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Dose-defining Study of Tirapazamine Combined With Embolization in Liver Cancer

Primary Purpose

Hepatocellular Carcinoma, Gastrointestinal Cancer Metastatic, Neuroendocrine Tumors

Status
Active
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Tirapazamine
Conventional Transarterial Embolization (TAE)
Sponsored by
Teclison Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hepatocellular Carcinoma focused on measuring Hypoxia, Embolization, Tirapazamine

Eligibility Criteria

20 Years - 99 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers
  • Confirmed diagnosis of HCC > 10 mm with a characteristic 4-phase CT or dynamic contrast enhanced MRI finding showing intense arterial uptake followed by "washout" of contrast in the venous-delayed phases per American Association for the Study of Liver Disease (AASLD) criteria.
  • Patients between ages 20 and 80
  • Patients with single or multiple (2-4 nodules) HCC who are unsuitable or unwilling for surgical resection or RFA. The largest tumor nodule should be less than 10 cm in the largest diameter. The total volume of tumor cannot exceed 50% of liver; or patients with liver metastatic gastrointestinal cancer, including neuroendocrine tumor
  • Patients are candidates for TAE or Transarterial ChemoEmbolization (TACE). No tumor invasion to portal vein or thrombosis in portal vein.
  • ECOG score 0-1 with no known cardiac, pulmonary or renal dysfunction
  • Child-Pugh score group A or B7 liver functional score
  • Prior local therapies such as surgical resection, radiofrequency ablation, or alcohol injection are allowed as long as tumor progresses from the prior treatment and the patients are still candidates for TAE. All prior therapy must be at least 4 weeks prior to enrollment and free from treatment-related toxicity.
  • No TAE/TACE in the past
  • Patients have normal organ function: ANC ≥ 1000 /µL, Hemoglobin ≥ 9 gm/dL, Platelets ≥ 50,000 /µL, Creatinine ≤ 2 mg/dL, AST and ALT < 5 X upper normal limit of the current institution; bilirubin ≤ 3.0 mg/dL, PT prolongation no more than 4 sec above upper limit of normal.

For the expansion cohort of neuroendocrine tumor or metastatic solid tumor with liver involvement

  • Unresectable, locally advanced or metastatic, well differentiated (low or intermediate grade), neuroendocrine tumors (NET).
  • Metastatic solid tumor with liver involvement.

Sites / Locations

  • Stanford University
  • University of Pennsylvania

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Tirapazamine

Arm Description

Intra-arterial administration with tirapazamine before embolization to evaluate the response in metastatic liver lesions of NET

Outcomes

Primary Outcome Measures

Overall Response rate (ORR) by RECIST
Overall Response Rate by RECIST criteria

Secondary Outcome Measures

Overall Response Rate
Overall Response Rate by mRECIST criteria
Duration of Response
Duration of Response by RECIST and mRECIST

Full Information

First Posted
June 10, 2014
Last Updated
September 19, 2023
Sponsor
Teclison Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT02174549
Brief Title
Dose-defining Study of Tirapazamine Combined With Embolization in Liver Cancer
Official Title
Phase I Dose-Escalating Study of Combining Intravenous Tirapazamine and Transarterial Embolization (TAE) in Liver Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
September 2014 (undefined)
Primary Completion Date
December 31, 2025 (Anticipated)
Study Completion Date
December 31, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Teclison Ltd.

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This phase 1 study is to determine the optimal dose and tolerability of a hypoxia-activating agent, tirapazamine, when it is combined with embolization in liver cancer. Liver cancer patients who are Child-Pugh score A, suitable for embolization with tumor no more than 4 nodules are eligible. Tirapazamine will be given by intra-arterial injection before embolization. Treatment effect is evaluated by MRI based on mRECIST criteria. Repeat treatment is necessary only if disease progression. Dose escalation cohort has been completed. Expansion cohort is open for metastatic liver dominant neuroendocrine tumor.
Detailed Description
The study is a 3+3 design for dose escalation. Each cohort will have 3-6 patients based on tolerability. Patients will receive escalated doses of tirapazamine until maximally tolerated dose. Embolization is performed per standard practice using Lipiodol and Gelfoam under X-ray guidance. Once a suitable dose is determined, an expansion cohort of 15 patients will be treated with the recommended phase 2 dose to determine preliminary efficacy. Expansion cohorts include (1) hepatocellular carcinoma, (2) metastatic solid tumors with liver metastasis, and (3) neuroendocrine tumor. Adverse events are evaluated by CTCAE vs. 5.0 and efficacy is evaluated by MRI using modified RECIST criteria and RECIST criteria. The dose escalation part has been completed. Only the third cohort or neuroendocrine tumor remains active for future patient enrollment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hepatocellular Carcinoma, Gastrointestinal Cancer Metastatic, Neuroendocrine Tumors
Keywords
Hypoxia, Embolization, Tirapazamine

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Model Description
Open label, dose escalation 3+3 design completed; now only for expansion cohort in neuroendocrine tumor.
Masking
None (Open Label)
Allocation
N/A
Enrollment
25 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Tirapazamine
Arm Type
Experimental
Arm Description
Intra-arterial administration with tirapazamine before embolization to evaluate the response in metastatic liver lesions of NET
Intervention Type
Drug
Intervention Name(s)
Tirapazamine
Intervention Description
Intra-arterial injection into the tumor feeding artery
Intervention Type
Procedure
Intervention Name(s)
Conventional Transarterial Embolization (TAE)
Other Intervention Name(s)
TAE conducted with Lipiodol and Surgifoam as the embolizing agents.
Intervention Description
Lipiodol and Gelfoam used to embolize tumor vessels and induce tumor hypoxia
Primary Outcome Measure Information:
Title
Overall Response rate (ORR) by RECIST
Description
Overall Response Rate by RECIST criteria
Time Frame
2 years
Secondary Outcome Measure Information:
Title
Overall Response Rate
Description
Overall Response Rate by mRECIST criteria
Time Frame
2 years
Title
Duration of Response
Description
Duration of Response by RECIST and mRECIST
Time Frame
2 years
Other Pre-specified Outcome Measures:
Title
Response Rate in TATE-treated target lesions
Description
by mRECIST and RECIST
Time Frame
2 years
Title
Progressive Free Survival
Description
by RECIST and mRECIST
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
20 Years
Maximum Age & Unit of Time
99 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients with well-differentiated NET and liver-dominant metastatic disease with intrahepatic disease progression, regardless of primary tumor origin or tumor functional status. Patients may have extrahepatic lesions as long as the majority of the disease burden is intrahepatic. No limitation in hepatic lesion tumor size or number but the total volume of liver tumors cannot exceed 50% of the liver volume. Patients are allowed to have prior US Food and Drug Administration (FDA)-approved treatments, including systemic therapies, surgery, ablation, or transarterial therapies for the metastatic NET. Age 20 or higher, ECOG functional status 0-1, and with no known major cardiac, pulmonary, or renal dysfunction. Are candidates for TAE or TACE and without portal vein occlusion per treating interventional radiologists. ANC no less than 1000 /μL. Hemoglobin ≥ 9 gm/dL. Platelets no less than 50,000 /μL. Creatinine no more than 2.0 mg/dL. AST, ALT no more than 5X upper limit of normal. Bilirubin no more than 2.5 mg/dl. PT prolongation ≤ 4 sec above upper limit of normal. Woman of child-bearing potential (WOCBP) should use highly effective contraception during trial participation and for 6 months after the last dose of tirapazamine and men who are partners with WOCBP should use highly effective contraception, including barrier contraception, during trial participation and for 3 months after the last dose of tirapazamine.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Michael Soulen, MD
Organizational Affiliation
Univ. of Pennsylvania
Official's Role
Principal Investigator
Facility Information:
Facility Name
Stanford University
City
Palo Alto
State/Province
California
ZIP/Postal Code
94305
Country
United States
Facility Name
University of Pennsylvania
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
34041204
Citation
Abi-Jaoudeh N, Dayyani F, Chen PJ, Fernando D, Fidelman N, Javan H, Liang PC, Hwang JI, Imagawa DK. Phase I Trial on Arterial Embolization with Hypoxia Activated Tirapazamine for Unresectable Hepatocellular Carcinoma. J Hepatocell Carcinoma. 2021 May 17;8:421-434. doi: 10.2147/JHC.S304275. eCollection 2021.
Results Reference
background
Links:
URL
https://pubmed.ncbi.nlm.nih.gov/34041204/
Description
Phase 1 dose escalation result in Hepatocellular carcinoma

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Dose-defining Study of Tirapazamine Combined With Embolization in Liver Cancer

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