- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02319200
Primary Prevention Hepatocellular Carcinoma by Metformin (METFOVIR)
PRIMARY PREVENTION OF HEPATOCELLULAR CARCINOMA BY METFORMIN IN PATIENTS WITH VIRAL C CIRRHOSIS : PROSPECTIVE MULTICENTER STUDY, RANDOMIZED CONTROL TRIAL. Ancillary Study of the ANRS CO12 CirVir Cohort
Metformin treatment during 36 months could be associated with decreased risk of HCC occurrence and liver related death in patients with compensated HCV cirrhosis and insulinoresistance.
This study is an ancillary of the observational study from the CIRVIR cohort in which more than 1200 patients with compensated HCV cirrhosis are currently included.
participating centers : 26
Study Overview
Status
Intervention / Treatment
Detailed Description
Hepatocellular carcinoma (HCC) is currently the first cause of death of patients with compensated HCV cirrhosis.Despite progresses,existing therapies are limited in their ability to prevent recurrences. Even diagnosed at early stage, long-term prognosis remains poor due to the high rate of recurrence after local treatments. Liver transplantation the only long-term curative treatment is limited by advanced age, comorbidities or the shortage of the graft It concerns less than 5 % of HCC patients . Therefore, the best approach to reduce mortality remains the reduction of HCC incidence.
Abundant observational studies have related a relation between insulinoresistance occurrence and outcome of many cancers. The level of IR assessed by the HOMA index have been recognized as an independent predictive factor of HCC occurrence in patients with compensated viral C cirrhosis. Metformin, a Type 2 diabetic treatment drug, inhibits hepatic gluconeogenesis and increases the stimulation of the glucose uptake in muscle.
Independently of its' anti diabetic effects, Metformin is credited of anti tumoral, anti oxidant, anti inflammatory, and anti angiogenic properties.
Amount epidemiological and experimental data have demonstrated the anti tumoral and chemopreventive effect of metformin in certain cancers.
From our cohort of patients with compensated HCV cirrhosis and not treated by insulin, we have observed that the level of IR assessed by the HOMA was a strong and independent risk factor of HCC occurrence and liver related death. We have also observed in our cohort of diabetic patients with compensated HCV cirrhosis, that treatment by Metformin was associated with a decreased risk of HCC occurrence and liver related death.
HYPOTHESIS
Treatment with metformin could decreased the HCC occurrence and liver related death or transplantation.
MAIN OBJECTIVE
Evaluation the impact of Metformin treatment on HCC occurrence and liver related death in patients with compensated HCV cirrhosis and Insulinoresistance SECONDARY OBJECTIVE
- Occurrence of decompensation of the cirrhosis (ascite, sepsis, encephalopathy, haemorrhage)
- Evaluation of the treatment tolerance
MAIN CRITERION JUDGMENT
Rate of HCC occurrence or liver related-death or transplantation.
SECONDARY CRITERION JUDGMENT
- Occurrence of decompensation of the cirrhosis (ascite, sepsis, encephalopathy, haemorrhage),
- Tolerance
STUDY ASSESSMENTS
The patient of CIRVIR cohort meeting the inclusion criteria will be invited to participate to this study.
During their next visit, the hepatologist, will give full verbal and written information regarding the objective procedures of the study and the possible benefice and side effects of the treatment. A write informed consent will be obtained from all patients who agree to participate to the study.
The treatment period will begin following randomization. On day M0 baseline measurements will be taken and recorded, and metformin administration will be begun. In order to optimize the treatment tolerance, it will be suggested to the patients to take the pill during or at the end of the lunch. During the first week, the posology of the placebo and metformin will be 500 mg at the breakfast. After, the posology will be increased every week as follow: 500 mg morning and afternoon, then 1000 mg morning and afternoon (2000 mg per day). In case of intolerance, the maximum posology tolerated will be maintained. In fact regarding the primary data of the trial regarding the effect of metformin on colonic polyp, it seems possible that low dose of metformin are potentially active This treatment will continue until the end of the study.
FOLLOW UP
Patients will be seen at one month and followed every 3 months. Clinical evaluation and HCC screening are planed In CIRVIR cohort study, Every 6 months.
Duration of Treatment per patient:
• 36 months
Duration of Trial Recruitment:
• 24 months
PARTICIPATING CENTERS : 26
NUMBER OF SUBJECT
In order to demonstrate a reduction of 40% (HR 0.6) of events under metformin vs placebo with 80% power and 5% two-sided alpha risk, 200 patients per arm are necessary.A sample size reassessment will be made after 50% and 75% of patients included based on predictive power calculation.
We estimated that 5% of patients will not tolerate the treatment in the first month, and that 5% more will be lost to follow or not compliant to treatment during the follow up period. Therefore, the number of patients to be included is 222 patients per group.
