New medical tests and treatments aren’t offered to the public as soon as they’re discovered. They need to be appropriately studied to determine their safety and effectiveness. Clinical trials are formal research studies to evaluate a medical treatment. Clinical trials can study many things, including:
- New drugs not yet approved by the U.S. Food and Drug Administration (FDA)
- New uses of drugs already approved by the FDA
- New ways to administer drugs, such as in pill form
- New tests to find and track disease.
Clinical trials typically advance through several phases when testing a new treatment:
- Phase I trials test an experimental treatment on a very small group of people to assess its safety and side effects and to determine appropriate drug dosages.
- Phase II trials enroll a larger group and focus on determining effectiveness of the treatment for individuals with a certain disease or condition. They also continue to study safety, including short-term side effects.
- Phase III trials obtain additional information about safety and effectiveness, studying different populations and dosages, often using the drug in combination with other drugs. If the FDA decides that the Phase III results are positive, it will approve the treatment for clinical use.
In this video segment, Allison O’Neill, M.D., a pediatric medical oncologist, discusses how clinical trials can guide the development of a standard of care for FLC.
In this video, Ghassan Abou-Alfa, M.D., a medical oncologist, discusses the importance of clinical trials for fibrolamellar patients.
Current clinical trials
Study name and description
- DNAJB1-PRKACA Fusion Kinase Peptide Vaccine Combined With Nivolumab and Ipilimumab for Patients With Fibrolamellar Hepatocellular Carcinoma (Baltimore, MD)
This phase I clinical trial of an immune therapy for fibrolamellar carcinoma (FLC) is now recruiting subjects at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University in Baltimore, MD. The study asks if individuals can mount an effective immune response against FLC by specifically targeting the unique chimeric protein (resulting from a DNAJB1-PRKACA gene fusion) believed to drive the growth of almost all such tumors. Trial subjects will be given an experimental vaccine (the first patient in the trial received this vaccine on April 21, 2020) containing a peptide (small segment of a protein) that corresponds to the junction region linking the two parts of the chimeric protein. They will simultaneously receive two FDA-approved drugs, Opdivo (nivolumab) and Yervoy (ipilimumab), that may enhance the immune response against FLC by overcoming “checkpoint” systems that can limit the immune system’s ability to fight a cancer.
Enrollment in this trial is open to FLC patients 12 years old and older. The study’s principal investigator is Dr. Mark Yarchoan. Details and contact information can be found at: https://www.clinicaltrials.gov/ct2/show/NCT-04248569
Dr. Mark Yarchoan, the principal investigator of this trial, discusses the rationale for the FLC fusion peptide vaccine, the accompanying drug regimen and the eligibility criteria for this first-in-human study in the video below:
- Nivolumab, Fluorouracil, and Interferon Alpha-2B for the Treatment of Unresectable Fibrolamellar Cancer (Houston, TX)
This new phase I/II trial studies the side effects and how well the combination of nivolumab, fluorouracil, and interferon alpha-2b work for the treatment of fibrolamellar carcinoma (FLC) that cannot be removed by surgery. Immunotherapy with checkpoint inhibitors, such as nivolumab, may help the body’s immune system attack the cancer and may interfere with the ability of tumor cells to grow and spread. Treatment with a combination of nivolumab, fluorouracil, and interferon alpha-2b may work better in treating unresectable fibrolamellar cancer compared to treatment with fluorouracil and interferon alpha-2b alone. This clinical trial stages the drug administration and includes the analysis of “before and after” patient biopsies (samples of tumor tissue) to better understand how the drug combination may affect patients’ immune responses to FLC.
