- ICH GCP
- Registr klinických studií v USA
- Klinická studie NCT07664007
Effects of EPA Supplementation on Patients With Unresectable Hepatocellular Carcinoma.
Effects of Nutritional Supplementation With Eicosapentaenoic Acid (EPA) on Body Composition and Systemic Pro-inflammatory and Pro-resolving Mediators in Patients Diagnosed With Unresectable Hepatocellular Carcinoma.
Přehled studie
Postavení
Podmínky
Detailní popis
Cancer-associated cachexia is a debilitating and potentially life-threatening syndrome characterized by progressive loss of body weight, skeletal muscle, and adipose tissue, leading to functional impairment and reduced response to oncologic therapy. It is driven in part by systemic inflammation and increased pro-inflammatory cytokines, and it cannot always be reversed with conventional support.
Eicosapentaenoic acid (EPA), an omega-3 polyunsaturated fatty acid (PUFA), has anti-inflammatory properties and is rapidly incorporated into cell membranes, modulating lipid mediator pathways. EPA supplementation may help to attenuate systemic inflammation, alleviate cachexia symptoms, and promote the production of specialized pro-resolving mediators. A daily dose of 3 grams appears sufficient to achieve maximal incorporation into cell membranes without significant adverse events.
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide, with most patients diagnosed at advanced stages. Cachexia is common in advanced HCC and contributes to functional decline, increased treatment toxicity, and poorer outcomes. Preclinical studies suggest that omega-3 PUFAs may also exert anti-tumor effects through modulation of COX-2 and Wnt/beta-catenin signaling pathways.
For these reasons, in this proposal, the investigators aim to determine wheter supplementation with EPA in combination with chemotherapy will modify the blood profile of pro-inflammatory and pro-resolving mediators, promoting the resolution of inflammation associated with HCC, and, in turn, mitigate muscle mass loss during oncologic treatment.
Typ studie
Zápis (Aktuální)
Fáze
- Nelze použít
Kontakty a umístění
Studijní místa
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Zaragoza
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Zaragoza, Zaragoza, Španělsko, 50009
- Hospital Clínico Universitario Lozano Blesa. IIS Aragón
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Kritéria účasti
Kritéria způsobilosti
Věk způsobilý ke studiu
- Dospělý
- Starší dospělý
Přijímá zdravé dobrovolníky
Popis
Inclusion Criteria:
- Participants diagnosed with unresectable HCC, candidates for systemic treatment with Sorafenib or similar agents.
- Eastern Cooperative Oncology Group (ECOG) performance status of 0-1.
- Life expectancy > 8 weeks.
- Not eligible for curative treatment (surgical resection/ablative therapy/liver transplantation).
- Not having a history of previous or concomitant malignancy except when a disease-free interval > 5 years had been documented.
- Not receiving any other systemic antitumor agents (docetaxel, doxorubicin, irinotecan).
Exclusion Criteria:
- Allergy to omega-3 acid or fish-derived products.
- Psychological or medical conditions that can interfere with study participation or the ability to provide informed consent.
- Drug abuse (except for alcohol).
- Any experimental therapy within 30 days prior to study entry.
- Recurrent epistaxis
Studijní plán
Jak je studie koncipována?
Detaily designu
- Primární účel: Léčba
- Přidělení: Randomizované
- Intervenční model: Paralelní přiřazení
- Maskování: Trojnásobný
Zbraně a zásahy
Skupina účastníků / Arm |
Intervence / Léčba |
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Experimentální: Intervention group
Patients with unresectable hepatocellular carcinoma (HCC) were given 3 grams/day of an oral lipidic emulsion of eicosapentaenoic acid in addition to their oncologic care during 12 weeks.
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1 sachet/day of 20 ml containing 3g EPA during 12 weeks
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Komparátor placeba: Control group
Patients with unresectable hepatocellular carcinoma (HCC) were given a placebo oral lipidic emulsion in addition to their oncologic care during 12 weeks.
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1 sachet/day of 20 ml of placebo during 12 weeks
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Co je měření studie?
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
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Effect of EPA supplementation on muscle mass
Časové okno: At baseline, and at 12 weeks (study completion)
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Muscle mass is assessed by calculating the skeletal muscle index using computed tomography, based on a single axial slice at the L3 level.
