Radiofrequency Ablation Plus Systematic Neoadjuvant Therapy for Recurrent Hepatocellular Carcinoma (RANT Study) (RANT)
Primary Purpose
Hepatocellular Carcinoma Recurrent
Status
Recruiting
Phase
Not Applicable
Locations
China
Study Type
Interventional
Intervention
Tislelizumab/Sintilimab+Lenvatinib/Bevacizumab
RFA
Sponsored by
About this trial
This is an interventional treatment trial for Hepatocellular Carcinoma Recurrent focused on measuring immune checkpoint inhibitors, targeted therapy, neoadjuvant therapy, radiofrequency ablation, hepatocellular carcinoma, recurrence
Eligibility Criteria
Inclusion Criteria:
- Research subjects understand the research content and significance, and provide the written informed consent;
- age 18 - 75 years and gender is not limited;
- a history of liver resection or RFA for HCC which was clinically or pathologically diagnosed according to the standard of the American Association for the Study of Liver Diseases; the number of lesions ≤ 3, the largest lesion ≤ 3 cm, as demonstrated on by contrast enhanced CT/MRI;
- Patients who are unable or unwilling to undergo liver resection, and have not received other anti-tumor therapies before detection of the recurrence;
- Child Pugh A (≤ 7 points), no pleural ascites and hepatic encephalopathy requiring treatment; Eastern Cooperative Oncology Group (ECOG) Performance Status score of 0-1;
- Within 7 days before enrollment, have sufficient liver and kidney function, suitable laboratory indicators (untreated): hemoglobin (HGB) ≥ 9.0 g/dl, neutrophils ≥ 1,500/mm3, PLT ≥ 50×109/L, serum ALB ≥ 28 g/L, TBIL < 50 umol/L, ALT, AST < 5 times the upper limit of normal, Bun, Cr < 1.5 times the upper limit of normal, INR < 1.7 or prolonged PT < 4 s;
- Consent to take the immune checkpoint inhibitor and molecular-targeted drugs;
- No other diseases affecting RFA treatment and targeted therapy combining with immune checkpoint inhibitors.
Exclusion Criteria:
- Patients who have a history of immune checkpoint inhibitor or targeted therapy;
- Tumor invades the branch or trunk of portal vein;
- Patients with extrahepatic metastasis;
- Patients who have an active autoimmune disease or a history of autoimmune disease, hyperthyroidism or hypothyroidism, asthma requiring bronchodilator treatment.
- Patients who have significant cardiovascular disease (heart failure grade Ⅲ or higher as defined by the New York Heart Association), myocardial infarction, unstable arrhythmia, unstable angina pectoris that occurred within 3 months before treatment;
- Patients who have a history of idiopathic pulmonary fibrosis, organizing pneumonia (such as bronchiolitis obliterans), drug-induced pneumonia, idiopathic pneumonia, or an evidence of active pneumonia during chest CT scan screening;
- Patients who have received allogeneic stem cell or solid organ transplantation (including liver transplantation);
- Patients who have taken any anti-tumor Chinese herbal medicine within 7 days before enrollment;
- Patients who have any other diseases, metabolic disorders, abnormal results of physical examination or laboratory tests, which may lead to contraindication to the use of the experimental drugs, or affect the reliability of the research results, or leave the patient at high risk of treatment complications, or affect patient compliance.
Sites / Locations
- Institute of hepatobiliary surgery,Southwest HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
Neoadjuvant therapy+ RFA
RFA alone
Arm Description
After confirmation of HCC recurrence by imaging exam, subjects will receive neoadjuvant therapy (immune checkpoint inhibitors + targeted therapy) and then RFA
After confirmation of HCC recurrence by imaging exam, subjects will receive RFA treatment only.
Outcomes
Primary Outcome Measures
1-year recurrence-free survival
Evaluated by hepatic imaging examination (contrast-enhanced US/CT/MRI) at early stage combined with AFP and PIVKA-Ⅱtests.
1-year overall survival
Evaluated by hepatic imaging examination (contrast-enhanced US/CT/MRI) at early stage combined with AFP and PIVKA-Ⅱtests.
