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A TheraSphere® Advanced Dosimetry Retrospective Global Study in HCC (TARGET)

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ClinicalTrials.gov Identifier: NCT03295006
Recruitment Status : Recruiting
First Posted : September 27, 2017
Last Update Posted : September 27, 2017
Sponsor:
Information provided by (Responsible Party):
BTG International Inc.

Brief Summary:
This retrospective, multinational, single-arm study will be conducted in at least 8 sites. An interim analysis will be conducted with data from 100 patients with up to 10 well defined HCC tumor(s) and with at least one tumor ≥3 cm. Normal tissue absorbed dose using pre-procedural 99mTc MAA SPECT or SPECT/CT imaging will be measured to allow the mean absorbed normal tissue dose corresponding to a ≤15% probability of CTCAE grade 3 or higher hyperbilirubinemia (in the absence of disease progression) to be calculated. Total bilirubin will be recorded and graded according to CTCAE version 4.02. All dose-related SAEs at 3 months follow-up will be followed until resolution, death or lost-to-follow-up. AEs related to disease progression will not be considered related to TheraSphere.

Condition or disease Intervention/treatment
Hepatocellular Carcinoma Device: TheraSphere

Detailed Description:
Recently published evidence indicates a correlation between yttrium-90 dose delivered to the tumor and normal tissue with safety and efficacy outcomes but there are no validated methods to consistently measure dose delivered to the tumor and normal tissue. In contrast to the standard clinical approach based on average dose to one target volume, this trial, sponsored by Biocompatibles UK, will explore an alternative two-compartment TheraSphere dosimetry methodology to calculate absorbed dose to tumor and normal tissue

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Study Type : Observational
Estimated Enrollment : 300 participants
Observational Model: Other
Time Perspective: Retrospective
Official Title: A TheraSphere® Advanced Dosimetry Retrospective Global Study Evaluation in Hepatocellular Carcinoma Treatment
Actual Study Start Date : October 31, 2016
Estimated Primary Completion Date : June 14, 2018
Estimated Study Completion Date : June 14, 2018

Group/Cohort Intervention/treatment
Previous Therasphere treatment
Patients who had received TheraSphere yttrium-90 microspheres
Device: TheraSphere
Patients who had received TheraSphere




Primary Outcome Measures :
  1. Alternative two-compartment TheraSphere dosimetry methodology [ Time Frame: Baseline ]
    Normal tissue absorbed dose using pre-procedural 99mTc MAA (Technetium-99m Macroaggregated albumin) SPECT (Single-photon emission computer tomography) or SPECT/CT (Single-photon emission computer tomography/Computer Tomography) imaging, to allow the mean absorbed normal tissue dose corresponding to a ≤15% probability of Common Toxicities Criteria for Adverse Events (CTCAE) grade 3 or higher hyperbilirubinemia (in the absence of disease progression) to be calculated.


Secondary Outcome Measures :
  1. Tumor dose [ Time Frame: Baseline ]
    Tumor dose (to tumors ≥3 cm) using pre-procedural 99mTc MAA SPECT or SPECT/CT imaging.

  2. Serious adverse events [ Time Frame: 3 months ]
    All serious adverse events (SAEs) assessed as related or potentially related to TheraSphere

  3. Specific non-serious adverse events (AEs) assessed as related or potentially related to the dose of TheraSphere [ Time Frame: 3 months ]

    Specific non-serious adverse events (AEs) assessed as related or potentially related to the dose of TheraSphere, comprising of any of the following events:

    • Hyperbilirubinemia
    • Ascites
    • Pain
    • Fatigue
    • Nausea

  4. Clinical laboratory assessments [ Time Frame: 6 weeks and 3 months ]
    Clinical laboratory assessments

  5. Objective response (OR) of the target lesion and non-target sesions [ Time Frame: 3 months and 6 months ]
    Objective response (OR) of the target lesion (single largest lesion) and non-target lesion(s) after TheraSphere administration by Modified Response Evaluation Criteria in Solid Tumors (mRECIST) and Response Evaluation Criteria in Solid Tumors (RECIST) 1.1

  6. Volume changes [ Time Frame: 3 and 6 months ]
    Volume changes (i.e., perfused liver volume and non-perfused liver volume) from baseline afterTheraSphere administration.

  7. Overall Survival (OS) [ Time Frame: 6 months ]
    Overall Survival (OS)

  8. Target Alpha fetoprotein (AFP) response [ Time Frame: 6 weeks and 3 months ]

    Target Alpha fetoprotein (AFP) response (defined as a ≥50% decrease in AFP levels for patients with a baseline AFP level of

    ≥200 ng/mL).


  9. Albumin-bilirubin (ALBI) score [ Time Frame: 6 weeks and 3 months ]
    Albumin-bilirubin (ALBI) score, a measure of liver function for HCC patients after TheraSphere administration.

