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Effect and Safety of Huaier Granules Combined With Targeted Drugs and Anti- PD-(L)1 Antibody on the Treatment of uHCC

Primary Purpose

Unresectable Hepatocellular Carcinoma

Status
Not yet recruiting
Phase
Phase 4
Locations
Study Type
Interventional
Intervention
Huaier granule
Atezolizumab + Bevacizumab
Camrelizumab+Apatinib
Sintilimab+Bevacizumab
Sponsored by
Fudan University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Unresectable Hepatocellular Carcinoma focused on measuring Huaier granules, HCC, targeted therapy, PD-(L)1

Eligibility Criteria

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

Inclusion Criteria: 18 years and older Diagnosed as unresectable hepatocellular carcinoma (CNLC liver cancer stage II and III, did not meet the indications of transcatheter arterial chemoembolization or disease progression after transcatheter arterial chemoembolization) by histopathological and/or cytological examination, or meeting the clinical diagnostic criteria of primary liver cancer by [The Standard for Diagnosis and Treatment of Hepatocellular Carcinoma (2019 Edition)]. Liver function status Child-Pugh Class A or B, 7 points. Planned to receive one of the following treatment regimen: Atezolizumab and Bevacizumab, Camrelizumab and Apatinib, Sintilimab and Bevacizumab. HCC patients treated with TACE can be enrolled only if tumor progression after TACE or 3 months after TACE. Patients with active HBV infection can be enrolled if meeting one of the following conditions: ① within 28 days before enrollment, the patient's HBV DNA is < 500 IU / ml, if they have received anti HBV treatment, they need to continue the original antiviral treatment; if not, they need to receive anti-HBV treatment throughout the medication (according to local treatment standards; e.g. entecavir); ② for those with HBV DNA > 500 IU / ml and without antiviral treatment, they shall receive anti-HBV treatment for at least 7 days before joining the study (according to local treatment standards; e.g. entecavir), and are willing to continue to receive anti-HBV treatment during the study. Before joining the study, the serum HBV-DNA virus shall be retested and decreased by more than 1 log value; ③ For those with HBV DNA > 500 IU / ml and who have received antiviral treatment, they shall receive anti-HBV treatment for at least 7 days before enrollment (according to local treatment standards; e.g. entecavir), and are willing to continue to receive anti-HBV treatment during the study. Before enrollment, the serum HBV-DNA virus level shall be retested and decreased; Patients with active HCV infection can be enrolled when disease were stable after treatment; Agree to receive Huaier granule treatment after enrollment. At least one evaluable tumor lesion. Be conscious, have language expression ability or reading ability, can communicate normally, and cooperate to complete the questionnaire evaluation; Volunteer to join the study and sign the informed consent form. Exclusion Criteria: More than two active primary tumors at the same time. Portal vein tumor thrombus invaded the superior mesenteric vein. Patients received systemic therapy, radiotherapy or transcatheter arterial chemoembolization in the past 3 months. Patients allergic to the components of Huaier granules, or avoid to use Huaier granules or use with caution. Patients not able to take medication orally. Pregnant or lactating women or women prepare for pregnancy. Coagulation dysfunction (INR > 2.0, PT> 16s) or diseases with high possibility of bleeding (including but not limited to esophageal and/or gastric variceal bleeding, active ulcer, uncontrolled hypertension). Participating in clinical trials of other drugs. Refused to cooperate with follow-up. Other reasons that the researcher considers unsuitable to participate in this study.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm Type

    Experimental

    Experimental

    Experimental

    Arm Label

    Arm 1

    Arm 2

    Arm 3

    Arm Description

    Huaier granules combined with Atezolizumab and Bevacizumab

    Huaier granules combined with Camrelizumab and Apatinib

    Huaier granules combined with Sintilimab and Bevacizumab

    Outcomes

    Primary Outcome Measures

    ORR
    Objective response rate: proportion of subjects who achieved complete remission (CR) or partial remission (PR) by primary tumor imaging evaluation.