Secondary Outcome Measures
procedure related complications
procedure related complications
immune-related adverse events
Full Information
NCT ID
NCT05277675
First Posted
February 27, 2022
Last Updated
March 11, 2022
Sponsor
Southwest Hospital, China
1. Study Identification
Unique Protocol Identification Number
NCT05277675
Brief Title
Radiofrequency Ablation Plus Systematic Neoadjuvant Therapy for Recurrent Hepatocellular Carcinoma (RANT Study)
Acronym
RANT
Official Title
A Prospective Study of Radiofrequency Ablation Combined With Systematic Neoadjuvant Therapy in the Treatment of Recurrent Hepatocellular Carcinoma
Study Type
Interventional
2. Study Status
Record Verification Date
March 2022
Overall Recruitment Status
Recruiting
Study Start Date
November 1, 2021 (Actual)
Primary Completion Date
November 1, 2022 (Anticipated)
Study Completion Date
October 30, 2023 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Southwest Hospital, China
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
5. Study Description
Brief Summary
To compare systemic neoadjuvant therapy (combination of immune checkpoint inhibitors and anti-angiogenic drugs (short for "targeted-immune therapy") combined with radiofrequency ablation (RFA) and RFA alone in the treatment of recurrent hepatocellular carcinoma(HCC) in 1-year recurrence-free survival (RFS) and overall survival (OS)
To evaluate the clinical value of systemic neoadjuvant therapy (i.e. immune checkpoint inhibitors and targeted therapy) combined with RFA in the treatment of recurrent HCC, as well as the safety and efficacy of this strategy.
Detailed Description
RFA is an important minimally invasive approach for recurrent HCC treatment, but is hampered by the high recurrence rate and limited ablation volume for the tumor. Therefore, the key to improving the efficacy of RFA is to maximize the complete ablation zone of tumor lesions and the killing of residual cancer cells. In recent years, due to the unique advantages of immune checkpoint inhibitors(ICIs), immunotherapy has gradually become a vital part of neoadjuvant therapy, and the scope of immunotherapy in malignant tumors expands. With administration of ICIs, revived tumor-specific CD8+ T cells proliferate and kill existing tumor cells and recirculate into the blood. After resection or ablation of the primary tumor, the remaining circulating tumor-specific CD8+ T cells and T cell clones present in the metastatic site can retain long-term anti-tumor immunity and play a vital role in continuous killing of residual cancer cells and immune surveillance. At present, the combination of targeted therapy and immune checkpoint inhibitors has achieved a higher objective response rate (ORR) and disease control rate (DCR) in the treatment of in treatment of HCC, which provides a reliable theoretical and practical basis for using as a strategy of neoadjuvant therapy.
The current reports on neoadjuvant therapy for HCC are limited to patients who are going undergo surgical resection, and there is no report on the neoadjuvant therapy prior to RFA. Since molecular targeted drugs generally have anti-angiogenic effects, drug withdrawal for two weeks or more (bevacizumab should be stopped for at least 4 weeks) before surgery is required to reduce the risk of intraoperative bleeding caused by targeted drugs and the hard-to-heal incision after operation. The longer-term drug withdrawal will prolong the preoperative waiting period, and the tumor may progress, leaving the patients loss of the opportunity for surgery. However, due to its advantage of minimal invasiveness, patients can undergo RFA directly without drug withdrawal.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hepatocellular Carcinoma Recurrent
Keywords
immune checkpoint inhibitors, targeted therapy, neoadjuvant therapy, radiofrequency ablation, hepatocellular carcinoma, recurrence
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
160 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Neoadjuvant therapy+ RFA
Arm Type
Experimental
Arm Description
After confirmation of HCC recurrence by imaging exam, subjects will receive neoadjuvant therapy (immune checkpoint inhibitors + targeted therapy) and then RFA
Arm Title
RFA alone
Arm Type
Active Comparator
Arm Description
After confirmation of HCC recurrence by imaging exam, subjects will receive RFA treatment only.
Intervention Type
Drug
Intervention Name(s)
Tislelizumab/Sintilimab+Lenvatinib/Bevacizumab
Intervention Description
Immune checkpoint inhibitor (tislelizumab/sintilimab) combined with anti-angiogenic drugs (lenvatinib/bevacizumab) used as neoadjuvant therapy
Intervention Type
Procedure
Intervention Name(s)
RFA
Intervention Description
RFA will be performed in a percutaneous way guided contrast enhanced ultrasound.
