Clinical Trial Comparing TACE With TACE + SABR in Stage BCLC B HCC (HepSTAR)

NCT ID: NCT02958163

Last Updated: 2017-11-07

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE2

Total Enrollment

3 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-02-20

Study Completion Date

2017-10-17

Brief Summary

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This will be multicentre a phase II randomized controlled and open-label trial. It will compare the 6-months objective response (CR+PR) rates obtained with Drug Eluting Bead Trans-Arterial Chemo-Embolization (DEB-TACE) alone versus DEB-TACE followed by Stereotactic Ablative Radiotherapy (SABR) in patients with hepatocarcinoma stage BCLC B.

This trial will also include one substudy. This substudy will confront the immuno-histochemical results collected on tumoral biopsies to the biological and imaging (MRI) results. Every patient participating to the trial can also participate to this substudy.

Detailed Description

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The patients will be randomized in 2 arms determining the treatment they will receive:

Arm A: actual standard treatment = TACE Arm B: experimental arm = TACE + SABR

Conditions

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Liver Neoplasms Hepatocellular Cancer

Keywords

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Hepatocellular cancer Stereotactic Body Radiotherapy Chemoembolization, Therapeutic

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Trans-Arterial Chemo-embolization (TACE)

Trans-arterial Embolisation will be performed with drug-eluting beads loaded with Doxorubicin. First session will be given within 4 weeks after randomization.

4-phase MRI will be performed every 2 months to assess the response. In case of insufficient response according to the MRI performed at 2 or 4 months, a second or third session of DEB-TACE will be allowed, according to the physician's choice.

Once complete response is achieved, the follow-up period will start. The date of the last session of TACE corresponds to the treatment completion date.

Group Type ACTIVE_COMPARATOR

Trans-arterial Chemo-Embolization

Intervention Type PROCEDURE

Trans-Arterial Chemo-Embolization will be performed with Doxorubicin-Eluting-Beads (DEB-TACE). It will be performed in each arm of treatment.

Doxorubicin

Intervention Type DRUG

Drug-eluting Bead for Trans Arterial Chemo-Embolization will be loaded with Doxorubicin.

TACE+Stereotactic Ablative Radiotherapy

The first part of the treatment, which is the DEB-TACE delivery, will be exactly the same than in arm A. The radiotherapy (SABR) will then start within 4 to 6 weeks after.

Afterwards, 4-phase MRI will be performed every 2 months to assess the response. In case of insufficient response according to the MRI performed at 2 or 4 months, a second or third session of DEB-TACE will be allowed, according to the physician's choice.

Once complete response is achieved, the follow-up period will start. The date of the last SABR fraction or the last session of TACE corresponds to the treatment completion date.

Group Type EXPERIMENTAL

Trans-arterial Chemo-Embolization

Intervention Type PROCEDURE

Trans-Arterial Chemo-Embolization will be performed with Doxorubicin-Eluting-Beads (DEB-TACE). It will be performed in each arm of treatment.

Doxorubicin

Intervention Type DRUG

Drug-eluting Bead for Trans Arterial Chemo-Embolization will be loaded with Doxorubicin.

Stereotactic Ablative Radiotherapy

Intervention Type RADIATION

SABR schemes will be adapted according to the CP score and the vicinity of surrounding organs at risk. These are the different schemes proposed in this trial:

48Gy = 3x16Gy BED 124.8Gy ( α/β=10) 50Gy = 5x10Gy BED 100Gy ( α/β=10) 48Gy = 6x8Gy BED 86.4Gy ( α/β=10) 40Gy = 5x8Gy BED 72Gy ( α/β=10)

For patients with Child-Pugh (CP) A cirrhosis : the choice of the scheme will be left to each physician. The highest BED should be favored if dose constraints to the organs at risk are respected.

For patients with CP B cirrhosis : only the latter scheme will be allowed: 40Gy = 5x8Gy.

Interventions

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Trans-arterial Chemo-Embolization

Trans-Arterial Chemo-Embolization will be performed with Doxorubicin-Eluting-Beads (DEB-TACE). It will be performed in each arm of treatment.

