Skip to content

Doxorubicin-eluting LC Bead M1 for Patients With Hepatocellular Carcinoma

Doxorubicin-eluting LC Bead M1 for Patients With Hepatocellular Carcinoma (DEBDOX)

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02007954
Acronym
DEBDOX
Enrollment
24
Registered
2013-12-11
Start date
2014-02-28
Completion date
2016-11-18
Last updated
2017-08-11

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Hepatocellular Carcinoma

Keywords

HCC

Brief summary

The purpose of this study is to determine the feasibility and safety of using small beads (70-150 micron in place of 100-300 micron) to deliver chemotherapy into the liver to treat patients with hepatocellular carcinoma (HCC). The beads (LC-Bead M1) will be loaded with doxorubicin (DEBDOX-M1), and used to administer transarterial chemoembolization (TACE) DEBDOX, loaded with doxorubicin, is a device that utilizes tiny beads (70-150 microns) to deliver chemotherapy agents into liver tumor(s) via the hepatic artery. This device allows for continuous release of doxorubicin into the liver tumor tissue(s) causing necrosis of the targeted tumor(s). The potential advantages of the smaller beads are deeper penetration into the tumor bed, while avoiding premature proximal occlusion of vessels feeding the tumor, and more consistent dosing. Response to therapy will be evaluated monthly by clinic visits and blood tests (to include assessment of liver function and tumor markers) and by imaging (usually MRIs) every 1-2 months. Patients will be on study for 6 months after which they will be exited from the study and followed for survival. Once exited from the study they will continue to be eligible to receive the smaller beads (DEBDOX), should it be recommended.

Interventions

DEVICEDEBDOX

DEBDOX, loaded with doxorubicin, is a device that utilizes beads in place of lipiodol to deliver the chemotherapy into the liver tumor. The device allows for continuous elution of doxorubicin into the liver tumor tissue. The advantages of this method of delivery in comparison to conventional TACE are that the beads are able to deliver a greater volume and concentration of the drugs to the tumor because of their unique ability to elute the drug over a period of several days. As a result of this unique delivery, systemic toxicity is significantly reduced. The potential advantages of the smaller beads are deeper penetration into the tumor bed, while avoiding premature proximal occlusion of vessels feeding the tumor, and more consistent dosing. These properties translate into greater potency of therapy and potentially improved patient survival.

Sponsors

Yale University
Lead SponsorOTHER

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

1. The patient has preserved liver function (Child-Pugh A-B class) without significant liver decompensation. 2. The patient has an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 at study entry. 3. The patient is age 18 years or older. 4. The patient has a life expectancy of \> 12 weeks. 5. The patient has measurable or evaluable disease that will be directly treated with intrahepatic therapy (as defined by Response Evaluation Criteria in Solid Tumors \[RECIST\] 1.1). 6. The patient has adequate hematologic function as defined by the following criteria: * An absolute neutrophil count (ANC) ≥ 1500/micro L, * Hemoglobin ≥ 9.5 g/dL, and a * Platelet count ≥ 50,000/micro L. 7. The patient has adequate hepatic function, as defined by the following criteria: * Total bilirubin \</= 3.0 mg/dL * Aspartate transaminase (AST) and alanine transaminase (ALT) \</= 8 x the upper limit of normal (ULN). 8. The patient has adequate renal function, as defined by the following criteria: * Serum creatinine \</= 2.0 x the institutional ULN 9. The patient has a baseline international normalized ratio (INR) \< 1.5. 10. The patient, if a woman of childbearing potential, has a negative pregnancy test. 11. The patient is able to give written informed consent. 12. The patient is willing and able to comply with study procedures, scheduled visits, and treatment plans. 13. Patients with early stage HCC may be included in the protocol to receive DEBDOX-M1 prior to resection

