Randomized Phase II Trial of Chemoembolization and Sorafenib

Hepatocellular Carcinoma Clinical Trial

Official title: Randomized Phase II Trial of Chemoembolization and Sorafenib: Comparison Between Continuous and Sequential Treatment Regimens

Status Withdrawn

Clinical Trial Summary

The study will be a single-center, randomized Phase II study of conventional TACE in combination with sorafenib, given either continuously or sequentially, in patients with unresectable HCC. The primary variables will be tumor response (by MR Imaging) and plasma VEGF levels, prior to and after cTACE.

Clinical Trial Description

Transcatheter arterial chemoembolization (TACE) is the most widely performed procedure for patients with unresectable HCC. Although TACE can induce tumor necrosis, tumor recurrence and metastasis is not uncommon and likely due to stimulation of angiogenesis immediately after TACE. Plasma VEGF levels are significantly elevated following TACE procedures, usually peaking 24 to 48 hours after treatment.

Sorafenib, a multikinase inhibitor, has been shown to increase survival in patients with advanced HCC, presumably due to its predominant and strong antiangiogenic activities thereby preventing tumor growth. However, despite its targeted approach, sorafenib is not without toxicities; consequently most patients are unable to remain on full dose throughout the course of their treatment.

Because of sorafenib's antiangiogenic properties, it has been suggested that sorafenib could be used in combination with TACE to counteract the post-TACE angiogenic release and therefore prevent or minimize the risk of tumor recurrence. The possible synergy between TACE and sorafenib has been tested in numerous clinical studies. Although the safety profile has been clearly established, the efficacy of this combination therapy has yet to be demonstrated. Several combination methods have been tested, i.e., continuously where sorafenib is administered before the first TACE and then continuously throughout the planned TACE treatments, or sequentially where sorafenib is administered after the completion of TACE (usually 4 days after). Here, the investigators postulate that the sequence of the combination could have a significant impact on patient outcomes. Specifically, the investigators hypothesize that the continuous method is superior to that of the sequential protocol because the presence of sorafenib before the first TACE will preempt the peak of angiogenesis from TACE. To that end, the investigators propose to measure VEGF levels serially in order to detect differences between the two methods. ;

Related Conditions & MeSH terms

• Carcinoma, Hepatocellular
• Hepatocellular Carcinoma

• NCT number: NCT02908165
• Study type: Interventional
• Source: Yale University
• Status: Withdrawn
• Phase: Phase 2
• Start date: June 2016
• Completion date: June 2020