Enrollment in this trial is open to FLC patients 12 years old and older. The study’s principal investigator is Dr. Sunyoung Lee at University of Texas M.D. Anderson Cancer Center. Dr. Ahmed Kaseb at M.D. Anderson Cancer Center is the co-investigator. Additional details and contact information can be found at: https://clinicaltrials.gov/ct2/show/NCT04380545
Dr. Ahmed Kaseb, an investigator and key contact for this study, discusses the design, eligibility criteria and rationale for this trial in the video below:
targeting HCC, including fibrolamellar
- Cisplatin and Combination Chemotherapy in Treating Children and Young Adults With Hepatoblastoma or Liver Cancer After Surgery (181 study locations)
This phase II/III clinical trial studies how well, in combination with surgery, cisplatin and combination chemotherapy works in treating children and young adults with hepatoblastoma or hepatocellular carcinoma. It is enrolling patients with all types of hepatocellular carcinoma, not just fibrolamellar alone. Because giving combination chemotherapy may kill more tumor cells than one type of chemotherapy alone, this partially randomized study is investigating combinations of drugs that work in different ways to kill tumor cells, including cisplatin, doxorubicin, fluorouracil, vincristine sulfate, carboplatin, etoposide, irinotecan, sorafenib, gemcitabine and oxaliplatin.
The study is also commonly referred to as the “Pediatric Hepatic Malignancy International Therapeutic Trial (PHITT)”. It is sponsored by the Children’s Oncology Group. Enrollment in this study is open to patients up to age 30. The study’s principal investigator is Dr. Gregory M. Tiao of the Cincinnati Children’s Hospital Medical Center. More details and contact information can be found at: https://clinicaltrials.gov/ct2/show/NCT03533582
Dr. Allison O’Neill, an investigator involved with the study, discusses the Children’s Oncology Group and the rationale behind this trial in the video below:
- Checkpoint Inhibition In Pediatric Hepatocellular Carcinoma (Boston, MA)
This phase II clinical trial is studying an immunotherapy drug (pembrolizumab or KEYTRUDA) as a possible treatment for pediatric hepatocellular carcinoma. It is enrolling patients with all types of hepatocellular carcinoma, not just fibrolamellar alone. In this research study, the investigators plan to investigate whether pediatric patients with hepatocellular carcinoma experience stable disease or other response to pembrolizumab.
Enrollment in this study is open to patients up to age 30. The study’s principal investigator is Dr. Allison O’Neill of the Dana-Farber Cancer Institute. More details and contact information can be found at: https://clinicaltrials.gov/ct2/show/NCT04134559
Dr. Allison O’Neill, the principal investigator of the trial, discusses key aspects of this study and the role of immunotherapy in FLC treatment in the video segment below:
Trials potentially open to fibrolamellar patients
- Neratinib HER Mutation Basket Study (62 study locations)
This is an open-label, multi-center, multinational, Phase II study exploring the efficacy and safety of neratinib therapy in patients with solid tumors with activating HER2, HER3 or EGFR mutations or with EGFR gene amplification. The trial will consist of a screening period, a treatment period, and an end of treatment visit occurring when neratinib is discontinued for any reason, a safety follow-up visit occurring 28 to 42 days after the last dose of neratinib and a survival follow-up period lasting for a maximum of 12 months for each patient after their last dose of neratinib or until initiation of additional anti-cancer therapy. For more information go to: https://clinicaltrials.gov/ct2/show/NCT01953926
- NCI MATCH Clinical Trial (multiple locations)
The National Cancer Institute has launched a Molecular Analyses for Therapy Choice (MATCH) Clinical Trial, exploring the effectiveness of targeted cancer therapy based on genetic mutation rather than type of cancer. While the study is not testing any drugs known to target the principal genetic mutation involved in fibrolamellar carcinoma, patients may be able to participate if their genetic profile includes a mutation targeted in the study. Please click the link below for details and talk to your doctor to see if this is right for you. Learn More
Please visit clinicaltrials.gov for a comprehensive list of active trials.
The Fibrolamellar Cancer Foundation does not provide medical advice. We provide website users with information to help them better understand their health conditions and current approaches towards diagnosis, treatment and supportive care. Always seek the advice of your physician or other qualified healthcare provider.