This is a single-arm, open-label Phase IIa study designed to evaluate the efficacy, safety, and PK of CVM-1118 in combination with Sintilimab (Tyvyt ®) and TACE in participants with incurable/non-metastatic HCC. Approximately 40 participants will be enrolled, all receiving CVM-1118 (200 mg orally \[PO\], twice daily \[BID\]) in combination with Sintilimab (200 mg via intravenous \[IV\] infusion every 3 weeks \[Q3W\]) and TACE. All participants will initiate treatment with CVM-1118 and Sintilimab on Cycle 1 Day 1 (C1D1), with each cycle lasting 21 days, continuing until the occurrence of unacceptable toxicity, disease progression, death, consent withdrawal, for 2 years (i.e., Cycle 34) or study termination (whichever occurs first). CVM-1118 will be temporarily suspended from 2 days prior to each TACE procedure until 7 days post-TACE. The protocol permits conventional TACE (cTACE) or drug-eluting beads TACE (DEB-TACE) based on investigator's discretion, with the requirement that each participant maintains the same TACE modality throughout the treatment period. The first TACE procedure will be initiated between weeks 2-4 (C1D15 - C2D8) following systemic therapy initiation, with a maximum of 2 TACE treatments per lesion, an interval of ≥1 month between TACE sessions, and no more than 4 TACE treatments in total per participant. The study comprises four periods: screening, treatment, safety follow-up, and survival follow-up. During the screening period, participants will undergo required examinations and evaluations. Eligible participants will enter the treatment period to receive the combination regimen. Tumor response will be assessed per RECIST v1.1 and mRECIST (see Appendix 1), with evaluations conducted every 9 weeks (±1 week) following initial dosing. During the safety follow-up period, all participants will undergo final safety assessments 28 days (+7 days) after investigational product cessation or prior to initiating new antitumor therapy. Subsequently, participants will enter the survival follow-up period with 12-week interval contacts to document disease status, anti-tumor therapies received, survival status, and other relevant clinical information until death, loss to follow-up, consent withdrawal, or study closure (whichever occurs first). Throughout the study, participants will undergo scheduled safety evaluations and PK blood sampling at designated timepoints. Subsequent PK sampling schedules may be adjusted or eliminated based on accumulated pharmacokinetic data from preceding participants. * CVM 1118 will be administered at 200 mg, PO, BID. Treatment continues until unacceptable toxicity, disease progression, death, consent withdrawal, for 2 years (i.e., Cycle 34), or study termination (whichever occurs first). CVM-1118 will be temporarily suspended from 2 days prior to each TACE procedure until 7 days post-TACE. CVM-1118 should be swallowed whole with a glass of water in a fasted state, with no food intake for at least 2 hours before and 1 hour after CVM 1118 administration. CVM 1118 should be administered at approximately the same time each day. Investigators are permitted to adjust the dosing for participants as required by referring to the "Dose Adjustment". * Sintilimab will be administered at 200 mg, IV, Q3W. Treatment continues until unacceptable toxicity, disease progression, death, consent withdrawal, for 2 years (i.e., Cycle 34) or study termination (whichever occurs first). Investigators are permitted to adjust the drug administration regimen for participants as required by referring to the "Dose Adjustment". * TACE modality for each participant, including the choice between cTACE and DEB-TACE, will be determined by investigators at their discretion; however, each participant must remain consistent with the selected TACE modality (cTACE or DEB-TACE) throughout the treatment period. The first TACE procedure will be initiated 2-4 weeks after the start of systemic therapy (C1D15 to C2D8), with a maximum of 2 treatments per lesion (minimum 1-month interval between TACE sessions) and up to 4 treatments per participant in total.
This study is conducted in China and is not under a U.S. IND. However, the investigational product is a U.S. FDA-regulated drug with existing INDs \[125830, 138523, 138900\], and the data from this study are intended to support a future U.S. marketing application.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
40
CVM-1118 (200 mg, PO, BID) + Sintilimab (200 mg, IV, Q3W) + TACE (4 times in maximum)
Zhongshan Hospital, Fudan University
Shanghai, Shanghai Municipality, China
RECRUITINGObjective response rate (ORR)
Objective response rate (ORR) assessed per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1)
Time frame: Up to approximately 2 years
Objective Response Rate (ORR)_mRECIST
Assessment by modified RECIST criteria
Time frame: Up to approximately 2 years
Disease control rate (DCR)
The DCR is defined as the proportion of subjects with CR, PR, or SD based on RECIST Version 1.1 and mRECIST
Time frame: Up to approximately 2 years
Duration of response (DoR)
Duration of response is defined as the duration from the first documentation of objective response to the first documented disease progression or death due to any cause, whichever occurs first
Time frame: Up to approximately 2 years
Progression free survival (PFS)
Progression free survival (PFS) is defined as time from the first dose of study drug to the time of progression or death
Time frame: Up to approximately 2 years
Time to progression (TTP)
Time to progression (TTP) is defined as the time from the first dose of study drug to the time of progression
Time frame: Up to approximately 2 years
Overall survival (OS)
Overall survival (OS) is defined as time from first dose of study drug to death
Time frame: Up to approximately 4 years
Rate of Adverse event (AE) and Serious Adverse Event (SAE)
Rate of Adverse event (AE) and Serious Adverse Event (SAE) are assessed using Common Terminology Criteria for Adverse Events v.6 (CTCAE) criteria
Time frame: Starting from the first dose of combination treatment until 28 days following the last dose of treatment by CTCAE v6.
Maximum Plasma Concentration [Cmax] of CVM-1118 and its metabolite CVM-1125 after CVM-1118 dosing
Maximum Plasma Concentration \[Cmax\] of CVM-1118 and its metabolite CVM-1125 will be measured to see maximum exposure after CVM-1118 dosing
Time frame: During Cycle 1 (each cycle is 21 days)
Area Under the Curve [AUC] of CVM-1118 and its metabolite CVM-1125 after CVM-1118 dosing
Area Under the Curve \[AUC\] of CVM-1118 and its metabolite CVM-1125 after CVM-1118 dosing
Time frame: During Cycle 1 (each cycle is 21 days)
Peak time(Tmax) of CVM-1118 and its metabolite CVM-1125 after CVM-1118 dosing
Peak time(Tmax) is to evaluate the Pharmacokinetics(PK) of CVM-1118 and its metabolite CVM-1125
Time frame: During Cycle 1 (each cycle is 21 days)
Half time(t1/2) of CVM-1118 and its metabolite CVM-1125 after CVM-1118 dosing
Half time(t1/2) is to evaluate the Pharmacokinetics(PK) of CVM-1118 and its metabolite CVM-1125
Time frame: During Cycle 1 (each cycle is 21 days)
Clearance rate(CL) of CVM-1118 and its metabolite CVM-1125 after CVM-1118 dosing
Clearance rate(CL) is to evaluate the Pharmacokinetics(PK) of CVM-1118 and its metabolite CVM-1125
Time frame: During Cycle 1 (each cycle is 21 days)
Apparent volume of distribution(Vd) of CVM-1118 and its metabolite CVM-1125 after CVM-1118 dosing
Apparent volume of distribution(Vd) is to evaluate the Pharmacokinetics(PK) of CVM-1118 and its metabolite CVM-1125
Time frame: During Cycle 1 (each cycle is 21 days)
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