Randomized, Double-Blind, Placebo-Controlled, Phase II Trial Of Short Course Sorafenib Therapy Prior to Radiofrequency Ablation for Intermediate Sized (3.5 to 7cm) Hepatocellular Cancer
试验速览
- 阶段
- 2 期
- 状态
- 已完成
- 入组人数
- 20
- 试验地点
- 2
- 主要终点
- Coagulation Zone Diameter-Long Axis
研究概览
简要总结
The purpose of this research study is to determine if sorafenib improves the effectiveness of a procedure called radiofrequency ablation (RFA) for the treatment of hepatocellular cancer (HCC). Radiofrequency ablation has been used to treat many types of tumors, including hepatocellular cancers. During RFA a needle is inserted into the tumor tissue and heat is used to kill the tumor cells. Sorafenib has been approved by the FDA for the treatment of hepatocellular cancer that cannot be treated with surgery. Pre-clinical data suggests that sorafenib may improve the efficacy of RFA.
详细描述
Hepatocellular cancer (HCC) has a poor prognosis with increasing mortality in the United States. Because HCC generally develops in patients with underlying liver disease, resection is often not possible. Liver transplant improves survival for HCC patients but given the national organ donor shortage often patients have to wait a considerable time for transplant. Liver-directed therapies such as radiofrequency ablation (RFA) remain important tools to control tumor growth and to potentially "bridge" patients to liver transplant. However, liver-directed therapies for HCC tumors greater than 3cm in size are suboptimal, leaving a critical unmet need.
Antiangiogenic systemic agents, such as oral sorafenib, reduce tumor blood flow and have been shown to improve RFA efficacy in animal and in computer models.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Confirmed hepatocellular cancer (HCC) by pathology or by NCCN imaging guidelines
- •All HCC stages are allowed. May be a liver transplant candidate.
- •At least one tumor (index tumor) accurately measured as 3.5-7cm in diameter (long and short axis diameter to be recorded, but only one needs to meet this criteria) on baseline imaging.
- •No prior therapy for the index tumor
- •No prior systemic treatment for HCC within 4 weeks and no prior anti-VEGF therapy within 8 weeks of study entry.
- •Life expectancy > 8 weeks.
- •ECOG >=0 or 1
- •RFA clinically indicated for index tumor.
- •Acceptable overall RFA and anesthesia risk.
- •Adequate bone marrow, liver and renal function: Hemoglobin >9.0 g/dl; Absolute neutrophil count (ANC)>1,500/mm3; Platelet count correctable to >50,000/mm3; compensated liver function (Child-Turcotte-Pugh A, B7 or B8); Creatinine <1.5 times ULN; INR correctable to <1.
- •Ability to take oral medication and no evidence of impaired absorption.
- •Exclusion Criteria
- •Urgent treatment of the index tumor anticipated.
- •Participants who have not recovered from adverse events due to agents administered more than 4 weeks earlier. Participants currently receiving any other study agents.
- •Known brain metastases
- •History of allergic reactions attributed to compounds of similar chemical or biologic composition to sorafenib.
- •Participants receiving medications or substances that are inducers of CYP3A4 (rifampicin, St. John's wort, phenytoin, carbamazepine, phenobarbital and dexamethasone) or that are metabolized/eliminated by predominantly UGT1A1 pathway or by CYP2B6 and CYP2C
- •Decompensated liver disease
- •Uncontrolled hypertension
- •Thrombolic or embolic events within the past 6 months.
- •Hemorrhage/bleeding event within 4 weeks
- •Serious non-healing wound, ulcer, or bone fracture.
- •Evidence of severe or uncorrectable bleeding diathesis or coagulopathy
- •Major surgery, open biopsy or significant traumatic injury within 4 weeks of study entry.
- •Contraindication to or inability to undergo the RFA procedure,
- •Contraindication to or inability to undergo imaging with MRI
- •Uncontrolled intercurrent illness
- •Individuals with a history of a different malignancy unless disease-free for at least 5 years and are deemed by the Investigator to be at low risk for recurrence. Individuals with the following cancers are eligible if diagnosed and treated within the past 5 years: cervical cancer in situ, and basal cell or squamous cell carcinoma of the skin.
- •HIV-positive individuals on combination antiretroviral therapy
- •For additional inclusion/exclusion criteria details contact Study Site.
排除标准
- 未提供
研究组 & 干预措施
Sorafenib
Participants received a nine-day course of oral sorafenib 400 mg twice a day and radiofrequency ablation (RFA) on Day 10. Tumors in each group underwent RFA using a standard regimen (1 cm tip, 70 ± 2º C, 5 min).
干预措施: Sorafenib (Drug)
Sorafenib
Participants received a nine-day course of oral sorafenib 400 mg twice a day and radiofrequency ablation (RFA) on Day 10. Tumors in each group underwent RFA using a standard regimen (1 cm tip, 70 ± 2º C, 5 min).
干预措施: radiofrequency ablation (Procedure)
Placebo
Participants received a nine-day course of placebo pills twice a day and radiofrequency ablation (RFA) on Day 10. Tumors in each group underwent RFA using a standard regimen (1 cm tip, 70 ± 2º C, 5 min).
干预措施: radiofrequency ablation (Procedure)
结局指标
主要结局
Coagulation Zone Diameter-Long Axis
时间窗: Up to day 50 from study enrollment (target 30 days after RFA)
The size of the coagulation zone was determined on CT imaging obtained after RFA for the single index tumor.
Coagulation Zone Volume
时间窗: Up to day 50 from study enrollment (target 30 days after RFA)
The size of the coagulation zone was determined on CT imaging obtained after RFA for the single index tumor.
Coagulation Zone Diameter-Short Axis
时间窗: Up to day 50 from study enrollment (target 30 days after RFA)
The size of the coagulation zone was determined on CT imaging obtained after RFA for the single index tumor.
次要结局
- Number of Treatment-Related Grade 1-4 Adverse Events (AEs) on Day of Radiofrequency Ablation (RFA)(Up to day 14 (target day 10 RFA))
- Number of Treatment-Related Grade 1-4 Adverse Events (AEs) by Day 9(Day 9)
- Number of Treatment-Related Grade 1-4 Adverse Events (AEs) One Month After Radiofrequency Ablation (RFA)(Up to day 40 post RFA (target 30 days))
- Feasibility Rate(Up to day 14 since enrollment)
研究者
Andrea Bullock
Principal Investigator
Beth Israel Deaconess Medical Center