    Secondary Outcome Measures

    PFS
    Progression free survival: time from the date when the subject first received Huaier Granules combined with targeted drug and anti-PD-(L)1 antibody to the first observation of tumor progression or death from any cause.
    DCR
    Disease control rate: proportion of subjects who achieved complete remission (CR) or partial remission (PR) or stable disease (SD) by primary tumor imaging evaluation.
    TTR
    Time to response: time from the date when the subject first received Huaier Granules combined with targeted drug and anti-PD-(L)1 antibody to the first observation of tumor remission (CR or PR)
    DoR
    Duration of response: time from the first observation of tumor remission (CR or PR) to the first observation of tumor progression or death from any cause after the subject was treated with Huaier Granule combined with targeted drug and anti-PD-(L)1 antibody.
    Quality of life score
    Evaluated by the quality of life core scale [The European Organization for Reasearch and Treatment of Cancer Quality of Life Questionnare-Core 30(EORTC QLQ-C30 )(Chinese version)] developed by European cancer research and treatment organization. The scope of each domain is 0 to 100. Higher scores in the functional and general health areas indicate better functional status and quality of life, and higher scores in the symptomatic areas indicate more symptoms or problems (poorer quality of life).
    Incidence and severity of adverse events (AE)
    Incidence and severity of serious adverse events (SAE)
    Incidence and severity of adverse reactions (ADR)
    Incidence and severity of serious adverse reactions (SADR)
    Incidence and severity of suspicious and unexpected serious adverse reactions (SUSAR)

    Full Information

    First Posted
    December 13, 2022
    Last Updated
    May 16, 2023
    Sponsor
    Fudan University
    Collaborators
    LinkDoc Technology (Beijing) Co. Ltd., Huazhong University of Science and Technology
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05660213
    Brief Title
    Effect and Safety of Huaier Granules Combined With Targeted Drugs and Anti- PD-(L)1 Antibody on the Treatment of uHCC
    Official Title
    Effect and Safety of Huaier Granules Combined With Targeted Drugs and Anti- PD-(L)1 Antibody on the Treatment of Unresectable Hepatocellular Carcinoma: a Prospective, Multi-center, Exploratory Study
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    May 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    August 30, 2023 (Anticipated)
    Primary Completion Date
    January 1, 2025 (Anticipated)
    Study Completion Date
    March 1, 2025 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Fudan University
    Collaborators
    LinkDoc Technology (Beijing) Co. Ltd., Huazhong University of Science and Technology

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No
    Data Monitoring Committee
    Yes

    5. Study Description

    Brief Summary
    This is a prospective, multi-center, exploratory study. The purpose of this study is to evaluate the efficacy, safety and the impact on the quality of life of Huaier Granules combined with targeted drugs and anti- PD-(L)1 antibody on the first-line treatment of unresectable hepatocellular carcinoma.
    Detailed Description
    China is a country with a high incidence of liver cancer. The latest forecast data of the International Agency for Research on Cancer (IARC) shows that the number of newly diagnosed liver cancer in China in 2020 is close to half of the total in the world. Hepatocellular carcinoma (HCC) is the main type of liver cancer, accounting for more than 85%-90%. About 60% of HCC patients are of advanced stage when first visit, and lose the opportunity to receive radical treatment. Currently, targeted drugs are recommended by the guidelines for first-line treatment of advanced HCC. Several studies have shown that the use of immune checkpoint inhibitors (mainly PD-(L)1 inhibitors) combined with targeted drugs can increase the survival benefits of patients with advanced HCC. However, the overall ORR of first-line treatment is less than 50%, and some patients have experienced high-grade adverse events. Huaier granules is an extract from a medicinal fungus. Previous studies have shown that Huaier granules can inhibit the proliferation, angiogenesis, metastasis and invasion of cancer cells, and can reverse the resistance of targeted drugs. Huaier granules is one of the most commonly used Chinese patent medicines in the treatment of HCC, and is recommended by CSCO guidelines(liver cancer). Several previous studies have shown that Huaier granules can improve the efficacy and reduce the incidence of adverse events in all stages of HCC treatment. In this study, about 7 research centers will participate. The study will be conducted with 2 parts: In Part I, we planned to enroll 60 participants. All the participants will be treated with Huaier granules combined with targeted drug and anti- PD-(L)1 antibody, the three specific treatment regimens were Huaier granules combined with Atezolizumab and Bevacizumab, Huaier granules combined with Camrelizumab and Apatinib, Huaier granules combined with Sintilimab and Bevacizumab, each group will enroll 20 participants. Part II may commerce according to the results of Part I, the treatment regimen with the best effectiveness will be selected into the large-sample confirmatory study. In this study, participants will be followed up for 12 months.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Unresectable Hepatocellular Carcinoma
    Keywords
    Huaier granules, HCC, targeted therapy, PD-(L)1

