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A Clinical Trial Using Irreversible Electroporation for the Treatment of Liver Cancers

Primary Purpose

Hepatocellular Carcinoma, Metastatic Liver Cancers

Status
Completed
Phase
Not Applicable
Locations
Taiwan
Study Type
Interventional
Intervention
Irreversible Electroporation (IRE) System
Sponsored by
National Taiwan University Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hepatocellular Carcinoma focused on measuring Hepatocellular Carcinoma, irreversible electroporation, liver cancer

Eligibility Criteria

20 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Patients must meet all of the following inclusion criteria to be eligible for this study:

  1. The diagnosis of hepatocellular carcinoma (HCC) or metastatic liver cancers with pathologic proven, and the diagnosis of HCC will be made by pathology / cytology or according to the American Association for the Study of Liver Diseases (AASLD) (2010) diagnostic criteria. In brief, Nodules larger than 1 cm found on ultrasound screening of a cirrhotic liver should be investigated further with either tri-phase multidetector computed tomography (CT) scan or dynamic contrast enhanced magnetic resonance imaging (MRI). If the appearances are typical of HCC (i.e., hypervascular in the arterial phase with washout in the portal venous or delayed phase), the lesion should be treated as HCC. If the findings are not characteristic or the vascular profile is not typical, a second contrast enhanced study with the other imaging modality should be performed, or the lesion should be biopsied. Biopsies of small lesions should be evaluated by expert pathologists. Tissue that is not clearly HCC should be stained with all the available markers including cluster of differentiation 34 (CD34), cytokeratin 7 (CK7), glypican 3, heat shock protein 70 (HSP70), and glutamine synthetase to improve diagnostic accuracy.
  2. Unsuitable for surgical resection but local ablation is indicated, however, the distance between tumour and vessels is smaller than 5 mm.
  3. Have at least one, but less than or equal to 3 tumors,
  4. Each tumor must be ≤ 5 cm in diameter,
  5. Child-Pugh class A-B,
  6. Eastern Cooperative Oncology Group (ECOG) score of 0-1,
  7. American Society of Anaesthesiologists (ASA) score ≤ 3,
  8. Adequate bone marrow, liver and renal function. Platelet count ≥ 100 K/Μl. Total bilirubin ≦ 2 mg/dL. alanine transaminase (ALT) and aspartate transaminase (AST) < 5 x upper limit of normal. prothrombin time (PT)- international normalized ratio (INR) ≦ 2.0. Serum creatinine ≦ 1.5 x upper limit of normal
  9. Prior Informed Consent Form
  10. Life expectancy of at least 3 months.
  11. The disease status is not suitable to receive surgical resection, percutaneous alcohol injection, transarterial chemoembolization or other standard treatment.

Exclusion Criteria:

Patients presenting with any of the following will not be enrolled into this study:

1. History of cardiac disease:

  1. Congestive heart failure >New York Heart Association (NYHA) class 2
  2. Active coronary artery disease (CAD) (myocardial infarction more than 6 months prior to study entry is allowed)
  3. Cardiac arrhythmias (>Grade 2 NCI-CTCAE Version 3.0) which are poorly controlled with anti-arrhythmic therapy or requiring pace maker
  4. Uncontrolled hypertension 2. Any active metal implanted device (eg Pacemaker), 3. Women who are pregnant or women of child-bearing potential who are not using an acceptable method of contraception, 4. Received treatment with an investigational agent/ procedure within 30 days prior to treatment with the IRE System, 5. Known history of HIV infection 6. Concurrent extrahepatic cancer

Sites / Locations

  • National Taiwan University Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

irreversible electroporation (IRE)

Arm Description

irreversible electroporation (IRE) (AngioDynamics, NY) To use 2 to 6 unipolar electrodes of IRE in a predetermined grid pattern. 90 pulses of 2,000 - 3,000 V were applied with a pulse generator (AngioDynamics, NY) across the gap between the electrodes for 100 microseconds (0.1 msec) per each ablation.

Outcomes

Primary Outcome Measures

Tumor response
Tumor response, according to modified RECIST criteria, will be evaluated by abdominal computed tomography (CT) or magnetic resonance imaging (MRI) 1 month after treatment.

Secondary Outcome Measures

Change of Eastern Cooperative Oncology Group (ECOG) evaluation
Complete an Eastern Cooperative Oncology Group (ECOG) evaluation
Change of vital signs
Measure vital signs including temperature, respiratory rate, blood pressure, and heart rate.
Physical examination
Conduct a physical examination.
Clinical laboratory assessments
Collect blood samples for Clinical laboratory assessments, including hematology, A-fetoprotein (AFP) (for hepatocellular carcinoma (HCC)) / carcinoembryonic antigen (CEA) (for adenocarcinoma) and chemistry evaluations.
Urinalysis
Collect urine sample for a routine urinalysis.
Conduct CT or MR scans for tumour response evaluation
Subjects will still be followed-up in the event of disease progression in order to document local recurrence, a secondary endpoint.
Review concomitant medications
Use of medications will be reviewed and recorded.
Assess for presence of adverse events
An adverse event assessment will be performed.

Full Information

First Posted
June 27, 2016
Last Updated
July 2, 2020
Sponsor
National Taiwan University Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT02828865
Brief Title
A Clinical Trial Using Irreversible Electroporation for the Treatment of Liver Cancers
Official Title
A Prospective Clinical Trial Using Irreversible Electroporation for the Treatment of Liver Cancers
Study Type
Interventional

2. Study Status

Record Verification Date
July 2020
Overall Recruitment Status
Completed
Study Start Date
November 2012 (undefined)
Primary Completion Date
December 18, 2013 (Actual)
Study Completion Date
May 27, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Taiwan University Hospital

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Liver cancer including primary hepatocellular carcinoma (HCC) and metastatic liver cancers is one the most common malignancies in the world. Over 10000 new cases per year are diagnosed in Taiwan. Despite the many treatment options, the prognosis of HCC remains dismal. More than 8000 people died of this cancer every year in Taiwan. A majority (70% to 85%) of patients present with advanced or unresectable disease. In contrast, small liver cancers can be cured with an appreciable frequency. Five-year disease-free survival exceeding 50% has been reported for surgical resection, and for the inoperable patients who do not have vascular invasion or extrahepatic spread. Radiofrequency ablation (RFA) is recommended as an alternative curative therapy. However, the main drawback of RFA is its limitation to tumor size and location. The tumors larger than 5 cm in diameter or located adjacent to vessels, could not be ablated completely sometimes.
Detailed Description
Irreversible electroporation (IRE), developed and manufactured by AngioDynamics US Ltd, can ablate tumor by fenestrating the cancer cell membrane by electric pulse. The anti-tumor effect does not result from thermotherapy, so is also not diminished by adjacent vessels. Several pre-clinical studies have already demonstrated IRE is a safe and effective treatment for live cancers. The system has been approved as safe by the European Union (EU) in 2008 and received Food and Drug Administration (FDA) approval in 2010. However, there are still few experiences in using IRE for tumor ablation in Taiwan. In this study, the investigators will perform IRE for 40 inoperable patients with liver cancers adjacent to vessels who are suitable to receive radiofrequency ablation (RFA) in the investigators hospital. The investigators will evaluate the potential side effect and ablate effect of tumors by abdominal computed tomography (CT) or magnetic resonance imaging (MRI), and the investigators will also follow-up this patients for 2 years to evaluate the overall survival and local recurrence rate. The investigators will appraisal the clinical feasibility and advantage of the system by this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hepatocellular Carcinoma, Metastatic Liver Cancers
Keywords
Hepatocellular Carcinoma, irreversible electroporation, liver cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
18 (Actual)