Exclusion criteria

1. The patient has a history of another primary cancer (ie, a primary cancer not associated with the patient's current liver tumor), with the exception of (a) curatively resected nonmelanomatous skin cancer; (b) curatively treated cervical carcinoma in situ; or (c) other primary solid tumor treated with curative intent, no known active disease present, and no treatment administered during the last 3 years prior to enrollment (date of informed consent). 2. The patient is receiving concurrent treatment with other anticancer therapy, including other chemotherapy, immunotherapy, hormonal therapy, radiotherapy, chemoembolization, targeted therapy, or an investigational agent. 3. The patient has extrahepatic, metastatic, symptomatic HCC. Enlarged reactive lymph nodes, or indeterminate lesions, such as lung nodules are acceptable. 4. The patient's tumor has replaced \>70% of the liver volume. 5. The patient has clinically significant ascites. Trace ascites on imaging is acceptable. 6. Marco-shunting noted on the hepatic angiogram. 7. The patient has untreatable bleeding diathesis. 8. The patient has complete main portal vein thrombosis with reversal of flow. 9. The patient has a left ventricle ejection fraction of less than 45%. 10. The patient has evidence of clinically significant peripheral vascular disease. 11. The patient has clinically significant or symptomatic extrahepatic disease, for example, an uncontrolled inter-current illness including, but not limited to: * Ongoing or active infection requiring parenteral antibiotics * Symptomatic congestive heart failure (class II to IV of the New York Heart Association classification for heart disease) * Unstable angina pectoris, angioplasty, stenting, or myocardial infarction within 6 months * Uncontrolled hypertension (systolic blood pressure \> 150 mmHg, diastolic blood pressure \> 90 mmHg, found on 2 consecutive measurements separated by a 1-week period despite adequate medical support) * Clinically significant cardiac arrhythmia (multifocal premature ventricular contractions, bigeminy, trigeminy, ventricular tachycardia that is symptomatic or requires treatment \[NCI-CTCAE Grade 3\] or asymptomatic sustained ventricular tachycardia) * Psychiatric illness/social situations that would compromise patient safety or limit compliance with study requirements 12. There is evidence of substance abuse or medical, psychological or social conditions that may interfere with the patient's participation in the study or evaluation of study results. 13. The patient is pregnant or breast-feeding. 14. The patient is allergic to contrast media that cannot be readily prevented with premedication or managed. 15. The patient has extra-hepatic, metastatic, and symptomatic HCC.

Design outcomes

Primary

MeasureTime frameDescription
Collection of Adverse Events Related to Study Device as a Measure of Safety1 monthFor safety, all toxicities assessed as being at least possibly related will be analyzed by descriptive statistics to show type, grade (NCI Common Toxicity Criteria v.4 toxicity criteria), frequency and time from DEBDOX-M1TACE.
Success of DEBDOX-M1 Procedure as a Measure of Feasibility6 monthsFeasibility is defined as achieving an acceptable level of technical success in the use of DEBDOX-M1 beads treating hepatic lesions in patients with hepatocellular carcinoma.

Secondary

MeasureTime frameDescription
Efficacy - Tumor Response by qEASL1 monthEfficacy as assessed by radiographic tumor response using qEASL at baseline and at 1-month imaging following TACE treatments. Complete Response (CR): Disappearance of any intratumoral arterial enhancement in all target lesions. Partial Response (PR): At least a 65% decrease in the sum of enhancing tissue volume of the lesions. Stable Disease (SD): Any cases that do not qualify for complete response, partial response, or progressive disease. Progressive Disease (PD): an increase of at least 73% in the sum of enhancing tissue volume of the lesions.
Efficacy - Tumor Response by mRECIST1 monthEfficacy as assessed by radiographic tumor response using modified RECIST (mRECIST) criteria at baseline and at 1-month imaging following TACE treatments. Complete Response (CR): Disappearance of any intratumoral arterial enhancement in all target lesions Partial Response (PR): At least 30% decrease in the sum of diameters of viable target lesions, taking as reference the baseline sum of the diameters of target lesions Progressive Disease (PD): At least 20% increase in the sum of diameters of viable target lesions, taking as reference the smallest sum of diameters of viable target lesions since treatment started Stable Disease (SD): Any cases that do not qualify for either PR or PD.
Efficacy - Tumor Response by EASL1 monthEfficacy as assessed by radiographic tumor response using EASL amendment at baseline and at 1 month imaging following TACE treatments. Complete Response (CR): Achieving 100% tumor necrosis of lesions targeted by DEBDOX-M1. Baseline degree of tumor enhancement used as a reference. Partial Response (PR): Demonstrating greater than 50% tumor necrosis in lesions targeted by DEBDOX-M1. Stable Disease (SD): Not meeting requirements for CR or PR and not demonstrating evidence of progression of lesions targeted by DEBDOX-M1. Progressive Disease (PD): Reappearance of or increased tumor enhancement greater than 25% in lesions previously targeted by DEBDOX-M1.
Efficacy - Number of Patients Downstaged or Bridged to Surgical Interventions6 monthsThe number of patients who underwent a liver transplantation following treatment on this protocol.
AFP Tumor Marker Pre- and Post-treatment1 monthThe change in alpha-fetoprotein tumor marker levels pre- and post-treatment with one DEBDOX-M1 TACE procedure.