    7. Study Design

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

    8. Arms, Groups, and Interventions

    Arm Title
    Arm 1
    Arm Type
    Experimental
    Arm Description
    Huaier granules combined with Atezolizumab and Bevacizumab
    Arm Title
    Arm 2
    Arm Type
    Experimental
    Arm Description
    Huaier granules combined with Camrelizumab and Apatinib
    Arm Title
    Arm 3
    Arm Type
    Experimental
    Arm Description
    Huaier granules combined with Sintilimab and Bevacizumab
    Intervention Type
    Drug
    Intervention Name(s)
    Huaier granule
    Intervention Description
    Treatment period: Huaier Granule, oral administration, 20g each time, 3 times a day. Continuous medication until the end of the study, intolerable toxicity, withdrawal from the study for any reason or death, whichever occurs first; or after researcher's judgement, patient would no longer benefit from the treatment. After disease progression, whether to continue the medication or not should be determined by the researcher and patient together.
    Intervention Type
    Drug
    Intervention Name(s)
    Atezolizumab + Bevacizumab
    Intervention Description
    Targeted Drug and Anti-PD-(L)1 antibody: Continuous medication until disease progression, intolerable toxicity, withdrawal from the study for any reason or death, whichever occurs first. Refer to drug instructions for specific usage.
    Intervention Type
    Drug
    Intervention Name(s)
    Camrelizumab+Apatinib
    Intervention Description
    Targeted Drug and Anti-PD-(L)1 antibody: Continuous medication until disease progression, intolerable toxicity, withdrawal from the study for any reason or death, whichever occurs first. Refer to drug instructions for specific usage.
    Intervention Type
    Drug
    Intervention Name(s)
    Sintilimab+Bevacizumab
    Intervention Description
    Targeted Drug and Anti-PD-(L)1 antibody: Continuous medication until disease progression, intolerable toxicity, withdrawal from the study for any reason or death, whichever occurs first. Refer to drug instructions for specific usage.
    Primary Outcome Measure Information:
    Title
    ORR
    Description
    Objective response rate: proportion of subjects who achieved complete remission (CR) or partial remission (PR) by primary tumor imaging evaluation.
    Time Frame
    Start of treatment until 12-month follow-up
    Secondary Outcome Measure Information:
    Title
    PFS
    Description
    Progression free survival: time from the date when the subject first received Huaier Granules combined with targeted drug and anti-PD-(L)1 antibody to the first observation of tumor progression or death from any cause.
    Time Frame
    Start of treatment until 12-month follow-up
    Title
    DCR
    Description
    Disease control rate: proportion of subjects who achieved complete remission (CR) or partial remission (PR) or stable disease (SD) by primary tumor imaging evaluation.
    Time Frame
    Start of treatment until 12-month follow-up
    Title
    TTR
    Description
    Time to response: time from the date when the subject first received Huaier Granules combined with targeted drug and anti-PD-(L)1 antibody to the first observation of tumor remission (CR or PR)
    Time Frame
    Start of treatment until 12-month follow-up
    Title
    DoR
    Description
    Duration of response: time from the first observation of tumor remission (CR or PR) to the first observation of tumor progression or death from any cause after the subject was treated with Huaier Granule combined with targeted drug and anti-PD-(L)1 antibody.
    Time Frame
    Start of treatment until 12-month follow-up
    Title
    Quality of life score
    Description
    Evaluated by the quality of life core scale [The European Organization for Reasearch and Treatment of Cancer Quality of Life Questionnare-Core 30(EORTC QLQ-C30 )(Chinese version)] developed by European cancer research and treatment organization. The scope of each domain is 0 to 100. Higher scores in the functional and general health areas indicate better functional status and quality of life, and higher scores in the symptomatic areas indicate more symptoms or problems (poorer quality of life).
    Time Frame
    Up to 12 months since the start of treatment
    Title
    Incidence and severity of adverse events (AE)
    Time Frame
    Start of treatment until 12-month follow-up
    Title
    Incidence and severity of serious adverse events (SAE)
    Time Frame
    Start of treatment until 12-month follow-up
    Title
    Incidence and severity of adverse reactions (ADR)
    Time Frame
    Start of treatment until 12-month follow-up
    Title
    Incidence and severity of serious adverse reactions (SADR)
    Time Frame
    Start of treatment until 12-month follow-up
    Title
    Incidence and severity of suspicious and unexpected serious adverse reactions (SUSAR)
    Time Frame
    Start of treatment until 12-month follow-up

