Tislelizumab Consolidation After Liver-Directed Therapy for Hepatocellular Carcinoma

Eligibility Criteria

• * Each patient eligible to participate in this study must meet all the following criteria:
• 1. Written informed consent
• 2. Primary diagnosis of HCC, planned to receive radiation, treatment naïve to systemic therapy for HCC, prior TACE permitted
• 3. Hepatocellular carcinoma diagnosis by histologic findings and/or imaging criteria of LI-RADS 5
• 4. Eastern Cooperative Oncology Group performance status score of 0-2
• 5. Age\>/=18 years
• 6. Child-Pugh class A liver function or B7, BCLC A-C or deemed not a candidate for surgery or liver transplantation
• 7. No extrahepatic metastasis detected on CT chest with or without IV contrast, abdomen and pelvis with IV and oral contrast (triphasic-if feasible based on kidney function), or MRI abdomen/liver and chest CT.
• 8. Females of childbearing potential must be willing to use a highly effective method of birth control for the duration of the study, and ≥ 6 months after the last dose of tislelizumab, and have a negative urine or serum pregnancy test ≤ 7 days of first dose of study drug
• 9. Non-sterile males must be willing to use a highly effective method of birth control for the duration of the study and for ≥ 6 months after the last dose of tislelizumab. Males must agree not to donate or bank sperm during treatment with tislelizumab and for \> 6 months after treatment stop.
• 10. Must have 1 target lesion measurable in 1 dimension according to RECIST 1.1.
• 11. Demonstrate adequate bone marrow and organ function as defined below:
• 1. Hematologic - Absolute neutrophil count (ANC) ≥ 1,500/mcL, Hemoglobin \> 8.5 g/dL, Platelet count ≥ 75,000/mcL
• 2. Renal - Serum creatinine OR calculated\* serum creatinine clearance (GFR can be used in place of creatinine or creatinine clearance) ≤ 1.5x upper limit of normal (ULN) OR ≥ 30 mL/min for participants with creatinine levels \> 1.5x institutional ULN
• * Calculate serum creatinine clearance using the standard Cockcroft-Gault formula.
• 3. Hepatic - Serum total bilirubin ≤ 3 mg/dL , AST (SGOT) and ALT (SGPT) ≤ 5x ULN , Alkaline phosphatase (ALP) ≤ 8x ULN Coagulation - International Normalized Ratio (INR) or prothrombin time (PT) or activated partial thromboplastin time (aPTT) ≤ 2.0x ULN \*This applies only to participants not receiving therapeutic anticoagulation; participants receiving therapeutic anticoagulation should be on a stable dose.
• 1. Prior radiotherapy to the region of the liver that would result in excessive doses to normal tissues due to overlap of radiation therapy fields
• 2. Prior selective internal radiotherapy/hepatic arterial Yttrium therapy, at any time
• 3. Severe, active co-morbidity as per investigator
• 4. More than five discrete intrahepatic parenchymal foci of definite HCC or left/right or main portal vein thrombus
• 5. Direct tumor extension into the stomach, duodenum, small bowel or large bowel
• 6. Measurable common or main branch biliary duct involvement with HCC
• 7. Extrahepatic metastases or malignant nodes (that enhance with typical features of HCC) \> 3.0 cm, in sum of maximal diameters (e.g. presence of one 3.4 cm metastatic lymph node or two 2 cm lung lesions).
• 8. Prior liver transplant
• 9. HIV positive
• 10. Immunodeficiency requiring chronic systemic therapy or that may relapse
• 11. Participants who have received prior immunotherapy.
• 12. Participants with clinically meaningful ascites, defined as ascites requiring non-pharmacologic intervention (e.g. paracentesis) to maintain symptomatic control
• 13. Participants with clinically meaningful encephalopathy
• 14. Participants who have undergone prior solid organ or bone marrow transplant except for patients with prior renal transplant for whom dialysis may be employed in the event of graft rejection.
• 15. Patients must have documented hepatitis virology status.
• 16. Participants with a history of autoimmune hypothyroidism on a stable dose of thyroid replacement hormone are eligible.
• 17. Participants with controlled Type 1 diabetes mellitus on a stable insulin regimen are eligible.
• 18. Participants with eczema, psoriasis, lichen simplex chronicus of vitiligo with dermatologic manifestations only are eligible provided: 1) rash covers \< 10% of body surface area (BSA), disease is well controlled at baseline and requires only low potency topical steroids (e.g., hydrocortisone 2.5%, hydrocortisone butyrate 0.1%, flucinolone 0.01%, desonide 0.05%, aclometasone dipropionate 0.05%).
• 19. Any malignancy ≤ 5 years before first dose of study drug except for the specific cancer under investigation in this study and any locally recurring cancer that has been treated curatively (e.g. resected basal or squamous cell skin cancer, superficial bladder cancer, carcinoma in situ of the cervix or breast).
• 20. Treatment with a live, attenuated vaccine within four weeks prior to initiation of study treatment with Tislelizumab.
• 1. Note: Seasonal vaccines for influenza and COVID-19 are generally inactivated vaccines and are allowed. Intranasal vaccines are live vaccines and are not allowed.
• 21. Any condition that required systemic treatment with either corticosteroids (\> 10 mg daily of prednisone or equivalent) or other immunosuppressive medication ≤ 14 days before first dose of study drug a. Note: Participants who are currently or have previously been on any of the following steroid regimens are not excluded: i. Adrenal replacement steroid (dose ≤ 10 mg daily of prednisone or equivalent) ii. Topical, ocular, intra-articular, intranasal, or inhaled corticosteroid with minimal systemic absorption iii. Short course (≤ 7 days) of corticosteroid prescribed prophylactically (e.g., for contrast dye allergy) or for the treatment of a non- autoimmune condition (e.g., delayed-type hypersensitivity reaction caused by contact allergen)
• 22. With uncontrolled diabetes or \> Grade 1 laboratory test abnormalities in potassium, sodium, or corrected calcium despite standard medical management or ≥ Grade 3 hypoalbuminemia ≤ 14 days before first dose of study drug
• 23. With history of interstitial lung disease, non-infectious pneumonitis or uncontrolled diseases including pulmonary fibrosis, acute lung diseases, etc.
• 24. With severe chronic or active infections requiring systemic antibacterial, antifungal or antiviral therapy, including tuberculosis infection, etc.
• 25. Severe infections within 4 weeks before first dose of study drug, including but not limited to hospitalization for complications of infection, bacteremia, or severe pneumonia.
• 26. Received therapeutic oral or intravenous antibiotics within two weeks before first dose of study drug
• 27. Any major surgical procedure requiring general anesthesia ≤ 28 days before first dose of study drug
• 28. Any of the following cardiovascular risk factors:
• 29. Has received any herbal medicine used to control cancer within fourteen days of the first study drug administration
• 30. Participants with toxicities (because of prior anticancer therapy) which have not recovered to baseline or stabilized, except for AEs not considered a likely safety risk (e.g., alopecia, neuropathy and specific laboratory abnormalities)
• 31. Underlying medical conditions (including laboratory abnormalities) or alcohol or drug abuse or dependence that, will be unfavorable for the administration of study drug or affect the explanation of drug toxicity or AEs or result in insufficient or might impair compliance with study c conduct.
• 32. Concurrent participation in another therapeutic clinical study.