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Nanocrystalline Megestrol Acetate Versus Placebo for Anorexia in Patients With Unresectable Hepatocellular Carcinoma Receiving TACE Combined With Targeted and Immunotherapy

A Multicenter, Randomized, Controlled Phase II Clinical Trial of Nanocrystalline Megestrol Acetate Versus Placebo for Anorexia in Patients With Unresectable Hepatocellular Carcinoma Receiving TACE Combined With Targeted and Immunotherapy

Primary Objective: To evaluate the effect of nanocrystalline megestrol acetate versus placebo on body weight and appetite in patients with unresectable hepatocellular carcinoma receiving TACE combined with targeted and immunotherapy.Secondary Objectives: To evaluate the effect of nanocrystalline megestrol acetate versus placebo on quality of life, inflammatory markers, nutritional indicators, and psychological stress in patients with unresectable hepatocellular carcinoma receiving TACE combined with targeted and immunotherapy.Exploratory Objective: To explore the impact of nanocrystalline megestrol acetate versus placebo on survival benefit in patients with unresectable hepatocellular carcinoma receiving TACE combined with targeted and immunotherapy.

Studieoversigt

Status

Ikke rekrutterer endnu

Betingelser

Intervention / Behandling

Undersøgelsestype

Interventionel

Tilmelding (Anslået)

88

Fase

  • Fase 2

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiekontakt

Studiesteder

    • Guangdong
      • Guangzhou, Guangdong, Kina, 510515
        • Nanfang Hospital of Southern Medical University
        • Kontakt:

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

  • Voksen
  • Ældre voksen

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Ingen

Beskrivelse

Inclusion Criteria:

  • Patients with unresectable primary hepatocellular carcinoma (HCC) confirmed by imaging or histopathology
  • No previous receipt of immunotherapy and/or targeted drug therapy
  • Child-Pugh score ≤ 7
  • At least one measurable lesion per RECIST 1.1 criteria; lesions without prior radiotherapy, cryotherapy or other local treatment
  • Single intrahepatic lesion < 10 cm, or fewer than 10 intrahepatic lesions with tumor burden < 50%
  • Meet precachexia criteria: non-volitional weight loss ≤ 5% in 6 months, plus systemic inflammation (CRP > 5 mg/L) or decreased appetite (FAACT-A/CS-12 score ≤ 37 points)
  • Meet cachexia criteria: accompanied by decreased appetite or systemic inflammation, with either non-volitional weight loss > 5% in 6 months or BMI < 18.5 kg/m² plus weight loss > 2%
  • Voluntarily participate and sign informed consent
  • Age ≥ 18 years, male or female
  • Able to swallow tablets normally
  • ECOG performance status 0 or 1
  • Life expectancy ≥ 12 weeks
  • Adequate major organ function without blood products or colony-stimulating factors within 14 days
  • Hematology: ANC ≥ 1.5×10⁹/L, Hb ≥ 80 g/L, PLT ≥ 50×10⁹/L
  • Liver function: TBIL ≤ 1.5×ULN, AST/ALT ≤ 5.0×ULN, ALB ≥ 28 g/L
  • Coagulation function: INR, PT or aPTT ≤ 1.5×ULN
  • Renal function: SCr ≤ 1.5×ULN or creatinine clearance ≥ 60 mL/min
  • Urine protein ≤ 1+ or 24-hour urine protein < 1.0 g
  • Cardiac function: LVEF ≥ 50%
  • Females of childbearing potential with negative pregnancy test within 3 days before first dosing
  • Fertile male and female patients agree to effective contraception from screening to 120 days after last study drug
  • HBV/HCV infected patients receive stable antiviral therapy without drug interaction

Exclusion Criteria:

  • Active or untreated CNS metastases; inadequately controlled metastatic brain or leptomeningeal disease
  • Uncontrolled tumor-related pain
  • Thromboembolic disease, ascites or lower limb edema within 6 months
  • History of other malignancies within 5 years before randomization, except curable low-risk tumors
  • Unresolved adverse toxicities from prior antitumor therapy not recovered to ≤ Grade 1 (CTCAE v5.0), excluding alopecia
  • Pregnant, breastfeeding females or those planning pregnancy during the study
  • Any unstable medical, psychiatric or social condition that may interfere with study participation
  • Positive HIV infection
  • Major surgery within 28 days prior to randomization
  • Severe cardiovascular disease, myocardial infarction, unstable arrhythmia, angina or cerebrovascular events
  • Severe systemic infection within 4 weeks before dosing or active infection requiring systemic anti-infective treatment
  • Impaired gastrointestinal absorption, long-term tube feeding, parenteral nutrition or eating disorders
  • Concomitant use of other appetite-enhancing or weight-stimulating agents
  • Cushing's syndrome, adrenal or pituitary insufficiency, poorly controlled diabetes
  • Uncontrolled hypertension despite oral antihypertensive treatment
  • Esophagogastric varices, severe ulcers, gastrointestinal bleeding, obstruction, perforation or fistula within 6 months
  • Known hypersensitivity to any component of the investigational product
  • Any other condition considered inappropriate for enrollment by the investigator.

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Firedobbelt

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Placebo komparator: Placebo gruppe
The first systemic treatment administration was defined as baseline, with continuous use of nanocrystalline medroxyprogesterone or placebo for 12 weeks during the antitumor therapy period.
Eksperimentel: Nanocrystalline megestrol acetate
The dose of medroxyprogesterone used in this study was 625 mg/day. The first systemic treatment administration was defined as baseline, with continuous use of nanocrystalline medroxyprogesterone or placebo for 12 weeks during the antitumor therapy period.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
The proportion of patients with >5% weight loss from baseline.
Tidsramme: Percentage weight change at Week 12 compared to baseline
Weight is measured in kilograms (kg).
Percentage weight change at Week 12 compared to baseline

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
L3-SMI
Tidsramme: Baseline(day1); prior to dosing in each systemic treatment cycle(each cycle lasts 21-28 days).
A single cross-sectional image of the third lumbar vertebra (L3) is obtained via CT/MRI scanning. Skeletal muscles at the L3 level, including the psoas major, erector spinae, quadratus lumborum, transversus abdominis, external oblique, and internal oblique muscles, are identified and quantified. The total skeletal muscle area of this slice is calculated using image analysis software such as Slice-O-Matic or ImageJ. The L3 skeletal muscle index (L3-SMI) is then derived by dividing the total muscle area by the square of height.
Baseline(day1); prior to dosing in each systemic treatment cycle(each cycle lasts 21-28 days).
The incidence and severity of adverse events (AEs) assessed by CTCAE5.0
Tidsramme: Adverse events (AEs) of each subject will be followed up for 30 days after the last dose of nanocrystalline megestrol acetate or until the initiation of new anti-tumor therapy, whichever occurs first.
Adverse events (AEs) of each subject will be followed up for 30 days after the last dose of nanocrystalline megestrol acetate or until the initiation of new anti-tumor therapy, whichever occurs first.
Objective Response Rate
Tidsramme: Baseline(day1), and after every two treatment cycles(up to 2 years).each cycle lasts 21-28 days.
Baseline(day1), and after every two treatment cycles(up to 2 years).each cycle lasts 21-28 days.
Life quality
Tidsramme: Baseline(day1); prior to dosing in each systemic treatment cycle(each cycle lasts 21-28 days).

The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) contains 30 items to evaluate health-related quality of life in cancer patients.

The global quality of life scale is scored from 1 to 7. All other items use a 4-point scale (1 = not at all, 2 = a little, 3 = quite a bit, 4 = very much). The raw score of each domain is the average score of its corresponding items. All raw scores are linearly converted to standardized scores ranging from 0 to 100 for unified comparison.For functional scales, the standardized score is calculated as: [1 - (RS-1)/range] × 100. The range refers to the score interval of each domain, namely the difference between the maximum and minimum values.