The SliceOmatic software (TomoVision) is used for the calculations.
Sarcopenia is evaluated using two criteria: Carey reference values for end-stage liver disease patients awaiting transplantation, and Martin reference values for oncology patients.
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At baseline, and at 12 weeks (study completion)
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Sekundární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
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Evolution of nutritional status.
Časové okno: At baseline, at 6 weeks, and at 12 weeks (study completion)
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Nutritional status is assessed using the validated Patient-Generated Subjective Global Assessment tool (PG-SGA, Bauer 2002) that classify patients as well nourished (A), moderately malnourished or at risk of malnutrition (B), or severely malnourished (C).
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At baseline, at 6 weeks, and at 12 weeks (study completion)
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Effect of EPA supplementation on quality of life assessed using the EORTC-QLQ-30.
Časové okno: At baseline, at 6 weeks, and at 12 weeks (study completion)
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Quality of life is assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-30)
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At baseline, at 6 weeks, and at 12 weeks (study completion)
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Change in the quality of life assessed using the EORTC-QLQ-HCC18.
Časové okno: At baseline, at 6 weeks, and at 12 weeks (study completion)
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Quality of life is assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Hepatocellular Carcinoma 18-question module (QLQ-HCC18).
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At baseline, at 6 weeks, and at 12 weeks (study completion)
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Effect of EPA supplementation on plasma and serum profiles of pro-inflammatory and pro-resolving lipid mediators.
Časové okno: At baseline, and at 12 weeks (study completion)
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Plasma and serum concentrations of pro-inflammatory and pro-resolving lipid mediators derived from polyunsaturated fatty acids are determined using targeted LC-MS/MS.
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At baseline, and at 12 weeks (study completion)
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Change in C-reactive protein (CRP) concentration upon supplementation.
Časové okno: At baseline, and at 12 weeks (study completion)
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The C-reactive protein is measured using an immunoturbidimetric assay following the standard laboratory methods in the Hospital Clínico Universitario Lozano Blesa.
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At baseline, and at 12 weeks (study completion)
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Change in interleukin 6 upon supplementation.
Časové okno: At baseline, and at 12 weeks (study completion)
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Plasma IL-6 levels are determined by enzyme-linked immunosorbent assay.
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At baseline, and at 12 weeks (study completion)
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Change in interleukin 8 upon supplementation.
Časové okno: At baseline, and at 12 weeks (study completion)
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Plasma Il-8 is quantified using the Human XL Cytokine Luminex® Kit Performance Assay (R&D Systems).
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At baseline, and at 12 weeks (study completion)
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Change in interferon gamma (IFNγ) upon supplementation.
Časové okno: At baseline, and at 12 weeks (study completion)
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Plasma IFNγ is quantified using the Human XL Cytokine Luminex® Kit Performance Assay (R&D Systems).
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At baseline, and at 12 weeks (study completion)
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Change in the neutrophil-to-lymphocyte ratio (NLR) upon supplementation.
Časové okno: At baseline, and at 12 weeks (study completion)
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NLR is calculated by dividing the absolute neutrophil count by the absolute lymphocyte count obtained from peripheral blood samples.
Both values were derived from the complete blood count (CBC) analysis.
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At baseline, and at 12 weeks (study completion)
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Spolupracovníci a vyšetřovatelé
Vyšetřovatelé
- Vrchní vyšetřovatel: Angel Lanas Arbeloa, MD, PhD, University Hospital Lozano Blesa. IIS Aragón. CIBER de Enfermedades Hepáticas y Digestivas
Publikace a užitečné odkazy
Obecné publikace
- Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, Cohen MH, Douglass HO Jr, Engstrom PF, Ezdinli EZ, Horton J, Johnson GJ, Moertel CG, Oken MM, Perlia C, Rosenbaum C, Silverstein MN, Skeel RT, Sponzo RW, Tormey DC. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med. 1980 Oct;69(4):491-7. doi: 10.1016/s0149-2918(05)80001-3.
- Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr. 2002 Aug;56(8):779-85. doi: 10.1038/sj.ejcn.1601412.