8. Arms, Groups, and Interventions

Arm Title
irreversible electroporation (IRE)
Arm Type
Experimental
Arm Description
irreversible electroporation (IRE) (AngioDynamics, NY) To use 2 to 6 unipolar electrodes of IRE in a predetermined grid pattern. 90 pulses of 2,000 - 3,000 V were applied with a pulse generator (AngioDynamics, NY) across the gap between the electrodes for 100 microseconds (0.1 msec) per each ablation.
Intervention Type
Device
Intervention Name(s)
Irreversible Electroporation (IRE) System
Primary Outcome Measure Information:
Title
Tumor response
Description
Tumor response, according to modified RECIST criteria, will be evaluated by abdominal computed tomography (CT) or magnetic resonance imaging (MRI) 1 month after treatment.
Time Frame
1 month after treatment
Secondary Outcome Measure Information:
Title
Change of Eastern Cooperative Oncology Group (ECOG) evaluation
Description
Complete an Eastern Cooperative Oncology Group (ECOG) evaluation
Time Frame
one to two years
Title
Change of vital signs
Description
Measure vital signs including temperature, respiratory rate, blood pressure, and heart rate.
Time Frame
one to two years
Title
Physical examination
Description
Conduct a physical examination.
Time Frame
one to two years
Title
Clinical laboratory assessments
Description
Collect blood samples for Clinical laboratory assessments, including hematology, A-fetoprotein (AFP) (for hepatocellular carcinoma (HCC)) / carcinoembryonic antigen (CEA) (for adenocarcinoma) and chemistry evaluations.
Time Frame
one to two years
Title
Urinalysis
Description
Collect urine sample for a routine urinalysis.
Time Frame
one to two years
Title
Conduct CT or MR scans for tumour response evaluation
Description
Subjects will still be followed-up in the event of disease progression in order to document local recurrence, a secondary endpoint.
Time Frame
one to two years
Title
Review concomitant medications
Description
Use of medications will be reviewed and recorded.
Time Frame
one to two years
Title
Assess for presence of adverse events
Description
An adverse event assessment will be performed.
Time Frame
one to two years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
20 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must meet all of the following inclusion criteria to be eligible for this study: The diagnosis of hepatocellular carcinoma (HCC) or metastatic liver cancers with pathologic proven, and the diagnosis of HCC will be made by pathology / cytology or according to the American Association for the Study of Liver Diseases (AASLD) (2010) diagnostic criteria. In brief, Nodules larger than 1 cm found on ultrasound screening of a cirrhotic liver should be investigated further with either tri-phase multidetector computed tomography (CT) scan or dynamic contrast enhanced magnetic resonance imaging (MRI). If the appearances are typical of HCC (i.e., hypervascular in the arterial phase with washout in the portal venous or delayed phase), the lesion should be treated as HCC. If the findings are not characteristic or the vascular profile is not typical, a second contrast enhanced study with the other imaging modality should be performed, or the lesion should be biopsied. Biopsies of small lesions should be evaluated by expert pathologists. Tissue that is not clearly HCC should be stained with all the available markers including cluster of differentiation 34 (CD34), cytokeratin 7 (CK7), glypican 3, heat shock protein 70 (HSP70), and glutamine synthetase to improve diagnostic accuracy. Unsuitable for surgical resection but local ablation is indicated, however, the distance between tumour and vessels is smaller than 5 mm. Have at least one, but less than or equal to 3 tumors, Each tumor must be ≤ 5 cm in diameter, Child-Pugh class A-B, Eastern Cooperative Oncology Group (ECOG) score of 0-1, American Society of Anaesthesiologists (ASA) score ≤ 3, Adequate bone marrow, liver and renal function. Platelet count ≥ 100 K/Μl. Total bilirubin ≦ 2 mg/dL. alanine transaminase (ALT) and aspartate transaminase (AST) < 5 x upper limit of normal. prothrombin time (PT)- international normalized ratio (INR) ≦ 2.0. Serum creatinine ≦ 1.5 x upper limit of normal Prior Informed Consent Form Life expectancy of at least 3 months. The disease status is not suitable to receive surgical resection, percutaneous alcohol injection, transarterial chemoembolization or other standard treatment. Exclusion Criteria: Patients presenting with any of the following will not be enrolled into this study: 1. History of cardiac disease: Congestive heart failure >New York Heart Association (NYHA) class 2 Active coronary artery disease (CAD) (myocardial infarction more than 6 months prior to study entry is allowed) Cardiac arrhythmias (>Grade 2 NCI-CTCAE Version 3.0) which are poorly controlled with anti-arrhythmic therapy or requiring pace maker Uncontrolled hypertension 2. Any active metal implanted device (eg Pacemaker), 3. Women who are pregnant or women of child-bearing potential who are not using an acceptable method of contraception, 4. Received treatment with an investigational agent/ procedure within 30 days prior to treatment with the IRE System, 5. Known history of HIV infection 6. Concurrent extrahepatic cancer
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kai-Wen Huang, PhD
Organizational Affiliation
National Taiwan University Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Taiwan University Hospital
City
Taipei
ZIP/Postal Code
10002
Country
Taiwan

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

A Clinical Trial Using Irreversible Electroporation for the Treatment of Liver Cancers

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