Other

MeasureTime frameDescription
Exploratory Endpoint - Total Drug Exposure Over Time (AUC) of Doxorubicin and Doxorubicinol Post TACE24 hoursTotal drug exposure over time (AUC) of doxorubicin and its metabolite doxorubicinol post DEBDOX in the first 10 patients enrolled on protocol. Time points assessed in protocol were pre-dose, and then 5min, 20min, 40min, 1hr, 2hr, and 24hr post administration of 50-100mg doxorubicin..
Exploratory Endpoint - Pharmacokinetic (PK) Profile of Doxorubicin and Doxorubicinol Post DEBDOX-M1 TACE24 hoursPK analysis of doxorubicin and its metabolite doxorubicinol post DEBDOX-M1 in the first 10 patients enrolled on protocol including peak plasma concentration (Cmax). Time points assessed in protocol were pre-dose, and then 5min, 20min, 40min, 1hr, 2hr, and 24hr post administration of 50-100mg doxorubicin.
Exploratory Endpoint - Tmax of Doxorubicin and Doxorubicinol Post DEBDOX-M1 TACE24 hoursTime taken to reach maximum concentration (Tmax) of doxorubicin and its metabolite doxorubicinol post DEBDOX-M1 in the first 10 patients enrolled on protocol. Time points assessed in protocol were pre-dose, and then 5min, 20min, 40min, 1hr, 2hr, and 24hr post administration of 50-100mg doxorubicin..

Countries

United States

Participant flow

Recruitment details

The study enrolled patients diagnosed with unresectable hepatocellular carcinoma without prior locoregional therapy or concurrent anticancer therapy. Patients were enrolled from February 2014 to January 2015, with the last patient completing follow-up in August 2015.

Participants by arm

ArmCount
DEBDOX
DEBDOX: DEBDOX, loaded with doxorubicin, is a device that utilizes beads in place of lipiodol to deliver the chemotherapy into the liver tumor. The device allows for continuous elution of doxorubicin into the liver tumor tissue. The advantages of this method of delivery in comparison to conventional TACE are that the beads are able to deliver a greater volume and concentration of the drugs to the tumor because of their unique ability to elute the drug over a period of several days. As a result of this unique delivery, systemic toxicity is significantly reduced. The potential advantages of the smaller beads are deeper penetration into the tumor bed, while avoiding premature proximal occlusion of vessels feeding the tumor, and more consistent dosing. These properties translate into greater potency of therapy and potentially improved patient survival.
24
Total24

Withdrawals & dropouts

PeriodReasonFG000
Overall StudyDeath1
Overall StudyDisease progression and unrelated AE1
Overall StudyReceived liver transplant3
Overall StudySwitch in treatment modality2

Baseline characteristics

CharacteristicDEBDOX
Age, Continuous62.5 years
Race/Ethnicity, Customized
Non-Hispanic
African American
7 Participants
Race/Ethnicity, Customized
Non-Hispanic
Asian
1 Participants
Race/Ethnicity, Customized
Non-Hispanic
Unknown
0 Participants
Race/Ethnicity, Customized
Non-Hispanic
White
15 Participants
Race/Ethnicity, Customized
Unknown
African American
0 Participants
Race/Ethnicity, Customized
Unknown
Asian
0 Participants
Race/Ethnicity, Customized
Unknown
Unknown
1 Participants
Race/Ethnicity, Customized
Unknown
White
0 Participants
Region of Enrollment
United States
24 participants
Sex: Female, Male
Female
3 Participants
Sex: Female, Male
Male
21 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
1 / 24
other
Total, other adverse events
24 / 24
serious
Total, serious adverse events
4 / 24

Outcome results

Primary

Collection of Adverse Events Related to Study Device as a Measure of Safety

For safety, all toxicities assessed as being at least possibly related will be analyzed by descriptive statistics to show type, grade (NCI Common Toxicity Criteria v.4 toxicity criteria), frequency and time from DEBDOX-M1TACE.

