Italian Study Of Validation Of Angiogenesis Polymorphisms In HCC Patients Treated With Sorafenib
- Conditions
- Hepatocellular Carcinoma
- Interventions
- Procedure: blood sample collection
- Registration Number
- NCT02786342
- Brief Summary
Sorafenib represents the standard care for advanced hepatocellular carcinoma (HCC). However, molecular predictors of sorafenib efficacy have not yet been identified.
The primary aim of the study is to validate the prognostic or predictive role of eNOS,Ang2, HIF-1, VEGF and VEGFR polymorphisms in relation to clinical outcome (progression-free survival, PFS) of HCC patients treated with sorafenib.
- Detailed Description
Sorafenib is a multikinase inhibitor acting on vascular endothelial growth factor receptors (VEGFR) and platelet-derived growth factor receptor beta (PDGFRβ) involved in tumor cell proliferation and tumor angiogenesis.
Angiogenesis is a cascade of linked and sequential steps ultimately leading to tumour neovascularisation. Preclinical data suggested that significant HCC growth is dependent on angiogenesis, and an increase in tumour dimension may induce vascular endothelial cell proliferation.
Vascular endothelial growth factor (VEGF)-driven pathway has been demonstrated to play a major role in tumour angiogenesis. In fact, VEGF as a potent permeability factor promotes cell migration during invasion and as an endothelial growth factor stimulates endothelial cell proliferation, inducing the budding of new blood vessels around the growing tumour masses .
Single nucleotide polymorphisms (SNPs) in VEGF and VEGF receptor (VEGFR) genes have also been correlated to tumour neoangiogenesis through different biological mechanisms.
In the ALICE-1 study HCC patients receiving sorafenib were tested for VEGF-A, VEGF-C and VEGFR-1,2,3 SNPs. At univariate analysis VEGF-A alleles C of rs25648, T of rs833061, C of rs699947, C of rs2010963, VEGF-C alleles T of rs4604006, G of rs664393, VEGFR-2 alleles C of rs2071559, C of rs2305948 were significant predictors of PFS and overall survival (OS). At multivariate analysis rs2010963, rs4604006 and Barcelona Clinic Liver Cancer (BCLC) stage resulted to be independent factors influencing PFS and OS.
In the ALICE-2 study SNPs of hypoxia inducible factor 1α (HIF-1α) were statistically significant for PFS and OS. The extended analysis of VEGF and VEGFR SNPs confirms the results of ALICE-1 study. The presence of GG genotype of rs12434438 (HIF-1α) select a population with a particularly poor outcome independently from the clinical effect of the two VEGF SNPs (PFS: 2.6 months, p\<0,0001; OS: 6.6 months, p\<0,0001).
In ePHAS study a training cohort of 41 HCC patients and a validation cohort of 87 patients receiving sorafenib was analyzed. At univariate analysis, patients homozygous for an endothelial nitric oxide synthase (eNOS) haplotype (HT1: T-4b at eNOS-786/eNOS VNTR) had a lower median PFS (2.6 vs. 5.8 months, p \<0.0001) and OS (3.2 vs.14.6 months, p = 0.024) than those with other haplotypes. These data were confirmed in the validation set in which patients homozygous for HT1 had a lower median PFS (2.0 vs. 6.7 months, p \<0.0001) and OS (6.4 vs.18.0 months, p \< 0.0001).
On the basis of these premises this prospective study aims at validating the potential role of eNOS, VEGF, VEGFR, HIF-1 and Ang2 polymorphisms in patients with HCC treated with sorafenib.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 160
- Signed and dated informed consent.
- Ability to understand and the willingness to sign a written informed consent document.
- Male or Female, aged >18 years.
- Eastern Cooperative Oncology Group (ECOG) performance status score of 2 or less.
- Life expectancy of 12 weeks or more.
- Adequate hematologic function.
- Patients were required to have at least one untreated target lesion that could be measured in one dimension, according to the Response Evaluation Criteria in Solid Tumors (RECIST version 1.1).
- Concomitant antiviral systemic therapy was allowed.
- Resolution of all acute toxic effects of any prior local treatment.
- HCC diagnosed according to the AASLD and/or EASL criteria.
- Previous or concurrent cancer that is distinct in primary site or histology from HCC.
- Renal failure requiring hemo- or peritoneal dialysis.
- Presence of recent (< 6 months) or current cardiac failure Known history of human immunodeficiency virus (HIV) infection.
- Known central nervous system tumors including metastatic brain disease.
- Patients with clinically significant gastrointestinal bleeding within 30 days prior to study entry.
- Any prior local therapy within 4 weeks of study entry.
- Pregnancy or breastfeeding.
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Advanced HCC patients treated with sorafenib blood sample collection -
- Primary Outcome Measures
Name Time Method PFS up to three years prognostic/predictive role of eNOS,Ang2, HIF-1, VEGF and VEGFR polymorphisms in relation to Progression Free Survival
- Secondary Outcome Measures
Name Time Method OS up to three years prognostic/predictive role of eNOS,Ang2, HIF-1, VEGF and VEGFR polymorphisms in relation to Overall Survival
Trial Locations
- Locations (10)
Azienda Ospedaliera Universitaria Pisana
🇮🇹Pisa, PI, Italy
AOU di Cagliari - PO San Giovanni di Dio
🇮🇹Cagliari, CA, Italy
Oncologia medica , PO FAENZA, Ausl della Romagna
🇮🇹Faenza, RA, Italy
Ospedale Civile degli Infermi
🇮🇹Rimini, RM, Italy
IRCCS Istituto Tumori Giovanni Paolo II
🇮🇹Bari, BA, Italy
Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori
🇮🇹Meldola, FC, Italy
Oncologia medica - AOU di Parma
🇮🇹Parma, PR, Italy
Istituto Oncologico Veneto
🇮🇹Padova, PD, Italy
Azienda Sanitaria Universitaria Integrata di Udine S. Maria della Misericordia
🇮🇹Udine, UD, Italy
policlinico universitario Campus Bio-medico
🇮🇹Roma, Italy