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出境医 / 临床实验 / Novel Treatment of Advanced Hepatocellular Carcinoma (NTAHCC)

Novel Treatment of Advanced Hepatocellular Carcinoma (NTAHCC)

Study Description
Brief Summary:
The purpose of this study is to evaluate the efficacy and safety of arginine hydrochloride combined with Levamisole in the treatment of patients with hepatocellular carcinoma.

Condition or disease Intervention/treatment Phase
HCC Drug: Anlotinib Hydrochloride Capsules Drug: Arginine hydrochloride Drug: levamisole Phase 3

Detailed Description:
Hepatocellular carcinoma (HCC) is the sixth most common cancer and the second leading cause of cancer-related deaths in the world. Because HCC is insidious and early diagnosis is difficult, most patients have locally advanced or distant metastasis at the time of diagnosis. So they are not suitable candidates for curative treatments by resection or transplantation. Currently, There are only not more than five drugs to be selected for advanced HCC, although it prolongs the survival for less than 3 months. Recently, metabolomics studies of HCC have shown that typical Warburg effect was observed in hepatoma carcinoma cells. Arginine hydrochloride is a new anticancer drug in the treatment of HCC, which is mainly aimed at the pathway of energy metabolism. levamisole may play an anti-tumor role by inhibiting the reverse TCA cycle. The investigators have been proceeding this trial to evaluate the efficacy and safety of arginine hydrochloride combined with levamisole in the treatment of patients with advanced hepatocellular carcinoma.
Study Design
Layout table for study information
Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 300 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Multicenter, Randomized, Open, Parallel, Prospective, Exploratory Clinical Study of Arginine Hydrochloride and Levamisole in the Treatment of Advanced HCC
Actual Study Start Date : April 10, 2019
Estimated Primary Completion Date : April 10, 2023
Estimated Study Completion Date : April 10, 2023
Arms and Interventions
Arm Intervention/treatment
Experimental: One-drug Regimes
Drug: Anlotinib Hydrochloride Capsules Anlotinib Hydrochloride Capsules Anlotinib Hydrochloride Capsules 12mg / capsule; 12mg/d; po;
Drug: Anlotinib Hydrochloride Capsules
Anlotinib Hydrochloride Capsules, 12mg/d
Other Name: AHC

Experimental: Two-drug Regimes
Anlotinib Hydrochloride Capsules Arginine hydrochloride
Drug: Anlotinib Hydrochloride Capsules
Anlotinib Hydrochloride Capsules, 12mg/d
Other Name: AHC

Drug: Arginine hydrochloride
AHC,12mg/d AH,40g/d
Other Name: AH+AHC

Experimental: Three-drug Regimes
Anlotinib Hydrochloride Capsules Arginine hydrochloride Levamisole Hydrochloride
Drug: Anlotinib Hydrochloride Capsules
Anlotinib Hydrochloride Capsules, 12mg/d
Other Name: AHC

Drug: Arginine hydrochloride
AHC,12mg/d AH,40g/d
Other Name: AH+AHC

Drug: levamisole
AHC,12mg/d AH,40mg/d LM,150mg/d
Other Name: AH+AHC+LM

Outcome Measures
Primary Outcome Measures :
  1. Progression-free Survival [ Time Frame: 24 months ]
    Time from start of treatment until the first documented event of symptomatic progression or death


Secondary Outcome Measures :
  1. Overall Survival [ Time Frame: 48 months ]
    Time from start of treatment to death from any cause, or last known date of survival


Other Outcome Measures:
  1. Disease Control Rate (DCR) [ Time Frame: 28 days ]
    the percentage of patients with advanced or metastatic cancer who have achieved complete response, partial response and stable disease

  2. Objective Response Rate(ORR) [ Time Frame: 28 days ]
    Proportion of patients with reduction in tumor burden of a predefined amount

  3. The change of AFP biomarker [ Time Frame: approximately 24 months ]
    Concentration of AFP biomarker change in tumor markers


