Additional Chemotherapy Administered Directly Into the Liver Using a Chemo Pump in Patients With Bile Duct Cancer Inside the Liver Treatable by Surgery (PUMP IV)
Maksan uusiutumisen estäminen osittaisen hepatekomian jälkeen intrahepaattisen kolangiokarsinooman avulla käyttämällä adjuvanttia maksavaltimoiden infuusiopumpun kemoterapia - pumpun IV -tutkimus
The goal of this clinical trial is to learn if additional chemotherapy by means of a chemo pump can prevent return of disease in adult patients with bile duct cancer in the liver that can be treated with surgery. The main questions it aims to answer are:
- Does addition of chemotherapy by means of a chemo pump lead to less return of disease within the liver two years after surgery?
- Does addition of chemotherapy by means of a chemo pump lead to longer survival of patients?
- Does addition of chemotherapy by means of a chemo pump lead to an increase in quality of life?
Participants will receive an implanted chemo pump, through which additional chemotherapy will be given to the liver in addition to surgery.
Tutkimuksen yleiskatsaus
Tila
Ehdot
Interventio / Hoito
Opintotyyppi
Ilmoittautuminen (Arvioitu)
Vaihe
- Vaihe 2
Yhteystiedot ja paikat
Opiskeluyhteys
- Nimi: Bas Groot Koerkamp, MD, PhD
- Puhelinnumero: +31(0)107031810
- Sähköposti: b.grootkoerkamp@erasmusmc.nl
Tutki yhteystietojen varmuuskopiointi
- Nimi: Thomas C Zwaan, MD
- Puhelinnumero: +31(0)621218051
- Sähköposti: t.zwaan@erasmusmc.nl
Opiskelupaikat
-
-
South Holland
-
Rotterdam, South Holland, Alankomaat, 3015GD
- Rekrytointi
- Erasmus Medical Center
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Ottaa yhteyttä:
- Bas Groot Koerkamp, MD, PhD
- Puhelinnumero: +31(0)107031810
- Sähköposti: b.grootkoerkamp@erasmusmc.nl
-
Ottaa yhteyttä:
- Thomas C Zwaan, MD
- Puhelinnumero: +31(0)621218051
- Sähköposti: t.zwaan@erasmusmc.nl
-
Päätutkija:
- Bas Groot Koerkamp, MD, PhD
-
-
Osallistumiskriteerit
Kelpoisuusvaatimukset
Opintokelpoiset iät
Hyväksyy terveitä vapaaehtoisia
Sukupuolet, jotka voivat opiskella
Kuvaus
Inclusion Criteria:
- 18 years or older
- ECOG or WHO performance status 0 or 1
- Diagnosis of resectable iCCA on imaging. No histological confirmation is needed before surgery, according to standard of care.
- Patient is able to undergo a laparotomy.
- Positioning of a catheter for HAIP chemotherapy is technically feasible based on a CT-scan with early arterial phase with 1mm cuts. The default site for the catheter insertion is the GDA. Accessory or aberrant hepatic arteries are no contraindication for catheter placement.
- Adequate bone marrow, liver, and renal function before inclusion (values may be max. 30 days old)
- Absolute neutrophil count (ANC) ≥ 1.5 x 10^ 9/L
- White blood cell count (WBC) ≥ 2.5 x 10^9/L
- Platelets ≥ 100 x 10^9/L
- Glomerular filtration rate (GFR) ≥ 30 ml/min
- Haemoglobin (Hb) ≥ 5.5 mmol/L
- Total bilirubin ≤ 25 µmol/L
- Written informed consent must be given according to ICH/good clinical practice (GCP), and national/local regulations.
Exclusion Criteria:
- Presence of extrahepatic disease at the time of first presentation. Patients with locoregional lymph node disease or with small (≤ 1 cm) extrahepatic lesions that are too small to characterize or biopsy are eligible.
- Second primary malignancy, except for adequately treated non-melanoma skin cancer, or other malignancy treated at least 3 years previously without evidence of recurrence or with a life expectancy longer than 5 years.
