Recruiting

Phase 2

Atezolizumab & Bevacizumab vs. Lenvatinib & CabozantinibTherasphere® and Systemic Therapy for Patients With Hepatocellular Carcinoma That is High-risk

Sponsor:

Northwestern University

Code:

NCT05620771

Conditions

Hepatocellular Carcinoma

Eligibility Criteria

Sex: All

Age: 18+

Healthy Volunteers: Not accepted

Interventions

Y90 + Atezolizumab and Bevacizumab

Y90 + TKI

Study Details

Brief summary:

The purpose of this research is to compare progression free survival between two available systemic therapies - immunotherapy and tyrosine kinase inhibitors - after Therasphere® (yttrium-90) treatment in adult patients with advanced hepatocellular carcinoma. The immunotherapy consists of a standard-of-care treatment with Atezolizumab and Bevacizumab. Treatment with tyrosine kinase inhibitors consists of standard-of-care Lenvatinib or Cabozantinib.

Conditions

Hepatocellular Carcinoma

Study ID

NCT05620771

Start date

Nov 30, 2022

Status verified date

May, 2026

Completion date

Jul 1, 2040

Anticipated

Primary completion date

Jul 1, 2040

Anticipated

Eligibility Criteria

Sex: All

Age: 18+

Healthy Volunteers: Not accepted

Inclusion Criteria:

3.1.1 Patients must have a diagnosis of hepatocellular carcinoma (HCC) confirmed by American Association for Study of Liver Diseases (AASLD) guidelines with a Childs-Pugh score of A or B7 \[Appendix 5\] NOTE: If the patient does not have histological confirmation of disease by biopsy, diagnosis of HCC must be documented with approval by a tumor board or other multidisciplinary conference. Please refer to the appropriate source documents.
3.1.2 Patients must have at least 1 lesion that is measurable using RECIST guidelines. NOTE: A previously irradiated lesion can be considered a target lesion if the lesion is well defined, measurable per RECIST, and has clearly progressed.
3.1.3 Patients may be treatment -naïve or have received any number of prior therapies. NOTE: Prior cancer targeted immunotherapy for any other cancer is contraindicated and not permitted.
3.1.4 Adults ≥18 years old of either gender are eligible.
3.1.5 Patients must exhibit an ECOG performance status of 0, 1, or 2 \[Appendix 1\]
3.1.6 Patients must have adequate organ function prior to registration as determined by: Hemoglobin (HgB) ≥ 8.5 g/dL (without the use of growth factors, transfusion permitted), Absolute Neutrophil Count (ANC) ≥ 50 x 109/L (without use of growth factors \[i.e., IL-11\], transfusion permitted to achieve this value), Prothrombin time (PT)/ International normalized ratio ≤ 2.3 or PT ≤ 6 seconds above control, Calculated creatinine clearance (CrCl) or 24-hour urine CrCl > 30 mL/min, Serum Bilirubin ≤ 3 times the upper limit of normal (ULN), AST 10X ULN, ALT 10X ULN
3.1.7 Females of childbearing potential (FOCBP), and non-sterilized males who are sexually active must agree to the use of two methods of contraception, with one method being highly effective and the other method being either highly effective or less effective as listed in Appendix 3. They must also refrain from egg and/or sperm cell donation and breastfeeding for 90 days after the final dose of investigational product(s). FOCBP are defined as those who are not surgically sterile (i.e., bilateral tubal ligation, bilateral oophorectomy, or complete hysterectomy) or postmenopausal (defined as 12 months with no menses without an alternative medical cause) FOCBP must agree to follow instructions for method(s) of contraception for the duration of treatment. Men who are sexually active with FOCBP must agree to follow instructions for method(s) of contraception for the duration of treatment.
3.1.8 FOCBP must have a negative pregnancy test (Serum or urine pregnancy test per site investigator discretion) prior to registration.
3.1.9 Patients must have the ability to understand and the willingness to sign a written informed consent prior to registration on study.

Exclusion Criteria:

