Transcatheter Arterial Chemoembolization (TACE) in Combination With Arsenic Trioxide Versus TACE in the Treatment of Middle-advanced Primary Hepatocellular Carcinoma (HCC) Patients

Primary Hepatocellular Carcinoma Clinical Trial

Official title:

A Prospective Multicenter Randomized Controlled Open-label Trial of Transcatheter Arterial Chemoembolization (TACE) in Combination With Arsenic Trioxide Versus TACE in the Treatment of Middle-advanced Primary Hepatocellular Carcinoma (HCC) Patients

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT02956772
• Other study ID #: RACE16001
• Status: Not yet recruiting
• Phase: Phase 2
• First received: November 2, 2016
• Last updated: February 21, 2017
• Start date: November 2016
• Est. completion date: November 2020

Study information

• Verified date: February 2017
• Source: Hunan Provincial People's Hospital
• Contact: Lin Long, Dr.
• Phone: 86-13507476175
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

A multicentre, randomized, open-label, parallel-group, active controlled study.

Description:

Primary hepatocellular carcinoma (HCC) is one of the most common types of cancer and accounts for significant morbidity and mortality worldwide. Notably, more than half of the new HCC cases and deaths develop in China. Transarterial chemoembolization (TACE) has been proposed as the first-line therapeutic strategy for the treatment of patients with unresectable HCC. However, TACE has several limitations itself which might be potentially associated with tumor metastasis and relapse.

Recent studies have demonstrated that arsenic trioxide (As2O3) can act as the first-line therapeutic option in the treatment of acute promyelocytic leukemia. Thereafter, several small studies in China showed promising clinical benefits when As2O3 is administrated among the HCC patients. With these preliminary results, the investigators are planning to carry out a multicenter randomized controlled trial through which to explore the potential efficacy and safety of adjuvant As2O3 treatment for HCC patients.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 190
• Est. completion date: November 2020
• Est. primary completion date: November 2019
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 80 Years

Eligibility

1. Subject is 18-80 years old.

2. Subject has no portal stem vein tumor thrombus.

3. Subject has primary middle-advanced liver cancer of Barcelona Clinic Liver Cancer stages B/C inappropriate for surgical resection or other locoregional therapy and still presents with tumor lesions in the liver.

4. Subject has evaluable tumor lesion(s) (using Magnetic Resonance Imaging /Computed Tomography) according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) Version 1.1: single lesion size =5cm or at least one lesion of >3cm in size when 2-3 lesions exist or there are 4 or more lesions.

5. Subject has an Eastern Cooperative Oncology Group (ECOG) performance status =1, Fibrosis index based on 4 factors (FIB-4)=6 and an expected survival time of 12 weeks or more.

6. Haematology: white blood cell count =3.0×10^9/L; hemoglobin=10 g/dL; blood platelet count=80×10^9/L

7. Blood biochemistry: serum albumin =2.8 g/dL, total bilirubin =2 mg/dL or =34.2 umol/L, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) = 2 times of upper limit of normal (ULN); amylase and lipase = 1.5 times of ULN; serum creatinine =2.0 mg/dL or < 1.5 times of ULN; estimated creatinine clearance =60 mL/min.

8. International normalized ratio (INR) is = 2.3 or prothrombin time (PT) is =3 seconds than upper limit of normal control.

9. Echocardiogram indicated a left ventricular ejection fraction (LVEF) of >50%.

10. Subject has a liver function Child-Pugh class A or B.

11. Subject is not pregnant or lactating.

12. Female subjects must be infertile or agree to take effective contraceptives; male subjects and their partners of reproductive potential must also agree to use appropriate contraceptives.

13. Subject had no second tumor in the last 5 years, excluding skin basal cell carcinoma or skin squamous carcinoma or any other carcinoma in situ.

14. Subject had no history of systemic chemotherapy.

15. Subject has no any other concomitant anticancer therapies, such as local radiotherapy, systemic chemotherapy and molecular targeted therapy.

16. Subject and (or) guardian is able to understand this study and willing to provide written, informed consent to participate in this clinical study.

Related Conditions & MeSH terms

• Carcinoma
• Carcinoma, Hepatocellular
• Primary Hepatocellular Carcinoma

Intervention

Drug:
• TACE
After the puncture of femoral artery via Seldinger method, a catheter was inserted and digital celiac axis or hepatic arteriography performed. Then a microcatheter was used to infuse chemotherapeutic agent (30 to 60 mg of pirarubicin) mixed with 5 to 20 mL of Lipiodol Ultra-Fluid. Embosphere microspheres (size of 100 to 300 um) were inserted for embolization.
• Arsenic trioxide
Arsenic trioxide 10 mg is put into 500 ml saline solution and then administrated by continuous intravenous drip for 5 hours during a treatment day.

Locations

Country	Name	City	State
China	Hunan Cancer Hospital	Changsha	Hunan
China	Hunan Provincial People's Hospital	Changsha	Hunan
China	Xiangya Hospital Central South University	Changsha	Hunan
China	Guizhou Cancer Hospital	Guiyang	Guizhou
China	Guizhou Province Tumor Hospital	Guiyang	Guizhou
China	The First Affiliated Hospital of University of South China	Hengyang	Hunan
China	The Tumor Hospital of Yunnan Province	Kunming	Yunnan
China	Jiangsu Province Hospital	Nanjing	Jiangsu
China	Xinjiang Medical University Cancer Hospital	Urumqi	Xinjiang

Sponsors (1)

Lead Sponsor	Collaborator
Hunan Provincial People's Hospital

Country where clinical trial is conducted

China, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Quality of life using EuroQol five dimensions five levels questionnaire		Baseline and week 6, 12, 18, 24 and 30 using EuroQol five dimensions five levels questionnaire
Primary	Progression free survival	Progression free survival (PFS) is defined as the time interval from the day of the random assignment to the first evidence of progression or death.	2-year
Secondary	Objective response rate	Tumor response is defined as complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) according to RECIST and will be assessed by the investigators. The tumor objective response rate (ORR) is calculated per treatment arm as the proportion of randomized patients having a confirmed best response of CR or PR.	2-year
Secondary	Overall Survival	Overall survival will be measured from the date of randomization up to the date of death of any cause	2-year
Secondary	Incidence of adverse events	Toxicities will be evaluated and graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) v 4.0.	Up to 2 years through study completion