Higher scores in functional domains and the global quality of life scale represent better function and quality of life. Higher scores on symptom scales and single-item measurements reflect more severe symptoms or health-related problems.

Baseline(day1); prior to dosing in each systemic treatment cycle(each cycle lasts 21-28 days).
Overall Survival
Tidsramme: Baseline(day 1); prior to dosing in each systemic treatment cycle(up to 2 years,each cycle is 21-28 days), assessed up to 100 weeks.
Overall survival was defined as the time from randomization to death from any cause.
Baseline(day 1); prior to dosing in each systemic treatment cycle(up to 2 years,each cycle is 21-28 days), assessed up to 100 weeks.
Inflammatory markers
Tidsramme: Baseline(day1); prior to dosing in each systemic treatment cycle(each cycle is 21-28 days).
CRP:C-reactive protein IL-6:Interleukin-6 IL-1:Interleukin-1
Baseline(day1); prior to dosing in each systemic treatment cycle(each cycle is 21-28 days).
Anxiety and depression
Tidsramme: Baseline(day1); prior to dosing in each systemic treatment cycle(each cycle lasts 21-28 days).

Anxiety and depression were assessed using the following two scales respectively.

Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Developed based on DSM-IV depression criteria, this 9-item scale evaluates depressive symptoms over the past two weeks. Each item is scored 0-3 points, with a total score ranging from 0 to 27. Higher total scores indicate more severe depressive symptoms. A score of ≥1 on Item 9 suggests suicidal risk. The PHQ-9 is used only for screening, not formal depression diagnosis.

Anxiety symptoms were assessed using the Generalized Anxiety Disorder 7-item scale (GAD-7). This 7-item international scale evaluates anxiety conditions in the previous two weeks. Each item adopts a 4-point scoring method, with a total score of 0-21. Higher scores correspond to increased anxiety severity.

Baseline(day1); prior to dosing in each systemic treatment cycle(each cycle lasts 21-28 days).
Progression-Free Survival
Tidsramme: Baseline(day1); prior to dosing in each systemic treatment cycle(each cycle lasts 21-28 days)with a maximum follow-up of 100 weeks.
Progression-free survival was defined as the time from randomization to tumor progression or death, whichever occurred first.
Baseline(day1); prior to dosing in each systemic treatment cycle(each cycle lasts 21-28 days)with a maximum follow-up of 100 weeks.
Appetite status assessment
Tidsramme: Baseline(day1); prior to dosing in each systemic treatment cycle(each cycle is 21-28 days).
The A/CS-12 is a subscale of the Functional Assessment of Anorexia/Cachexia Therapy (FAACT). It enables quantitative and qualitative assessment of anorexia. Each item is scored from 0 to 4 points, with a total score ranging from 0 to 48. Lower scores indicate poorer appetite status.
Baseline(day1); prior to dosing in each systemic treatment cycle(each cycle is 21-28 days).
Nutritional indicators
Tidsramme: Baseline(day1); prior to dosing in each systemic treatment cycle(each cycle is 21-28 days).
Albumin (ALB),Hemoglobin (Hb)
Baseline(day1); prior to dosing in each systemic treatment cycle(each cycle is 21-28 days).

Samarbejdspartnere og efterforskere

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Sponsor

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Anslået)

22. juni 2026

Primær færdiggørelse (Anslået)

1. september 2027

Studieafslutning (Anslået)

1. september 2027

Datoer for studieregistrering

Først indsendt

13. april 2026

Først indsendt, der opfyldte QC-kriterier

27. april 2026

Først opslået (Faktiske)

4. maj 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

4. maj 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

27. april 2026

Sidst verificeret

1. april 2026

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • NFEC-2025-731

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