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Phase II SBRT & Chemo for Unresectable Cholangiocarcinoma Followed by Liver Transplantation

Primary Purpose

Cholangiocarcinoma, Hepatobiliary Neoplasm, Liver Cancer

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Stereotactic Body Radiotherapy
Gemcitabine
Cisplatin
Carboplatin
Capecitabine
5FU
Liver transplantation
Sponsored by
Stanford University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cholangiocarcinoma

Eligibility Criteria

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

Inclusion Criteria:

  • Diagnosis of cholangiocarcinoma by any of the below:

    • Positive transcatheter biopsy or brush cytology
    • CA 19-9 ≥ 100mg/mL with a malignant-appearing stricture on cholangiography
    • Biliary ploidy by fluorescent in situ hybridization with a malignant stricture on cholangiography
  • Liver tumors not to exceed 8 cm in greatest axial dimension (800 cc of uninvolved liver)
  • Unresectable tumor above cystic duct
  • Hepatic lesion in patients for whom surgical resection is not possible or would not result in an opportunity for cure by any of the below:

    • Bilateral segmental ductal extension
    • Encasement of the main portal vein
    • Unilateral segmental ductal extension with contralateral vascular encasement
    • Unilateral atrophy with either contralateral segmental ductal or vascular (hepatic artery, portal vein) involvement
  • Ascites is allowed if the Model for End-Stage Liver Disease (MELD) score is <15[1]
  • Age > 18 years old
  • Eastern Clinical Oncology Group performance status 0, 1 or 2 (Appendix 1)
  • Lab values within 2 wks prior to randomization:

    • See STUDY SCHEMA for specific blood count inclusion criteria: ANC &#8805; 500 x 109/L (&#8805; 1500/mm3), Platelets &#8805; 5 x 109/L (&#8805; 50,000/mm3), Hgb &#8805; 9g/dL
    • Adequate liver function: Total bilirubin &#8804;1.5 x upper limit of normal (ULN); ALT and/or AST & alkaline phosphatase &#8804; 5 x ULN.
    • Adequate biliary drainage, with no evidence of active uncontrolled infection (patients on antibiotics are eligible).
    • See STUDY SCHEMA for specific renal function inclusion criteria: Adequate renal function with a calculated GFR &#8805; 40 ml/min. If the calculated GFR is below 40 ml/min a 24 hour urine creatinine clearance can be used.
    • Albumin > 2.5 mg/dL
    • INR &#8804; 1.5
  • Life expectancy > 6 months
  • Capable of giving written informed consent

Exclusion Criteria:

  • Prior radiotherapy to the upper abdomen
  • Contraindication to receiving radiotherapy
  • Prior chemotherapy
  • Prior biliary resection or attempted resection
  • Prior transperitoneal biopsy
  • Large esophageal varices without band ligation
  • Active GI bleed or within 2 weeks of study enrollment
  • Ascites refractory to medical therapy or shunting
  • Active/unresolved biliary tract obstruction
  • Presence of multifocal, lymphatic, or extrahepatic metastases
  • Participation in another concurrent treatment protocol
  • If history of other primary cancer, subject eligible only if she or he has:

    • Curatively resected non-melanomatous skin cancer
    • Curatively treated cervical carcinoma in situ
    • Other primary solid tumor curatively treated with no known active disease present and no treatment administered for the last 3 years
  • Any evidence of severe or uncontrolled systemic diseases or laboratory finding that in the view of the investigator makes it undesirable for the patient to participate in the trial
  • Any psychiatric or other disorder (eg brain metastases) likely to impact on informed consent
  • Pregnancy or breast-feeding
  • While not excluded, patients with significant impaired hearing must be made aware of potential ototoxicity and may choose not to be included. If included, baseline audiograms are recommended and, in those given cisplatin, should be followed by repeat audiograms prior to cycle 2.

Sites / Locations

  • Stanford University School of Medicine

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

SBRT, Chemo and Liver Transplantation

Arm Description

The patients received Stereotactic Body Radiotherapy and Chemotherapy followed by a liver transplantation. The chemo could be any combination of the following: Gemcitabine, Cisplatin, Carboplatin, Capecitabine and 5FU

Outcomes

Primary Outcome Measures

Progression-free Survival at 12 Months
Progression free survival is defined to be the time to progression of disease or death.