Eligibility Criteria
Layout table for eligibility information
Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • 1. Ages 18-65 years

    2. The diagnosis of ICC: in accordance with "diagnostic and treating standards on primary liver cancer" or histological/cytological diagnosis of primary liver cancer

    3. Un-resectable HCC : patients with developing primary liver cancer of Barcelona stage(BCLC) B; multiple nodules (less than 5, the total diameter of less than 20 cm), no invasion, no symptoms;refusing open surgical treatment and volunteering for the treatment

    4. The First-line system therapy failure (or residual lesion) from the group of this study a signed informed consent (time) for 2 weeks or more basic returned to normal and adverse events (NCI CTCAE Ⅰ level or less);

    5. Child-Pugh liver function class A/B(score: ≤7)

    6. Performance status 0 or 1 on the Eastern Cooperative Oncology Group (ECOG) scale in one week before admission

    7. Estimated survival time > 3 months

    8. HBV DNA#2000 IU/ml#10^4 copies/ml); or HBV DNA≥2000 IU/ml and are accepting effective antiviral therapy

    9. The major organ function is normal. that is meeting the following standards:

Blood routine examination: (No blood transfusion, no G-CSF and no medication were corrected within 14 days before screening)

  1. HB≥80g/L# b.ANC≥1.5×109/L#c.PLT≥50×109/L#

    Biochemical examination: (ALB was not transfused within 14 days before screening) a.ALB ≥29 g/L# b.ALT#AST<5ULN#c.TBIL ≤3ULN#d.creatinine

    1.5ULN( albumin and bilirubin, two indicators of Child-Pugh liver function class, can only have one for 2 points)

    10. For women of childbearing age, the results of serum/urine pregnancy tests must be negative within 7 days before initiation of treatment. All men and women who participate in the study have to take reliable contraceptive measures within the trial and eight weeks after the trial is completed

    11. volunteers must signed informed consent

    Exclusion Criteria:

    • 1. With a history of alimentary tract hemorrhage or a definite tendency of gastrointestinal bleeding, such as varices of fundus of stomach and esophagus with bleeding risk; local active ulcer lesions; fecal occult blood ≥#++#

      2. Patients with hepatobiliary cell carcinoma, mixed cell carcinoma or lamellar cell carcinoma; in the past (within 5 years) or at the same time suffering from other untreated malignant tumors; excluding cured basal cell carcinoma and carcinoma in situs of cervix

      3. Patients who are undergoing liver transplantation or have a history of organ transplantation(excluding the patient who has undergone liver transplantation before)

      4. Patients with an allergic history of Levamisole Hydrochloride and Anlotinib Hydrochloride Capsules

      5. The blood pressure can not be reduced to the normal range by the antihypertensive drug treatment in patients with hypertension(systolic pressure#140 mmHg, diastolic pressure#90 mmHg)

      6. Patients with myocardial ischemia or myocardial infarction over grade II or a poorly controlled arrhythmia (including QTc interval: men ≥ 450 ms; women ≥ 470 ms)

      7. Cardiac functional insufficiency of grade III to IV according to NYHA standard; echocardiography: LVEF#50%

      8. Many factors that influence oral medication, such as unable to swallow; chronic diarrhea; intestinal obstruction; the situations which significantly affect the use and absorption of drugs

      9. Abdominal fistula, gastrointestinal perforation, or abdominal abscess occurred within 28 days before participating the study

      10. Dysfunction of blood coagulation(INR#2.0 or PT# 16s#APTT > 43s#TT > 21s#Fbg < 2g/L), having a tendency to bleed or undergoing thrombolysis or anticoagulant therapy; ascites with clinical symptoms, that is requiring therapeutic abdominal paracentesis or drainage or Child-Pugh score ≥2

      11. Objective evidence of pulmonary fibrosis history, interstitial pneumonia, pneumoconiosis, radiation pneumonitis, drug associated pneumonia, and severe lung function impairment in the past and at present

      12. Urine routine showed that urine protein ≥++ or the urine protein in 24 hours#1.0 g

      13. Patients who have been treated with potent CYP3A4 inhibitors (ketoconazole, itraconazole, voriconazole, ritonavir, clarithromycin, telithromycin, troleandomycin, erythromycin, cimetidine and so on) within 28 days before participating the study, or potent CYP3A4 inducers (dexamethasone, phenytoin, rifampin, rifabutin, carbamazepine, phenobarbitone and so on) within 12 days before participating the study.

