search
Back to results

Radiation Therapy in Treating Patients With Hepatocellular Carcinoma, Cholangiocarcinoma, or Liver Metastasis Who Have Impaired Liver Function

Primary Purpose

Cholangiocarcinoma, Cirrhosis, Hepatocellular Carcinoma

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Laboratory Biomarker Analysis
Magnetic Resonance Imaging
Radiation Therapy
Survey Administration
Sponsored by
M.D. Anderson Cancer Center
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 hepatocellular carcinoma, cholangiocarcinoma, or liver metastasis from any histology
  • Patients may have single or multinodular tumors
  • There is no specific tumor size cut-off for this protocol; however, the radiation treatment plan must meet the protocol's dose constraints
  • Compromised liver function as defined by any of the following:

    • Cohort 1: Advanced cirrhosis group

      • Borderline Child-Pugh class A6
      • Child-Pugh class B

        • The patients in this advanced cirrhosis group must have at least 400 ml of functional liver, as estimated on either diagnostic imaging (computed tomography [CT] or magnetic resonance imaging [MRI]) or single photon emission computed tomography (SPECT)/CT with Tc-99m sulfur colloid; there is no upper limit on the functional liver volume for these patients
    • Cohort 2: Low functional liver volume without underlying chronic liver disease

      • Previous irinotecan or oxaliplatin chemotherapy
      • Previous liver resection(s)

        • These patients must have at least 400 ml of functional liver, as estimated by either diagnostic imaging computed tomography or magnetic resonance imaging (CT or MRI) or SPECT/CT with Tc-99m sulfur colloid; there is no upper limit on the functional liver volume for these patients;
    • Cohort 3: History of prior liver-directed radiation therapy with either fractionated external beam radiation therapy (EBRT), stereotactic body radiation therapy (SBRT) or yttrium-90 radioembolization (Y90 RE); the interval between prior EBRT and re-irradiation on protocol should be equal to or greater than 12 months; the interval between prior Y90 RE and re-irradiation on protocol should be equal to or greater than 6 months;

      • Cirrhosis group:

        • Child-Pugh class A5;
        • Borderline Child-Pugh class A6;
        • The patients in this group must have at least 400 ml of functional liver, as estimated on either diagnostic imaging (CT or MRI) or SPECT/CT with Tc-99m sulfur colloid; there is no upper limit on the functional liver volume for these patients
    • Low functional liver volume without underlying liver disease

      • Previous irinotecan or oxaliplatin chemotherapy
      • Previous liver resection(s)
      • These patients must have at least 400 ml of functional liver, as estimated by either diagnostic imaging (CT or MRI) or SPECT/CT with Tc-99m sulfur colloid; there is no upper limit on the functional liver volume for these patients
  • Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-2
  • Women of childbearing potential (those who have not undergone a hysterectomy or who have not been postmenopausal for at least 24 consecutive months) must agree to practice adequate contraception and to refrain from breast feeding
  • Prior history of surgical resection, chemotherapy, transarterial chemoembolization (TACE), and/or radiofrequency ablation are allowed
  • Expected survival must be greater than 3 months
  • Patients may receive concurrent capecitabine or sorafenib at the discretion of the treating physicians
  • Signed study-specific consent form

Exclusion Criteria:

  • Prior liver-directed radiation therapy in cohort 1 (advanced cirrhosis group) or cohort 2 (low functional volume group)
  • Prior yttrium-90 therapy for patients in cohorts 1 or 2
  • Patients with a Child-Pugh score less than 6 or greater than 9 for radiation naive patients with cirrhosis (cohort 1)
  • Child-Pugh score of greater than 6 for patients with cirrhosis who previously received liver directed radiation (EBRT or Y90 RE) (cohort 3)
  • Unstable angina and/or symptomatic congestive heart failure requiring hospitalization within the last 6 months; transmural myocardial infarction within the last 6 months prior to study entry
  • Current evidence of fever or untreated infection
  • Active hepatitis, including but not limited to viral and drug-induced
  • Poorly controlled inflammatory bowel disease
  • Women with a positive pregnancy test
  • Inability to comply with study and/or follow-up procedures
  • Patients with an active second malignancy or prior invasive malignancy unless disease free for a minimum of 3 years; non-melanoma skin cancer and previous early prostate cancer that had a non-rising prostate-specific antigen (PSA) can be enrolled

Sites / Locations

  • M D Anderson Cancer CenterRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (radiation therapy)

Arm Description

Patients undergo radiation therapy 5 days a week for a total of 15 or 25 fractions in the absence of disease progression or unacceptable toxicity.

Outcomes

Primary Outcome Measures

Maximum dose constraint
Defined as the highest level dose constraint at which no more than 1 of 6 evaluable patients has had a dose limiting toxicity. Toxicities will be summarized with frequency by type, severity and their relationship to the treatment.

Secondary Outcome Measures

Local disease control rate
The Kaplan Meier method will be used to estimate 2-year local disease control rate.
Tumor response
Will be observed.
Patterns of failure
Will be observed.
Overall survival
The Kaplan Meier method will be used to estimate the probability of overall survival.

Full Information

First Posted
December 7, 2015
Last Updated
May 2, 2023
Sponsor
M.D. Anderson Cancer Center
Collaborators
National Cancer Institute (NCI)
search

1. Study Identification

Unique Protocol Identification Number
NCT02626312
Brief Title
Radiation Therapy in Treating Patients With Hepatocellular Carcinoma, Cholangiocarcinoma, or Liver Metastasis Who Have Impaired Liver Function
Official Title
Phase I Trial of Radiation Therapy in Patients With Liver Cancers and Impaired Liver Function
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Recruiting
Study Start Date
February 15, 2016 (Actual)
Primary Completion Date
April 28, 2024 (Anticipated)
Study Completion Date
April 28, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
M.D. Anderson Cancer Center
Collaborators
National Cancer Institute (NCI)

4. Oversight

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

5. Study Description

Brief Summary
This phase I trial studies the side effects and the best dose of radiation therapy in treating patients with hepatocellular carcinoma, cholangiocarcinoma, or cancer that has spread from the original (primary) tumor to the liver who also have impaired liver function (liver damage caused by cirrhosis, chemotherapy, or surgery). Radiation therapy (RT) uses high energy x-rays to kill tumor cells and shrink tumors. New methods of giving RT to the liver may help control cancer.
Detailed Description
PRIMARY OBJECTIVES: I. To evaluate the safety of high dose radiotherapy in patients who have liver tumors (hepatocellular carcinoma [HCC]/cholangiocarcinoma/liver metastases from any primary) and who have impaired liver function or low functional liver volume or who have received prior liver radiation. SECONDARY OBJECTIVES: I. To evaluate 2 year local control with radiotherapy in these patients. II. To evaluate tumor response, patterns of failure, and survival in these patients. III. To evaluate imaging- and serum-based biomarkers in these patients, as correlates of hepatic toxicity and tumor response. OUTLINE: This is a dose-escalation study. Patients undergo radiation therapy 5 days a week for a total of 15 or 25 fractions in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up at 4-8 weeks and then every 3-4 months for 2 years. Patients who progress during the two year follow-up period are followed up every 6 months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cholangiocarcinoma, Cirrhosis, Hepatocellular Carcinoma, Metastatic Malignant Neoplasm in the Liver

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
88 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Treatment (radiation therapy)
Arm Type
Experimental
Arm Description
Patients undergo radiation therapy 5 days a week for a total of 15 or 25 fractions in the absence of disease progression or unacceptable toxicity.
Intervention Type
Other
Intervention Name(s)
Laboratory Biomarker Analysis
Intervention Description
Correlative studies
Intervention Type
Procedure
Intervention Name(s)
Magnetic Resonance Imaging
Other Intervention Name(s)
Magnetic Resonance Imaging Scan, Medical Imaging, Magnetic Resonance / Nuclear Magnetic Resonance, MRI, MRI Scan, NMR Imaging, NMRI, Nuclear Magnetic Resonance Imaging
Intervention Description
Correlative studies
Intervention Type
Radiation
Intervention Name(s)
Radiation Therapy
Other Intervention Name(s)
Cancer Radiotherapy, Irradiate, Irradiated, irradiation, Radiation, Radiotherapeutics, RADIOTHERAPY, RT, Therapy, Radiation
Intervention Description
Undergo radiation therapy
Intervention Type
Other
Intervention Name(s)
Survey Administration
Intervention Description
Ancillary studies
Primary Outcome Measure Information:
Title
Maximum dose constraint
Description
Defined as the highest level dose constraint at which no more than 1 of 6 evaluable patients has had a dose limiting toxicity. Toxicities will be summarized with frequency by type, severity and their relationship to the treatment.
Time Frame
4-8 weeks after completion of radiation therapy
Secondary Outcome Measure Information:
Title
Local disease control rate
Description
The Kaplan Meier method will be used to estimate 2-year local disease control rate.
Time Frame
Up to 2 years
Title
Tumor response
Description
Will be observed.
Time Frame
Up to 2 years
Title
Patterns of failure
Description
Will be observed.
Time Frame
Up to 2 years
Title
Overall survival
Description
The Kaplan Meier method will be used to estimate the probability of overall survival.
Time Frame
Up to 2 years
Other Pre-specified Outcome Measures:
Title
Tumor biomarker expression in serum
Description
Imaging- and serum-based biomarkers will be correlated with hepatic toxicity and tumor response. Plots such as box plot and scatter plots will be used to evaluate expressions of markers between patients with and without response, and between patients having experienced DLTs and patients having not experienced DLTs, and Wilcoxon rank sum test will be used to compare expressions of markers between these patients.
Time Frame
Baseline

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosis of hepatocellular carcinoma, cholangiocarcinoma, or liver metastasis from any histology Patients may have single or multinodular tumors There is no specific tumor size cut-off for this protocol; however, the radiation treatment plan must meet the protocol's dose constraints Compromised liver function as defined by any of the following: Cohort 1: Advanced cirrhosis group Borderline Child-Pugh class A6 Child-Pugh class B The patients in this advanced cirrhosis group must have at least 400 ml of functional liver, as estimated on either diagnostic imaging (computed tomography [CT] or magnetic resonance imaging [MRI]) or single photon emission computed tomography (SPECT)/CT with Tc-99m sulfur colloid; there is no upper limit on the functional liver volume for these patients Cohort 2: Low functional liver volume without underlying chronic liver disease Previous irinotecan or oxaliplatin chemotherapy Previous liver resection(s) These patients must have at least 400 ml of functional liver, as estimated by either diagnostic imaging computed tomography or magnetic resonance imaging (CT or MRI) or SPECT/CT with Tc-99m sulfur colloid; there is no upper limit on the functional liver volume for these patients; Cohort 3: History of prior liver-directed radiation therapy with either fractionated external beam radiation therapy (EBRT), stereotactic body radiation therapy (SBRT) or yttrium-90 radioembolization (Y90 RE); the interval between prior EBRT and re-irradiation on protocol should be equal to or greater than 12 months; the interval between prior Y90 RE and re-irradiation on protocol should be equal to or greater than 6 months; Cirrhosis group: Child-Pugh class A5; Borderline Child-Pugh class A6; The patients in this group must have at least 400 ml of functional liver, as estimated on either diagnostic imaging (CT or MRI) or SPECT/CT with Tc-99m sulfur colloid; there is no upper limit on the functional liver volume for these patients Low functional liver volume without underlying liver disease Previous irinotecan or oxaliplatin chemotherapy Previous liver resection(s) These patients must have at least 400 ml of functional liver, as estimated by either diagnostic imaging (CT or MRI) or SPECT/CT with Tc-99m sulfur colloid; there is no upper limit on the functional liver volume for these patients Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-2 Women of childbearing potential (those who have not undergone a hysterectomy or who have not been postmenopausal for at least 24 consecutive months) must agree to practice adequate contraception and to refrain from breast feeding Prior history of surgical resection, chemotherapy, transarterial chemoembolization (TACE), and/or radiofrequency ablation are allowed Expected survival must be greater than 3 months Patients may receive concurrent capecitabine or sorafenib at the discretion of the treating physicians Signed study-specific consent form Exclusion Criteria: Prior liver-directed radiation therapy in cohort 1 (advanced cirrhosis group) or cohort 2 (low functional volume group) Prior yttrium-90 therapy for patients in cohorts 1 or 2 Patients with a Child-Pugh score less than 6 or greater than 9 for radiation naive patients with cirrhosis (cohort 1) Child-Pugh score of greater than 6 for patients with cirrhosis who previously received liver directed radiation (EBRT or Y90 RE) (cohort 3) Unstable angina and/or symptomatic congestive heart failure requiring hospitalization within the last 6 months; transmural myocardial infarction within the last 6 months prior to study entry Current evidence of fever or untreated infection Active hepatitis, including but not limited to viral and drug-induced Poorly controlled inflammatory bowel disease Women with a positive pregnancy test Inability to comply with study and/or follow-up procedures Patients with an active second malignancy or prior invasive malignancy unless disease free for a minimum of 3 years; non-melanoma skin cancer and previous early prostate cancer that had a non-rising prostate-specific antigen (PSA) can be enrolled
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Eugene J Koay
Organizational Affiliation
M.D. Anderson Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
M D Anderson Cancer Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Eugene J. Koay
Phone
713-563-2300
Email
ekoay@mdanderson.org
First Name & Middle Initial & Last Name & Degree
Eugene J. Koay

12. IPD Sharing Statement

Learn more about this trial

Radiation Therapy in Treating Patients With Hepatocellular Carcinoma, Cholangiocarcinoma, or Liver Metastasis Who Have Impaired Liver Function

We'll reach out to this number within 24 hrs