Clinical Drug Experience Knowledgebase

Criteria

Secondary cancer, Liver metastases

Inclusion criteria:

Age ≥ 18
Written Informed Consent obtained, signed and dated
ECOG performance status 0 or 1
Life expectancy > 6 months
Liver metastases from other primary cancers 1) with histologic confirmation of metastases, or 2) History of primary cancer with histology available and lesions in the liver consistent with metastases, or 3) histologic confirmation of primary cancer and a growing enhancing lesion in the liver consistent with a metastasis
Unresectable tumor/s, based on the opinion of an experienced surgeon specializing in hepatic resection, or the patient must be medically inoperable
Patients with extra-hepatic metastases controlled by supportive care or concomitant hormonotherapy are eligible.
Previous liver resection or local treatment (radiofrequency ablative therapy, chemoembolization, microwave treatment…) is permitted
Patients must have recovered from the effects of previous therapy (residual AE grade 0 or 1)
Radiological disease progression according to the investigator evaluation or according to RECIST 1.1
At least one tumor lesion that can be accurately measured in at least one dimension according to RECIST 1.1
Normal permeability of hepatic artery evaluated by injected CT-scan (arterial phase)
Total target volume of lesions < 500cc and < 50% of the total liver volume
700 cc of liver volume without tumor involvement and a radiation therapy dose < 15 Gy
The following laboratory parameters:
Platelet count ≥ 50 x 10^9/L
Hemoglobin ≥ 8.5 g/dL
Absolute neutrophil count ≥ 1.5 x 10^9/L,
Prothrombin rate (PR)> 50%
International Normalized Ratio (INR) < 1.5 or correctable with vitamin K. Patients receiving anti-coagulation or anti-aggregation therapy must stop temporarily during treatment.
Total bilirubin <30 μmol/l
Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 5 x upper limit of normal
Albumin >2.5 g/dL
Very low or undetectable HBV DNA and HCV RNA
Serum Creatinine ≤ 1.5 time the upper limit of normal value
Glomerular Filtration Rate > 44mL/min/1.73m2
All female patients of childbearing potential must have a negative serum/urinary pregnancy test within the 7 days prior to NBTXR3 administration. Otherwise, Patients must be post-menopausal, surgically sterile, or using 'effective contraception'. The definition of 'effective contraception' will be based on the judgment of the investigator.

Exclusion criteria:

Patients with ongoing chronic active viral B or C hepatitis must have received an antiviral treatment with negative or very low viremia before the onset of the radiation therapy
Biliary tract dilatation, biliodigestive anastomosis, bile duct drainage
Uncontrolled extra-hepatic metastatic disease with a symptomatic treatment or well tolerated hormonotherapy (AE 0/1)
Previous cancer cured for less than 2 years
Previous anticancer treatment (chemotherapy or/and biologicals) with a wash out < 4 weeks
Previous treatment with intra-arterial injection of Y90 loaded microspheres in the same hepatic lobe than the current tumor.
Previous intra-arterial chemotherapy
Prior radiation therapy to the right upper abdomen, precluding re-irradiation of the liver. That is, any previous radiation therapy in which a mean dose to the liver of 15 Gy in conventional fractionation was delivered, or previous doses to critical normal structures that would make re-irradiation unsafe
Impossibility to follow the dosimetry constraints (mean total liver dose > 15Gy)
Presence of arterio-venous intra tumoral shunting
Encephalopathy related to liver failure
Clinical ascitis
Presence of another scalable tumor disease except cervical carcinoma in situ, treated basal cell carcinoma, or superficial bladder tumors (Ta, Tis &T1)
Presence of hepato pulmonary syndrome
Auto immune hemolytic anemia
Auto immune disorder, excepted auto immune thyroiditis
Uncontrolled hypertension or congestive heart failure
Active coronary artery disease (myocardial infarction more than 6 months prior to study entry is permitted)
Previous gastrointestinal bleed within the past 2 months
Known syndrome AIDS-related illness or serious non controlled acute or chronic illness
Active, clinically severe bacterial or fungal infections (> grade 2 NCI-CTCAE, version 5.0)
Complete initial work up earlier than 4 weeks prior to patient registration
Patient whose general health condition does not allow treatment feasibility
Patients unable and/or unwilling to comply with scheduled visits, treatment plans, laboratory tests, and other study procedures
Patients participating in another clinical investigation at the time of signature of the informed consent.