STATISTICAL ANALYSIS
Clinical data of all the patients will be prospectively collected in a computerized database
Populations analyzed The main analysis will be based on the intent-to-treat population (ITT) of all randomized patients
In addition an explanatory analysis (PP) of all patients randomized & treated without major protocol violations/deviations will be carried out. Pre-defined major protocol violations/deviations are:
- missing data for the primary efficacy endpoints
- no study drug received
- violation of inclusion criteria
- Additional protocol violations will be possibly defined during the blind data review
Statistical tests. Main criterion: rate of HCC occurrence and liver related-death or transplantation.
The cumulative incidence of HCC and liver-related death or transplantation will be compared according to metformin treatment at inclusion using the log-rank test.
In addition, univariate Cox regression models will be used to identify predictive factors of primary endpoint.
For each endpoint, variables with a P value less than 0.10 in the univariate analysis predicting outcomes will be entered into stepwise Cox regression multivariate models. For sensitivity analyses, the incidence of HCC will be also adjusted on usual risk factors. The same models considering competing risks will be tested using the Fine and Gray test.
Secondary criteria : Occurrence of decompensation of the cirrhosis (ascite, sepsis, encephalopathy, haemorrhage).
Comparisons between groups will be performed first in a univariate manner using the χ2 test or the Fisher-exact tests. Multiple logistic regression models will be used to assessed a possible difference between groups when adjusted on parameters known or identified during the study as possibly affecting these outcomes.
Study Type
Enrollment (Actual)
Phase
- Phase 3
Contacts and Locations
Study Locations
-
-
-
Bobigny, France, 93009
- Roulot Dominique
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age of 18 years or older
- Patients included in ANRS cohort CO12 CirVir
- Without Hepatic local lesion (s) suggestive of HCC in the inclusion
- No indication for liver transplantation at baseline
- Child Pugh A or B7 at inclusion
- Without co-infection with HIV or HBV
- No history of lactic acidosis or of lactic acidosis at inclusion
- Insulino-resistance: (HOMA ≥2), or Body mass index≥ 25 kg/m ² without diabetes, or untreated known diabetes with HbA1c < 7 %
- No treatment with Metformin or other oral hypoglycemic containing metformin within 30 days before enrollment
- Available healthcare insurance
- Signed written informed consent.
Exclusion Criteria:
- Patient under guardianship or homeless
- Pregnant or breast-feeding women
- Patients with severe disease (excluding HCV liver disease) may threaten short-term life
- Cirrhosis with Child Pugh score> 7
- An alcohol consumption, higher than 40g / day for men and 30g / day for women
- Type 1 diabetes
- Diabetes treated with metformin
- Diabetes not treated with metformin with HbA1c ≥ 7%
- Hypersensitivity / intolerance in biguanides
- Hypersensitivity to the active substance or to any of the excipients.
- Kidney failure defined by creatinine clearance less than 30 ml/ min (MDRD formula)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Metformin
1000 mg (2x500 mg) at morning and 1000 mg (2x500 mg) at afternoon (2000 mg per day) Metformin daily during 36 months |
1000 mg (2x500 mg) at morning and 1000 mg (2x500 mg) at afternoon (2000 mg per day) Metformin daily during 36 months
Other Names:
|
Placebo Comparator: placebo tablet
2 tablets at morning and 2 tablets at afternoon 4 tablets per day
|
4 tablets per day for 36 months
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
rate of HCC occurrence and liver related-death or transplantation.
Time Frame: at 6 months
|
at 6 months
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
occurrence of liver-related complications (Ascites , gastrointestinal bleeding, encephalopathy)
Time Frame: at 6 months
|
at 6 months
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Dominique Roulot, MD, Hospital AVICENNE
Publications and helpful links
General Publications
- Nkontchou G, Cosson E, Aout M, Mahmoudi A, Bourcier V, Charif I, Ganne-Carrie N, Grando-Lemaire V, Vicaut E, Trinchet JC, Beaugrand M. Impact of metformin on the prognosis of cirrhosis induced by viral hepatitis C in diabetic patients. J Clin Endocrinol Metab. 2011 Aug;96(8):2601-8. doi: 10.1210/jc.2010-2415. Epub 2011 Jul 13.
- Sangiovanni A, Prati GM, Fasani P, Ronchi G, Romeo R, Manini M, Del Ninno E, Morabito A, Colombo M. The natural history of compensated cirrhosis due to hepatitis C virus: A 17-year cohort study of 214 patients. Hepatology. 2006 Jun;43(6):1303-10. doi: 10.1002/hep.21176.
- N'Kontchou G, Mahamoudi A, Aout M, Ganne-Carrie N, Grando V, Coderc E, Vicaut E, Trinchet JC, Sellier N, Beaugrand M, Seror O. Radiofrequency ablation of hepatocellular carcinoma: long-term results and prognostic factors in 235 Western patients with cirrhosis. Hepatology. 2009 Nov;50(5):1475-83. doi: 10.1002/hep.23181.
- Perseghin G, Calori G, Lattuada G, Ragogna F, Dugnani E, Garancini MP, Crosignani P, Villa M, Bosi E, Ruotolo G, Piemonti L. Insulin resistance/hyperinsulinemia and cancer mortality: the Cremona study at the 15th year of follow-up. Acta Diabetol. 2012 Dec;49(6):421-8. doi: 10.1007/s00592-011-0361-2. Epub 2012 Jan 4.
- Goodwin PJ, Ennis M, Pritchard KI, Trudeau ME, Koo J, Taylor SK, Hood N. Insulin- and obesity-related variables in early-stage breast cancer: correlations and time course of prognostic associations. J Clin Oncol. 2012 Jan 10;30(2):164-71. doi: 10.1200/JCO.2011.36.2723. Epub 2011 Dec 12.
- Nkontchou G, Bastard JP, Ziol M, Aout M, Cosson E, Ganne-Carrie N, Grando-Lemaire V, Roulot D, Capeau J, Trinchet JC, Vicaut E, Beaugrand M. Insulin resistance, serum leptin, and adiponectin levels and outcomes of viral hepatitis C cirrhosis. J Hepatol. 2010 Nov;53(5):827-33. doi: 10.1016/j.jhep.2010.04.035. Epub 2010 Jul 14.
- Salmon D, Bani-Sadr F, Loko MA, Stitou H, Gervais A, Durant J, Rosenthal E, Quertainmont Y, Barange K, Vittecoq D, Shoai-Tehrani M, Alvarez M, Winnock M, Trinchet JC, Dabis F, Sogni P. Insulin resistance is associated with a higher risk of hepatocellular carcinoma in cirrhotic HIV/HCV-co-infected patients: results from ANRS CO13 HEPAVIH. J Hepatol. 2012 Apr;56(4):862-8. doi: 10.1016/j.jhep.2011.11.009. Epub 2011 Dec 13.
- Svegliati-Baroni G, Faraci G, Fabris L, Saccomanno S, Cadamuro M, Pierantonelli I, Trozzi L, Bugianesi E, Guido M, Strazzabosco M, Benedetti A, Marchesini G. Insulin resistance and necroinflammation drives ductular reaction and epithelial-mesenchymal transition in chronic hepatitis C. Gut. 2011 Jan;60(1):108-15. doi: 10.1136/gut.2010.219741. Epub 2010 Oct 21.
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Digestive System Diseases
- Pathologic Processes
- RNA Virus Infections
- Virus Diseases
- Infections
- Blood-Borne Infections
- Communicable Diseases
- Neoplasms by Histologic Type
- Neoplasms
- Neoplasms by Site
- Adenocarcinoma
- Neoplasms, Glandular and Epithelial
- Digestive System Neoplasms
- Liver Diseases
- Flaviviridae Infections
- Hepatitis, Viral, Human
- Liver Neoplasms
- Hepatitis, Chronic
- Hepatitis
- Fibrosis
- Carcinoma
- Carcinoma, Hepatocellular
- Hepatitis C
- Liver Cirrhosis
- Hepatitis C, Chronic
- Hypoglycemic Agents
- Physiological Effects of Drugs
- Metformin
Other Study ID Numbers
- P120138
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Hepatocellular Carcinoma
-
Roswell Park Cancer InstituteNational Comprehensive Cancer NetworkCompletedAdvanced Adult Hepatocellular Carcinoma | Localized Non-Resectable Adult Hepatocellular Carcinoma | Stage IIIA Hepatocellular Carcinoma | Stage IIIB Hepatocellular Carcinoma | Stage IIIC Hepatocellular Carcinoma | Stage IVA Hepatocellular Carcinoma | Stage IVB Hepatocellular Carcinoma | Stage III... and other conditionsUnited States
-
Academic and Community Cancer Research UnitedNational Cancer Institute (NCI)RecruitingUnresectable Hepatocellular Carcinoma | Stage III Hepatocellular Carcinoma AJCC v8 | Stage IIIA Hepatocellular Carcinoma AJCC v8 | Stage IV Hepatocellular Carcinoma AJCC v8 | Stage IVA Hepatocellular Carcinoma AJCC v8 | Stage IVB Hepatocellular Carcinoma AJCC v8 | BCLC Stage B Hepatocellular Carcinoma and other conditionsUnited States
-
Roswell Park Cancer InstituteMerck Sharp & Dohme LLCActive, not recruitingAdvanced Adult Hepatocellular Carcinoma | Child-Pugh Class A | Stage III Hepatocellular Carcinoma | Stage IIIA Hepatocellular Carcinoma | Stage IIIB Hepatocellular Carcinoma | Stage IIIC Hepatocellular Carcinoma | Stage IV Hepatocellular Carcinoma | Stage IVA Hepatocellular Carcinoma | Stage IVB Hepatocellular...United States
