Cancer Chemotherapy and Pharmacology

, Volume 81, Issue 5, pp 957–963 | Cite as

A phase I trial of escalating doses of cixutumumab (IMC-A12) and sorafenib in the treatment of advanced hepatocellular carcinoma

  • Anthony B. El-KhoueiryEmail author
  • Robert O’Donnell
  • Thomas J. Semrad
  • Philip Mack
  • Suzette Blanchard
  • Nathan Bahary
  • Yixing Jiang
  • Yun Yen
  • John Wright
  • Helen Chen
  • Heinz-Josef Lenz
  • David R. Gandara
Clinical Trial Report



The insulin-like growth factor (IGF) pathway is activated in hepatocarcinogenesis. Cixutumumab is a monoclonal antibody against human insulin-like growth factor-1 receptor (IGF-1R). Given the cross-talk between the IGF and VEGF pathways, we performed a phase I study of the combination of cixutumumab and sorafenib in hepatocellular cancer (HCC).


Eligible patients with no prior systemic therapy for advanced HCC and Child–Pugh A to B7 were treated with sorafenib 400 mg BID and escalating doses of cixutumumab (2, 4, or 6 mg/kg IV weekly) in a 3 + 3 design. Dose limiting toxicity (DLT) was defined as treatment-related grade 3 or 4 non-hematologic toxicity (except for a subset of manageable toxicities) or any grade 4 hematologic toxicities.


In 21 patients enrolled, there were 3 DLTs; grade 3 hyperglycemia, grade 3 hypophosphatemia, and grade 5 peritonitis. The maximum tolerated dose of cixutumumab was 4 mg/kg IV weekly with standard dose sorafenib. Eighteen of 21 (86%) patients had grade 3 or above toxicities attributed to treatment. One patient also experienced grade 4 colonic perforation and grade 5 peritonitis. The median number of cycles completed was 4 (0–26). Of 16 patients evaluable for response, 81% achieved stable disease. The median progression free survival was 6.0 months (95% CI 3.6–undefined) and the median overall survival was 10.5 months (95% CI 7.1–undefined).


While the combination of cixutumumab and sorafenib had a toxicity profile similar to that of sorafenib monotherapy, it manifested limited clinical efficacy in unselected patients with HCC.


Hepatocellular cancer Sorafenib IMC-A12 Cixutumumab Phase I 



This study was supported by the NCI under NO1-CM-62209 (California Cancer Consortium). T. S. is supported by the National Cancer Institute of the National Institutes of Health under award number K12CA138464.

Compliance with ethical standards

Conflict of interest

Dr. Anthony El-Khoueiry and Dr. Heinz-Josef Lenz both have received honoraria for advisory board participation from Bayer. No potential conflicts of interest were disclosed by other authors.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants involved in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Anthony B. El-Khoueiry
    • 1
    Email author
  • Robert O’Donnell
    • 2
  • Thomas J. Semrad
    • 2
  • Philip Mack
    • 2
  • Suzette Blanchard
    • 3
  • Nathan Bahary
    • 4
  • Yixing Jiang
    • 5
  • Yun Yen
    • 3
  • John Wright
    • 6
  • Helen Chen
    • 6
  • Heinz-Josef Lenz
    • 1
  • David R. Gandara
    • 2
  1. 1.University of Southern California Norris Comprehensive Cancer CenterLos AngelesUSA
  2. 2.University of California Davis Comprehensive Cancer CenterSacramentoUSA
  3. 3.City of Hope Comprehensive Cancer CenterDuarteUSA
  4. 4.University of Pittsburgh Comprehensive Cancer CenterPittsburghUSA
  5. 5.University of MarylandBaltimoreUSA
  6. 6.National Cancer Institute at the National Institutes of HealthBethesdaUSA

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