- Known homozygous dihydropyrimidine dehydrogenase (DPYD) deficiency
- Prior hepatic radiation, ablation, or resection for iCCA.
- Clinical evidence of portal hypertension (ascites, gastroesophageal varices, or portal vein thrombosis). Some postoperative ascites is allowed.
- (Partial) portal vein thrombosis in future liver remnant.
- Pregnant or lactating women.
- History of psychiatric disability judged by the investigator to be clinically significant, precluding informed consent or interfering with compliance for HAIP chemotherapy.
- Serious concomitant systemic disorders that would compromise the safety of the patient or his/her ability to complete the study, at the discretion of the investigator.
- Organ allografts requiring immunosuppressive therapy.
- Serious infections (uncontrolled or requiring treatment).
- Participation in another interventional study for iCCA with survival as outcome.
- Participation in another prospective study with an interventional medical product.
- Any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before registration in the trial
Opintosuunnitelma
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
- Ensisijainen käyttötarkoitus: Hoito
- Jako: Ei käytössä
- Inventiomalli: Yksittäinen ryhmätehtävä
- Naamiointi: Ei mitään (avoin tarra)
Aseet ja interventiot
Osallistujaryhmä / Arm |
Interventio / Hoito |
|---|---|
|
Kokeellinen: Surgery + chemo pump (Hepatic Arterial Infusion Pump chemotherapy)
Surgery + chemo pump |
Participants in this arm will receive in addition to standard care (surgery) a chemo pump. This pump will provide participants with 4 cycles of treatment with chemotherapy (Floxuridin), each lasting 4 weeks. Total treatment with chemotherapy will last 16 weeks (approx. 4 months)
Muut nimet:
|
Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
|
Two-year hepatic recurrence free survival (hRFS)
Aikaikkuna: From pump implantation until 2 years after that surgery
|
The percentage of patients who do not have return of disease in the liver two years after surgery. The time frame is defined as the period between pump implantation and return of disease in the liver. A recurrence is defined as a biopsy-proven recurrent lesion or radiological evidence with cross-sectional imaging in combination with an elevated CA19.9 or CEA level in the blood samples. |
From pump implantation until 2 years after that surgery
|
Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
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Overall recurrence free survival (RFS)
Aikaikkuna: From pump implantation until the earliest return of disease in the body during the study (up to 5 years after inclusion)
|
The percentage of patients who do not have return of disease in the given time frame. A recurrence is defined as a biopsy-proven recurrent lesion or radiological evidence with cross-sectional imaging in combination with an elevated CA19.9 or CEA level in the blood samples. |
From pump implantation until the earliest return of disease in the body during the study (up to 5 years after inclusion)
|
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Overall survival (OS)
Aikaikkuna: From pump implantation until death or lost to follow-up during the study (up to 5 years after inclusion)
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OS is defined as the interval between pump implantation and the date of death (by any cause) or date of last follow-up |
From pump implantation until death or lost to follow-up during the study (up to 5 years after inclusion)
|
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Post-operative complications
Aikaikkuna: From pump implantation until 90 days after surgery
|
All complications rated Clavien-Dindo grade 3 or higher are recorded for the first 90 days after surgery. |
From pump implantation until 90 days after surgery
|
|
Chemotherapy related adverse events (AEs)
Aikaikkuna: From inclusion until 4 weeks after the end of treatment with chemotherapy
|
Chemotherapy related adverse events (AEs) will be collected if they are grade III or higher according to CTCAE version 5.0 |
From inclusion until 4 weeks after the end of treatment with chemotherapy
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Proportion of patients started with HAIP chemotherapy
Aikaikkuna: From pump implantation until the first cycle of HAIP chemotherapy, on average between 4 and 16 weeks after implantation of the HAIP chemopump
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The number of patients that could receive at least 1 cycle of HAIP chemotherapy with floxuridin |