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: 18 years and older Diagnosed as unresectable hepatocellular carcinoma (CNLC liver cancer stage II and III, did not meet the indications of transcatheter arterial chemoembolization or disease progression after transcatheter arterial chemoembolization) by histopathological and/or cytological examination, or meeting the clinical diagnostic criteria of primary liver cancer by [The Standard for Diagnosis and Treatment of Hepatocellular Carcinoma (2019 Edition)]. Liver function status Child-Pugh Class A or B, 7 points. Planned to receive one of the following treatment regimen: Atezolizumab and Bevacizumab, Camrelizumab and Apatinib, Sintilimab and Bevacizumab. HCC patients treated with TACE can be enrolled only if tumor progression after TACE or 3 months after TACE. Patients with active HBV infection can be enrolled if meeting one of the following conditions: ① within 28 days before enrollment, the patient's HBV DNA is < 500 IU / ml, if they have received anti HBV treatment, they need to continue the original antiviral treatment; if not, they need to receive anti-HBV treatment throughout the medication (according to local treatment standards; e.g. entecavir); ② for those with HBV DNA > 500 IU / ml and without antiviral treatment, they shall receive anti-HBV treatment for at least 7 days before joining the study (according to local treatment standards; e.g. entecavir), and are willing to continue to receive anti-HBV treatment during the study. Before joining the study, the serum HBV-DNA virus shall be retested and decreased by more than 1 log value; ③ For those with HBV DNA > 500 IU / ml and who have received antiviral treatment, they shall receive anti-HBV treatment for at least 7 days before enrollment (according to local treatment standards; e.g. entecavir), and are willing to continue to receive anti-HBV treatment during the study. Before enrollment, the serum HBV-DNA virus level shall be retested and decreased; Patients with active HCV infection can be enrolled when disease were stable after treatment; Agree to receive Huaier granule treatment after enrollment. At least one evaluable tumor lesion. Be conscious, have language expression ability or reading ability, can communicate normally, and cooperate to complete the questionnaire evaluation; Volunteer to join the study and sign the informed consent form. Exclusion Criteria: More than two active primary tumors at the same time. Portal vein tumor thrombus invaded the superior mesenteric vein. Patients received systemic therapy, radiotherapy or transcatheter arterial chemoembolization in the past 3 months. Patients allergic to the components of Huaier granules, or avoid to use Huaier granules or use with caution. Patients not able to take medication orally. Pregnant or lactating women or women prepare for pregnancy. Coagulation dysfunction (INR > 2.0, PT> 16s) or diseases with high possibility of bleeding (including but not limited to esophageal and/or gastric variceal bleeding, active ulcer, uncontrolled hypertension). Participating in clinical trials of other drugs. Refused to cooperate with follow-up. Other reasons that the researcher considers unsuitable to participate in this study.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Jia Fan, PhD
    Phone
    136016669720
    Email
    Fan.jia@zs-hospital.sh.cn
    First Name & Middle Initial & Last Name or Official Title & Degree
    Huichuan Sun, PhD
    Phone
    13701922065
    Email
    Sun.huichuan@zs-hospital.sh.cn
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Jia Fan, PhD
    Organizational Affiliation
    Affiliated Zhongshan Hospital, Fudan University
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No

    Learn more about this trial

    Effect and Safety of Huaier Granules Combined With Targeted Drugs and Anti- PD-(L)1 Antibody on the Treatment of uHCC

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