Time frame: 1 month

Population: 30-day toxicity report of device-related adverse events for all 24 patients with classification and grading based on CTCAE v4.0.

ArmMeasureGroupValue (NUMBER)
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyFever2 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyHypertension6 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyAnorexia4 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyFatigue2 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyWeight loss1 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyWeight gain1 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyInsomnia1 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyHyperglycemia5 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyHypoglycemia1 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyAscites1 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyDiarrhea2 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyConstipation1 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyGas1 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyNausea/Vomiting1 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyGroin hematoma1 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyHyperbilirubinemia2 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyHypoalbuminemia1 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyCellulitis1 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyHeadache2 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyConfusion1 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyAbdominal non-specific pain2 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyPain - general1 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyPain - right shoulder1 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyHypercreatininemia1 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyHypokalemia1 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyHyponatremia3 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyGrade 3 Elevated Transaminase1 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyHypoxia1 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyCardiac arrest1 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyTotal Grade 3 or higher adverse events3 Adverse Events
DEBDOXCollection of Adverse Events Related to Study Device as a Measure of SafetyTotal Grade 1-2 adverse events46 Adverse Events
Primary

Success of DEBDOX-M1 Procedure as a Measure of Feasibility

Feasibility is defined as achieving an acceptable level of technical success in the use of DEBDOX-M1 beads treating hepatic lesions in patients with hepatocellular carcinoma.

Time frame: 6 months

Population: The 24 patients received a total of 50 DEBDOX-M1 TACE procedures.

ArmMeasureValue (NUMBER)
DEBDOXSuccess of DEBDOX-M1 Procedure as a Measure of Feasibility100 percentage of successful treatments
Secondary

AFP Tumor Marker Pre- and Post-treatment

The change in alpha-fetoprotein tumor marker levels pre- and post-treatment with one DEBDOX-M1 TACE procedure.

Time frame: 1 month

Population: 23 out of 24 patients analyzed due to one patient not completing AFP post-TACE.

ArmMeasureGroupValue (MEAN)
DEBDOXAFP Tumor Marker Pre- and Post-treatmentPre-M1 TACE289.7 ng/mL
DEBDOXAFP Tumor Marker Pre- and Post-treatmentPost-M1 TACE145.4 ng/mL
Comparison: Shapiro-Wilk test was run for normality. Baseline and follow-up AFP compared using two-tailed Student's t-test.p-value: 0.01t-test, 2 sided
Secondary

Efficacy - Number of Patients Downstaged or Bridged to Surgical Interventions

The number of patients who underwent a liver transplantation following treatment on this protocol.

Time frame: 6 months

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
DEBDOXEfficacy - Number of Patients Downstaged or Bridged to Surgical Interventions6 Participants
Secondary

Efficacy - Tumor Response by EASL

Efficacy as assessed by radiographic tumor response using EASL amendment at baseline and at 1 month imaging following TACE treatments. Complete Response (CR): Achieving 100% tumor necrosis of lesions targeted by DEBDOX-M1. Baseline degree of tumor enhancement used as a reference. Partial Response (PR): Demonstrating greater than 50% tumor necrosis in lesions targeted by DEBDOX-M1. Stable Disease (SD): Not meeting requirements for CR or PR and not demonstrating evidence of progression of lesions targeted by DEBDOX-M1. Progressive Disease (PD): Reappearance of or increased tumor enhancement greater than 25% in lesions previously targeted by DEBDOX-M1.

Time frame: 1 month

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
DEBDOXEfficacy - Tumor Response by EASLComplete Response5 Participants
DEBDOXEfficacy - Tumor Response by EASLPartial Response5 Participants
DEBDOXEfficacy - Tumor Response by EASLStable Disease10 Participants
DEBDOXEfficacy - Tumor Response by EASLProgressive Disease3 Participants
DEBDOXEfficacy - Tumor Response by EASLObjective response (CR + PR)10 Participants
DEBDOXEfficacy - Tumor Response by EASLDisease control rate (CR + PR + SD)20 Participants
Secondary

Efficacy - Tumor Response by mRECIST

Efficacy as assessed by radiographic tumor response using modified RECIST (mRECIST) criteria at baseline and at 1-month imaging following TACE treatments. Complete Response (CR): Disappearance of any intratumoral arterial enhancement in all target lesions Partial Response (PR): At least 30% decrease in the sum of diameters of viable target lesions, taking as reference the baseline sum of the diameters of target lesions Progressive Disease (PD): At least 20% increase in the sum of diameters of viable target lesions, taking as reference the smallest sum of diameters of viable target lesions since treatment started Stable Disease (SD): Any cases that do not qualify for either PR or PD.