Primary cancer: Hepato Cellular Carcinoma - HCC

Inclusion criteria:

Age ≥ 18
Written Informed Consent obtained, signed and dated
ECOG performance status 0 or 1
Life expectancy > 3 months
Histological or cytological diagnosis of Hepatocellular cancer or imaging diagnosis by the American Association for the Study of Liver Disease (AASLD) guidelines or European association for the Study of the Liver (EASL) guidelines.
Patients with HCC:
Without main branch or intrahepatic trunk portal vein tumor thrombosis (Vp3 or Vp4, respectively), with progression or recurrence of HCC after surgical or loco-regional treatment
With main branch (right and/or left) or intrahepatic trunk portal vein tumor thrombosis (Vp3 or Vp4, respectively), AND without right atrial involvement.
Recurrent intrahepatic cholangiocarcinoma is eligible only in the phase I part
Liver cirrhosis Child Pugh A - B7
Previous liver resection or local treatment (radiofrequency ablative therapy, chemoembolization, microwave treatment…) is permitted
Patients with previous treatment with sorafenib or other targeted or systemic therapy are eligible if wash out > 4 weeks
Patients must have recovered from the effects of previous therapy (residual AE grade 0 or 1)
Radiological disease progression according to the investigator evaluation or according to RECIST 1.1
At least one tumor lesion that can be accurately measured in at least one dimension according to RECIST 1.1
Normal permeability of hepatic artery evaluated by injected CT-scan (arterial phase)
Total target volume of lesions < 500cc and < 50% of the total liver volume
700 cc of liver volume without tumor involvement and a radiation therapy dose < 15 Gy
The following laboratory parameters:
Platelet count ≥ 50 x 10^9/L
Hemoglobin ≥ 8.5 g/dL
Absolute neutrophil count ≥ 1.5 x 10^9/L,
Prothrombin rate (PR)> 50%
International Normalized Ratio (INR) < 1.5 or correctable with vitamin K
Patients receiving anti-coagulation or anti-agregant therapy must stop temporarily during treatment.
Total bilirubin <30 μmol/l
Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 5 x upper limit of normal
Albumin >2.5 g/dL
Very low or undetectable HBV DNA and HCV RNA
Serum Creatinine ≤ 1.5 time the upper limit of normal value
Glomerular Filtration Rate > 44mL/min/1.73m2
All female patients of childbearing potential must have a negative serum/urinary pregnancy test within the 7 days prior to NBTXR3 administration. Otherwise, Patients must be post-menopausal, surgically sterile, or using 'effective contraception'. The definition of 'effective contraception' will be based on the judgment of the investigator.

Exclusion criteria:

Patient suitable for a curative treatment by surgery or local treatment (radiofrequency ablation, microwave treatment, etc.)
Patients with ongoing chronic active viral B or C hepatitis, those patients must have received an antiviral treatment with negativation of the viremia or very low viremia before the onset of the radiation therapy
Biliary tract dilatation, biliodigestive anastomosis, bile duct drainage
Extrahepatic Portal Vein Tumor Thrombosis
Extra-hepatic metastasis
Previous cancer cured for less than 2 years
Previous anticancer treatment (chemotherapy or/and biologicals) with a wash out < 4 weeks
Previous treatment with intra-arterial injection of Y90 loaded microspheres in the same hepatic lobe than the current tumor.
Previous intra-arterial chemotherapy
Concurrent treatment with any other anticancer therapy, including chemotherapy, immunotherapy, targeted therapy, gene therapy, or patients planning to receive these treatments during the study. Hormonotherapy is permitted
Prior radiation therapy to the right upper abdomen, precluding re-irradiation of the liver. That is, any previous radiation therapy in which a mean dose to the liver of 15 Gy in conventional fractionation was delivered, or previous doses to critical normal structures that would make re-irradiation unsafe
Impossibility to follow the dosimetry constraints (mean total liver dose > 15Gy)
Presence of arterio-venous intra tumoral shunting
Encephalopathy related to liver failure
Clinical ascitis
Presence of another scalable tumor disease except cervical carcinoma in situ, treated basal cell carcinoma, or superficial bladder tumors (Ta, Tis &T1)
Presence of hepato pulmonary syndrome
Auto immune hemolytic anemia
Auto immune disorder, excepted auto immune thyroiditis
Uncontrolled hypertension or congestive heart failure
Active coronary artery disease (myocardial infarction more than 6 months prior to study entry is permitted)
Previous gastrointestinal bleed within the past 2 months
Known syndrome AIDS-related illness or serious non- controlled acute or chronic illness
Active, clinically severe bacterial or fungal infections (> grade 2 NCI-CTCAE, version 5.0)
Complete initial work up earlier than 4 weeks prior to patient registration
Patient whose general health condition does not allow treatment feasibility
Patients unable and/or unwilling to comply with scheduled visits, treatment plans, laboratory tests, and other study procedures
Patients participating in another clinical investigation at the time of signature of the informed consent. Phase I and II parts target the same liver cancer populations (same inclusion and