Brivanib as adjuvant therapy to transarterial chemoembolization in patients with hepatocellular carcinoma: A randomized phase III trial.

Abstract

UNLABELLED:

Transarterial chemoembolization (TACE) is the current standard of treatment for unresectable intermediate-stage hepatocellular carcinoma (HCC). Brivanib, a selective dual inhibitor of vascular endothelial growth factor and fibroblast growth factor signaling, may improve the effectiveness of TACE when given as an adjuvant to TACE. In this multinational, randomized, double-blind, placebo-controlled, phase III study, 870 patients with TACE-eligible HCC were planned to be randomly assigned (1:1) after the first TACE to receive either brivanib 800 mg or placebo orally once-daily. The primary endpoint was overall survival (OS). Secondary endpoints included time to disease progression (TTDP; a composite endpoint based on development of extrahepatic spread or vascular invasion, deterioration of liver function or performance status, or death), time to extrahepatic spread or vascular invasion (TTES/VI), rate of TACE, and safety. Time to radiographic progression (TTP) and objective response rate were exploratory endpoints. The trial was terminated after randomization of 502 patients (brivanib, 249; placebo, 253) when two other phase III studies of brivanib in advanced HCC patients failed to meet OS objectives. At termination, median follow-up was approximately 16 months. Intention-to-treat analysis showed no improvement in OS with brivanib versus placebo (median, 26.4 [95% confidence interval {CI}: 19.1 to not reached] vs. 26.1 months [19.0-30.9]; hazard ratio [HR]: 0.90 [95% CI: 0.66-1.23]; log-rank P=0.5280). Brivanib improved TTES/VI (HR, 0.64 [95% CI: 0.45-0.90]), TTP (0.61 [0.48-0.77]), and rate of TACE (0.72 [0.61-0.86]), but not TTDP (0.94 [0.72-1.22]) versus placebo. Most frequent grade 3-4 adverse events included hyponatremia (brivanib, 18% vs. placebo, 5%) and hypertension (13% vs. 3%).

CONCLUSIONS:

In this study, brivanib as adjuvant therapy to TACE did not improve OS.

• Authors: Masatoshi Kudo, Guohong Han, Richard S Finn, Ronnie T P Poon, Jean-Frederic Blanc, Lunan Yan, Jijin Yang, Ligong Lu, Won-Young Tak, Xiaoping Yu, Joon-Hyeok Lee, Shi-Ming Lin, Changping Wu, Tawesak Tanwandee, Guoliang Shao, Ian B Walters, Christine Dela Cruz, Valerie Poulart, Jian-Hua Wang
• Journal: Hepatology (Baltimore, Md.) (Hepatology) Vol. 60 Issue 5 Pg. 1697-707 (Nov 2014) ISSN: 1527-3350 [Electronic] United States
• PMID: 24996197 (Publication Type: Clinical Trial, Phase III, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 by the American Association for the Study of Liver Diseases.

Chemical References

• Receptors, Fibroblast Growth Factor
• Triazines
• Vascular Endothelial Growth Factor A
• brivanib
• Alanine

Topics

• Adult
• Aged
• Aged, 80 and over
• Alanine (adverse effects, analogs & derivatives, pharmacology, therapeutic use)
• Carcinoma, Hepatocellular (drug therapy)
• Chemoembolization, Therapeutic
• Chemotherapy, Adjuvant
• Double-Blind Method
• Female
• Humans
• Liver Neoplasms (drug therapy)
• Male
• Middle Aged
• Receptors, Fibroblast Growth Factor (antagonists & inhibitors)
• Treatment Failure
• Triazines (adverse effects, pharmacology, therapeutic use)
• Vascular Endothelial Growth Factor A (antagonists & inhibitors)
• Young Adult