Meclizine for Hepatocellular Carcinoma — OPTIM  

Carcinoma, Hepatocellular Clinical Trial

Official title: A Window of Opportunity Trial With Meclizine in Hepatocellular Carcinoma

Status Active, not recruiting

Clinical Trial Summary

Meclizine hydrochloride is an antihistamine widely used for treatment of vertigo and motion sickness. In HCC it has been used for anti-emetic effects, but it is used here as a CAR (constitutive androstane receptor) inverse agonist.

The hypothesis of this study is that Meclizine, CAR inverse agonist, will have beneficial therapeutic effect in patients with hepatocellular carcinoma who are candidates for surgical resection, ablation, TACE, Y90 or systemic therapy by blocking tumorigenesis and inducing apoptosis. The effects of Meclizine will be analyzed by measuring messenger RNA level of CAR target genes CYP2B6, c-Myc and FoxM1, the downstream effectors of CAR, by real time quantitative PCR.

Clinical Trial Description

The constitutive androstane receptor (CAR, NR1I3) is a nuclear receptor that plays a central role in hepatic detoxification of potentially toxic compounds, or xenobiotics. Chronic CAR activation by specific agonists induces tumors in wild type mice, and strongly promotes hepatocarcinogenesis in combination with initiating mutagens. Both effects are absent in CAR null mice. These tumorigenic effects are associated with an acute induction of hepatocyte proliferation in mice. Preliminary results using partially humanized mice demonstrate a very similar proliferative effect of CAR activation in human hepatocytes.

The transcriptional activity of CAR can be reversed by specific inverse agonists. These ligands are analogous to steroid receptor antagonists, converting the transcriptional activation of the agonist bound receptor into transcriptional repression. These compounds are termed inverse agonists because they do not depend on the presence of agonist ligands to exert their repressive effects. Mouse and human CAR proteins are more divergent than other nuclear receptors, and respond to quite different profiles of agonists and inverse agonists. Preliminary results demonstrate that the specific mouse CAR inverse agonist androstanol blocks proliferation and induces apoptosis in mouse liver tumors. This raises the possibility that targeting CAR may represent a new modality of treatment for hepatocellular cancer (HCC) analogous to estrogen and androgen receptor antagonists in breast and prostate cancers. Meclizine, a widely used antihistamine medication for vertigo and motion sickness, is an inverse agonist ligand of human CAR. Investigators hypothesize that reversing CAR function with meclizine will have a beneficial therapeutic effect in patients with HCC by blocking proliferation and inducing apoptosis.

Investigators therefore propose a novel window of opportunity trial in which biopsy proven HCC patients will receive oral meclizine daily for 28 (up to 35) days while awaiting surgical resection, radiofrequency ablation, transarterial chemoembolization, Y90 or systemic therapy. The primary test of treatment outcome will be the predicted decrease in expression of downstream CAR target genes (CYP2B6, MYC and FOXM1) in pre and post treatment tumor specimens. Investigators will also measure the change in tumor proliferation and apoptosis by measuring Ki-67 proliferation index and TUNEL assays (terminal deoxynucleotidyl transferase dUTP Nick-End Labeling assay), serum levels of AFP and GDF 15, and overall tumor response by imaging. HCC is the most rapidly increasing cause of cancer mortality in the United States and medical treatment options are limited. Successful completion of this study may identify a new approach to treatment of HCC. ;

Related Conditions & MeSH terms

• Carcinoma
• Carcinoma, Hepatocellular

• NCT number: NCT03253289
• Study type: Interventional
• Source: Baylor College of Medicine
• Status: Active, not recruiting
• Phase: Phase 1
• Start date: October 13, 2017
• Completion date: December 1, 2026