  10. Dose to Portal Vein Thrombosis (PVT) [ Time Frame: baseline, 90 days, 180 days ]
    Dose to Portal Vein Thrombosis (PVT) based upon pre- and postprocedure imaging (if PVT present).

  11. Dosimetric analysis time [ Time Frame: baseline ]
    Dosimetric analysis time (i.e., workflow).

  12. Dose accuracy [ Time Frame: baseline ]
    Dose accuracy based upon phantom imaging studies.

  13. Dose reproducibility [ Time Frame: baseline ]
    Measurement of inter-observer agreement based on a round robin review of the same 20 patients obtained from a minimum of 8 users (with each user at a different site) and an exploratory assessment of intra-observer agreement based on a review of 10 patients by a minimum of 8 users at least 2 weeks apart. The 10 patients for the intra-observer agreement will be a subset of the patients included in the assessment of inter-observer agreement.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Patients with up to 10 well-defined unilobar HCC tumors per lobe with at least one tumor ≥3 cm ± PVT.
Criteria

Inclusion Criteria:

  • Up to 10 well defined unilobar/bilobar HCC tumor(s) per lobe with at least one tumor ≥3 cm ± PVT
  • Liver dominant disease (limited extra-hepatic metastases in the lung and/or lymph nodes are permitted (up to 5 lesions in the lung, with each individual lesion ≤2cm; any number of lymph node lesions with each individual lesion ≤2 cm).
  • Child Pugh stage A or B7.
  • BCLC A, B or C.
  • Must be male or female, 18 years of age or older.
  • Bilirubin ≤2 mg/dL.
  • Tumor replacement <50% of total liver volume assessed by diagnostic imaging consisting of multi-phase contrast enhanced CT or contrast enhanced MRI.
  • Diagnostic imaging consisting of multi-phase contrast enhanced CT or contrast enhanced MRI within 3 months prior to TheraSphere® administration.
  • Infusion of 99mTc-MAA in a single arterial location sufficient to cover up to 10 well-defined tumors per lobe ≤ 6 weeks prior to TheraSphere® administration.
  • Patients must have received TheraSphere® in a single treatment setting in one or more arterial locations sufficient to cover up to 10 well-defined tumors based on angiography. Subsequent TheraSphere® treatment to the second lobe may occur at least 4 weeks following the initial TheraSphere® treatment.
  • For patients receiving a second TheraSphere® treatment bilirubin levels must have been recorded prior to the second treatment
  • Patients must have had clinical evaluation (assessment of liver specific AEs) and laboratory evaluation (at least a serum bilirubin level) at baseline.
  • Tumor(s), ≥3 cm, measurable by mRECIST and RECIST 1.1 at baseline

Exclusion Criteria:

  • Prior external beam radiation treatment to the liver.
  • Prior loco-regional liver directed therapy (cTACE, DEB-TACE and SIR-Spheres).
  • Prior liver transplantation.
  • Whole liver TheraSphere® treatment following prior liver resection.
  • TheraSphere administration to ≤2 segments (e.g., radiation segmentectomy).
  • Additional active therapy (TACE and treatment with SIR-Spheres) between first TheraSphere treatment and 3 month (90 days) imaging.
  • Hepatic vein invasion.
  • Diagnosis of disease progression at peri-procedural imaging as compared to the baseline imaging (physician's discretion).

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03295006


Contacts
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Contact: Frances Harrison 610-278-1660 frances.harrison@btgplc.com

Locations
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United States, Illinois
Northwestern Memorial Hospital, Robert H Lurie Comprehensive Cancer Center Recruiting
Chicago, Illinois, United States, 60611-2927
Contact: Carlene del Castillo, RN    312-695-1518    carlene.castillo@northwestern.edu   
Principal Investigator: Riad Salem, MD         
Sponsors and Collaborators
BTG International Inc.
Investigators
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Principal Investigator: Marnix Lam, MD, PhD Universitair Medisch Centrum Utrecht
Principal Investigator: Riad Salem, MD Northwestern University
Principal Investigator: Etienne Garin, MD Centre Eugène Marquis
Principal Investigator: Hugo de Jong, PhD Universitair Medisch Centrum Utrecht

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Responsible Party: BTG International Inc.
ClinicalTrials.gov Identifier: NCT03295006     History of Changes
Other Study ID Numbers: BTG-007961
First Posted: September 27, 2017    Key Record Dates
Last Update Posted: September 27, 2017
Last Verified: September 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: Yes
Device Product Not Approved or Cleared by U.S. FDA: No
Product Manufactured in and Exported from the U.S.: No

Keywords provided by BTG International Inc.:
TheraSphere, hepatocellular carcinoma, dosimetry

Additional relevant MeSH terms:
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Carcinoma
Carcinoma, Hepatocellular
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Adenocarcinoma
Liver Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Digestive System Diseases
Liver Diseases