Trial for Hepatocellular Carcinoma Adjuvant Treatment by Lipiocis

NCT ID: NCT00116454

Last Updated: 2013-09-23

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE3
• Total Enrollment: 73 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2005-07-31
• Study Completion Date: 2013-08-31

Brief Summary

The recurrence of hepatocellular carcinoma (HCC), two years after curative treatment is high, about 40% - 50%. Recently, it has been shown that intra-arterial radioactive lipiodol (Lipiocis®) could reduce the recurrence of cancer and increase the survival after resection of HCC developed on cirrhosis B. The aim of the present trial is to investigate the effect of Lipiocis® in preventing recurrence after curative treatment of HCC in patients with viral or alcoholic hepatitis related cirrhosis by surgical or percutaneous ablation.

Detailed Description

The usual therapeutic approaches of early hepatocellular carcinoma (HCC) are partial hepatectomy or percutaneous ethanol injection. However, these therapeutic procedures do not suppress the cirrhotic liver tissue which represents a major risk factor for recurrence and/or occurrence of a second tumor in the liver. Recently, it has been shown that intra-arterial radioactive lipiodol (Lipiocis®) could reduce the recurrence of cancer and increase the survival after resection of HCC developed on cirrhosis B. The aim of the present randomized and multicenter trial is to investigate the effect of iodine-131-labelled lipiodol (131I-lipiodol = Lipiocis®) in preventing recurrence after curative treatment of HCC (hepatocellular carcinoma) in patients with viral or alcoholic hepatitis related cirrhosis by surgical or percutaneous ablation. The period of this study will be 3 years including 1 year for the enrollment and 2 years for the follow-up. Fifty patients will receive one 2200 MBq dose of Lipiocis and 50 patients will not be treated by Lipiocis (control group). The intra-arterial hepatic administration of Lipiocis will occur 11 to 12 weeks after the initial curative treatment.

The inclusion criteria are as follows : 1) men or women, aged between 18 and 75 years old, with cirrhosis or chronic hepatitis associated with C, B, delta infection or alcool intake or both and confirmed by liver biopsy and 2) one or two HCC nodules treated by surgical or percutaneous ablation (ethanol, acetic acid 50% or radiofrequency).

The efficacy of the initial curative treatment will be assessed by the following criteria: alpha-fetoprotein concentration below 25ng/ml, no progression in size of the tumour demonstrated by ultrasonography and no arterial hypervascularization on CT scan imaging.

The patients with the following criteria will be excluded: co-infection with HIV (Human Immunodeficiency Virus)associated with a CD count <200/mm3 and a viral charge >5000 HIV RNA copies/ml, documented iodine intolerance, respiratory disease, decompensated cirrhosis (Child-Pugh score over or equal 8), bilirubin concentration over 51µmol/l, portal or hepatic vein thrombosis, extra-hepatic metastasis, excessive alcohol intake (over 50g per day), blood platelet count below 50,000/mm3, neutrophil count below 1500/mm3, creatininemia over 120µmol/l, other severe concurrent disease, previous treatment for hepatocellular carcinoma and women who can be pregnant or breastfeeding.

The main endpoint will be to determine whether the Lipiocis® treatment reduces the percentage of recurrence from 50% to 20% at 24 months. The secondary end-points will be the overall survival, the survival without recurrence of the primary tumor, the survival without new tumor, the deterioration of hepatocellular function and the side effects of the Lipiocis® treatment.

Conditions

Carcinoma, Hepatocellular; Hepatitis, Viral, Human

Keywords

Carcinoma, Hepatocellular; Viral Hepatitis, Alcoholic Hepatitis

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

lipiocis group

intra-arterial hepatic administration, one 2200 MBQ dose, duration of treatment 1 week

Group Type: EXPERIMENTAL

131 I-lipiodol

Intervention Type: DRUG

intra-arterial hepatic administration of Lipiocis will occur, 11 to 12 weeks after the initial curative treatment

control group

group untreated

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

131 I-lipiodol

intra-arterial hepatic administration of Lipiocis will occur, 11 to 12 weeks after the initial curative treatment

Intervention Type: DRUG

Other Intervention Names

Lipiocis

Eligibility Criteria

Inclusion Criteria

• Men or women , aged between 18 and 75 years old
• Cirrhosis or chronic hepatitis associated with C, B, delta infection or alcool intake or both and confirmed by liver biopsy
• One or two HCC nodules treated by surgical or percutaneous ablation (ethanol, acetic acid 50% or radiofrequency).
• The efficacy of the initial curative treatment will be assessed by the following criteria: alpha-fetoprotein concentration < or equal 25ng/ml, no progression in size of the tumour demonstrated by ultrasonography and no arterial hypervascularization on CT scan imaging

Exclusion Criteria

• HIV coinfection associated with a CD count<200/mm3 and a viral charge>5000 HIV RNA copies/ml
• Documented iodine intolerance
• Respiratory insufficiency
• Decompensated cirrhosis (Child-Pugh score over 8)
• Bilirubin concentration over 51 µmol/l
• Portal or hepatic vein thrombosis
• Extra-hepatic metastasis
• Excessive alcohol intake (over 50g per day)
• Blood platelet count below 50000/mm3
• Neutrophil count above 1500/mm3
• Creatininemia over 120µmol/l
• Myocardial infarction or rhythm disorders
• Psychiatric disease with hospitalization
• Previous treatment for hepatocellular carcinoma
• Pregnant or breastfeeding
• Treatment with interferon and/or ribavirin 3 months before inclusion
• Treatment with tamoxifen or somatostatin analogs or systemic chemotherapy

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 75 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

ANRS, Emerging Infectious Diseases

OTHER_GOV

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Olivier Rosmorduc, MD

Role: PRINCIPAL_INVESTIGATOR

Hopital Saint Antoine SERVICE D'HEPATOLOGIE

Fabrice Carrat, MD

Role: STUDY_DIRECTOR

INSERM U 444 FACULTE DE MEDECINE ST ANTOINE

Locations

Service d'Hépatologie Hôpital Saint Antoine

Paris, , France

Countries

France

Related Links

http://www.anrs.fr

Related Info

Other Identifiers

ANRS HC06 LIPIOCIS

Identifier Type: OTHER

Identifier Source: secondary_id

2004-003883-31

Identifier Type: -

Identifier Source: org_study_id