HAIC Combined with PD-1 Inhibitor in Potentially Resectable Locally Advanced HCC
NCT ID: NCT03869034
Last Updated: 2024-12-03
Study Results
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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ACTIVE_NOT_RECRUITING
PHASE2
40 participants
INTERVENTIONAL
2019-03-25
2025-12-31
Brief Summary
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Detailed Description
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Hepatocellular carcinoma patients are mostly diagnosed in locally advanced stage, and hepatic artery interventional therapy and/or systemic therapy are the main treatments options for these patients. In recent years, some researchers have reported that chemotherapy plays a critical role in transcatheter arterial intervention (Shi et al. JNCI, 2012, 105: 59). Compared with transcatheter arterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC) provides a more stable and long-lasting local control rate, which promised better outcomes. However, the effectiveness of HAIC varies greatly depending on the chemotherapy drug used, with an efficiency ranging from 7-81% and OS ranging from 6-15.9 months.
The single-drug treatment of PD-1 inhibitor in advanced hepatocellular carcinoma has a tumor response rate of 17%, the disease control rate exceeds 60%, and the overall survival time exceeds 12 months. And it has good tolerance and less adverse events. In studies in other cancers, combined with traditional chemotherapy can further improve the efficacy of PD-1 inhibitors.
Our study is a prospective phase II clinical study for patients with potentially resectable locally advanced hepatocellular carcinoma (tumor confined to the liver with invasion to branches of the portal vein or hepatic vein). Progressive survival (PFS) based on RECIST 1.1 is the primary end point of the present study. The OS and overall survival rate, RFS, ORR, DCR, conversion rate, pathological response, and safety are the secondary endpoints. The exploratory endpoints included the research on biomarkers. The efficacy and safety of HAIC combined with PD-1 inhibitor in the treatment of potentially resectable locally advanced hepatocellular carcinoma will be discussed.
Radiological assessments are performed every two cycles over the course of treatment, then every 3 months within the first two years following the completion of treatment and every 6 months thereafter, until PD were recorded. All subjects are followed until death or lost to follow up. The recurrence, metastasis sites, detection methods, adjuvant treatment and accurate survival time were recorded in detail.
Due to the lack of historical data and expected effect size for this population, the sample size of this pilot study is arbitrarily set at 40, including two intervention arms. Arm A will included 30 patients who receive HAIC combined with sintilimab. Arm B will included 10 patients who receive only HAIC. The patients are assigned to any group according to their willing.
The Kaplan-Meier method was used to estimate progression-free survival and overall survival; the Log-rank method was used for single factor analysis; the Cox model was analyzed by multivariate analysis. All the statistical tests were two-sided, and P \< 0.05 was considered statistically significant.
Conditions
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Study Design
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NON_RANDOMIZED
PARALLEL
TREATMENT
NONE
Study Groups
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A, Combination group (HAIC+PD-1)
HAIC+PD-1
HAIC+PD1
Sintilimab ( 200mg Q3W iv D1)+FOLFOX-HAIC（oxaliplatin, 130 mg/m2 and leucovorin, 200 mg/m2, and fluorouracil, 400 mg/m2, bolus and 2400 mg/m2 over 46 hours Q3W D2 D3), maximally 8 cycles Multi-disciplinary consultation was organized to decide the chance of surgery and subsequent treatment per 2 treatment cycles. Patients who achieved partial response (PR) or minor response (MR) per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 and were assessed as eligible for R0 resection go on to undergo surgical resection. After recovery from operation , sintilimab monotherapy was given per three weeks for maximally 16 doses. Patients who were ineligible for resection would continue to receive the combination therapy.
B, HAIC group (HAIC only)
HAIC
HAIC
FOLFOX-HAIC: oxaliplatin, 130 mg/m2 and leucovorin, 200 mg/m2, and fluorouracil, 400 mg/m2, bolus and 2400 mg/m2 over 46 hours Q3W D2 D3, for maximally 8 cycles, and the safety parameters are reviewed before the start of each course of HAIC treatment. Patients who achieve partial response (PR) or minor response (MR) per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 and are assessed as eligible for R0 resection go on to undergo surgical resection. No other anti-tumor therapies are allowed before PD or postoperative relapse is confirmed.
Interventions
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HAIC+PD1
Sintilimab ( 200mg Q3W iv D1)+FOLFOX-HAIC（oxaliplatin, 130 mg/m2 and leucovorin, 200 mg/m2, and fluorouracil, 400 mg/m2, bolus and 2400 mg/m2 over 46 hours Q3W D2 D3), maximally 8 cycles Multi-disciplinary consultation was organized to decide the chance of surgery and subsequent treatment per 2 treatment cycles. Patients who achieved partial response (PR) or minor response (MR) per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 and were assessed as eligible for R0 resection go on to undergo surgical resection. After recovery from operation , sintilimab monotherapy was given per three weeks for maximally 16 doses. Patients who were ineligible for resection would continue to receive the combination therapy.