Secondary Outcome Measures

Pathologic Complete Response Rate
Pathologic complete response will be defined as no residual tumor cells seen on the explanted liver specimen.
Serum CA 19-9 Levels
Initial level of Cancer antigen 19-9
Overall Survival at 12 Months
the estimated probability for the percentage of participants with overall survival at 12 months.
Liver Transplant Rate
The number of patients receiving liver transplant among patients who initially have tumors ≤3 cm
Freedom From Local Progression at 12 Months
the proportion of patients who experienced a local recurrence at 12 months with death as a competing risk
Liver Transplant Conversion Rate
The ability to successfully perform liver transplant among patients who initially have tumor >3 cm
Median Time to Overall Survival
The time to overall survival is defined as the time to death from any cause. The median was determined via Kaplan Meier methodology.

Full Information

First Posted
June 15, 2010
Last Updated
June 30, 2016
Sponsor
Stanford University
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1. Study Identification

Unique Protocol Identification Number
NCT01151761
Brief Title
Phase II SBRT & Chemo for Unresectable Cholangiocarcinoma Followed by Liver Transplantation
Official Title
Phase II Study of Stereotactic Body Radiotherapy (SBRT) and Chemotherapy for Unresectable Cholangiocarcinoma Followed by Liver Transplantation
Study Type
Interventional

2. Study Status

Record Verification Date
June 2016
Overall Recruitment Status
Terminated
Why Stopped
Poor accrual
Study Start Date
January 2011 (undefined)
Primary Completion Date
April 2012 (Actual)
Study Completion Date
July 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Stanford University

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to determine progression-free survival at 12 months for stereotactic body radiotherapy (SBRT) and chemotherapy for unresectable hilar cholangiocarcinoma (CCA).
Detailed Description
Investigators hope to learn more about neoadjuvant SBRT and chemotherapy for unresectable CCA, and if SBRT followed by chemotherapy can lead to successful liver transplantation. This knowledge is important for this patient group as this disease is a highly lethal malignancy that often presents as unresectable, however surgery or transplantation are the only curative options.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cholangiocarcinoma, Hepatobiliary Neoplasm, Liver Cancer, Bile Duct Cancer, Cancer of Gallbladder

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
2 (Actual)

