Transarterial Chemoembolization Prior to Transplantation for Hepatocellular Carcinoma (CATCH)
10. april 2019 opdateret af: Rennes University Hospital
Efficacy of Transarterial Chemoembolization With DC-BeadsR Prior to Liver Transplantation for Hepatocellular Carcinoma on Patient Survival : A Prosepctive Multicentre and Randomized Study
The hope to treat more patients with hepatocellular carcinoma successfully is however tempered by the shortage of donors leading to an increasing waiting time for liver transplantation (LT).
Intention-to-treat analysis have showed that the reported excellent long-term outcome is curtailed and significantly hampered by the growing incidence of patients who must be removed from the waiting list because of tumor progression.
A way to face with this issue is to treat hepatocellular carcinoma prior to LT.
Among therapeutic options to impede tumor progression, Transarterial Chemoembolization (TACE) is the most common modality used.
While there are many studies concerning TACE in this setting, none are controlled studies and thus there is no firm evidence concerning its efficacy in reducing drop-out or increasing survival.
Moreover TACE may induce risks (liver failure, arterial complications…) while waiting for LT.
Most of the available data have been based upon analysis of patients who received a transplant and have not included patients who were eligible for LT but died, or showed progression, before it could be performed.
Therefore, studies conducted on an intention-to-treat basis are needed to clarify the benefit and the risks of TACE prior to LT in patients with hepatocellular carcinoma.
Studieoversigt
Status
Afsluttet
Betingelser
Intervention / Behandling
Detaljeret beskrivelse
- Multicentre, prospective, randomized, 2 parallel group study
- Preoperative evaluation of hepatocellular carcinoma in recipients: Tumor diagnosis will be mainly based upon EASL guidelines. HCCs will be classified according to UCSF criteria (size, number of nodules). Clinical and biological status will be updated every 3 month.
- Pre-transplant treatment:
TACE group: An emulsion of Lipiodol and a cytotoxic drug (50mg/m2 of doxorubicin) will be injected as selectively as possible. Then, an embolic agent will be used to assure stop of flow. The first injection will be performed within 10 days following enlisting and repeated every 8 weeks until LT (only if hypervascularized vital tumor tissue is again visible on CT Scan and if liver function remains within Child A stage) or until complete response. Clinical/biological follow-up will be done once a month.
Control group (no treatment until LT): clinical/biological follow-up and CT-scan every 3 month.
This prospective, multicentric, and randomized study may allow investigators to show that TACE with DC-BeadsR can significantly increase intention to treat survival of patients transplanted for HCC. We also expect that this result will be associated with less recurrence of the cancer after transplantation.
Obviously, we expect that the beneficial effect of TACE will be associated with a acceptable rate of complication related to the procedure.
- Pathologic examination: In all patients in whom LT will be performed, the diagnosis of hepatocellular carcinoma will be confirmed by a histological examination of the explanted liver.
- Dropout criteria: Patients with progression but still meeting the transplant criteria will be maintained in their respective group. Patients with progression over the transplant criteria will be excluded from the waiting list and censored.
Undersøgelsestype
Interventionel
Tilmelding (Faktiske)
7
Fase
- Fase 3
Kontakter og lokationer
Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.
Studiesteder
-
-
-
Créteil, Frankrig, 94010
- Hôpital Henri Mondor - Assistance Publique-Hôpitaux de Paris
-
Grenoble, Frankrig, 38000
- Hôpital Michalon, CHU de Grenoble
-
Lille, Frankrig, 59000
- Hôpital Claude Huriez, CHU de Lille
-
Lyon, Frankrig, 69000
- Hôpital de la Croix Rousse, HCL, Lyon
-
Paris, Frankrig, 75000
- Hôpital Saint-Antoine / APHP
-
Rennes, Frankrig, 35033
- Hopital Pontchaillou
-
Tours, Frankrig, 37000
- Hôpital Trousseau, CHU de Tours
-
-
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
18 år og ældre (Voksen, Ældre voksen)
Tager imod sunde frivillige
Ingen
Køn, der er berettiget til at studere
Alle
Beskrivelse
Inclusion Criteria:
- Adult patients >18 years
- With well compensated cirrhosis and hepatocellular carcinoma meeting UCSF criteria
- Without general contraindication to LT
- Written informed consent.
Exclusion Criteria:
- Patients that already had TACE
- Or other local treatment for HCC
- Or neoadjuvant systemic chemotherapy
- Or planned living donor
- Or non arterialized lesion(s)
- Or Contraindication to DC-BeadsR
- Or allergy to contrast agents
- Or contraindication to Doxorubicin.
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: Ingen (Åben etiket)
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
|---|---|
|
Ingen indgriben: Styring
Sædvanlig pleje
|
|
|
Eksperimentel: Intra-arterial administration of DC BeadsR
Intra-arterial administration of DC BeadsR, (1 vial of 100-300 µm) as selectively as possible loaded with doxorubicin (50 mg per procedure) and mixed with an equal volume of contrast medium.
The first injection will be performed within 21 days following enlisting and repeated 1-2 times until LT (only if hypervascularized vital tumor tissue is again visible on CT Scan and if liver function remains within Child A stage) or until complete response
|
Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Survival
Tidsramme: 3 years
|
Intention to treat survival at 3 years following inscription on the waiting list for liver transplantation in patient with hepatocellular carcinoma
|
3 years
|
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Gentagelsesrate
Tidsramme: 3 år
|
3 år
|
|
|
Dropout rate
Tidsramme: 3 years
|
Dropout rate (tumor progression beyond transplanted criteria and all causes mortality)
|
3 years
|
|
Post-transplantation survival rate
Tidsramme: 3 years
|
3 years
|
|
|
Allograft survival
Tidsramme: 3 years
|
3 years
|
|
|
Time to dropout
Tidsramme: 3 years
|
3 years
|
|
|
TACE-induced complications (local and general)
Tidsramme: 3 years
|
3 years
|
|
|
Contrast agent - induced complications
Tidsramme: 3 years
|
3 years
|
|
|
Doxorubicin-induced complications
Tidsramme: 3 years
|
3 years
|
|
|
Efficacy of TACE
Tidsramme: 3 years
|
Efficacy of TACE (morphological response to TACE: captation rate of Lipiodol and morphological response (RECIST guidelines), as well as histological criteria: percentage of necrosis on pathological examination)
|
3 years
|
Samarbejdspartnere og efterforskere
Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.
Sponsor
Efterforskere
- Ledende efterforsker: Philippe COMPAGNON, MD, Service de Chirurgie Digestive - Transplantation Hépatique / Hôpital Henri Mondor - Assistance Publique-Hôpitaux de Paris / Faculté de Médecine - Université Paris-Est
- Ledende efterforsker: Karim BOUDJEMA, MD PhD, Service de Chirurgie Hépato-biliaire et Digestive, Transplantation Hépatique / CHU de Rennes / Université de Rennes 1
- Studiestol: Bruno Laviolle, MD, PhD, Service de Pharmacologie et CIC - INSERM 0203 / CHU de Rennes / Université de Rennes
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
1. august 2012
Primær færdiggørelse (Faktiske)
28. maj 2014
Studieafslutning (Faktiske)
16. februar 2016
Datoer for studieregistrering
Først indsendt
28. august 2012
Først indsendt, der opfyldte QC-kriterier
28. august 2012
Først opslået (Skøn)
30. august 2012
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
12. april 2019
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
10. april 2019
Sidst verificeret
1. september 2018
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
- 2012~A00269-34
Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .