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A Study of ThermoDox™ in Combination With Radiofrequency Ablation (RFA) in Primary and Metastatic Tumors of the Liver

Primary Purpose

Hepatocellular Carcinoma, Liver Neoplasms

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
ThermoDox
Sponsored by
Imunon
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hepatocellular Carcinoma focused on measuring Radiofrequency ablation, RFA, Doxorubicin, Liposome, HCC, MLC, hepatocellular carcinoma, liver tumor, tumor, ablation, heat therapy, anti-tumor, liver cancer, metastatic liver cancer (MLC)

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Be 18 years of age or older.
  • Are willing to sign an informed consent form, indicating that they are aware of the investigational nature of this study that is in keeping with the policies of the institution.
  • Have a diagnosis of metastatic liver cancer (MLC) or primary hepatocellular cancer (HCC) confined to the liver.
  • Be an appropriate candidate for receiving RFA as a medically indicated treatment.
  • Have an echocardiogram revealing an Ejection Fraction (EF) ≥ 50%.
  • Willing to return to the study site for their imaging scans.
  • Have life expectancy of ≥ 3 months.
  • Have ECOG performance status of 0-2 or Karnofsky score of 60-100% (see Appendix II).
  • Have no more than Childs-Pugh Class B liver disease.
  • Subjects must have no prior doxorubicin exposure.
  • No single lesion should be > 7 cm in maximum diameter.
  • Subjects must agree to receive no other systemic therapy from the time of study enrollment until a minimum of 21 days after their ThermoDox infusion

Exclusion Criteria:

  • Have serious medical illnesses including, but not limited to, congestive heart failure, myocardial infarction or cerebral vascular accident within the last six months, or life threatening cardiac arrhythmias.
  • Are pregnant or breast feeding. In women of childbearing potential, a negative pregnancy test (serum) is required at baseline, 1 month and each 3 month follow-up visit.
  • Are not practicing an acceptable form of birth control (i.e. diaphragm, cervical cap, condom, surgical sterility or birth control pills. Woman whose husband has undergone a vasectomy must use a second form of birth control).
  • Have known serious allergic reactions (anaphylaxis) to any of the drugs or liposomal components or imaging agents to be used in this study.
  • Have portal or hepatic vein invasion/thrombosis.
  • Have PT or PTT > 1.5 times the institution's upper normal limit (UNL), except in subjects who are therapeutically anticoagulated for non-related medical conditions such as atrial fibrillation.
  • Have platelet count > 75,000/mm3, absolute neutrophil count > 1500/mm3, or Hgb > 10 (unless the hemoglobin value has been stable, the subject is cardiovascularly stable, asymptomatic and judged able to withstand the RFA
  • Have serum creatinine ≤ 2.0 mg/dl (or calculated CrCl ≤ 60mL/min).
  • Have contraindications to receiving doxorubicin HCl.
  • Are being treated with other investigational agents (within a minimum of 30 days or 5 half-lives of the investigational agent).
  • Have other concurrent malignancy (subjects with benign or non aggressive malignant tumors-e.g.: squamous cell cancer of the skin-may be included), evidence of extrahepatic cancer from their primary malignancy, or ongoing, medically significant active infection.
  • Documented HIV positive.
  • NYHA class III or IV cardiovascular disease or LVEF < 50%.
  • Evidence of hemachromatosis.
  • Are on any of the medications listed in section 6.3, which could have an adverse effect when combined with the study drug, and who cannot stop the medication for the duration of the study and 30 days beyond the treatment.

Sites / Locations

  • Northshore Hospital - Long Island Jewish Health System

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

ThermoDox + RFA

Arm Description

ThermoDox administered as single dose intravenously over 30 minutes in combination with radiofrequency ablation. Dose is determined by dose cohort patient enters study.

Outcomes

Primary Outcome Measures

To determine the maximum tolerated dose (MTD) of systemically delivered, heat-activated liposome encapsulated doxorubicin (ThermoDox) in combination with radiofrequency ablation (RFA) of liver neoplasms.
To test alternative infusion reaction prophylaxis regimens
To assess the safety of ThermoDox plus RFA afer administration of potential multiple cycles
To determine the Pharmacokinetics (PK) of ThermoDox

Secondary Outcome Measures

To document any anti-tumor activity and assess recurrences.
To measure post ablation lesion volume.
To determine the cardiotoxicity of ThermoDox through enhanced ECG monitoring.

Full Information

First Posted
February 26, 2007
Last Updated
February 5, 2019
Sponsor
Imunon
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1. Study Identification

Unique Protocol Identification Number
NCT00441376
Brief Title
A Study of ThermoDox™ in Combination With Radiofrequency Ablation (RFA) in Primary and Metastatic Tumors of the Liver
Official Title
A Phase I Dose Escalation Tolerability Study of ThermoDox™ (Thermally Sensitive Liposomal Doxorubicin) in Combination With Radiofrequency Ablation (RFA) of Primary and Metastatic Tumors of the Liver
Study Type
Interventional

2. Study Status

Record Verification Date
February 2019
Overall Recruitment Status
Completed
Study Start Date
February 2007 (undefined)
Primary Completion Date
October 2008 (Actual)
Study Completion Date
December 2009 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Imunon

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to determine the maximum tolerated dose (MTD) of ThermoDox when used in combination with radiofrequency ablation (RFA) in the treatment of primary and metastatic tumors of the liver.
Detailed Description
Ablative treatment approaches, such as RFA or microwave ablation, have received increased attention as alternates to other treatment approaches such as hepatic arterial embolization or chemoembolization (TACE) or percutaneous ethanol injection (PEI) in the majority of patients who are either not candidates for surgical resection or are not offered palliative supportive care only for diffuse disease. RFA can be applied repetitively to the same patient to treat multiple tumors at time of diagnosis or upon tumor recurrence (local or distant to the site of ablation), and is largely limited in its application only by tumor location and size (tumors near larger vessels, bowel or the hepatobiliary tree are more difficult to ablate). To extend the volume of the ablation region in a controlled fashion in patients and to improve the ability to kill tumor cells in the ablation margin region and allow for the improved treatment of HCC and MLC lesions > 3 cm in diameter by complete thermal ablation, Celsion Corporation has developed ThermoDox, a thermally sensitive, intravenously administered liposomal formulation of doxorubicin capable of selectively releasing its drug contents when exposed to temperatures of > 39.5°C. The concept behind this treatment approach is to create a large concentration gradient of doxorubicin in the immediate region of the tumor which borders the zone of RFA induced cell necrosis. The temperature isotherms produced in this boundary region should be adequate to activate doxorubicin release by the thermally sensitive liposomes deposited locally around the ablation zone. This in effect increases the region of tissue that can be treated beyond that achievable by RFA alone. Several clinical objectives are being tested in this study. The MTD for ThermoDox is to be confirmed. This study will assess the safety of using ThermoDox in conjunction with RFA over multiple cycles, consistent with the clinical needs of the subjects. While this study is not powered to define effectiveness of the combination of RFA plus ThermoDox, the results of this study should allow for an assessment of risk and benefit for designing future studies. This study will also test alternative infusion reaction prophylaxis regimens.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hepatocellular Carcinoma, Liver Neoplasms
Keywords
Radiofrequency ablation, RFA, Doxorubicin, Liposome, HCC, MLC, hepatocellular carcinoma, liver tumor, tumor, ablation, heat therapy, anti-tumor, liver cancer, metastatic liver cancer (MLC)

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
30 (Actual)