8. Arms, Groups, and Interventions

Arm Title
SBRT, Chemo and Liver Transplantation
Arm Type
Experimental
Arm Description
The patients received Stereotactic Body Radiotherapy and Chemotherapy followed by a liver transplantation. The chemo could be any combination of the following: Gemcitabine, Cisplatin, Carboplatin, Capecitabine and 5FU
Intervention Type
Procedure
Intervention Name(s)
Stereotactic Body Radiotherapy
Other Intervention Name(s)
External photon radiation
Intervention Description
Standard of care
Intervention Type
Drug
Intervention Name(s)
Gemcitabine
Other Intervention Name(s)
Gemzar
Intervention Description
100 mg/m2, IV
Intervention Type
Drug
Intervention Name(s)
Cisplatin
Other Intervention Name(s)
Platinol, Platinol-AQ
Intervention Description
25 mg/m2, IV
Intervention Type
Drug
Intervention Name(s)
Carboplatin
Other Intervention Name(s)
Paraplatin, Paraplatin-AQ
Intervention Description
AUC 2, based on Calvert formula, IV
Intervention Type
Drug
Intervention Name(s)
Capecitabine
Other Intervention Name(s)
Xeloda
Intervention Description
1000 mg/m2, PO
Intervention Type
Drug
Intervention Name(s)
5FU
Other Intervention Name(s)
Fluorouracil, Adrucil, Carac, Efudix, Efudex, Fluoroplex
Intervention Description
200 mg/m2
Intervention Type
Procedure
Intervention Name(s)
Liver transplantation
Primary Outcome Measure Information:
Title
Progression-free Survival at 12 Months
Description
Progression free survival is defined to be the time to progression of disease or death.
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Pathologic Complete Response Rate
Description
Pathologic complete response will be defined as no residual tumor cells seen on the explanted liver specimen.
Time Frame
12 months
Title
Serum CA 19-9 Levels
Description
Initial level of Cancer antigen 19-9
Time Frame
12 months
Title
Overall Survival at 12 Months
Description
the estimated probability for the percentage of participants with overall survival at 12 months.
Time Frame
12 months
Title
Liver Transplant Rate
Description
The number of patients receiving liver transplant among patients who initially have tumors ≤3 cm
Time Frame
12 months
Title
Freedom From Local Progression at 12 Months
Description
the proportion of patients who experienced a local recurrence at 12 months with death as a competing risk
Time Frame
12 months
Title
Liver Transplant Conversion Rate
Description
The ability to successfully perform liver transplant among patients who initially have tumor >3 cm
Time Frame
12 months
Title
Median Time to Overall Survival
Description
The time to overall survival is defined as the time to death from any cause. The median was determined via Kaplan Meier methodology.
Time Frame
18 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosis of cholangiocarcinoma by any of the below: Positive transcatheter biopsy or brush cytology CA 19-9 &#8805; 100mg/mL with a malignant-appearing stricture on cholangiography Biliary ploidy by fluorescent in situ hybridization with a malignant stricture on cholangiography Liver tumors not to exceed 8 cm in greatest axial dimension (800 cc of uninvolved liver) Unresectable tumor above cystic duct Hepatic lesion in patients for whom surgical resection is not possible or would not result in an opportunity for cure by any of the below: Bilateral segmental ductal extension Encasement of the main portal vein Unilateral segmental ductal extension with contralateral vascular encasement Unilateral atrophy with either contralateral segmental ductal or vascular (hepatic artery, portal vein) involvement Ascites is allowed if the Model for End-Stage Liver Disease (MELD) score is <15[1] Age > 18 years old Eastern Clinical Oncology Group performance status 0, 1 or 2 (Appendix 1) Lab values within 2 wks prior to randomization: See STUDY SCHEMA for specific blood count inclusion criteria: ANC &#8805; 500 x 109/L (&#8805; 1500/mm3), Platelets &#8805; 5 x 109/L (&#8805; 50,000/mm3), Hgb &#8805; 9g/dL Adequate liver function: Total bilirubin &#8804;1.5 x upper limit of normal (ULN); ALT and/or AST & alkaline phosphatase &#8804; 5 x ULN. Adequate biliary drainage, with no evidence of active uncontrolled infection (patients on antibiotics are eligible). See STUDY SCHEMA for specific renal function inclusion criteria: Adequate renal function with a calculated GFR &#8805; 40 ml/min. If the calculated GFR is below 40 ml/min a 24 hour urine creatinine clearance can be used. Albumin > 2.5 mg/dL INR &#8804; 1.5 Life expectancy > 6 months Capable of giving written informed consent Exclusion Criteria: Prior radiotherapy to the upper abdomen Contraindication to receiving radiotherapy Prior chemotherapy Prior biliary resection or attempted resection Prior transperitoneal biopsy Large esophageal varices without band ligation Active GI bleed or within 2 weeks of study enrollment Ascites refractory to medical therapy or shunting Active/unresolved biliary tract obstruction Presence of multifocal, lymphatic, or extrahepatic metastases Participation in another concurrent treatment protocol If history of other primary cancer, subject eligible only if she or he has: Curatively resected non-melanomatous skin cancer Curatively treated cervical carcinoma in situ Other primary solid tumor curatively treated with no known active disease present and no treatment administered for the last 3 years Any evidence of severe or uncontrolled systemic diseases or laboratory finding that in the view of the investigator makes it undesirable for the patient to participate in the trial Any psychiatric or other disorder (eg brain metastases) likely to impact on informed consent Pregnancy or breast-feeding While not excluded, patients with significant impaired hearing must be made aware of potential ototoxicity and may choose not to be included. If included, baseline audiograms are recommended and, in those given cisplatin, should be followed by repeat audiograms prior to cycle 2.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Daniel T Chang
Organizational Affiliation
Stanford University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Stanford University School of Medicine
City
Stanford
State/Province
California
ZIP/Postal Code
94305
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Phase II SBRT & Chemo for Unresectable Cholangiocarcinoma Followed by Liver Transplantation

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