Regorafenib-pembrolizumab vs. TACE/TARE in Intermediate Stage HCC Beyond Up-to-7

Stopped early · Phase 3

Conditions studied: Carcinoma, Hepatocellular

In brief

REPLACE is a phase III, multicenter, randomized, open-label trial to evaluate the efficacy and safety of regorafenib and pembrolizumab (Rego-Pembro) versus transarterial chemoembolization (TACE) or transarterial radioembolization (TARE) for the first-line treatment of hepatocellular carcinoma (HCC or liver cancer). Approximately 496 patients in around 80 clinical sites worldwide will be randomized to receive either: * Investigational arm: Regorafenib in combination with pembrolizumab * Control arm: Transarterial chemoembolization (TACE) or transarterial radioembolization (TARE) In both arms, patients will receive trial treatment until progressive disease, unacceptable toxicity, deterioration of patient's condition that warrants permanent trial treatment discontinuation or other treatment discontinuation criteria is met. After trial treatment discontinuation, subsequent treatment will be administered according to the Investigator's clinical judgment.

Key facts

Study ID

NCT04777851

Run by

Translational Research in Oncology

People needed

45

Starts

2023-10-11

Expected to finish

2026-02-26

Last updated by the study team

2026-03-09

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Signed and dated Patient Informed Consent Form (PICF)
• ≥ 18 years-old at the time of PICF signature
• Confirmed diagnosis of HCC
• Intermediate-stage HCC, defined as follows:
• Multinodular HCC localized to the liver
• No evidence of MVI or EHS
• Not amenable to curative treatment
• Child-Pugh Class A
• ECOG PS 0 or 1
• ALBI grade 1 or 2
• Beyond up-to-seven criteria
• Disease amenable to TACE or TARE and no contradiction to intra-arterial treatment
• Measurable disease by CT or MRI as per RECIST 1.1
• No prior systemic therapy or loco-regional therapy for HCC
• Adequate hematologic and organ function
• Willing and able to comply with scheduled visits, treatment plans, laboratory tests and other trial procedures
• Women of childbearing potential (CBP) must have confirmed negative serum pregnancy test
• Use of highly-effective contraceptive methods in women of CBP and men
• Patients with hepatitis C virus (HCV) or hepatitis B virus (HBV) infection are eligible if they meet criteria as defined within the protocol

You may not qualify if…

• No measurable tumor of a diffuse infiltrative HCC type.
• Fibrolamellar HCC, sarcomatoid HCC or mixed hepatocellular/ cholangiocarcinoma subtypes.
• Clinically meaningful ascites.
• Prior treatment with regorafenib, a PD-1, PD-L1/PD-L2, or cytotoxic T lymphocyte associated protein 4 (CTLA-4) inhibitors, or any other antibody or drug specifically targeting T-cell co-stimulation or checkpoint pathways.
• Major surgical procedure, open biopsy, or significant traumatic injury ≤28 days prior to randomization.
• Active autoimmune disease or history of autoimmune disease that might recur, which may affect vital organ function or require immune suppressive treatment including systemic corticosteroids.
• Requirement of systemic treatment with either corticosteroids or other immunosuppressive medications ≤ 14 days prior to randomization.
• Interstitial lung disease, non-infectious pneumonitis or uncontrolled lung diseases including pulmonary fibrosis, or clinically significant acute lung diseases.
• Cardiovascular conditions as defined within the protocol.
• Patient has a concurrent invasive malignancy or a prior invasive malignancy whose treatment was completed ≤ 2 years before randomization.
• Persistent proteinuria of NCI-CTCAE v5.0 Grade 3.
• Pregnant or breast-feeding (lactating) women or women who plan to become pregnant or breast-feed during the trial.

Where it is running

• UCLA Santa Monica Hematology Oncology — Santa Monica, California, United States
• UCL SAINT LUC - UC Louvain — Brussels, Belgium
• Antwerp University Hospital — Edegem, Belgium
• CHU Amiens-Picardie — Amiens, France
• Hôpital Beaujon - APHP — Clichy, France
• Hôpital Henri Mondor — Créteil, France
• JSC VIANI Batumi Referral Hospital — Batumi, Georgia
• Israel-Georgian Medical Research Clinic Healthycore — Tbilisi, Georgia
• Universitätsmedizin: Medizinische Klinik und Poliklinik I — Mainz, Germany
• Humanity and Health Clinical Trial Center — Hong Kong, Hong Kong
• Ospedale Garibaldi Nesima — Catania, Italy
• Institutul Clinic Fundeni — Bucharest, Romania
• Regional Institute of Gastroenterology and Hepatology "Dr Octavian Fodor" — Cluj-Napoca, Romania
• Center of Oncology Euroclinic Victoria Hospital — Iași, Romania
• Clinic for Digestive Surgery, University Clinical Center of Serbia — Belgrade, Serbia
• Institue of Oncology Vojvodine Sremska Kamenica (Oncology Institute of Volvodina) — Kamenitz, Serbia
• Inje University Haeundae Paik Hospital — Busan, South Korea
• Cha Bundang Medical Center — Seongnam-si, South Korea
• Severance Hospital, Yonsei University Health System — Seoul, South Korea
• Hospital Universitario La Paz — Madrid, Spain
• Hospital Universitario Miguel Servet — Zaragoza, Spain
• National Taiwan University Hospital — Taipei, Taiwan
• Chang Gung Memorial Hospital - Linkou — Taoyuan, Taiwan
• Gülhane Eğitim ve Araştırma Hastanesi — Ankara, Turkey (Türkiye)
• Gazi University MF — Ankara, Turkey (Türkiye)

Full record on ClinicalTrials.gov

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