3.2.1 Patients who are concurrently enrolled in another clinical study unless it is an observational (noninterventional) clinical study or the follow-up period of an interventional study.
3.2.2 Patients who are receiving any other investigational agents within 28 days of registration.
3.2.3 Patients who have a history of allergic reactions attributed to compounds of similar chemical or biologic composition to Y-90, PD-1 \&PD-L1 antagonists and TKI's. Note: Patients must not have a history of severe allergic reactions (i.e., Grade 4 allergy, anaphylactic reaction from which the subject did not recover within 6 hours of initiation of supportive care) to any unknown allergens or any components of the systemic therapy
3.2.4 Patients must not have had prior treatment any PDL1 or PD-1 antagonists.
3.2.5 Patients who have known additional malignancy that progressed or required treatment within the last 3 years. Note: Exceptions include adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated Stage I or II cancer from which the patient is currently in complete remission, or any other cancer from which the patient has been disease free for at least three years.
3.2. 6 Patients with active autoimmune disease or history of autoimmune disease that might recur, which may affect vital organ function or require immune suppressive treatment including chronic prolonged systemic corticosteroids (defined as corticosteroid use of duration one month or greater), should be excluded.
3.2.7 Patients with renal failure currently requiring dialysis of any kind.
3.2.8 Patients with untreated central nervous system (CNS) metastatic disease (including spinal cord and leptomeningeal disease) are excluded. Note: Subjects with previously treated CNS metastases that are radiographically and neurologically stable for at least 6 weeks and do not require corticosteroids (of any dose) for symptomatic management are permitted to enroll.
3.2.9 Patients with chronic Hepatitis B with evidence of ongoing viral replication (detectable HBsAg, HBeAg, or HBV DNA). They must have HBV DNA viral load >100 IU/mL at screening. Note: One viral load is sufficient as long as it meets this criterion. However, patient may need another viral load done per treating physician's discretion to confirm eligibility. Note:. Both HBeAg positive and negative patients will are eligible.
3.2.10 Patients with a known history of Human immunodeficiency virus(HIV) who are not on effective anti-retroviral therapy.
3.2.11 Patients with a known history of hepatitis C virus (HCV) infection who have not been treated and cured. Note: For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral.
3.2.12 Patients receiving any concurrent chemotherapy, biologic, or hormonal therapy for cancer treatment within 28 days of registration. Note: Prior cancer immunotherapy for any other cancer is not permitted. Note: Concurrent use of hormones for non-cancer-related conditions (e.g., insulin for diabetes and hormone replacement therapy) is acceptable.
3.2.13 Patients who have unresolved toxicities from prior anticancer therapy, defined as having not resolved to NCI CTCAE v 5 \[Appendix 6\] Grade 0 or 1 with the exception of alopecia and laboratory values listed per the inclusion criteria. Note: Subjects with any grade irreversible toxicity that is not reasonably expected to be exacerbated by any of the investigational products may be included (e.g., hearing loss) after consultation with the PI and NU QAM.
3.2.14 Patients receiving radiation therapy within 14 days of registration.
3.2.15 Patients receiving live vaccines within 28 days of study registration.
3.2.16 No systemic glucocorticoids will be permitted within 48 hours prior to study registration. Note: Topical steroids, bronchodilators and local steroid injections are permitted if clinically required.
3.2.17 Patients with cardiac disease defined as one of the following are not eligible: Congestive heart failure > class II NYHA.\[Appendix 4\], Unstable angina (anginal symptoms at rest) or new onset angina (began within the last 90 days ), Myocardial infarction within the past 180 days.
3.2.18 Patients who have had major surgery within 4 weeks prior to registration.
3.2.19 Patients with prior transplant of any kind
3.2.20 Patients who are pregnant or nursing.
3.2.21 Patients who have an uncontrolled intercurrent illness.
3.2.22 Active alcohol use, drug use, or a psychiatric disease that would, in the opinion of the PI or a subinvestigator (sub-I), prevent the subject from complying with the study protocol and/or endanger the subject during their participation in the study.

Study Design

Enrollment

200 participants

Anticipated

Allocation

Randomized

Intervention Model

Single group

Primary purpose

Treatment

Interventions and Outcome Measures

Arms

experimental: Y90 + Atezolizumab and Bevacizumab

experimental: Y90 + TKI

Interventions

Y90 + Atezolizumab and Bevacizumab

Patients will receive Durvalumumab + Tremelimumab if Bevacizumab is contraindicated. Patients should begin systemic therapy anytime within 90 days after completion of Y-90 treatment. Treatment will continue until disease progression (clinical or radiological) or unacceptable toxicity/death. Patients will be continued on therapy till either progression is noted (clinical and/or radiological) or if patient is not tolerating therapy. However, there is the possibility of treatment beyond progression per PI discretion.

Y90 + TKI

Patients should begin systemic therapy anytime within 90 days after completion of Y-90 treatment. Treatment will continue until disease progression (clinical or radiological) or unacceptable toxicity/death. Patients will be continued on therapy till either progression is noted (clinical and/or radiological) or if patient is not tolerating therapy. However, there is the possibility of treatment beyond progression per PI discretion.

Primary outcome measure

Progression Free Survival (PFS) [ Time Frame: Up to 2 years ]

Central Contacts and Locations

Central contacts

Study Coordinator

3126951301 cancer@northwestern.edu

Locations

Northwestern University

Recruiting

Chicago, Illinois, United States, 60611

Contacts

Aparna Kalyan, MD

312-472-1234

Principal Investigator:

Aparna Kalyan, MD

Northwestern Medicine Kishwaukee Hospital

Recruiting

DeKalb, Illinois, United States, 60115

Contacts

Aparna Kalyan, MD

312-472-1234 cancer@northwestern.edu

Northwestern Medicine Delnor Hospital

Recruiting

Geneva, Illinois, United States, 60134

Contacts

Aparna Kalyan, MD

312-472-1234 cancer@northwestern.edu

Northwestern Medicine Grayslake Outpatient Center

Recruiting

Grayslake, Illinois, United States, 60030

Contacts

Aparna Kalyan

312-472-1234 cancer@northwestern.edu

Northwestern Medicine Lake Forest Hospital

Recruiting

Lake Forest, Illinois, United States, 60045

Contacts

Aparna Kalyan, MD

312-472-1234 cancer@northwestern.edu

Northwestern Medicine Orland Park

Recruiting

Orland Park, Illinois, United States, 60462

Contacts

Aparna Kalyan

312-472-1234 cancer@northwestern.edu

Northwestern Medicine Warrenville

Recruiting

Warrenville, Illinois, United States, 60555

Contacts

Aparna Kalyan, MD

312-472-1234 cancer@northwestern.edu

More Information

Sponsor

Northwestern University

Last update posted

May 26, 2026

Last verified

May, 2026

Trial information was received from ClinicalTrials.gov and was last updated on 2026-09-09. This information was provided to ClinicalTrials.gov by Northwestern University on 2026-05-26.