-
M.D. Anderson Cancer CenterNational Cancer Institute (NCI)CompletedUnresectable Hepatocellular Carcinoma | Advanced Adult Hepatocellular Carcinoma | Stage IIIB Hepatocellular Carcinoma AJCC v7 | Stage IIIC Hepatocellular Carcinoma AJCC v7 | BCLC Stage C Hepatocellular Carcinoma | Stage IV Hepatocellular Carcinoma AJCC v7 | Stage III Hepatocellular Carcinoma AJCC... and other conditionsUnited States
-
City of Hope Medical CenterNational Cancer Institute (NCI)RecruitingUnresectable Hepatocellular Carcinoma | Stage III Hepatocellular Carcinoma AJCC v8 | Stage IIIA Hepatocellular Carcinoma AJCC v8 | Stage IV Hepatocellular Carcinoma AJCC v8 | Stage IVA Hepatocellular Carcinoma AJCC v8 | Stage IVB Hepatocellular Carcinoma AJCC v8 | BCLC Stage B Hepatocellular Carcinoma and other conditionsUnited States
-
Academic and Community Cancer Research UnitedNational Cancer Institute (NCI); Genentech, Inc.RecruitingUnresectable Hepatocellular Carcinoma | Stage III Hepatocellular Carcinoma AJCC v8 | Stage IIIA Hepatocellular Carcinoma AJCC v8 | Stage IV Hepatocellular Carcinoma AJCC v8 | Stage IVA Hepatocellular Carcinoma AJCC v8 | Stage IVB Hepatocellular Carcinoma AJCC v8 | Stage IIIB Hepatocellular Carcinoma... and other conditionsUnited States
-
National Cancer Institute (NCI)CompletedUnresectable Hepatocellular Carcinoma | Advanced Adult Hepatocellular Carcinoma | Recurrent Hepatocellular Carcinoma | Stage IIIB Hepatocellular Carcinoma AJCC v7 | Stage IIIC Hepatocellular Carcinoma AJCC v7 | Stage IV Hepatocellular Carcinoma AJCC v7 | Stage III Hepatocellular Carcinoma AJCC v7 and other conditionsUnited States, Canada, Puerto Rico
-
Edward KimBristol-Myers Squibb; National Cancer Institute (NCI)TerminatedUnresectable Hepatocellular Carcinoma | Stage III Hepatocellular Carcinoma AJCC v8 | Stage IIIA Hepatocellular Carcinoma AJCC v8 | Stage IV Hepatocellular Carcinoma AJCC v8 | Stage IVA Hepatocellular Carcinoma AJCC v8 | Stage IVB Hepatocellular Carcinoma AJCC v8 | Stage IIIB Hepatocellular Carcinoma... and other conditionsUnited States
-
Mayo ClinicNational Cancer Institute (NCI)RecruitingAdvanced Hepatocellular Carcinoma | BCLC Stage B Hepatocellular Carcinoma | BCLC Stage C Hepatocellular Carcinoma | Metastatic Hepatocellular Carcinoma | BCLC Stage A Hepatocellular CarcinomaUnited States
-
Northwestern UniversityBristol-Myers Squibb; National Cancer Institute (NCI)CompletedStage IIIA Hepatocellular Carcinoma | Stage IIIB Hepatocellular Carcinoma | Stage IIIC Hepatocellular Carcinoma | Stage IVA Hepatocellular Carcinoma | Stage IVB Hepatocellular CarcinomaUnited States
Clinical Trials on Metformin
-
Anji PharmaSuspendedDiabetes Mellitus, Type 2Spain, United States, Canada, Hungary, Brazil, Czechia, Poland, Bulgaria
-
ShionogiCompleted
-
NuSirt BiopharmaCompletedType 2 Diabetes MellitusUnited States
-
Charles University, Czech RepublicCompleted
-
Bristol-Myers SquibbCompletedType 2 Diabetes MellitusSouth Africa, United States, Canada, Puerto Rico, Hungary, Germany, Czechia, Poland, Romania, United Kingdom
-
Woman'sPfizer; American Cancer Society, Inc.; Our Lady of the Lake Regional Medical...WithdrawnInsulin Resistance | Breast Cancer Stage | Racial BiasUnited States
-
Hoffmann-La RocheCompletedDiabetes Mellitus Type 2United States, Mexico, Argentina
-
Hadassah Medical OrganizationWithdrawn
-
Garvan Institute of Medical ResearchWeizmann Institute of ScienceActive, not recruitingType 2 Diabetes Mellitus | Pre DiabetesAustralia
-
University Hospital, Basel, SwitzerlandCompletedBecker's Muscular Dystrophy (BMD)Switzerland