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Transarterial Chemoembolization (TACE) and Stereotactic Body Radiation (SBRT) in Patients With Hepatocellular Carcinoma (HCC) Prior to Liver Transplantation (TREASURE-Tx)

3 november 2026 bijgewerkt door: AIO-Studien-gGmbH

Transarterial Chemoembolization (TACE) and Stereotactic Body Radiation (SBRT) in Patients With Hepatocellular Carcinoma (HCC) Prior to Liver Transplantation A Randomized, 2-arm Phase II Study Comparing the Combination of Transarterial Chemoembolization (TACE) and Stereotactic Body Radiation (SBRT) Versus TACE Alone in Patients With Hepatocellular Carcinoma as Bridging to Liver Transplantation With Regard to Explant Histopathology

In this randomised study it should be investigated, whether and to what extent standard TACE treatment combined with additional stereotactic body radiotherapy (SBRT) leads to improved outcomes for patients with HCC when used as a bridging therapy prior to liver transplantation.

Studie Overzicht

Toestand

Werving

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

Hepatocellular carcinoma (HCC) is one of the most frequent malignancies worldwide and is characterized by a rising incidence. A first line curative treatment option is surgical resection. As most patients with HCC suffer from liver cirrhosis, resection is often constrained due to limited liver function. In patients with tumors within Milan criteria, liver transplantation remains a curative therapeutic option even if liver resection is not feasible. Due to organ shortage, there are long waiting periods and waitlist withdrawal because of tumor progression remains an eminent risk. Hence, bridging therapies are used to halt tumor growth. Transarterial chemoembolization (TACE) is one of the most commonly used bridging therapies. Other possible bridging therapies are local ablation and stereotactic body radiation therapy (SBRT). Importantly, there are several studies showing a potential benefit of the combination of TACE and SBRT in the treatment of HCC. Recently, we were able to show a high rate of complete histopathological response in patients who were treated with a combination of TACE and SBRT as bridging to liver transplant, suggesting a potential benefit of combining both therapies in a pre-transplant setting.

Studietype

Ingrijpend

Inschrijving (Geschat)

44

Fase

  • Niet toepasbaar

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studiecontact

  • Naam: Ursula Ehmer, PD Dr. med.
  • Telefoonnummer: +49 (0) 89 4140-9324
  • E-mail: ursula.ehmer@tum.de

Studie Contact Back-up

Studie Locaties

      • München, Duitsland, 81675
        • Werving
        • Klinik und Poliklinik für Innere Medizin II, TUM Klinikum, Rechts der Isar
        • Contact:

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

18 jaar en ouder (Volwassen, Oudere volwassene)

Accepteert gezonde vrijwilligers

Nee

Geslachten die in aanmerking komen voor studie

Allemaal

Beschrijving

Inclusion Criteria:

  1. Written informed consent obtained from the subject prior to performing any protocol related procedures, including screening evaluations.

  2. Age ≥ 18 years at time of study entry.

  3. HCC diagnosed by histopathology and/or according to EASL or AASLD criteria at an early stage (BCLC A or UNOS T2), without any curative treatment option (resection or ablation) other than liver transplantation as determined by tumor board decision of at least one tumor lesion. Guidance: Patients with prior HCC who had surgery or locoregional treatment and had a complete remission for over 2 years and develop denovo HCC at a location different from previously treated HCC lesion(s) are eligible to participate.

  4. Patients planned for liver transplantation after discussion within a multidisciplinary board.

  5. Patients eligible to receive a matchReMELD-Na (SE-ReMELD-Na) - Score for hepatocellular carcinoma according to German transplant regulations. Guidance: All listing assessments must be completed before first on-study radiologic tumor assessment (first radiologic tumor assessment in treatment follow-up).

  6. Treatment of all lesions by SBRT is feasible as determined by the local physician. The central review board recommendation process has been initiated (i.e. image upload by site).

  7. At least one measurable site of disease with spiral CT scan or MRI according to mRECIST for HCC.

  8. Sufficient liver function (< Child Pugh B8)

  9. Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1.

  10. Adequate blood count, liver enzymes and renal function:

    1. Hemoglobin ≥ 7 g/dL, absolute neutrophil count ≥ 1000 /µL, platelets ≥ 35000/µL
    2. Total bilirubin and serum albumin as part of Child Pugh requirement
    3. ALAT and ASAT ≤5 x ULN
  11. Patients with active HIV Infection must show a CD4 cell count above 200/µL and no detectable HIV RNA for at least three months prior to the study

  12. Female patients with reproductive potential must have a negative urine or serum pregnancy test within 14 days prior to start of the study (randomization).

  13. Patients of childbearing potential who are sexually active must use an adequate contraceptive method with a failure rate less than 1 % per year. Enrolled patients must agree to use adequate contraception for the duration of study treatment and up to 6 months after the end of the treatment (depending on treatment received), manufactures recommendation (TACE) and local guidelines.

  14. Subject is willing and able to comply with the protocol for the duration of the study including undergoing treatment and scheduled visits and examinations including follow up.

Exclusion Criteria:

  1. Involvement in the planning and/or conduct of the study.
  2. Prior local tumor specific treatment of the same tumor nodule within the last 24 months.
  3. Histological proven fibrolamellar HCC or mixed HCC/cholangiocarcinoma.
  4. Other invasive malignancies within the past 2 years (except for non-melanoma skin cancer or non-invasive bladder cancer).
  5. Impaired liver function Child-Pugh Class B > 7.
  6. Ongoing or active systemic infection or psychiatric illness/social situations that would limit compliance with study requirements. Uncontrolled intercurrent illness, including but not limited to, ongoing or active infection, or psychiatric illness/social situations that would limit compliance with study requirement, substantially increase risk of incurring AEs, or compromise the ability of the patient to give written informed consent.
  7. Dementia or significantly altered mental status that would prohibit the understanding or rendering of information, consent, and compliance with the requirements of the protocol.
  8. Pregnancy and breastfeeding. Should a patient become pregnant, the treating physician has to be informed immediately.
  9. Any condition, comorbidity or circumstance that, in the opinion of the investigator, would interfere with evaluation of study treatment or affect patient safety or study results.
  10. Weight less than or equal to 30 kg.
  11. Prior radiotherapy to the upper abdomen

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

  • Primair doel: Behandeling
  • Toewijzing: Gerandomiseerd
  • Interventioneel model: Parallelle opdracht
  • Masker: Geen (open label)

Wapens en interventies

Deelnemersgroep / Arm
Interventie / Behandeling
Actieve vergelijker: The patients will receive two procedures of TACE prior to liver transplantation

Standard arm: The patients will receive two procedures of TACE prior to liver transplantation

The patients will receive two procedures of TACE prior to liver transplantation as bridging therapy (standard of care)

Experimenteel: The patients will receive two procedures of TACE followed by SBRT prior to liver transplantation

Experimental arm: The patients will receive two procedures of TACE followed by SBRT prior to liver transplantation

The patients will receive a stereotactic body radiation therapy (SBRT) in addition to two procedures of TACE prior to liver transplantation

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Primary Endpoint: histopathological response (presence of vital tumor tissue) in explant histopathology after liver transplantation.
Tijdsspanne: After liver transplantation (at least 24 months after randomization)

The percentage of vital tumor tissue is defined as the maximum percentage of vital tumor tissue per surface area per patient.

After liver transplantation (at least 24 months after randomization)

Secundaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Overall survival (OS)
Tijdsspanne: 24 months after randomization

Overall survival (OS) is defined as time from randomization to death from any cause. Overall survival-rate at 24 months is defined as the (estimated) proportion of patients who are still alive 24 months after randomization.

24 months after randomization
Objective response rate (ORR)
Tijdsspanne: up to 24 months after randomization

The objective response rate (ORR) is defined as the proportion of all randomized patients in whom a CR or PR was observed

up to 24 months after randomization
Complete response rate (CRR)
Tijdsspanne: up to 24 months after randomization

The complete response rate (CRR) is defined as the proportion of all randomized patients in whom a CR was observed

up to 24 months after randomization
Progression-free survival (PFS)
Tijdsspanne: up to 24 months after randomization

Progression-free survival (PFS) is defined as time from randomization to objective tumor progression or death from any cause

up to 24 months after randomization
Recurrence Rate
Tijdsspanne: up to 24 months after transplantation

Recurrence Rate is defined as the percentage of patients in whom cancer recurs after transplantation within 24 months. The recurrence is determined by regular standard of care follow-up examinations, which include imaging procedures (CT, MRI, ultrasound) and blood tests (e.g. alpha-fetoprotein). A division is made between local recurrence in the transplanted liver and distant metastases.

up to 24 months after transplantation
Recurrence free survival (RFS)
Tijdsspanne: up to 24 months after transplantation

Recurrence free survival (RFS) is defined as time from transplantation to tumor recurrence or death from HCC. Death from any other cause will be used as a censoring event.

up to 24 months after transplantation
Quality of Life Assessments
Tijdsspanne: up to 24 months after randomization

Quality of Life evaluated with EQ-5D-5L

up to 24 months after randomization
Safety reporting - treatment-emergent adverse events
Tijdsspanne: Up to 24 months after informed consent

Type, incidence, causal relationship, and severity of treatment-emergent adverse events

Up to 24 months after informed consent
Safety reporting - albumin-bilirubin score (ALBI Score)
Tijdsspanne: Up to 24 months after informed consent

Analysis of the effect on albumin-bilirubin score (ALBI Score)

Up to 24 months after informed consent
Safety reporting - Child Pugh Score
Tijdsspanne: Up to 24 months after informed consent

Analysis of the effect on Child Pugh Score

Up to 24 months after informed consent

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start (Werkelijk)

28 juli 2026

Primaire voltooiing (Geschat)

1 januari 2031

Studie voltooiing (Geschat)

1 maart 2031

Studieregistratiedata

Eerst ingediend

16 september 2026

Eerst ingediend dat voldeed aan de QC-criteria

3 november 2026

Eerst geplaatst (Werkelijk)

9 november 2026

Updates van studierecords

Laatste update geplaatst (Werkelijk)

9 november 2026

Laatste update ingediend die voldeed aan QC-criteria

3 november 2026

Laatst geverifieerd

1 november 2026

Meer informatie

Termen gerelateerd aan deze studie

Trefwoorden

Andere studie-ID-nummers

  • AIO-HEP-0124

Plan Individuele Deelnemersgegevens (IPD)

Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?

NEE

Informatie over medicijnen en apparaten, studiedocumenten

Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel

Nee

Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct

Nee

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