Intervention Type PROCEDURE

Doxorubicin

Drug-eluting Bead for Trans Arterial Chemo-Embolization will be loaded with Doxorubicin.

Intervention Type DRUG

Stereotactic Ablative Radiotherapy

SABR schemes will be adapted according to the CP score and the vicinity of surrounding organs at risk. These are the different schemes proposed in this trial:

48Gy = 3x16Gy BED 124.8Gy ( α/β=10) 50Gy = 5x10Gy BED 100Gy ( α/β=10) 48Gy = 6x8Gy BED 86.4Gy ( α/β=10) 40Gy = 5x8Gy BED 72Gy ( α/β=10)

For patients with Child-Pugh (CP) A cirrhosis : the choice of the scheme will be left to each physician. The highest BED should be favored if dose constraints to the organs at risk are respected.

For patients with CP B cirrhosis : only the latter scheme will be allowed: 40Gy = 5x8Gy.

Intervention Type RADIATION

Other Intervention Names

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TACE DEB-TACE SABR

Eligibility Criteria

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Inclusion Criteria

* Hepatocellular carcinoma larger than 3 cm and non-resectable, with a diagnosis established either by:

* dynamic imaging (non-invasively), showing a typical contrast enhancement and wash-out
* histopathology
* satellite lesions are allowed (at most three lesions) as long as the doses constraints are still achievable
* Hepatocellular carcinoma belonging to Barcelona Clinic Liver Cancer Stage System class B
* Tumor must be measurable on a multi-phase MRI according to mRECIST criteria
* Non-tumoral liver volume ≥ 800 cc
* Child-Pugh (CP) A to B7 cirrhosis
* HCC Patients can be included if they require treatment prior to liver transplantation
* ECOG performance status 0-1
* AST/ALT \< 5 times ULN
* Initial platelets ≥ 50 000 x 10E9/l, neutrophils \> 1500 x 10E9/l, Hb \> 9 g/dl
* Serum creatinine \< 1.5 X normal, or calculated Creatinine clearance rate ≥ 60 mL/min
* As tumor biopsy can be performed after inclusion, pure hepatocellular carcinoma but also mixed hepatocellular carcinoma will be allowed in this trial. Cholangiocarcinoma cannot be included.
* Written informed consent form to be signed,
* Patient willing and able to comply to the follow-up schedule
* Patients in fertile age should use a contraceptive method during treatment and 4 months after.

Exclusion Criteria

* Eligibility for resection or ablative treatments
* Extra hepatic spread of the disease
* Previous treatment of the same lesion with TACE
* Previous treatment with selective internal radiotherapy or radiotherapy to the upper abdomen
* Uncontrolled Ascites
* Uncontrolled Encephalopathy
* Any clinical sign of acute viral or non-viral hepatitis (new serological testing are not required)
* Known current pregnancy
* Uncontrolled active co-morbidity
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Erasme University Hospital

OTHER

Sponsor Role collaborator

Jules Bordet Institute

OTHER

Sponsor Role collaborator

University of Liege

OTHER

Sponsor Role collaborator

Clinique Saint Joseph, Liège

OTHER

Sponsor Role collaborator

Centre Hospitalier Universitaire UCLouvain Namur

OTHER

Sponsor Role collaborator

Cliniques universitaires Saint-Luc- Université Catholique de Louvain

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Xavier GEETS

Role: PRINCIPAL_INVESTIGATOR

Cliniques Universitaires Saint Luc/MIRO

Ivan BORBATH

Role: PRINCIPAL_INVESTIGATOR

Cliniques universitaires Saint-Luc- Université Catholique de Louvain

Locations

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Hôpital de JOLIMONT

Jolimont, Hainaut, Belgium

Site Status

Centre Hospitalier Universitaire/CHC Saint Joseph

Liège, Liège, Belgium

Site Status

Cliniques Universitaires Saint Luc

Brussels, Woluwé Saint Lambert, Belgium

Site Status

Institut Jules Bordet/Hôpital Erasme

Brussels, , Belgium

Site Status

Clinique et Maternité Sainte Elisabeth/CHU Mont Godinne

Namur, , Belgium

Site Status

Countries

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Belgium

Other Identifiers

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28248368

Identifier Type: -

Identifier Source: org_study_id