8. Arms, Groups, and Interventions

Arm Title
ThermoDox + RFA
Arm Type
Experimental
Arm Description
ThermoDox administered as single dose intravenously over 30 minutes in combination with radiofrequency ablation. Dose is determined by dose cohort patient enters study.
Intervention Type
Drug
Intervention Name(s)
ThermoDox
Intervention Description
15 ml vial containing 2mg/ml Doxorubicin HCl, DPPC, MSPC, DSPE-MPEG 2000. Administered as single dose intravenously over 30 minutes. Dose is determined by dose cohort patient enters study.
Primary Outcome Measure Information:
Title
To determine the maximum tolerated dose (MTD) of systemically delivered, heat-activated liposome encapsulated doxorubicin (ThermoDox) in combination with radiofrequency ablation (RFA) of liver neoplasms.
Time Frame
1 month
Title
To test alternative infusion reaction prophylaxis regimens
Time Frame
48 hours
Title
To assess the safety of ThermoDox plus RFA afer administration of potential multiple cycles
Time Frame
3 years
Title
To determine the Pharmacokinetics (PK) of ThermoDox
Time Frame
48 hours
Secondary Outcome Measure Information:
Title
To document any anti-tumor activity and assess recurrences.
Time Frame
3 years
Title
To measure post ablation lesion volume.
Time Frame
1 month
Title
To determine the cardiotoxicity of ThermoDox through enhanced ECG monitoring.
Time Frame
48 hours

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Be 18 years of age or older. Are willing to sign an informed consent form, indicating that they are aware of the investigational nature of this study that is in keeping with the policies of the institution. Have a diagnosis of metastatic liver cancer (MLC) or primary hepatocellular cancer (HCC) confined to the liver. Be an appropriate candidate for receiving RFA as a medically indicated treatment. Have an echocardiogram revealing an Ejection Fraction (EF) ≥ 50%. Willing to return to the study site for their imaging scans. Have life expectancy of ≥ 3 months. Have ECOG performance status of 0-2 or Karnofsky score of 60-100% (see Appendix II). Have no more than Childs-Pugh Class B liver disease. Subjects must have no prior doxorubicin exposure. No single lesion should be > 7 cm in maximum diameter. Subjects must agree to receive no other systemic therapy from the time of study enrollment until a minimum of 21 days after their ThermoDox infusion Exclusion Criteria: Have serious medical illnesses including, but not limited to, congestive heart failure, myocardial infarction or cerebral vascular accident within the last six months, or life threatening cardiac arrhythmias. Are pregnant or breast feeding. In women of childbearing potential, a negative pregnancy test (serum) is required at baseline, 1 month and each 3 month follow-up visit. Are not practicing an acceptable form of birth control (i.e. diaphragm, cervical cap, condom, surgical sterility or birth control pills. Woman whose husband has undergone a vasectomy must use a second form of birth control). Have known serious allergic reactions (anaphylaxis) to any of the drugs or liposomal components or imaging agents to be used in this study. Have portal or hepatic vein invasion/thrombosis. Have PT or PTT > 1.5 times the institution's upper normal limit (UNL), except in subjects who are therapeutically anticoagulated for non-related medical conditions such as atrial fibrillation. Have platelet count > 75,000/mm3, absolute neutrophil count > 1500/mm3, or Hgb > 10 (unless the hemoglobin value has been stable, the subject is cardiovascularly stable, asymptomatic and judged able to withstand the RFA Have serum creatinine ≤ 2.0 mg/dl (or calculated CrCl ≤ 60mL/min). Have contraindications to receiving doxorubicin HCl. Are being treated with other investigational agents (within a minimum of 30 days or 5 half-lives of the investigational agent). Have other concurrent malignancy (subjects with benign or non aggressive malignant tumors-e.g.: squamous cell cancer of the skin-may be included), evidence of extrahepatic cancer from their primary malignancy, or ongoing, medically significant active infection. Documented HIV positive. NYHA class III or IV cardiovascular disease or LVEF < 50%. Evidence of hemachromatosis. Are on any of the medications listed in section 6.3, which could have an adverse effect when combined with the study drug, and who cannot stop the medication for the duration of the study and 30 days beyond the treatment.
Facility Information:
Facility Name
Northshore Hospital - Long Island Jewish Health System
City
Manhasset
State/Province
New York
ZIP/Postal Code
11030
Country
United States

12. IPD Sharing Statement

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A Study of ThermoDox™ in Combination With Radiofrequency Ablation (RFA) in Primary and Metastatic Tumors of the Liver

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