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A TheraSphere® Advanced Dosimetry Retrospective Global Study in HCC

Completed
Conditions
Hepatocellular Carcinoma
Registration Number
NCT03295006
Lead Sponsor
Boston Scientific Corporation
Brief Summary

This retrospective, multinational, single-arm study will be conducted in at least 8 sites. An interim analysis will be conducted with data from 100 patients with up to 10 well defined HCC tumor(s) and with at least one tumor ≥3 cm. Normal tissue absorbed dose using pre-procedural 99mTc MAA SPECT or SPECT/CT imaging will be measured to allow the mean absorbed normal tissue dose corresponding to a ≤15% probability of CTCAE grade 3 or higher hyperbilirubinemia (in the absence of disease progression) to be calculated. Total bilirubin will be recorded and graded according to CTCAE version 4.02. All dose-related SAEs at 3 months follow-up will be followed until resolution, death or lost-to-follow-up. AEs related to disease progression will not be considered related to TheraSphere.

Detailed Description

Recently published evidence indicates a correlation between yttrium-90 dose delivered to the tumor and normal tissue with safety and efficacy outcomes but there are no validated methods to consistently measure dose delivered to the tumor and normal tissue. In contrast to the standard clinical approach based on average dose to one target volume, this trial, sponsored by Biocompatibles UK, will explore an alternative two-compartment TheraSphere dosimetry methodology to calculate absorbed dose to tumor and normal tissue

Recruitment & Eligibility

Status
COMPLETED
Sex
All
Target Recruitment
209
Inclusion Criteria
  • Up to 10 well defined unilobar/bilobar HCC tumor(s) per lobe with at least one tumor ≥3 cm ± PVT
  • Liver dominant disease (limited extra-hepatic metastases in the lung and/or lymph nodes are permitted (up to 5 lesions in the lung, with each individual lesion ≤2cm; any number of lymph node lesions with each individual lesion ≤2 cm).
  • Child Pugh stage A or B7.
  • BCLC A, B or C.
  • Must be male or female, 18 years of age or older.
  • Bilirubin ≤2 mg/dL.
  • Tumor replacement <50% of total liver volume assessed by diagnostic imaging consisting of multi-phase contrast enhanced CT or contrast enhanced MRI.
  • Diagnostic imaging consisting of multi-phase contrast enhanced CT or contrast enhanced MRI within 3 months prior to TheraSphere® administration.
  • Infusion of 99mTc-MAA in a single arterial location sufficient to cover up to 10 well-defined tumors per lobe ≤ 6 weeks prior to TheraSphere® administration.
  • Patients must have received TheraSphere® in a single treatment setting in one or more arterial locations sufficient to cover up to 10 well-defined tumors based on angiography. Subsequent TheraSphere® treatment to the second lobe may occur at least 4 weeks following the initial TheraSphere® treatment.
  • For patients receiving a second TheraSphere® treatment bilirubin levels must have been recorded prior to the second treatment
  • Patients must have had clinical evaluation (assessment of liver specific AEs) and laboratory evaluation (at least a serum bilirubin level) at baseline.
  • Tumor(s), ≥3 cm, measurable by mRECIST and RECIST 1.1 at baseline
Exclusion Criteria
  • Prior external beam radiation treatment to the liver.
  • Prior loco-regional liver directed therapy (cTACE, DEB-TACE and SIR-Spheres).
  • Prior liver transplantation.
  • Whole liver TheraSphere® treatment following prior liver resection.
  • TheraSphere administration to ≤2 segments (e.g., radiation segmentectomy).
  • Additional active therapy (TACE and treatment with SIR-Spheres) between first TheraSphere treatment and 3 month (90 days) imaging.
  • Hepatic vein invasion.
  • Diagnosis of disease progression at peri-procedural imaging as compared to the baseline imaging (physician's discretion).