HAIC
FOLFOX-HAIC: oxaliplatin, 130 mg/m2 and leucovorin, 200 mg/m2, and fluorouracil, 400 mg/m2, bolus and 2400 mg/m2 over 46 hours Q3W D2 D3, for maximally 8 cycles, and the safety parameters are reviewed before the start of each course of HAIC treatment. Patients who achieve partial response (PR) or minor response (MR) per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 and are assessed as eligible for R0 resection go on to undergo surgical resection. No other anti-tumor therapies are allowed before PD or postoperative relapse is confirmed.
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
2. Hepatocellular carcinoma: patients need to be diagnosed as hepatocellular carcinoma (HCC) histologically before treatment.
3. Never received any anti-cancer treatment in the past.
4. potentially resectable Locally advanced HCC: with at least one measurable lesion (RECIST 1.1), and tumor(s) confined to the left or right hemi-liver, with macroscopic invasion to branch of the portal vein and/or hepatic vein.
5. No extrahepatic metastases.
6. No contraindications for the treatment of HAIC and PD-1 inhibitors.
7. KPS≥90.
8. Liver function: Child-Pugh class A.
9. The expected survival of the patient is more than 6 months.
10. Adequate hematological and organ function.
11. The following conditions are met:
Platelet≥75×10\^9/L; White blood cell≥3.0×10\^9/L; Hemoglobin≥90 g/L; Serum creatinine≤1.5 × upper limit of normal (ULN); PT≤3 second extension; total bilirubin ≤1.5 x ULN； AST and ALT ≤2.5 x ULN.
12. Agree to accept postoperative follow-up required by the design of this study.
13. Patients must have the ability to understand and voluntarily sign the informed consent, and must sign an informed consent before starting any specific procedure for the study.
Exclusion Criteria
2. With uncontrolled hepatitis B (HBV-DNA\>2000 IU/ml and elevated ALT).
3. Multi-nodules hepatocellular carcinoma beyond hemi-hepatic range.
4. Patients with tumor thrombus reaches or exceeds the portal vein.
5. History of other malignancies.
6. History of allergic reactions to related drugs.
7. History of organ transplantation.
8. Pregnant women, nursing mothers.
9. Patients have other factors that may interfere with patient enrollment and assessment results.
10. Refuse follow-up as required by this study protocol and refuse to sign informed consent.
18 Years
70 Years
ALL
No
Sponsors
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Innovent Biologics, Inc.
OTHER
Sun Yat-sen University
OTHER
Responsible Party
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XU li
Clinical Professor
Principal Investigators
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Min-shan Chen, MD, PhD
Role: PRINCIPAL_INVESTIGATOR
Sun Yat-sen University
Locations
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Sun Yat-sen University Cancer Center
Guangzhou, Guangdong, China
Countries
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References
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Lyu N, Kong Y, Mu L, Lin Y, Li J, Liu Y, Zhang Z, Zheng L, Deng H, Li S, Xie Q, Guo R, Shi M, Xu L, Cai X, Wu P, Zhao M. Hepatic arterial infusion of oxaliplatin plus fluorouracil/leucovorin vs. sorafenib for advanced hepatocellular carcinoma. J Hepatol. 2018 Jul;69(1):60-69. doi: 10.1016/j.jhep.2018.02.008. Epub 2018 Feb 20.
Lyu N, Lin Y, Kong Y, Zhang Z, Liu L, Zheng L, Mu L, Wang J, Li X, Pan T, Xie Q, Liu Y, Lin A, Wu P, Zhao M. FOXAI: a phase II trial evaluating the efficacy and safety of hepatic arterial infusion of oxaliplatin plus fluorouracil/leucovorin for advanced hepatocellular carcinoma. Gut. 2018 Feb;67(2):395-396. doi: 10.1136/gutjnl-2017-314138. Epub 2017 Jun 7. No abstract available.
He MK, Le Y, Li QJ, Yu ZS, Li SH, Wei W, Guo RP, Shi M. Hepatic artery infusion chemotherapy using mFOLFOX versus transarterial chemoembolization for massive unresectable hepatocellular carcinoma: a prospective non-randomized study. Chin J Cancer. 2017 Oct 23;36(1):83. doi: 10.1186/s40880-017-0251-2.
Other Identifiers
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HAICPD1-HCC
Identifier Type: -
Identifier Source: org_study_id