Surgical resection and liver transplantation are the primary curative treatments for hepatocellular carcinoma (HCC). However, many patients are ineligible for these treatments due to advanced disease, social factors, or limited availability of liver donors. Therefore, for patients with unresectable HCC, locoregional therapies like transarterial radioembolization (TARE with Y90) are considered the next best non-operative option, especially when the cancer remains confined to the liver. Despite the use of these liver-directed therapies, relapse rates and mortality remain high, underscoring the need for new predictive biomarkers and therapeutic targets, including immune modulation. The rationale behind NP-101 (TQ formula) stems from its immune modulatory properties as a potent drug derived from a natural substance, black seed or Nigella Sativa. Previous studies have demonstrated its immune modulation and anti-cancer effects, showing promise in preclinical models of HCC. In a randomized phase 2 study conducted in Covid patients, NP-101 exhibited safety and significantly increased T effector cells (CD4+ and CD8+ T lymphocytes), resulting in accelerated recovery. The immune modulation effect of NP-101, observed in the Covid study, and its potential to enhance CD4+ and CD8+ T effector lymphocytes can potentially modify the immune microenvironment and improve outcomes in locally advanced HCC patients undergoing Y90 treatment. This study will investigate the safety, efficacy and maximum tolerated dose of NP-101 in patients with unresectable hepatocellular carcinoma. The dosing scheme for NP-101 in this study will follow a Bayesian Optimal Interval design. Based on the target dose-limiting toxicity (DLT) rate of 30% and assuming a 3+3 design, three subjects will be sequentially enrolled at each of the 3 dose levels (beginning with 3g) until at least one DLT occurs. If no DLTs occur, dosing will be escalated to the next dose level for the next three enrolled subjects. At either of the two dose levels, if 1 DLT occurs, three more subjects will be enrolled at that dose level. If no DLTs occur in these subjects, three more subjects will be enrolled at the next highest dose level. Dosing escalation will be stopped if two or more total DLTs occur at any dose level. The maximum tolerated dose (MTD) will be one dose level below the dose level at which two or more DLTs occurred.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
18
Subjects will be assigned to take 3 g of NP-101 orally once daily for 28 days pre Y-90 treatment.
Subjects will be assigned to take 4.8 g of NP-101 orally once daily for 28 days pre Y-90 treatment.
Subjects will be assigned to take 6 g of NP-101 orally once daily for 28 days pre Y-90 treatment.
University of Florida
Gainesville, Florida, United States
Maximum tolerated dose
Determine the maximum tolerated dose of NP-101
Time frame: 2 months
Overall response rate
Determine the overall response rate. Overall response rate is defined as the percentage of participants who have a confirmed complete response or partial response, as determined by mRECIST.
Time frame: 20 weeks
Disease control rate
Determine the disease control rate, which is defined as the percentage of participants who have experienced either a complete response, a partial response, or stable disease per mRECIST criteria.
Time frame: 20 weeks
Duration of response
Determine the duration of response, which is defined as the the time from the date of first documented response until the date of documented progression per mRECIST or death due to any cause.
Time frame: 20 weeks
Progression-free survival
Determine the progression-free survival, which is defined as time between first study treatment and first documentation of disease progression using RECIST criteria, or to death due to any cause, whichever comes first.
Time frame: 1 year
Overall survival
Determine the overall survival, which is defined as time between first study treatment and the date of death due to any cause. In the absence of confirmation of death, survival time will be censored at the last date the subject is known to be alive.
Time frame: 172 weeks
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