This research will assess the effects of Itacitinib as a second line treatment for patients with advanced inflammatory hepatocellular carcinoma (HCC), a type of liver cancer. Itacinib is a protein inhibitor of the tyrosine kinase, JAK1, which is believed to enable cancer cells to metastasise to other parts of the body.
JAKaL is a single arm phase Ib study evaluating the effect of Itacitinib in 25 patients with advanced HCC. Many patients diagnosed with HCC will have advanced disease where only palliative care is offered to them, this could account for the relatively low reported 5-year survival rate of approximately 10%. There are a number of epidemiological and pre-clinical studies that have investigated the role of chronic inflammatory conditions in the development of HCC and these provide evidence that inflammation promotes malignant transformation. The production of tumour-promoting cytokines by inflammatory cells can activate transcription factors, such as STAT3 via the JAK/STAT pathway in premalignant cells. STAT3, once activated, can cause the expression of further genes necessary for cell activation, localisation, survival and proliferation. Inhibition of JAK could therefore be a way of directly affecting malignant cell proliferation, as STAT3 in most malignancies are persistently phosphorylated and thereby stimulated to carry out its function; to sustain cell proliferation and block apoptosis. For reference, STAT3 is a member of the STAT protein family and is switched on, via phosphorylation, by receptor-associated Janus kinases (JAK), a type of tyrosine kinase, and together they form homo-/heterodimers that translocate to the cell nucleus and act as transcription activators. STAT3 mediates the expression of a variety of genes and therefore is integral to many cellular processes, as mentioned above, such as cell growth and apoptosis, and thus they can promote oncogenesis by being over-active in the different signalling pathways it is involved in. Itacitinib has not yet been approved by the U.S. Food and Drug Administration (FDA) for any clinical indication but has been developed as potential treatments for myelofibrosis (MF), rheumatoid arthritis (RA), psoriasis, graft-versus-host disease (GVHD), B cell malignancies and solid tumours like HCC. It is a small molecule selective inhibitor of JAK1 thereby preventing its phosphorylation of STAT proteins, particularly STAT3, resulting in a decrease in the expression of genes responsible for cell activation, localisation, survival and proliferation
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
19
Novel and small molecule selective inhibitor of JAK1
Imperial College Healthcare NHS Trust
London, United Kingdom
To Assess the Safety and Tolerability of Itacitinib in Patients With HCC: Adverse Events
Assessment of adverse events relating to experimental drug intake according to the Common Terminology Criteria for Adverse Events (CTCAE) V4.03. An adverse event (AE) is any untoward medical occurrence in a patient or clinical trial subject administered a medicinal product and which dose not necessarily have a casual relationship with this treatment. An AE can therefore be any unfavourable and unintended (including an abnormal laboratory finding), symptoms, or disease temporally associated with the use of an investigational medicinal project (IMP), whether or not considered related to the IMP. Treatment-related adverse events (TrAE) are AEs that are possibly, probably, or likely related to the IMP. Here, TrAEs are reported.
Time frame: Throughout study completion, up to 1 year
To Assess Efficacy of Itacitinib by Overall Response Rate: Objective Response Rate (ORR)
The Response Evaluation Criteria in Solid Tumours (RECIST) criteria v1.1. classifies response based on the assessment of target and non-target lesions on CT scans as: * Complete Response (CR): requires all of: * disappearance of all target and non-target lesions * pathological lymph nodes must have reduced to \<10 mm in short axis * no new lesions * Partial Response (PR): requires all of: * at least 30% decrease in sum of diameters (SOD) of target lesions compared to baseline sum diameters * non-progressive disease of non-target lesions * no new lesions * Progressive Disease (PD): either one of: * any new lesions * at least 20% relative and 5 mm absolute increase of SOD of target lesions compared to smallest SOD ever recorded for the patient * Stable Disease (SD): not meeting criteria for PD or PR.
Time frame: Throughout study completion, up to 1 year
Efficacy of Itacitinib by Progression Free Survival
Progression free survival (PFS), defined as time from study entry to first evidence of disease progression assessed by RECIST or death due to any cause.
Time frame: Throughout study completion, up to 1 year
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Efficacy of Itacitinib by Overall Survival
Overall survival (OS), defined as time from study entry to death due to any cause.
Time frame: Throughout study completion, up to 1 year