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Safety and Efficacy of Everolimus Treatment in Liver Transplantation for Liver Cancer

Primary Purpose

Carcinoma, Hepatocellular

Status
Active
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Everolimus
Tacrolimus
Myfortic
CellCept
Imuran
Sponsored by
Baylor Research Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Carcinoma, Hepatocellular focused on measuring Immunosuppressive Agents, Liver Transplantation

Eligibility Criteria

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

Screening Inclusion Criteria:

  • Have a diagnosis of hepatocellular carcinoma (HCC) and high risk for HCC recurrence
  • Able to provide written informed consent
  • Male and female patients of any race, 18 years or older
  • De novo recipients of a primary orthotopic liver transplant from a deceased or living donor
  • Patients willing to comply with study requirements
  • Women of child-bearing potential (WOCBP) must agree to use an effective method(s) of contraception during treatment and during the post treatment follow-up period

Screening Exclusion Criteria:

  • Past or present malignancy within the last 5 years.
  • Severe infection considered by the local site investigator to be unsafe for study participation.
  • Use of other investigational drugs at the time of screening or within the last 30 days.
  • Patients scheduled for a combined transplant (such as liver-kidney), or having a previous solid organ, bone marrow, or autologous islet cell transplant.
  • Recipients of donor/recipient ABO incompatible grafts.
  • Recipients of organs from human immunodeficiency virus (HIV) or HBsAg positive donors.
  • Macrovascular tumor invasion.
  • Proteinuria greater than 2 grams/24 hours.
  • Conditions which can result in impaired absorption, distribution, metabolism or excretion of the study treatment.
  • Patients with non-infectious pneumonitis.
  • Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive human chorionic gonadotropin (hCG) laboratory test.
  • Women of child-bearing potential (WOCBP) not practicing an effective method(s) of contraception.
  • Patients who receive sirolimus (Rapamune®) as part of their transplant immunosuppression regimen

Randomization Screening Inclusion Criteria :

- For patients with a history of any hepatic vessel thrombosis, occlusion, stent placement, or major revision of liver vessels, must have a Doppler ultrasound prior to randomization to rule out any hepatic vessel complication, including hepatic arterial thrombosis (HAT).

Randomization Exclusion Criteria:

  • Patients who receive sirolimus (Rapamune) any time prior to randomization will be withdrawn from the study.
  • Patients who develop clinically significant systemic infections requiring active use of IV antibiotics any time prior to randomization.
  • Wound healing problem, per Investigator's assessment, that would make the patient ineligible for study randomization
  • Confirmed presence of a thrombosis in a major hepatic artery(s), major hepatic vein(s), portal vein or inferior vena cava via Doppler ultrasound or other imaging obtained prior to randomization.
  • Proteinuria greater than 2 grams/24 hours.
  • Consideration by the investigator, for any reason, that the subject is an unsuitable candidate to receive everolimus or be randomized into the study.

Sites / Locations

  • University of California at San Francisco
  • Northwestern University School of Medicine
  • University of Kansas Medical Center
  • Mayo Clinic
  • Washington University School of Medicine
  • Mount Sinai Medical Center
  • University of Pennsylvania
  • University of Tennessee- Methodist University Hospital
  • Baylor University Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Everolimus and Tacrolimus

Tacrolimus and Myfortic or CellCept or Imuran

Arm Description

Everolimus Dosing: 1.5 mg BID (3.0 mg/day) Tacrolimus Dosing: 0.05 mg/kg BID

Myfortic: 360 mg to 1080 mg BID OR CellCept: 500 mg to 1500 mg BID OR Imuran: 0.5mk/kg to 2mg/kg QD AND Tacrolimus Dosing: 0.05 mg/kg BID

Outcomes

Primary Outcome Measures

Disease free survival (DFS) defined as the time from randomization to the time of tumor recurrence or death, whichever occurs first.