      14. Pregnant or lactating women; fertile patients who are unwilling or unable to adopt effective contraceptives

      15. Patients with mental sickness or the history of psychotropic drug abuse

      16. Patients with severe infection (unable to control the infection effectively)

      17. The treatment history affecting this program or its efficacy, such as stem cell transplantation, immune regulation (including PD-1 and other test regimens) recently (within half a year)

      18. The researchers believe that any other factors unsuitable for entering into the study.

Contacts and Locations

Locations
Layout table for location information
China, Henan
The First Affiliated Hospital of Zhengzhou University Recruiting
Zhengzhou, Henan, China, 450000
Contact: Zujiang Yu, pro    0086-0371-67966942    johnyuem@zzu.edu.cn   
Contact: Juan Li, pro    0086-0371-67966942    ananli1984@126.com   
Sponsors and Collaborators
The First Affiliated Hospital of Zhengzhou University
Luoyang Central Hospital
Nanyang Central Hospital
Anyang Tumor Hospital
The Third People's Hospital of Jiaozuo
Sanmenxia Central Hospital
Pingdingshan Coal Medical Group General Hospital
Tracking Information
First Submitted Date  ICMJE May 10, 2019
First Posted Date  ICMJE May 15, 2019
Last Update Posted Date May 15, 2019
Actual Study Start Date  ICMJE April 10, 2019
Estimated Primary Completion Date April 10, 2023   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: May 11, 2019)
Progression-free Survival [ Time Frame: 24 months ]
Time from start of treatment until the first documented event of symptomatic progression or death
Original Primary Outcome Measures  ICMJE Same as current
Change History No Changes Posted
Current Secondary Outcome Measures  ICMJE
 (submitted: May 11, 2019)
Overall Survival [ Time Frame: 48 months ]
Time from start of treatment to death from any cause, or last known date of survival
Original Secondary Outcome Measures  ICMJE Same as current
Current Other Pre-specified Outcome Measures
 (submitted: May 11, 2019)
  • Disease Control Rate (DCR) [ Time Frame: 28 days ]
    the percentage of patients with advanced or metastatic cancer who have achieved complete response, partial response and stable disease
  • Objective Response Rate(ORR) [ Time Frame: 28 days ]
    Proportion of patients with reduction in tumor burden of a predefined amount
  • The change of AFP biomarker [ Time Frame: approximately 24 months ]
    Concentration of AFP biomarker change in tumor markers
Original Other Pre-specified Outcome Measures Same as current
 