Study & Design

Study Type
OBSERVATIONAL
Study Design
Not specified
Primary Outcome Measures
NameTimeMethod
Alternative two-compartment TheraSphere dosimetry methodologyBaseline

Normal tissue absorbed dose using pre-procedural 99mTc MAA (Technetium-99m Macroaggregated albumin) SPECT (Single-photon emission computer tomography) or SPECT/CT (Single-photon emission computer tomography/Computer Tomography) imaging, to allow the mean absorbed normal tissue dose corresponding to a ≤15% probability of Common Toxicities Criteria for Adverse Events (CTCAE) grade 3 or higher hyperbilirubinemia (in the absence of disease progression) to be calculated.

Secondary Outcome Measures
NameTimeMethod
Target Alpha fetoprotein (AFP) response6 weeks and 3 months

Target Alpha fetoprotein (AFP) response (defined as a ≥50% decrease in AFP levels for patients with a baseline AFP level of

≥200 ng/mL).

Dosimetric analysis timebaseline

Dosimetric analysis time (i.e., workflow).

Serious adverse events3 months

All serious adverse events (SAEs) assessed as related or potentially related to TheraSphere

Specific non-serious adverse events (AEs) assessed as related or potentially related to the dose of TheraSphere3 months

Specific non-serious adverse events (AEs) assessed as related or potentially related to the dose of TheraSphere, comprising of any of the following events:

* Hyperbilirubinemia

* Ascites

* Pain

* Fatigue

* Nausea

Volume changes3 and 6 months

Volume changes (i.e., perfused liver volume and non-perfused liver volume) from baseline afterTheraSphere administration.

Albumin-bilirubin (ALBI) score6 weeks and 3 months

Albumin-bilirubin (ALBI) score, a measure of liver function for HCC patients after TheraSphere administration.

Dose to Portal Vein Thrombosis (PVT)baseline, 90 days, 180 days

Dose to Portal Vein Thrombosis (PVT) based upon pre- and postprocedure imaging (if PVT present).

Dose accuracybaseline

Dose accuracy based upon phantom imaging studies.

Tumor doseBaseline

Tumor dose (to tumors ≥3 cm) using pre-procedural 99mTc MAA SPECT or SPECT/CT imaging.

Objective response (OR) of the target lesion and non-target sesions3 months and 6 months

Objective response (OR) of the target lesion (single largest lesion) and non-target lesion(s) at 3 months and 6 months (if available), and for all scans up to 400 days after TheraSphere administration by Modified Response Evaluation Criteria in Solid Tumors (mRECIST) and Response Evaluation Criteria in Solid Tumors (RECIST) 1.1

Overall Survival (OS)6 months

Overall Survival (OS)

Dose reproducibilitybaseline

Measurement of inter-observer agreement based on a round robin review of the same 20 patients obtained from a minimum of 8 users (with each user at a different site) and an exploratory assessment of intra-observer agreement based on a review of 10 patients by a minimum of 8 users at least 2 weeks apart. The 10 patients for the intra-observer agreement will be a subset of the patients included in the assessment of inter-observer agreement.

Clinical laboratory assessments6 weeks and 3 months

Clinical laboratory assessments

Trial Locations

Locations (14)

Stanford University Medical Center

🇺🇸

Stanford, California, United States

University of Florida College of Medicine

🇺🇸

Gainesville, Florida, United States

Northwestern Memorial Hospital, Robert H Lurie Comprehensive Cancer Center

🇺🇸

Chicago, Illinois, United States

Indiana University School of Medicine

🇺🇸

Indianapolis, Indiana, United States

Washington University in St. Louis, School of Medicine

🇺🇸

Saint Louis, Louisiana, United States

The University of Texas MD Anderson Cancer Center

🇺🇸

Houston, Texas, United States

Centre Eugene Marquis

🇫🇷

Rennes, France

Universitätsklinikum Essen

🇩🇪

Essen, Germany

Foundation IRCCS Istituto Nazionale Tumori

🇮🇹

Milan, Italy

Universitair Medisch Centrum Utrecht

🇳🇱

Utrecht, Netherlands

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Stanford University Medical Center
🇺🇸Stanford, California, United States

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