Secondary Outcome Measures

Tumor recurrence sites
Hepatitis C recurrence rate
Renal function
Acute cellular rejection
Post-transplant diabetes
Hypertension
Hyperlipidemia
Wound healing and associated risk factors
Hernia repair
Hepatic arterial thrombosis

Full Information

First Posted
March 5, 2014
Last Updated
July 19, 2022
Sponsor
Baylor Research Institute
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1. Study Identification

Unique Protocol Identification Number
NCT02081755
Brief Title
Safety and Efficacy of Everolimus Treatment in Liver Transplantation for Liver Cancer
Official Title
A 36 Month Multi-center, Open Label, Randomized, Comparator Study to Evaluate the Efficacy and Safety of Everolimus Immunosuppression Treatment in Liver Transplantation for Hepatocellular Carcinoma Exceeding Milan Criteria
Study Type
Interventional

2. Study Status

Record Verification Date
July 2022
Overall Recruitment Status
Active, not recruiting
Study Start Date
March 2014 (Actual)
Primary Completion Date
January 2023 (Anticipated)
Study Completion Date
January 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Baylor Research Institute

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study is a prospective Phase IV study to determine if the use of Everolimus results in lower liver tumor recurrence and improved patient and graft survival after liver transplant for hepatocellular carcinoma (HCC). The immunosuppressive comparators will be Everolimus and Tacrolimus therapy compared to Tacrolimus and Mycophenolic acid/Mycophenolate Mofetil/Azathioprine. Primary outcomes data is disease free survival (the time from randomization to HCC recurrence or death). Secondary outcomes are rate of recurrence of Hepatitis C, problems related to wound healing, hernia repair within the first 12 months, hepatic arterial thrombosis, renal function, acute cellular rejection, post-transplant diabetes, hypertension, and hyperlipidemia.
Detailed Description
The study population will consist of approximately 336 patients (224 Everolimus and Tacrolimus and 112 Tacrolimus and Mycophenolic acid/Mycophenolate Mofetil/Azathioprine). Initial screening criteria will include the presence of hepatocellular carcinoma in patients 18 years or older who are candidates to receive a primary orthotopic liver transplant (from deceased or living donor). Within 7 - 12 days post-transplant, patients will be re-evaluated for eligibility for randomization. The criteria include: pre-transplant imaging that shows HCC disease exceeding Milan criteria; pathology review for tumor burden and/or presence of microvascular invasion; AFP >200IU/mL; pre-transplant ablation or resection with HCC recurrence; progression or new tumors; evaluation to rule out any hepatic vessel complication. Subjects will remain in study treatment until Month 12 at which time the subject and investigator will determine the preferred immunosuppressive regimen. Subjects will be followed for an additional 24 months for outcome data as described above.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Carcinoma, Hepatocellular
Keywords
Immunosuppressive Agents, Liver Transplantation

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
336 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Everolimus and Tacrolimus
Arm Type
Experimental
Arm Description
Everolimus Dosing: 1.5 mg BID (3.0 mg/day) Tacrolimus Dosing: 0.05 mg/kg BID
Arm Title
Tacrolimus and Myfortic or CellCept or Imuran
Arm Type
Active Comparator
Arm Description
Myfortic: 360 mg to 1080 mg BID OR CellCept: 500 mg to 1500 mg BID OR Imuran: 0.5mk/kg to 2mg/kg QD AND Tacrolimus Dosing: 0.05 mg/kg BID
Intervention Type
Drug
Intervention Name(s)
Everolimus
Other Intervention Name(s)
Zortress, Afinitor
Intervention Description
Everolimus Dosing: 1.5 mg BID (3.0 mg/day) for 12 months
Intervention Type
Drug
Intervention Name(s)
Tacrolimus
Other Intervention Name(s)
Prograf
Intervention Description
Tacrolimus Dosing: 0.05 mg/kg BID for 12 months
Intervention Type
Drug
Intervention Name(s)
Myfortic
Other Intervention Name(s)
Mycophenolic Acid
Intervention Description
Myfortic®: 360 mg to 1080 mg BID for 12 months
Intervention Type
Drug
Intervention Name(s)
CellCept
Other Intervention Name(s)
Mycophenolate Mofetil
Intervention Description
CellCept: 500 mg to 1500 mg BID for 12 months
Intervention Type
Drug
Intervention Name(s)
Imuran
Other Intervention Name(s)
Azathioprine
Intervention Description
0.5 mg/kg to 2 mg/kg QD for 12 months
Primary Outcome Measure Information:
Title
Disease free survival (DFS) defined as the time from randomization to the time of tumor recurrence or death, whichever occurs first.
Time Frame
Through Month 36
Secondary Outcome Measure Information:
Title
Tumor recurrence sites
Time Frame
Through Month 36
Title
Hepatitis C recurrence rate
Time Frame
Through Month 36
Title
Renal function
Time Frame
Through Month 36
Title
Acute cellular rejection
Time Frame
Through Month 36
Title
Post-transplant diabetes
Time Frame
Through Month 36
Title
Hypertension
Time Frame
Through Month 36
Title
Hyperlipidemia
Time Frame
Through Month 36
Title
Wound healing and associated risk factors
Time Frame
Through Month 36
Title
Hernia repair
Time Frame
Through Month 36
Title
Hepatic arterial thrombosis
Time Frame
Through Month 36

