Chemoembolization Using Doxorubicin in Treating Patients With Liver Cancer That Cannot Be Removed By Surgery

Liver Cancer Clinical Trial

Official title:

Treatment of Patients With Hepatocellular Carcinoma Using Drug-Eluting Bead Embolization

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00293397
• Other study ID #: CDR0000456493
• Secondary ID: P30CA006973JHOC-
• Status: Completed
• Phase: N/A
• Start date: November 2005
• Est. completion date: April 2011

Study information

• Verified date: June 2018
• Source: Yale University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

RATIONALE: Drugs used in chemotherapy, such as doxorubicin, work in different ways to stop the growth of tumor cells, either by killing the cells or stopping them from dividing. Chemoembolization kills tumor cells by blocking the blood flow to the tumor and keeping chemotherapy drugs near the tumor.

PURPOSE: This clinical trial is studying how well chemoembolization using doxorubicin works in treating patients with liver cancer that cannot be removed by surgery.

Description:

OBJECTIVES:

• Determine, preliminarily, the feasibility of chemoembolization with GelSpheres™ beads mixed with doxorubicin hydrochloride in patients with unresectable hepatocellular carcinoma.

OUTLINE: This is a pilot study.

Patients undergo catheterization of the hepatic artery followed by chemoembolization comprising an infusion of GelSpheres™ beads mixed with doxorubicin hydrochloride into the target hepatic artery. Patients may receive up to 3 chemoembolization treatments.

After completion of study treatment, patients are followed at 1 month, every 2 months for 1 year, and then every 3 months during year 2.

PROJECTED ACCRUAL: A total of 20 patients will be accrued for this study.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 20
• Est. completion date: April 2011
• Est. primary completion date: April 2011
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 120 Years

Eligibility

DISEASE CHARACTERISTICS:

• Diagnosis of hepatocellular carcinoma (HCC) according to the European Association for the Study of Liver (EASL) disease diagnostic criteria AND the Okuda staging classification

• No advanced disease, as defined by any of the following:

• Barcelona Clinic Liver Cancer (BCLC) class C disease, as defined by the following:

• Vascular invasion, including segmental portal obstruction

• Extrahepatic spread

• Cancer-related symptoms (PST of 1-2)

• BCLC class D disease, as defined by the following:

• Okuda stage III disease

• World Health Organization (WHO) performance status 3 or 4

• Diffuse HCC, defined as massive ill-defined tumor involvement

• Child-Pugh Class C

• Not eligible for radical therapies (e.g., resection, liver transplantation, or percutaneous therapies)

• No significant liver decompensation

• Preserved liver function (Child-Pugh class A-B)

• No ascites (trace ascites allowed)

• No other active primary tumor

• Arteries supplying the lesion must be large enough to accept GelSpheres™ beads

PATIENT CHARACTERISTICS:

• Bilirubin = 3 mg/dL

• Albumin > 2.0 g/dL

• Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) = 5 times the upper limit of normal (ULN)

• Alkaline phosphatase = 5 times the upper limit of normal (ULN)

• No active gastrointestinal bleeding

• No encephalopathy

• No contraindication to hepatic embolization procedures, as indicated by any of the following:

• Porto-systemic shunt

• Hepatofugal blood flow

• Platelet count < 50,000/mm^3

• International normalized ratio (INR) = 1.8

• Partial thromboplastin time (PTT) = 39 seconds

• Renal failure

• Severe atheromatosis

• No contraindication to doxorubicin hydrochloride administration, as indicated by any of the following:

• Bilirubin > 5 mg/dL

• White blood cell (WBC) < 1,500/mm^3

• Ejection fraction < 50% by isotopic ventriculography or echocardiography

• Not pregnant

• No known allergy to contrast media

• No intolerance to occlusion procedures

• No vascular anatomy or bleeding that would preclude catheter placement or emboli injection, as indicated by any of the following:

• Active or risk of hemorrhage

• Patent extra-to-intracranial anastomoses or shunts

• End arteries leading directly to the cranial nerves

• Feeding arteries smaller than distal branches from which they emerge

• Collateral vessel pathways that would potentially endanger normal territories during embolization

PRIOR CONCURRENT THERAPY:

• No prior anticancer therapy for HCC

Related Conditions & MeSH terms

• Carcinoma, Hepatocellular
• Liver Cancer
• Liver Neoplasms

Intervention

Device:
• Drug-eluting beads loaded with doxorubicin hydrochloride
Doxorubicin eluting beads

Locations

Country	Name	City	State
United States	Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins	Baltimore	Maryland

Sponsors (2)

Lead Sponsor	Collaborator
Yale University	National Cancer Institute (NCI)

Country where clinical trial is conducted

United States, 

References & Publications (1)

Reyes DK, Vossen JA, Kamel IR, Azad NS, Wahlin TA, Torbenson MS, Choti MA, Geschwind JF. Single-center phase II trial of transarterial chemoembolization with drug-eluting beads for patients with unresectable hepatocellular carcinoma: initial experience in — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Safety	Safety was assessed using the CTCAE v 3.0 criteria, reported are the number of participants that experienced at least 1 event that was grade 2 (moderate) or higher.	1 month
Primary	Safety	Safety was assessed using the CTCAE v 3.0 criteria, reported are the number of participants that experienced at least 1 event that was grade 2 (moderate) or higher.	6 months
Primary	Efficacy - Tumor Response by the European Association for the Study of the Liver (EASL) Criteria	Efficacy as assessed by radiographic tumor response using EASL criteria at baseline and at 1 month post-TACE; Complete Response (CR): Achieving 100% tumor necrosis of targeted lesions Partial Response (PR): Demonstrating greater than 50% tumor necrosis in targeted lesions Progressive Disease (PD): Reappearance of or increased tumor enhancement greater than 25% in targeted lesions Stable Disease (SD): Not meeting requirements for CR or PR and not demonstrating evidence of progression in targeted lesions.	1 month
Primary	Efficacy - Tumor Response by Response Evaluation Criteria in Solid Tumors (RECIST)	Efficacy as assessed by radiographic tumor response using RECIST criteria at baseline, 1 month post treatment.; Complete Response (CR): Disappearance of all lesions targeted by therapy Partial Response (PR): At least 30% decrease in the sum of longest diameter (LD) of lesions targeted by therapy Progressive Disease (PD): At least 20% increase in sum of LD of lesions targeted by therapy Stable Disease (SD): Neither sufficient shrinkage for PR nor sufficient increase for PD.	1 month
Primary	Efficacy - Tumor Response by Response Evaluation Criteria in Solid Tumors (RECIST)	Efficacy as assessed by radiographic tumor response using RECIST criteria at baseline, and at 6 months post treatment.; Complete Response (CR): Disappearance of all lesions targeted by therapy Partial Response (PR): At least 30% decrease in the sum of longest diameter (LD) of lesions targeted by therapy Progressive Disease (PD): At least 20% increase in sum of LD of lesions targeted by therapy Stable Disease (SD): Neither sufficient shrinkage for PR nor sufficient increase for PD.	6 months
Primary	Efficacy - Overall Survival	Presented are the counts of patients that have survived up to 1 year.	1 Year
Primary	Efficacy - Overall Survival	Presented are the counts of patients that have survived up to 2 years.	2 Years