From pump implantation until the first cycle of HAIP chemotherapy, on average between 4 and 16 weeks after implantation of the HAIP chemopump
|
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Quality of life: EORTC QLQ-30
Aikaikkuna: From inclusion until 5 years after surgery
|
After study inclusion and every 3 months (+/- 30 days) thereafter patients will be asked to complete the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). This validated instrument includes 30 items covering functional domains, symptom scales, and global health status. Scores range from 0 to 100, with higher scores on the global health and functional scales indicating better quality of life. After 1 year of follow-up, the questionnaires will be taken annually until a maximum of 5 years. |
From inclusion until 5 years after surgery
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Quality of life: EQ-5D
Aikaikkuna: From inclusion until 5 years after surgery
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After study inclusion and every 3 months (+/- 30 days) thereafter patients will be asked to complete the EuroQol 5-Dimension (EQ-5D) questionnaire, a standardized measure of health-related quality of life. The EQ-5D includes five dimensions-mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The resulting health state is converted into an index score ranging from 0 (equivalent to death) to 1 (perfect health), though negative scores are possible. After 1 year of follow-up, the questionnaires will be taken annually until a maximum of 5 years. |
From inclusion until 5 years after surgery
|
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Cost-effectiveness
Aikaikkuna: From implantation of the chemo pump until 2 years after (=timeframe of the primary outcome)
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An assessment of the cost-effectiveness of HAIP chemotherapy for patients with iCCA will be made |
From implantation of the chemo pump until 2 years after (=timeframe of the primary outcome)
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Predictive biomarkers in the blood for efficacy of HAIP chemotherapy
Aikaikkuna: From implantation of the chemo pump until 1 year after surgery or return of disease (whichever comes first)
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A total of five additional blood samples will be collected. These samples will be collected:
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From implantation of the chemo pump until 1 year after surgery or return of disease (whichever comes first)
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Predictive biomarkers from liver tissue for efficacy of HAIP chemotherapy
Aikaikkuna: From resection until 25 years after (conform applicable laws)
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Additionally, tumor tissue will be collected from the removed part of the liver during the surgery. These tissue samples will be stored for further research into biomarkers. |
From resection until 25 years after (conform applicable laws)
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Yhteistyökumppanit ja tutkijat
Sponsori
Yhteistyökumppanit
Tutkijat
- Päätutkija: Bas Groot Koerkamp, MD, PhD, Erasmus Medical Center
Opintojen ennätyspäivät
Opi tärkeimmät päivämäärät
Opiskelun aloitus (Todellinen)
Ensisijainen valmistuminen (Arvioitu)
Opintojen valmistuminen (Arvioitu)
Opintoihin ilmoittautumispäivät
Ensimmäinen lähetetty
Ensimmäinen toimitettu, joka täytti QC-kriteerit
Ensimmäinen Lähetetty (Todellinen)
Tutkimustietojen päivitykset
Viimeisin päivitys julkaistu (Todellinen)
Viimeisin lähetetty päivitys, joka täytti QC-kriteerit
Viimeksi vahvistettu
Lisää tietoa
Tähän tutkimukseen liittyvät termit
Avainsanat
Muita asiaankuuluvia MeSH-ehtoja
- Neoplasmat
- Neoplasmat histologisen tyypin mukaan
- Kasvaimet, rauhas- ja epiteelikasvaimet
- Adenokarsinooma
- Karsinooma
- Kolangiokarsinooma
- Maksakirroosi, perinnöllinen, keuhkoverenpainetauti
- Heterosykliset yhdisteet, 1-rengas
- Heterosykliset yhdisteet
- Nukleiinihapot, nukleotidit ja nukleosidit
- Pyrimidiininnukleosidit
- Pyrimidiinit
- Nukleosidit
- Deoksihiobonukleosidit
- Deoksiuridiini
- Uridiini
- Floksuridiini
Muut tutkimustunnusnumerot
- MEC-2024-0324
- 2024-513726-33-00 (Ctis)
Yksittäisten osallistujien tietojen suunnitelma (IPD)
Aiotko jakaa yksittäisten osallistujien tietoja (IPD)?
IPD-suunnitelman kuvaus
The decision on sharing IPD has not been made within the trial team. Once this decision is made, we will update this part.
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