Tenofovir Antiviral Therapy Following Transarterial Chemoembolization for HBV Related Hepatocellular Carcinoma

This study is currently recruiting participants.
Verified June 2013 by Taichung Veterans General Hospital
Sponsor:
Collaborators:
Gilead Sciences
Taipei Institute of Pathology, Taiwan
Information provided by (Responsible Party):
Chun-Ying Wu, Taichung Veterans General Hospital
ClinicalTrials.gov Identifier:
NCT01872988
First received: January 30, 2013
Last updated: June 7, 2013
Last verified: June 2013

January 30, 2013
June 7, 2013
September 2012
February 2018   (final data collection date for primary outcome measure)
overall survival [ Time Frame: up to 3-year ] [ Designated as safety issue: Yes ]
Same as current
Complete list of historical versions of study NCT01872988 on ClinicalTrials.gov Archive Site
  • time to tumor progression [ Time Frame: 1- and 3-year ] [ Designated as safety issue: No ]
  • time to liver decompensation [ Time Frame: 1- and 3-year ] [ Designated as safety issue: Yes ]
Same as current
Not Provided
Not Provided
 
Tenofovir Antiviral Therapy Following Transarterial Chemoembolization for HBV Related Hepatocellular Carcinoma
Tenofovir Disoproxil Fumarate Improves Outcomes Following Palliative Transarterial Chemoembolization for Hepatitis B Virus Related Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is one of the most common solid cancers worldwide, and chronic hepatitis B virus (HBV) infection is the most common etiology of HCC in Asia. Transarterial chemoembolization (TACE) is the standard treatment for patients with unresectable HCC in the BCLC intermediate stage, but the HCC recurrence rates and long-term mortality rates are quite high. These intermediate-staged HCC patients usually need repeated TACE due to tumor recurrence, and they may die of HCC progression or liver decompensation after repeated TACE. Improved liver function and decreased liver disease progression due to oral antiviral therapy have been proven to be effective for chronic hepatitis B, and oral antiviral therapy may keep better liver reserve and provide better chance for HCC patients received TACE. In addition, chronic HBV infection is one of the most important factors for HCC development, and antiviral therapy can improve the outcomes after curative treatment. However, the evidence of improving outcomes of HCC patients underwent TACE by oral antiviral therapy is lacking. Moreover, Tenofovir Disoproxil Fumarate (TDF) is one of the most potent oral antiviral agents, and its safety and very low long-term viral resistance rate have been also reported. There is no study to evaluate the impacts of TDF for HBV-related HCC patients underwent TACE. Until now, routine antiviral therapy for HBV-related HCC patients underwent TACE has still not been recommended by current guidelines. The hypothesis of this study is that a potent oral antiviral therapy for patients with HBV-related HCC patients receiving TACE improve patients' outcomes

This is randomized double-blind placebo-controlled trial that will be conducted in referral teaching hospitals in Taiwan. This trial will recruit 320 patients fulfilling all of the following criteria: patients more than 20 years old, HCCs diagnosed by AASLD image criteria or pathology, medium-sized HCCs in BCLC intermediate stage and not more than 5 cm in maximum diameter and not more than 5 tumors that TACE is indicated, chronic HBV carrier (HBsAg+) with detectable HBV DNA in blood, ECOG performance status (PST) 0-2, Child-Pugh score ≦7, serum bilirubin < 2 mg/dL and prothrombin time (PT) prolongation < 3 seconds, and willingness to adhere to treatment and follow-up plans. Patients are ineligible if they have any of the following exclusion criteria: any vascular invasion by tumors, extra-hepatic metastasis, concurrent any other malignancy, concomitant immunosuppressive therapy, previous any HCC treatment, previous or current any antiviral therapy for HBV, concomitant other therapies for HCC except TACE, liver cirrhosis with severe gastroesophageal varices (EVF3 or with red color sign), poorly-controlled ascites or hepatic encephalopathy, contraindication for invasive procedures such as recent gastrointestinal bleeding or cerebral hemorrhage, contraindication to TACE such as allergy to contrast, pregnancy, sepsis, etc., chronic renal failure with eGFR < 60, concurrent any other chronic viral hepatitis with HCV, HDV, or HIV). The Primary endpoints of this study will be 1-, 3-year overall survival, and the secondary endpoints of this study will be time to tumor progression and time to liver decompensation.

Interventional
Phase 3
Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
  • Chronic Hepatitis B
  • Hepatocellular Carcinoma
  • Drug: Tenofovir
    Administer Tenofovir to HCC patients who are indicated for TACE after randomization
    Other Name: Viread
  • Drug: Placebo
    Administer Placebo to HCC patients who are indicated for TACE after randomization
    Other Name: Placebo
  • Active Comparator: Tenofovir treatment
    Start to administer Tenofovir treatment 300mg PO QD within 2 weeks after the 1st TACE. Maximum duration of tenofovir treatment: 3 years.
    Intervention: Drug: Tenofovir
  • Placebo Comparator: Placebo
    Start to administer placebo 1 Tab PO QD within 2 weeks after the 1st TACE. Maximum duration of tenofovir treatment: 3 years.
    Intervention: Drug: Placebo

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
320
February 2018
February 2018   (final data collection date for primary outcome measure)

Inclusion Criteria:

  1. more than 20 years old
  2. HCCs diagnosed by AASLD image criteria or pathology
  3. Intermediate-stage HCCs that TACE is indicated
  4. chronic HBV carrier with detectable HBV DNA in blood
  5. ECOG performance status (PST) 0-2
  6. Child-Pugh score ≦7
  7. serum bilirubin < 2 mg/dL
  8. prothrombin time prolongation < 3 seconds
  9. willingness to adhere to treatment and follow-up plans -

Exclusion Criteria:

  1. any vascular invasion by tumors
  2. extra-hepatic metastasis
  3. concurrent any other malignancy
  4. concomitant immunosuppressive therapy
  5. HCC recurrence within 2 years of previous curative treatment
  6. antiviral therapy for chronic hepatitis B within 6 months before HCC diagnosis
  7. concomitant other therapies for HCC except TACE
  8. liver cirrhosis with severe gastroesophageal varices (EVF3 or with red color sign), poorly-controlled ascites or hepatic encephalopathy
  9. contraindication for invasive procedures such as recent gastrointestinal bleeding or cerebral hemorrhage
  10. contraindication to TACE such as allergy to contrast, pregnancy, sepsis, etc.
  11. chronic renal failure with eGFR < 60
  12. concurrent any other chronic viral hepatitis with HCV, HDV, or HIV) -
Both
20 Years and older
No
Contact: Chun-Ying Wu, MD, PhD, MPH 886-4-23592525 ext 3304 chun@vghtc.gov.tw
Contact: Teng-Yu Lee, MD 886-4-23592525 ext 3316 tengyulee@gmail.com
Taiwan
 
NCT01872988
CF12045, JIRB11-036-A
Yes
Chun-Ying Wu, Taichung Veterans General Hospital
Taichung Veterans General Hospital
  • Gilead Sciences
  • Taipei Institute of Pathology, Taiwan
Principal Investigator: Chun-Ying Wu, MD, PhD, MPH Taichung Veterans General Hospital
Study Chair: Jaw-Town Lin, MD, PhD Fu Jen Catholic University
Taichung Veterans General Hospital
June 2013

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP