Liver-NET1

The study will assess the safety of the association of NP137 with the standard of care Atezolizumab-Bevacizumab in first line setting in patients with unresectable hepatocellular carcinoma.

NP137+Atezolizumab-Bevacizumab :
NP137 at 9 or 14 mg/kg IV will be administered every 21 days.
Atezolizumab will be administered by IV infusion at a fixed dose of 1200 mg on Day 1 of each 21-days cycle.
Bevacizumab will be administered by IV infusion at a dose of 15 mg/kg on Day 1 of each 21-day cycle.

1. Males or females ≥ 18 years of age.
2. Histologically confirmed (liver biopsy within 24 previous weeks) and documented unresectable hepatocellular carcinoma.
3. No prior systemic therapy for advanced HCC.
4. Liver tumor burden < 50% of the liver (per Investigator judgment).
5. Child-Pugh A (≤ 6) without any history of cirrhotic decompensation within the past 6 months.
6. Antiviral therapy required in hepatitis B virus patients (Hepatitis B antigen positive).
7. Willing to have liver biopsy between C4 and C5.
8. Presence of a measurable tumor per RECIST v1.1 criteria.
9. Eastern Cooperative Oncology Group (ECOG) performance status ≤ 1.
10. Life expectancy ≥ 12 weeks.
11. Absence of previous liver decompensation.
12. In case of cirrhosis, last esophageal varices detection by esogastroduodenal endoscopy have to be performed within last the 6 months before inclusion.
13. Adequate hematologic function prior to the first dose of NP137, defined as:
    1. Absolute neutrophils count ≥ 1500 cells/µL.
    2. Hemoglobin ≥ 9 g/dL with no transfusion within 4 weeks prior to first planned dose of NP137.
    3. Platelet count > 50,000/µL with no transfusion within 2 weeks prior to first planned dose of NP137.
14. Adequate renal function prior to first dose, defined as :
    1. Serum creatinine < 1.5 ULN.
    2. Creatinine clearance ≥ 30 mL/min/m² (by Cockroft-Gault equation of 24-hour urine) if creatinine ≥ 1.5 X ULN.
15. Adequate hepatic function prior first dose, defined as AST/ALT ≤ 5 X ULN.
16. Women patients of childbearing potential must have a negative serum pregnancy test at screening and baseline, and be willing to use a highly effective contraception. The patient should be advised to continue the contraception for at least 6 months following the completion of dosing. Women with cessation for > 24 months of previously occurring menses, or women of any age who have had a hysterectomy, or have had both ovaries removed will be considered to be of non-childbearing potential.
17. Male patients of reproductive potential must be willing to use one acceptable method of contraception, as judged by Investigator and Sponsor and/or to refrain from donating sperm from the time of screening through at least 6 months following the completion of dose administration.
18. Amenable to computed tomography (CT) with 3 or 4 phase liver or magnetic resonance imaging (MRI) of abdomen and pelvis, and CT of chest, or MRI of whole body, for initial tumor size measurements and subsequent follow-up.
19. Absence of other clinically relevant abnormalities for any screening laboratory test results as judged by the Investigator and Sponsor.
20. Willingness and ability to comply with scheduled visits, treatment plan, laboratory tests, and other study procedures.
21. Able to understand and provide written informed consent.
22. Patients covered by Health Insurance System.

1.  Any known history of encephalopathy.
2. Untreated or incompletely treated esophageal and/or gastric varices with bleeding or high-risk for bleeding.
3. Known esophageal varices with recent history of bleeding (within previous 6 months).
4. Uncontrolled pleural effusion, pericardial effusion, or ascites requiring recurrent drainage procedures.
5. Known fibrolamellar HCC, sarcomatoid HCC, or mixed cholangiocarcinoma and HCC.
6. Chronic treatment with immunosuppressive agents (like steroids) ≤ 6 weeks prior to first planned dose of treatment.
7. Major surgical procedures, open biopsy or significant traumatic injury ≤ 4 weeks prior to first dose of treatment or anticipation of major surgical procedure during the course of the trial, minor surgical procedures ≤ 1 week of first planned dose.
8. Local therapy to liver within 28 days prior to initiation of study treatment or non-recovery from side effects of any such procedure.
9. Any clinically significant cardiovascular condition as judged by the Investigator.
10. Severe or uncontrolled renal condition.
11. Untreated chronic hepatitis B.
12. Co-infection of HBV and HCV.
13. Use of any prohibited concomitant medications within 14 days of the Baseline/Day 1 visit.
14. Contraindication to additionnal liver biopsy planned between C4 and C5.
15. Contraindication to iodinated contrast agent infusion.
16. Known current alcohol (> 20g/ Day in women and > 30g/ Day in men) or substance abuse.
17. History of leptomeningeal disease.
18. Active or history of autoimmune disease or immune deficiency.
19. History of idiopathic pulmonary fibrosis, organizing pneumonia, drug-induced pneumonitis, or idiopathic pneumonitis, or evidence of active pneumonitis on screening chest computed tomography scan.
20. Known active tuberculosis.
21. History of malignancy other than HCC within 5 years prior to screening, with the exception of malignancies with a negligible risk of metastasis or death.
22. Pregnancy or breastfeeding, or intention of becoming pregnant during study treatment or within at least 6 months after the last dose of treatment.
23. Symptomatic, untreated, or actively progressing central nervous system (CNS) metastases.
24. Uncontrolled tumor-related pain.
25. Uncontrolled or symptomatic hypercalcemia.
26. Treatment with systemic immunostimulatory agents.
27. Inadequately controlled arterial hypertension.
28. Prior history of hypertensive crisis or hypertensive encephalopathy.
29. Evidence of bleeding diathesis or significant coagulopathy.
30. History of intestinal obstruction and/or clinical signs or symptoms of GI obstruction including sub-occlusive disease related to the underlying disease or requirement for routine parenteral hydration.
31. Serious, non-healing or dehiscing wound, active ulcer, or untreated bone fracture.
32. Metastatic disease that involves major airways or blood vessels, or centrally located mediastinal tumor masses.
33. Known clinically significant or life threatening organ or systemic disease such that in the opinion of the Investigator, the significance of the disease will compromise the patient’s participation in the trial.
34. Known intolerance or hypersensitivity to the active ingredient or to one of the components of the study drug.
35. Subject in exclusion period for another study.
36. Subject who cannot be contacted in an emergency.
37. Persons referred to in Articles L1121-5 to L1121-8 of the French code of public health (this corresponds to all persons protected: pregnant or parturient women, breastfeeding mothers, persons deprived of liberty by judicial or administrative decision, persons subject to a legal protection measure).

Lancement de l’étude : Mars 2023
Fin estimée des inclusions : Mars 2026
Nombre de patients à inclure : 52

Dr Gaël ROTH – CHU Grenoble

CHU GRENOBLE