Descriptive Information
Brief Title  ICMJE Novel Treatment of Advanced Hepatocellular Carcinoma
Official Title  ICMJE Multicenter, Randomized, Open, Parallel, Prospective, Exploratory Clinical Study of Arginine Hydrochloride and Levamisole in the Treatment of Advanced HCC
Brief Summary The purpose of this study is to evaluate the efficacy and safety of arginine hydrochloride combined with Levamisole in the treatment of patients with hepatocellular carcinoma.
Detailed Description Hepatocellular carcinoma (HCC) is the sixth most common cancer and the second leading cause of cancer-related deaths in the world. Because HCC is insidious and early diagnosis is difficult, most patients have locally advanced or distant metastasis at the time of diagnosis. So they are not suitable candidates for curative treatments by resection or transplantation. Currently, There are only not more than five drugs to be selected for advanced HCC, although it prolongs the survival for less than 3 months. Recently, metabolomics studies of HCC have shown that typical Warburg effect was observed in hepatoma carcinoma cells. Arginine hydrochloride is a new anticancer drug in the treatment of HCC, which is mainly aimed at the pathway of energy metabolism. levamisole may play an anti-tumor role by inhibiting the reverse TCA cycle. The investigators have been proceeding this trial to evaluate the efficacy and safety of arginine hydrochloride combined with levamisole in the treatment of patients with advanced hepatocellular carcinoma.
Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 3
Study Design  ICMJE Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Condition  ICMJE HCC
Intervention  ICMJE
  • Drug: Anlotinib Hydrochloride Capsules
    Anlotinib Hydrochloride Capsules, 12mg/d
    Other Name: AHC
  • Drug: Arginine hydrochloride
    AHC,12mg/d AH,40g/d
    Other Name: AH+AHC
  • Drug: levamisole
    AHC,12mg/d AH,40mg/d LM,150mg/d
    Other Name: AH+AHC+LM
Study Arms  ICMJE
  • Experimental: One-drug Regimes
    Drug: Anlotinib Hydrochloride Capsules Anlotinib Hydrochloride Capsules Anlotinib Hydrochloride Capsules 12mg / capsule; 12mg/d; po;
    Intervention: Drug: Anlotinib Hydrochloride Capsules
  • Experimental: Two-drug Regimes
    Anlotinib Hydrochloride Capsules Arginine hydrochloride
    Interventions:
    • Drug: Anlotinib Hydrochloride Capsules
    • Drug: Arginine hydrochloride
  • Experimental: Three-drug Regimes
    Anlotinib Hydrochloride Capsules Arginine hydrochloride Levamisole Hydrochloride
    Interventions:
    • Drug: Anlotinib Hydrochloride Capsules
    • Drug: Arginine hydrochloride
    • Drug: levamisole
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Recruiting
Estimated Enrollment  ICMJE
 (submitted: May 11, 2019)
300
Original Estimated Enrollment  ICMJE Same as current
Estimated Study Completion Date  ICMJE April 10, 2023
Estimated Primary Completion Date April 10, 2023   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • 1. Ages 18-65 years

    2. The diagnosis of ICC: in accordance with "diagnostic and treating standards on primary liver cancer" or histological/cytological diagnosis of primary liver cancer

    3. Un-resectable HCC : patients with developing primary liver cancer of Barcelona stage(BCLC) B; multiple nodules (less than 5, the total diameter of less than 20 cm), no invasion, no symptoms;refusing open surgical treatment and volunteering for the treatment

    4. The First-line system therapy failure (or residual lesion) from the group of this study a signed informed consent (time) for 2 weeks or more basic returned to normal and adverse events (NCI CTCAE Ⅰ level or less);

    5. Child-Pugh liver function class A/B(score: ≤7)

    6. Performance status 0 or 1 on the Eastern Cooperative Oncology Group (ECOG) scale in one week before admission

    7. Estimated survival time > 3 months

    8. HBV DNA#2000 IU/ml#10^4 copies/ml); or HBV DNA≥2000 IU/ml and are accepting effective antiviral therapy

    9. The major organ function is normal. that is meeting the following standards:

Blood routine examination: (No blood transfusion, no G-CSF and no medication were corrected within 14 days before screening)

  1. HB≥80g/L# b.ANC≥1.5×109/L#c.PLT≥50×109/L#

    Biochemical examination: (ALB was not transfused within 14 days before screening) a.ALB ≥29 g/L# b.ALT#AST<5ULN#c.TBIL ≤3ULN#d.creatinine

    1.5ULN( albumin and bilirubin, two indicators of Child-Pugh liver function class, can only have one for 2 points)

    10. For women of childbearing age, the results of serum/urine pregnancy tests must be negative within 7 days before initiation of treatment. All men and women who participate in the study have to take reliable contraceptive measures within the trial and eight weeks after the trial is completed

