Evaluation of Efficacy and Safety of Immune Check Point Inhibitors in Hepatocellular Carcinoma Patients in Ain Shams University Hospitals
试验速览
- 阶段
- 不适用
- 状态
- Enrolling By Invitation
- 入组人数
- 30
- 试验地点
- 1
- 主要终点
- Progression free survival in HCC patients receiving immunotherapy.
研究概览
简要总结
This study aims to evaluate the response to immunotherapy in HCC, assess the toxicity profile and measure overall survival within the study period. The primary end point is evaluation of progression free survival in HCC patients receiving immunotherapy. The secondary end point is to assess overall survival within the study period, duration of response and the response rate. The tertiary end point is to assess the toxicity profile.
详细描述
Treatment starts after MDT discussion and approval for diagnosis, staging and treatment protocol.
- This study includes patients with advanced HCC who will receive their first line of treatment. Cases will receive atezolizumab (1200 mg) + bevacizumab (15mg/kg) every 3 weeks or Tremilimumab (300 mg single dose IV infusion on first day only) + Durvalumab (1500 mg on the same day then every 4 weeks) according to eligibility criteria.
- Cases will be evaluated every cycle clinically and laboratory.
- Baseline investigations will include;
-
Laboratory ;
-
CBC
-
liver enzymes (ALT, AST, alkaline phosphatase, GGT)
-
liver function tests (serum albumin, serum bilirubin total and direct, INR)
-
kidney function tests (serum creatinine, BUN, 24 hrs urinary protein)
-
electrolytes Na, K, Ca)
t) Others; HBAlc, Thyroid function tests (TSH, T3, T4), Alpha feto protein 2. Radiological imagings;
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
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
- •Hepatocellular carcinoma based on histological diagnosis or the typical findings on radiological imaging including enhanced dynamic computed tomography (CT) and/or dynamic magnetic resonance imaging (MRI).
- •ECOG Performance status of 0 or 1
- •Patients with Child-Pugh class A
- •BCLC stage B with diffuse, infiltrative, or extensive bilobar involvement
- •BCLC stage B with tumor progression after failure of TACE
- •BCLC stage C
- •No prior systemic therapy for HCC
- •Additional eligibility criteria; Hb ≥ 9 g/dl, platelets ≥ 75x10%/1, ANC ≥ 1.5 x10% for Atezolizumab/bevacizumab and ANC ≥ 1x10%1 for Durvalumab/Tremilimumab, INR ≤ 2, albumin ≥ 2.8 g/dl, total bilirubin
- •≤ 3 mg/dl, AST and ALT ≤ 5 x ULN, creatinine clearance ≥ 50 ml/min
- •Additional criteria for Atezolizumab/Bevacizumab; upper endoscopy showing no risky high grade esophageal varices (within 6 months of first dose) unless adequately managed
排除标准
- •Performance status ≥ 2
- •Patients with Child-Pugh class B or C
- •BCLC stage A or D
- •Active tuberculosis or active human immunodeficiency virus (HIV) infection
- •HCV or HBV infection except if; HBV DNA < 500 IU/ml or started anti- HBV treatment for a minimum of 14 days prior to first dose
- •Severe infection requiring hospitalization within 4 weeks prior to first dose
- •History of allogenic stem cell or solid organ transplant
- •Treatment with systemic immunostimulatory or immunosuppressive medication
- •Active and history of autoimmune disease or immune deficiency
- •Receiving a live, attenuated vaccine within 4 weeks prior to first dose
- •History of idiopathic pulmonary fibrosis, or evidence of active pneumonitis
- •Central nervous system metastases
- •Symptomatic hypercalcemia (ionized calcium > 1.5 mmol/1 (6 mg/dl), calcium > 12 mg/dl, or corrected serum calcium > ULN)
- •History of severe allergic anaphylactic reactions to chimeric or humanized antibodies or fusion proteins
- •Prior history of hypertensive crisis or hypertensive encephalopathy
- •Cardiac conditions, such as severe heart failure, unstable angina, recent myocardial infarction, severe arrhythmias
- •Evidence of bleeding diathesis or coagulopathy Special for atezolizumab + bevacizumab
- •Risky esophageal or gastric varies unless adequately managed
- •Severe portal hypertensive gastropathy which is associated with decline in hemoglobin, uniess controlled
- •Severe proteinuria ≥ 3.5 g/24 hrs or by dipstick 4+ proteinuria, according to CTCAE. Special for tremelimumab + durvalumab
- •Main portal vein tumor thrombosis
结局指标
主要结局
Progression free survival in HCC patients receiving immunotherapy.
时间窗: From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 12 months
Progression-free survival (PFS) is defined as the time elapsed between treatment initiation and tumor progression or death from any cause. Progression (i.e., PD) was defined as presence of new measurable/non- measurable lesions, or ≥ 20% increase in tumour burden relative to nadir
次要结局
- overall survival within the study period,(From date of randomization until the date of loss of follow up or date of death from any cause, whichever came first, assessed up to 12 months)
- Response rate(From enrollment to study till 1 year or treatment)