- Fearon KC, Voss AC, Hustead DS; Cancer Cachexia Study Group. Definition of cancer cachexia: effect of weight loss, reduced food intake, and systemic inflammation on functional status and prognosis. Am J Clin Nutr. 2006 Jun;83(6):1345-50. doi: 10.1093/ajcn/83.6.1345.
- Martin L, Birdsell L, Macdonald N, Reiman T, Clandinin MT, McCargar LJ, Murphy R, Ghosh S, Sawyer MB, Baracos VE. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013 Apr 20;31(12):1539-47. doi: 10.1200/JCO.2012.45.2722. Epub 2013 Mar 25.
- Blazeby JM, Currie E, Zee BC, Chie WC, Poon RT, Garden OJ; EORTC Quality of Life Group. Development of a questionnaire module to supplement the EORTC QLQ-C30 to assess quality of life in patients with hepatocellular carcinoma, the EORTC QLQ-HCC18. Eur J Cancer. 2004 Nov;40(16):2439-44. doi: 10.1016/j.ejca.2004.06.033.
- Ozola Zalite I, Zykus R, Francisco Gonzalez M, Saygili F, Pukitis A, Gaujoux S, Charnley RM, Lyadov V. Influence of cachexia and sarcopenia on survival in pancreatic ductal adenocarcinoma: a systematic review. Pancreatology. 2015 Jan-Feb;15(1):19-24. doi: 10.1016/j.pan.2014.11.006. Epub 2014 Dec 4.
- Carey EJ, Lai JC, Wang CW, Dasarathy S, Lobach I, Montano-Loza AJ, Dunn MA; Fitness, Life Enhancement, and Exercise in Liver Transplantation Consortium. A multicenter study to define sarcopenia in patients with end-stage liver disease. Liver Transpl. 2017 May;23(5):625-633. doi: 10.1002/lt.24750.
- Lim K, Han C, Dai Y, Shen M, Wu T. Omega-3 polyunsaturated fatty acids inhibit hepatocellular carcinoma cell growth through blocking beta-catenin and cyclooxygenase-2. Mol Cancer Ther. 2009 Nov;8(11):3046-55. doi: 10.1158/1535-7163.MCT-09-0551. Epub 2009 Nov 3.
- Ikeda T, Tozuka S, Hasumura Y, Takeuchi J. Prostaglandin-E-producing hepatocellular carcinoma with hypercalcemia. Cancer. 1988 May 1;61(9):1813-4. doi: 10.1002/1097-0142(19880501)61:93.0.co;2-u.
- Onesti JK, Guttridge DC. Inflammation based regulation of cancer cachexia. Biomed Res Int. 2014;2014:168407. doi: 10.1155/2014/168407. Epub 2014 May 4.
- Aoyagi T, Terracina KP, Raza A, Matsubara H, Takabe K. Cancer cachexia, mechanism and treatment. World J Gastrointest Oncol. 2015 Apr 15;7(4):17-29. doi: 10.4251/wjgo.v7.i4.17.
- Tazi E, Errihani H. Treatment of cachexia in oncology. Indian J Palliat Care. 2010 Sep;16(3):129-37. doi: 10.4103/0973-1075.73644.
Termíny studijních záznamů
Hlavní termíny studia
Začátek studia (Aktuální)
Primární dokončení (Aktuální)
Dokončení studie (Aktuální)
Termíny zápisu do studia
První předloženo
První předloženo, které splnilo kritéria kontroly kvality
První zveřejněno (Aktuální)
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Aktuální)
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Naposledy ověřeno
Více informací
Termíny související s touto studií
Klíčová slova
Další relevantní podmínky MeSH
- Patologické procesy
- Novotvary podle místa
- Novotvary
- Tělesná hmotnost
- Změny tělesné hmotnosti
- Novotvary podle histologického typu
- Novotvary trávicího systému
- Nemoci trávicího systému
- Onemocnění jater
- Novotvary, žlázové a epiteliální
- Adenokarcinom
- Novotvary jater
- Karcinom
- Ztráta váhy
- Hubenost
- Patologické stavy, příznaky a symptomy
- Příznaky a symptomy
- Karcinom, Hepatocelulární
- Zánět
- Kachexie
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Studuje produkt zařízení regulovaný americkým úřadem FDA
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