Primary Outcome Measure Information:
Title
1-year recurrence-free survival
Description
Evaluated by hepatic imaging examination (contrast-enhanced US/CT/MRI) at early stage combined with AFP and PIVKA-Ⅱtests.
Time Frame
1 year after treatment
Title
1-year overall survival
Description
Evaluated by hepatic imaging examination (contrast-enhanced US/CT/MRI) at early stage combined with AFP and PIVKA-Ⅱtests.
Time Frame
1 year after treatment
Secondary Outcome Measure Information:
Title
procedure related complications
Description
procedure related complications
Time Frame
up to 1 year.
Title
immune-related adverse events
Time Frame
up to 1 year.
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Research subjects understand the research content and significance, and provide the written informed consent;
age 18 - 75 years and gender is not limited;
a history of liver resection or RFA for HCC which was clinically or pathologically diagnosed according to the standard of the American Association for the Study of Liver Diseases; the number of lesions ≤ 3, the largest lesion ≤ 3 cm, as demonstrated on by contrast enhanced CT/MRI;
Patients who are unable or unwilling to undergo liver resection, and have not received other anti-tumor therapies before detection of the recurrence;
Child Pugh A (≤ 7 points), no pleural ascites and hepatic encephalopathy requiring treatment; Eastern Cooperative Oncology Group (ECOG) Performance Status score of 0-1;
Within 7 days before enrollment, have sufficient liver and kidney function, suitable laboratory indicators (untreated): hemoglobin (HGB) ≥ 9.0 g/dl, neutrophils ≥ 1,500/mm3, PLT ≥ 50×109/L, serum ALB ≥ 28 g/L, TBIL < 50 umol/L, ALT, AST < 5 times the upper limit of normal, Bun, Cr < 1.5 times the upper limit of normal, INR < 1.7 or prolonged PT < 4 s;
Consent to take the immune checkpoint inhibitor and molecular-targeted drugs;
No other diseases affecting RFA treatment and targeted therapy combining with immune checkpoint inhibitors.
Exclusion Criteria:
Patients who have a history of immune checkpoint inhibitor or targeted therapy;
Tumor invades the branch or trunk of portal vein;
Patients with extrahepatic metastasis;
Patients who have an active autoimmune disease or a history of autoimmune disease, hyperthyroidism or hypothyroidism, asthma requiring bronchodilator treatment.
Patients who have significant cardiovascular disease (heart failure grade Ⅲ or higher as defined by the New York Heart Association), myocardial infarction, unstable arrhythmia, unstable angina pectoris that occurred within 3 months before treatment;
Patients who have a history of idiopathic pulmonary fibrosis, organizing pneumonia (such as bronchiolitis obliterans), drug-induced pneumonia, idiopathic pneumonia, or an evidence of active pneumonia during chest CT scan screening;
Patients who have received allogeneic stem cell or solid organ transplantation (including liver transplantation);
Patients who have taken any anti-tumor Chinese herbal medicine within 7 days before enrollment;
Patients who have any other diseases, metabolic disorders, abnormal results of physical examination or laboratory tests, which may lead to contraindication to the use of the experimental drugs, or affect the reliability of the research results, or leave the patient at high risk of treatment complications, or affect patient compliance.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Kai Feng, MD,PhD
Phone
+86-13228683383
Email
fengkai7688@hotmail.com
First Name & Middle Initial & Last Name or Official Title & Degree
Kuansheng Ma, MD,PhD
Phone
+86-15213249505
Email
kuanshengma@outlook.com
Facility Information:
Facility Name
Institute of hepatobiliary surgery,Southwest Hospital
City
Chongqing
State/Province
Chongqing
ZIP/Postal Code
400038
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kai Feng, M.D
Phone
+86-23-13228683383
Email
fengkai7688@hotmail.com
First Name & Middle Initial & Last Name & Degree
Kai Feng, M.D
12. IPD Sharing Statement
Learn more about this trial
Radiofrequency Ablation Plus Systematic Neoadjuvant Therapy for Recurrent Hepatocellular Carcinoma (RANT Study)
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