Sorafenib Tosylate in Treating Patients With Liver Cancer That Can Be Removed by Surgery
Sorafenib Tosylate in Treating Patients With Liver Cancer That Can Be Removed by Surgery
RATIONALE: Sorafenib tosylate may stop the growth of tumor cells by blocking some of the
 enzymes needed for cell growth and by blocking blood flow to the tumor.

 PURPOSE: This phase II trial is studying how well sorafenib tosylate works in treating
 patients with liver cancer that can be removed by surgery.
OBJECTIVES:

 Primary

 -  To assess anti-tumor activity of neoadjuvant sorafenib tosylate in tumor samples from
 patients with resectable hepatocellular carcinoma (HCC).

 Secondary

 -  To characterize pathologic findings in sorafenib tosylate pre-treated patients
 undergoing surgical resection for HCC: 1-2 core tumor biopsies will be performed prior
 to treatment and at day 35.

 -  To evaluate the number of R0 resections in these patients.

 -  To correlate pathological biomarker changes in resected tumors after 4-week treatment
 with sorafenib tosylate in comparison with biopsies obtained prior to treatment in these
 patients.

 -  To evaluate plasma biomarkers, including PIGF, VEGF-A, VEGF-C, sVEGFR2, sVEGFR3, sKIT,
 IL-6, Ang2, IL-8, bFGF, AFP, collagen 4, endostatin, thrombospondin, TSP-1 and
 angiostatin, and CXCL12 at baseline, day 28, and the day before surgery.

 -  To identify potential biomarkers of sensitivity and/or resistance on biological and
 pathological samples of these patients (exploratory).

 -  To characterize the safety profile of sorafenib tosylate in these patients.

 -  To assess the tolerance of liver resection after sorafenib tosylate treatment of these
 patients.

 OUTLINE: This is a multicenter study.

 Patients receive oral sorafenib tosylate twice daily on days 1-28 in the absence of
 unacceptable toxicity. Approximately 7 days after completion of sorafenib tosylate therapy,
 patients undergo liver resection.

 Blood and tissue specimens are collected periodically for laboratory and biomarker
 assessments. Biomarkers include both molecular markers investigating the direct antitumor
 effects of sorafenib tosylate against cancer cells vs the effects of the drug on
 angiogenesis.

 After completion of study treatment, patients are followed up on day 50 and at 3 months after
 surgery.
DISEASE CHARACTERISTICS:

 -  Histologically confirmed hepatocellular carcinoma (HCC)

 -  Fibrolamellar or mixed histology allowed

 -  No cholangiocarcinoma or other tubal disease

 -  Must be eligible for conservative hepatic resection or liver resection with curative
 intent

 -  No cirrhosis with Child-Pugh score > 7

 -  Chronic liver disease without liver insufficiency and without portal liver
 hypertension allowed

 -  No known history or presence of metastatic brain or meningeal tumors

 PATIENT CHARACTERISTICS:

 -  ECOG performance status 0-1

 -  Life expectancy ≥ 3 months

 -  WBC > 3,000/µL

 -  ANC > 1,500/µL

 -  Platelet count ≥ 100,000/µL

 -  Hemoglobin ≥ 9 g/dL

 -  Bilirubin < 1.5 times upper normal limit (ULN)

 -  AST and ALT ≤ 5 times UNL

 -  Alkaline phosphatase ≤ 5 times ULN

 -  Serum creatinine < 2 times ULN

 -  PT/INR/PTT < 1.5 times UNL

 -  Amylase and lipase < 1.5 times ULN

 -  Negative pregnancy test

 -  Fertile patients must use effective contraception

 -  Body mass index 18.5-30 kg/m^2 (WHO normal range: 18.5-25 kg/m^2)

 -  Able to swallow oral compound

 -  No criterion for unresectability or medical condition that contraindicates surgical
 resection

 -  No serious concurrent systemic disorder incompatible with the study, including any of
 the following:

 -  Uncontrolled hypertension (i.e., BP > 150/100 mm Hg despite optimal therapy)

 -  Active uncontrolled infection

 -  Active alcoholism

 -  No prior medical disorder, including any of the following:

 -  Cardiac arrhythmias requiring anti-arrhythmics (excluding beta-blockers or
 digoxin for chronic atrial fibrillation)

 -  Active coronary artery disease or ischemia

 -  Myocardial infarction within the past 6 months

 -  NYHA class III-IV congestive heart failure

 -  Pulmonary embolism within the past 6 months

 -  Gastrointestinal bleeding within the past 6 months

 -  No other prior malignancy within the past 5 years, except basal cell or squamous cell
 skin carcinoma or cured in situ cervical carcinoma

 -  No history or concurrent seizure disorder requiring medications (e.g., antiepileptic
 drugs)

 -  No history of HIV infection, or chronic hepatitis B or C

 -  No active clinically serious bacterial or fungal infection (i.e., grade 2 CTCAE v. 3)

 -  No condition that is unstable or could jeopardize the safety of the patient and
 his/her compliance with the study

 -  No substance abuse or medical, psychological, or social condition that could interfere
 with adherence to the study

 -  No known or suspected allergy to the investigational agent or to any agent given
 concurrently

 -  No presence of asthenia or rash > CTC grade 1 at enrollment

 -  Must be registered in a national health-care system

 PRIOR CONCURRENT THERAPY:

 -  No prior orthotopic liver transplantation

 -  Not a candidate for orthotopic liver transplantation

 -  No prior systemic or loco-regional treatment for HCC

 -  No prior organ allograft

 -  No treatment with any other investigational medicinal product within the past 28 days

 -  No concurrent treatment with full-dose anticoagulants

 -  Deep-vein or catheter-associated thrombosis prophylaxis allowed

 -  Warfarin or heparin therapy allowed if the coagulation parameters were within the
 acceptable ranges prior to initiation of anticoagulant therapy

 -  No concurrent or chronic co-administration of CYP3A4 inducers (e.g., rifampin,
 Hypericum perforatum, phenytoin, carbamazepine, phenobarbital, or dexamethasone)