    11. volunteers must signed informed consent

    Exclusion Criteria:

    • 1. With a history of alimentary tract hemorrhage or a definite tendency of gastrointestinal bleeding, such as varices of fundus of stomach and esophagus with bleeding risk; local active ulcer lesions; fecal occult blood ≥#++#

      2. Patients with hepatobiliary cell carcinoma, mixed cell carcinoma or lamellar cell carcinoma; in the past (within 5 years) or at the same time suffering from other untreated malignant tumors; excluding cured basal cell carcinoma and carcinoma in situs of cervix

      3. Patients who are undergoing liver transplantation or have a history of organ transplantation(excluding the patient who has undergone liver transplantation before)

      4. Patients with an allergic history of Levamisole Hydrochloride and Anlotinib Hydrochloride Capsules

      5. The blood pressure can not be reduced to the normal range by the antihypertensive drug treatment in patients with hypertension(systolic pressure#140 mmHg, diastolic pressure#90 mmHg)

      6. Patients with myocardial ischemia or myocardial infarction over grade II or a poorly controlled arrhythmia (including QTc interval: men ≥ 450 ms; women ≥ 470 ms)

      7. Cardiac functional insufficiency of grade III to IV according to NYHA standard; echocardiography: LVEF#50%

      8. Many factors that influence oral medication, such as unable to swallow; chronic diarrhea; intestinal obstruction; the situations which significantly affect the use and absorption of drugs

      9. Abdominal fistula, gastrointestinal perforation, or abdominal abscess occurred within 28 days before participating the study

      10. Dysfunction of blood coagulation(INR#2.0 or PT# 16s#APTT > 43s#TT > 21s#Fbg < 2g/L), having a tendency to bleed or undergoing thrombolysis or anticoagulant therapy; ascites with clinical symptoms, that is requiring therapeutic abdominal paracentesis or drainage or Child-Pugh score ≥2

      11. Objective evidence of pulmonary fibrosis history, interstitial pneumonia, pneumoconiosis, radiation pneumonitis, drug associated pneumonia, and severe lung function impairment in the past and at present

      12. Urine routine showed that urine protein ≥++ or the urine protein in 24 hours#1.0 g

      13. Patients who have been treated with potent CYP3A4 inhibitors (ketoconazole, itraconazole, voriconazole, ritonavir, clarithromycin, telithromycin, troleandomycin, erythromycin, cimetidine and so on) within 28 days before participating the study, or potent CYP3A4 inducers (dexamethasone, phenytoin, rifampin, rifabutin, carbamazepine, phenobarbitone and so on) within 12 days before participating the study.

      14. Pregnant or lactating women; fertile patients who are unwilling or unable to adopt effective contraceptives

      15. Patients with mental sickness or the history of psychotropic drug abuse

      16. Patients with severe infection (unable to control the infection effectively)

      17. The treatment history affecting this program or its efficacy, such as stem cell transplantation, immune regulation (including PD-1 and other test regimens) recently (within half a year)

      18. The researchers believe that any other factors unsuitable for entering into the study.

Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years to 65 Years   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE
Listed Location Countries  ICMJE China
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT03950518
Other Study ID Numbers  ICMJE HETCT-002
Has Data Monitoring Committee Not Provided
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE Not Provided
Responsible Party Zujiang YU, The First Affiliated Hospital of Zhengzhou University
Study Sponsor  ICMJE The First Affiliated Hospital of Zhengzhou University
Collaborators  ICMJE
  • Luoyang Central Hospital
  • Nanyang Central Hospital
  • Anyang Tumor Hospital
  • The Third People's Hospital of Jiaozuo
  • Sanmenxia Central Hospital
  • Pingdingshan Coal Medical Group General Hospital
Investigators  ICMJE Not Provided
PRS Account The First Affiliated Hospital of Zhengzhou University
Verification Date April 2019

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP