings from Research

In a multicenter study involving patients with unresectable hepatocellular carcinoma (HCC) who had failed first-line treatments, the combination of transarterial chemoembolization (TACE) and regorafenib showed a median overall survival of 14.3 months, indicating its potential effectiveness as a second-line therapy.

The treatment was generally well-tolerated, with a low incidence of severe adverse events (15.8%), suggesting that this combination therapy could be a safe option for patients with advanced HCC.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Regorafenib combined with transarterial chemoembolization for unresectable hepatocellular carcinoma: a real-world study. Han, Y., Cao, G., Sun, B., et al.[2022]

Regorafenib is an oral multikinase inhibitor approved for treating pretreated metastatic colorectal cancer and gastrointestinal stromal tumors, showing antiangiogenic and antiproliferative effects, based on data from phase III studies.

Currently, regorafenib is being investigated in phase III trials for hepatocellular carcinoma and in several phase II studies for other gastrointestinal tumors, indicating its potential for broader applications in cancer treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Regorafenib as a single-agent in the treatment of patients with gastrointestinal tumors: an overview for pharmacists. Rey, JB., Launay-Vacher, V., Tournigand, C.[2021]

In a study of 76 colorectal cancer liver metastases patients, combining regorafenib with drug-eluting beads-transarterial chemoembolization (DEB-TACE) significantly improved treatment response rates, with an objective response rate of 35.3% compared to 7.1% for regorafenib alone.

Patients receiving the combination therapy also experienced longer progression-free survival (7.6 months vs. 4.1 months) and overall survival (15.7 months vs. 9.2 months), although they reported more mild and tolerable side effects like abdominal pain and nausea.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment efficacy and safety of regorafenib plus drug-eluting beads-transarterial chemoembolization versus regorafenib monotherapy in colorectal cancer liver metastasis patients who fail standard treatment regimens. Cao, F., Zheng, J., Luo, J., et al.[2022]

In a study involving patients with advanced hepatocellular carcinoma (HCC) who had previously failed second-line treatment with regorafenib, the combination of transcatheter arterial chemoembolization (TACE) with regorafenib and PD-1 antibody showed a higher disease-control rate (DCR) of 88.9% compared to 55.6% for continued TACE with regorafenib.

While the combination treatment was more effective, it also posed a risk of severe immune responses, which could potentially increase the risk of death, leading some patients to prefer the continued TACE with regorafenib despite similar overall response rates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Study on efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with regorafenib and PD-1 antibody versus continued TACE combined with regorafenib in patients with hepatocellular carcinoma after failed second-line treatment with regorafenib. Wang, H., Xiao, W., Han, Y., et al.[2022]

In a study of 59 patients with advanced hepatocellular carcinoma (HCC) who had failed first-line treatment, regorafenib combined with transcatheter arterial chemoembolization (TACE) resulted in an objective response rate (ORR) of 42.3% and a disease control rate (DCR) of 66.1%, indicating significant efficacy in this patient population.

The treatment was generally safe, with most adverse events being manageable; only 9 patients experienced severe (grade 3 or 4) reactions, and there were no treatment-related deaths, suggesting that regorafenib combined with TACE is a viable option for advanced HCC.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Study on safety and efficacy of regorafenib combined with transcatheter arterial chemoembolization in the treatment of advanced hepatocellular carcinoma after first-line targeted therapy. Wang, H., Xiao, W., Han, Y., et al.[2022]

Regorafenib is an effective oral multikinase inhibitor approved by the FDA for treating metastatic colorectal cancer in patients who have not responded to standard chemotherapy and other targeted therapies, showing significant efficacy compared to placebo in the CORRECT trial.

While regorafenib has a greater antiangiogenic effect than sorafenib, it is associated with common severe side effects such as hand-foot skin reactions, diarrhea, hypertension, and fatigue, which require careful management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Management of regorafenib-related toxicities: a review. Krishnamoorthy, SK., Relias, V., Sebastian, S., et al.[2022]

In a study of 52 patients with advanced hepatocellular carcinoma, the combination of regorafenib plus immune checkpoint inhibitors and transarterial chemoembolization (R+ICIs+TACE) resulted in a significantly higher objective response rate (34.8% vs 4.3%) and improved progression-free survival (5.8 months vs 2.6 months) compared to regorafenib plus ICIs alone.

Patients receiving R+ICIs+TACE also experienced longer overall survival (15.0 months vs 7.5 months) without a significant increase in treatment-related adverse events, indicating that this combination therapy is both effective and safe for second-line treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy and Safety of Regorafenib Plus Immune Checkpoint Inhibitors with or Without TACE as a Second-Line Treatment for Advanced Hepatocellular Carcinoma: A Propensity Score Matching Analysis. Yang, X., Deng, H., Sun, Y., et al.[2023]

Regorafenib is an effective oral tyrosine kinase inhibitor approved for treating refractory metastatic colorectal cancer, advanced gastrointestinal stromal tumors, and unresectable hepatocellular carcinoma, with its efficacy supported by phase 3 trials like CORRECT, CONCUR, GRID, and RESORCE.

The review highlights the need for managing drug-related toxicities through dose optimization and emphasizes ongoing research into biomarkers that could predict patient responses to regorafenib, as well as its potential effectiveness in other cancer types.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evolving role of regorafenib for the treatment of advanced cancers. Grothey, A., Blay, JY., Pavlakis, N., et al.[2020]

References

1. England pubmed.ncbi.nlm.nih.gov

Regorafenib combined with transarterial chemoembolization for unresectable hepatocellular carcinoma: a real-world study. [2022]

2. France pubmed.ncbi.nlm.nih.gov

Regorafenib as a single-agent in the treatment of patients with gastrointestinal tumors: an overview for pharmacists. [2021]

3. Germany pubmed.ncbi.nlm.nih.gov

Treatment efficacy and safety of regorafenib plus drug-eluting beads-transarterial chemoembolization versus regorafenib monotherapy in colorectal cancer liver metastasis patients who fail standard treatment regimens. [2022]

4. China pubmed.ncbi.nlm.nih.gov

Study on efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with regorafenib and PD-1 antibody versus continued TACE combined with regorafenib in patients with hepatocellular carcinoma after failed second-line treatment with regorafenib. [2022]

5. China pubmed.ncbi.nlm.nih.gov

Study on safety and efficacy of regorafenib combined with transcatheter arterial chemoembolization in the treatment of advanced hepatocellular carcinoma after first-line targeted therapy. [2022]

6. England pubmed.ncbi.nlm.nih.gov

Management of regorafenib-related toxicities: a review. [2022]

7. New Zealand pubmed.ncbi.nlm.nih.gov

Efficacy and Safety of Regorafenib Plus Immune Checkpoint Inhibitors with or Without TACE as a Second-Line Treatment for Advanced Hepatocellular Carcinoma: A Propensity Score Matching Analysis. [2023]

8. Netherlands pubmed.ncbi.nlm.nih.gov

Evolving role of regorafenib for the treatment of advanced cancers. [2020]