Time frame: 1 month

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
DEBDOXEfficacy - Tumor Response by mRECISTComplete Response5 Participants
DEBDOXEfficacy - Tumor Response by mRECISTPartial Response5 Participants
DEBDOXEfficacy - Tumor Response by mRECISTStable Disease11 Participants
DEBDOXEfficacy - Tumor Response by mRECISTProgressive Disease2 Participants
DEBDOXEfficacy - Tumor Response by mRECISTObjective response (CR + PR)10 Participants
DEBDOXEfficacy - Tumor Response by mRECISTDisease control rate (CR + PR + SD)21 Participants
Secondary

Efficacy - Tumor Response by qEASL

Efficacy as assessed by radiographic tumor response using qEASL at baseline and at 1-month imaging following TACE treatments. Complete Response (CR): Disappearance of any intratumoral arterial enhancement in all target lesions. Partial Response (PR): At least a 65% decrease in the sum of enhancing tissue volume of the lesions. Stable Disease (SD): Any cases that do not qualify for complete response, partial response, or progressive disease. Progressive Disease (PD): an increase of at least 73% in the sum of enhancing tissue volume of the lesions.

Time frame: 1 month

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
DEBDOXEfficacy - Tumor Response by qEASLComplete Response5 Participants
DEBDOXEfficacy - Tumor Response by qEASLPartial Response4 Participants
DEBDOXEfficacy - Tumor Response by qEASLStable Disease13 Participants
DEBDOXEfficacy - Tumor Response by qEASLProgressive Disease1 Participants
DEBDOXEfficacy - Tumor Response by qEASLObjective response (CR + PR)9 Participants
DEBDOXEfficacy - Tumor Response by qEASLDisease control rate (CR + PR + SD)22 Participants
Other Pre-specified

Exploratory Endpoint - Pharmacokinetic (PK) Profile of Doxorubicin and Doxorubicinol Post DEBDOX-M1 TACE

PK analysis of doxorubicin and its metabolite doxorubicinol post DEBDOX-M1 in the first 10 patients enrolled on protocol including peak plasma concentration (Cmax). Time points assessed in protocol were pre-dose, and then 5min, 20min, 40min, 1hr, 2hr, and 24hr post administration of 50-100mg doxorubicin.

Time frame: 24 hours

ArmMeasureValue (MEAN)Dispersion
DEBDOXExploratory Endpoint - Pharmacokinetic (PK) Profile of Doxorubicin and Doxorubicinol Post DEBDOX-M1 TACE139.9 ng/mLStandard Deviation 98.2
Other Pre-specified

Exploratory Endpoint - Tmax of Doxorubicin and Doxorubicinol Post DEBDOX-M1 TACE

Time taken to reach maximum concentration (Tmax) of doxorubicin and its metabolite doxorubicinol post DEBDOX-M1 in the first 10 patients enrolled on protocol. Time points assessed in protocol were pre-dose, and then 5min, 20min, 40min, 1hr, 2hr, and 24hr post administration of 50-100mg doxorubicin..

Time frame: 24 hours

ArmMeasureValue (MEAN)Dispersion
DEBDOXExploratory Endpoint - Tmax of Doxorubicin and Doxorubicinol Post DEBDOX-M1 TACE6.6 minutesStandard Deviation 3.6
Other Pre-specified

Exploratory Endpoint - Total Drug Exposure Over Time (AUC) of Doxorubicin and Doxorubicinol Post TACE

Total drug exposure over time (AUC) of doxorubicin and its metabolite doxorubicinol post DEBDOX in the first 10 patients enrolled on protocol. Time points assessed in protocol were pre-dose, and then 5min, 20min, 40min, 1hr, 2hr, and 24hr post administration of 50-100mg doxorubicin..

Time frame: 24 hours

ArmMeasureValue (MEAN)Dispersion
DEBDOXExploratory Endpoint - Total Drug Exposure Over Time (AUC) of Doxorubicin and Doxorubicinol Post TACE327 ng*h/mLStandard Deviation 366

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026