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Deep Liver Phenotyping and Immunology Study (DELPHI)

28. mars 2022 oppdatert av: University of Oxford

Hepatocellular carcinoma (HCC) and cholangiocarcinoma are the two most common causes of primary liver cancer and HCC is the second highest cause of cancer death worldwide. It is known that most of these cancers occur in patients who already have a liver condition. Despite close monitoring of many patients who have liver disease with regular ultrasound scans, HCC and cholangiocarcinoma are often discovered at a late stage. This is because they rarely cause symptoms until they have reached an advanced stage. Early identification of these cancers would enable more patients to have curative treatments such as surgery or liver transplantation.

The investigators want to collect blood and urine samples as well as small samples of cells directly from the liver. In some cases this will be done using a technique called liver fine needle aspiration. This technique is low risk and has been successfully used in other studies. The investigators will compare samples from patients with cancer to those of patients with other diseases of the liver who are at risk of developing cancer in the future.

The investigators aim to detect changes in the liver, blood, urine and/or bile of patients who have liver conditions that could tell us their risk of a future cancer. These changes could be in the types of white blood cells found within the liver, or, they may be in products secreted by liver cells. In the latter case the liver cells may release small pieces of their DNA that could be detected in the blood. When liver cells are dysfunctional, they may also change the types of metabolic products that they produce, and the investigators may be able to detect these changes in the urine or bile.

Studieoversikt

Status

Rekruttering

Forhold

Detaljert beskrivelse

The purpose of this study is to perform a characterisation of the cancer predisposing 'field effect' that is associated with hepatic & hepato-biliary malignancy, and, to identify minimally invasive biomarkers that may detect this field effect. This will be achieved through collection of patient samples (Tissue/Blood/Urine/Bile). Comparisons will then be made between patients with hepatic & hepatobiliary cancer and patients with chronic liver disease and also longitudinally in individual patients who either develop or are cured of hepatic & hepato-biliary malignancy during the study. The investigators hope to exploit this knowledge to develop novel biomarker candidates that may ultimately form inputs to a multi-parametric early cancer detection model. The study aims are:

  1. Develop a cohort of patients with HCC, cholangiocarcinoma or liver metastases and a cohort of chronic liver disease patients representing all the commonly encountered aetiologies (viral, metabolic, autoimmune and alcohol related liver disease).
  2. Collect samples from directly within the non-cancerous liver (FNA liver/biopsy/ablation/resection specimens), blood and urine in addition tumour tissue (resection/biopsy/ablation), bile and bile duct brushings.
  3. Flow cytometric & molecular biologic analysis of tissue and peripheral blood and bile.
  4. Transcriptomic analysis of cell populations in liver and blood.
  5. Genetic & molecular biologic analysis of hepatic and immune cells and secreted products.

Studietype

Observasjonsmessig

Registrering (Forventet)

100

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiekontakt

Studiesteder

  • Storbritannia
    • Oxfordshire
      • Oxford, Oxfordshire, Storbritannia, OX3 9DU
        • Rekruttering
        • John Radcliffe Hospital
        • Ta kontakt med:

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

18 år til 75 år (Voksen, Eldre voksen)

Tar imot friske frivillige

Nei

Kjønn som er kvalifisert for studier

Alle

Prøvetakingsmetode

Ikke-sannsynlighetsprøve

Studiepopulasjon

Hepatology patients treated at a single hospital trust.

Beskrivelse

Inclusion Criteria:

  • Participant is willing and able to give informed consent for participation in the study.
  • Male or Female, aged 18 years to 75 years.

Malignancy Cohort: extra inclusion criteria - Diagnosed with a malignancy or with clinical suspicion of a malignancy affecting the Liver or Biliary Tree.

Control cohort: extra inclusion criteria

- Patients with confirmed chronic non-malignant hepatobiliary disease.

Additional Inclusion Criteria for Patients Undergoing optional Liver FNA

  • Willing to undergo ultrasound guided liver FNA (unless specific contra-indications to the procedure apply).
  • Has undergone appropriate clinical imaging of the upper abdomen (US/CT/MRI) within the last 12 months.
  • Full blood count (FBC) and coagulation profile (Coag) checked within 30 days prior to FNA procedure (Baseline Visit).

Exclusion Criteria:

  • Unable to consent.
  • Pregnancy.
  • Any concern by the investigator regarding the safe participation of the patient in the study; or investigator's consideration, for any other reason, that a patient is inappropriate for participation in the study.

Additional Exclusion Criteria for Patients Undergoing optional Liver FNA (These criteria will exclude a patient from having FNA as part of the study)

  • Significant comorbid medical condition(s) which may in the opinion of the investigator increase the risk of an FNA Liver.
  • Coagulopathy - International Normalized Ratio (INR) >1.3, Prothrombin Time (PT) >16 seconds, Platelet count <100 x 10^3/L.
  • Known bleeding disorder (e.g. Haemophilia).
  • Current use of an oral/injectable anticoagulant medication.
  • Current use of an oral antiplatelet agent.
  • The presence of ascites.

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

Kohorter og intervensjoner

Gruppe / Kohort
Malignancy Cohort
Patients with hepatic or hepatobiliary malignancy at enrolment
Control Cohort
Patients with chronic liver disease but no hepatic or hepatobiliary malignancy at enrolment

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Measurement of intra-hepatic and peripheral blood immune cell numbers in Malignancy Cohort and Control Cohort patients.
Tidsramme: At study enrolment
Proportion of immune cell populations relative to total immune cell count measured by single cell RNA sequencing.
At study enrolment

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Measurement of liver cancer occurrence and all-cause mortality.
Tidsramme: 15 years
Measurement of absolute numbers of liver cancers and deaths in study patients
15 years

Andre resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Measure safety of fine needle aspiration in cirrhosis
Tidsramme: 5 years
Measurement of absolute numbers of adverse events related to liver fine needle aspiration in study patients with cirrhosis.
5 years
Measure tolerability of liver fine needle aspiration
Tidsramme: 5 years
Measure post procedure analgesia dose and duration in patients undergoing liver fine needle aspiration as a study procedure
5 years

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

University of Oxford

Etterforskere

  • Hovedetterforsker: Rory J Peters, University of Oxford

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart (Faktiske)

12. mars 2021

Primær fullføring (Forventet)

31. oktober 2040

Studiet fullført (Forventet)

31. oktober 2040

Datoer for studieregistrering

Først innsendt

9. juni 2021

Først innsendt som oppfylte QC-kriteriene

22. juni 2021

Først lagt ut (Faktiske)

1. juli 2021

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

6. april 2022

Siste oppdatering sendt inn som oppfylte QC-kriteriene

28. mars 2022

Sist bekreftet

1. mars 2022

Mer informasjon

Begreper knyttet til denne studien

Nøkkelord

Ytterligere relevante MeSH-vilkår

Andre studie-ID-numre

  • 264839
  • C2195/A27431 (Annet stipend/finansieringsnummer: Cancer Research UK)
  • CA30358/A29725 (Annet stipend/finansieringsnummer: Cancer Research UK)

Legemiddel- og utstyrsinformasjon, studiedokumenter

Studerer et amerikansk FDA-regulert medikamentprodukt

Nei

Studerer et amerikansk FDA-regulert enhetsprodukt

Nei

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