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Screening Inclusion Criteria: Have a diagnosis of hepatocellular carcinoma (HCC) and high risk for HCC recurrence Able to provide written informed consent Male and female patients of any race, 18 years or older De novo recipients of a primary orthotopic liver transplant from a deceased or living donor Patients willing to comply with study requirements Women of child-bearing potential (WOCBP) must agree to use an effective method(s) of contraception during treatment and during the post treatment follow-up period Screening Exclusion Criteria: Past or present malignancy within the last 5 years. Severe infection considered by the local site investigator to be unsafe for study participation. Use of other investigational drugs at the time of screening or within the last 30 days. Patients scheduled for a combined transplant (such as liver-kidney), or having a previous solid organ, bone marrow, or autologous islet cell transplant. Recipients of donor/recipient ABO incompatible grafts. Recipients of organs from human immunodeficiency virus (HIV) or HBsAg positive donors. Macrovascular tumor invasion. Proteinuria greater than 2 grams/24 hours. Conditions which can result in impaired absorption, distribution, metabolism or excretion of the study treatment. Patients with non-infectious pneumonitis. Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive human chorionic gonadotropin (hCG) laboratory test. Women of child-bearing potential (WOCBP) not practicing an effective method(s) of contraception. Patients who receive sirolimus (Rapamune®) as part of their transplant immunosuppression regimen Randomization Screening Inclusion Criteria : - For patients with a history of any hepatic vessel thrombosis, occlusion, stent placement, or major revision of liver vessels, must have a Doppler ultrasound prior to randomization to rule out any hepatic vessel complication, including hepatic arterial thrombosis (HAT). Randomization Exclusion Criteria: Patients who receive sirolimus (Rapamune) any time prior to randomization will be withdrawn from the study. Patients who develop clinically significant systemic infections requiring active use of IV antibiotics any time prior to randomization. Wound healing problem, per Investigator's assessment, that would make the patient ineligible for study randomization Confirmed presence of a thrombosis in a major hepatic artery(s), major hepatic vein(s), portal vein or inferior vena cava via Doppler ultrasound or other imaging obtained prior to randomization. Proteinuria greater than 2 grams/24 hours. Consideration by the investigator, for any reason, that the subject is an unsuitable candidate to receive everolimus or be randomized into the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Goran Klintmalm, MD, PhD
Organizational Affiliation
Baylor Health Care System
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of California at San Francisco
City
San Francisco
State/Province
California
ZIP/Postal Code
94143
Country
United States
Facility Name
Northwestern University School of Medicine
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Facility Name
University of Kansas Medical Center
City
Kansas City
State/Province
Kansas
ZIP/Postal Code
66160
Country
United States
Facility Name
Mayo Clinic
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States
Facility Name
Washington University School of Medicine
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Facility Name
Mount Sinai Medical Center
City
New York
State/Province
New York
ZIP/Postal Code
10029
Country
United States
Facility Name
University of Pennsylvania
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Facility Name
University of Tennessee- Methodist University Hospital
City
Memphis
State/Province
Tennessee
ZIP/Postal Code
38104
Country
United States
Facility Name
Baylor University Medical Center
City
Dallas
State/Province
Texas
ZIP/Postal Code
75246
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Safety and Efficacy of Everolimus Treatment in Liver Transplantation for Liver Cancer

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