Bridge to Orthotopic Liver Transplantation (OLT) - Surefire Precision vs Endhole Embolization With DEBTACE

Not Applicable

Terminated

Conditions: Subjects Eligible for Liver Transplantation
Hepatocellular Carcinoma of the Liver

Brief Summary: The purpose of this study will be to prospectively evaluate the outcomes of patients with hepatocellular carcinoma (HCC) who undergo DEB-TACE (drug-eluting bead trans-arterial chemoembolization) with the Surefire Precision Infusion System for intentional effect of down-staging patients to OLT.

Patients with HCC and who are considered candidates for liver transplantation but outside Milancriteria and meet the eligibility criteria will be enrolled in the prospective single arm study.

Results of the prospective cohort will be compared to matched historical control patients who were previously treated with DEB-TACE, delivered with standard endhole catheters. This includes all patients treated at the University of Colorado since 2009 treated with 100-300 micron beads for whom follow-up is available.

Detailed Description: This is a single institution prospective clinical trial with historical matched controls. This protocol standardizes DEB-TACE delivery with the Surefire Precision Infusion System. This protocol does not change patient therapy. All patient safety monitoring, treatment procedures and follow-up procedures will be performed in accordance with standard clinical practice.

Fifty (50) subjects will be enrolled in the prospective arm. Data from one hundred (100) historical randomly sampled control subjects (1:2 ratio) will be selected.

Subjects will be followed at 1 week, 1 month, 3 months, then every 3 months, following the initial DEB-TACE procedure until the subject receives a liver transplant or death. The study will be concluded upon completion of enrollment and follow-up of the 50 patients. It is estimated that the time to complete patient enrollment and follow-up is 24 months. The estimated date for study completion (complete primary analyses) is June 2018. This is based on the average survival vs. time to transplant at this center. If there are individual patients that extend beyond this period the time may be slightly extended.

Recruitment & Eligibility

Inclusion Criteria

Patients aged 18 years or older with the diagnosis of HCC currently being evaluated for liver transplantation and considered for downstaging.
Patients undergoing Surefire DEB-TACE procedure as clinically determined
Single tumor that is >5 cm and less than 8 cm, OR 1 to 3 tumors with combined diameter greater than 15 cm and less than 24 cm
No portal invasion or extrahepatic spread
No previous chemotherapy, radiotherapy or transarterial embolization (with or without chemotherapy)
Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
Preserved liver function (Child-Pugh Class A or B).
Discrete hepatic artery feeding the tumor with vessel diameter > 1.5 mm

Exclusion Criteria

Advanced bilirubin levels > 3 mg/dl
AST or ALT>5 upper limit of normal or >250 U/l
Advanced tumoral disease, defined as vascular invasion, extrahepatic spread, or diffuse HCC (50% liver involvement)
Contraindications for doxorubicin administration.
Child's Class C
Vessels providing flow to the tumor that are less than 1.5 mm in diameter

Arm && Interventions

Group	Intervention	Description
DEB-TACE Procedure with Surefire Precision Infusion System	Surefire Precision Infusion System	The study duration for each patient is 24 months and includes a baseline visit, procedure visit and follow-up visits at 1 week, 1 month, 3 months, 6 months and every 3 months until liver transplant or death. The following evaluations/activities will be performed at baseline: Informed consent, history, physical exam, data collection of CT/ MRI within 1 month of the visit date, data collection of lab values and quality of life questionnaire. The treatment visit includes the DEB-TACE procedure with the Surefire Precision Infusion System. After the procedure, a Cone Beam CT of the liver will be performed to determine distribution and density of the beads in the tumor and adverse events monitoring. The following evaluations / activities will be performed during the follow-up period: physical exam, data collection of contrast enhanced CT/MRI to evaluate tumor response, data collection of lab values, adverse event monitoring and quality of life questionnaire.

Primary Outcome Measures

Name	Time	Method
Local Recurrence Rate (LRR)	6 months	For the outcome of local recurrence rate (LRR) we will test the null hypothesis of no difference in the proportion of patients with local recurrence by catheter type using a Fisher's exact test.

Secondary Outcome Measures

Name	Time	Method
Tumor Response	6 months	For the outcome of tumor response measured as the change in enhancing tumor size (pretreatment - post treatment) we will evaluate changes at 1 month and 6 month separately.
Survival Time	Every 3 months through 24 months	For the outcome of survival time, we will quantify the number of weeks from treatment until death.
Time to Progression	Every 3 months through 24 months	For the outcome of time to progression, we will quantify the number of weeks from treatment until tumor progression.