BCLC Stage a Hepatocellular Carcinoma, BCLC Stage B Hepatocellular Carcinoma, BCLC Stage C Hepatocellular Carcinoma, Hepatocellular Carcinoma
Conditions
Brief summary
This early phase I trial evaluates the use of hypoxia (lack of oxygen) as a measure in determining the outcome of Y90 selective internal radiation therapy in patients with liver cancer that has spread to a limited number of sites (oligometastatic). Radioembolization with Y90 is a minimally invasive procedure that combines embolization and radiation therapy to treat metastatic liver cancer. Tiny beads filled with radioactive isotope Y-90 are placed inside the blood vessel that provide blood supply to the tumor. This will block the blood flow to the tumor cells while providing a high radiation dose without harming healthy normal tissue.
Detailed description
PRIMARY OBJECTIVE: I. To investigate the variability of hypoxia in hepatocellular carcinoma (HCC) as quantified by blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) and dynamic 18F-Fluoromisonidazole (FMISO) positron emission tomography (PET). SECONDARY OBJECTIVES: I. Investigate whether hypoxia, as quantified by BOLD MRI, dynamic FMISO PET, HIF-1alpha and VEGF expression, predicts HCC response to yttrium-90 (Y90) selective internal radiation therapy (SIRT). II. Assess whether hypoxia quantification by BOLD MRI, dynamic FMISO, HIF-1alpha or VEGF expression individually or in combination more accurately predict the degree of HCC tumor response to Y90 SIRT. III. Compare the tumor dose response threshold between hypoxic and non-hypoxic HCCs treated with Y90 SIRT. OUTLINE: Patients receive 18F-fluoromisonidazole intravenously (IV) and undergo PET and dynamic contrast enhanced (DCE) MRI within 30 days before beginning Y90 SIRT. Patients undergo Y90 SIRT per standard of care. After completion of study intervention, patients are followed up at 90 days, and then every 12 weeks thereafter.
Interventions
PROCEDUREDynamic Contrast-Enhanced Magnetic Resonance Imaging
Undergo DCE MRI
PROCEDUREPositron Emission Tomography
Undergo PET
Given IV
PROCEDUREBiopsy
Undergo biopsy
Sponsors
National Cancer Institute (NCI)
Emory University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age \>= 18 years * Established HCC diagnosis, unilobar or bilobar disease * At least 1 tumor \>= 3 cm * Oligometastatic disease * Barcelona Clinic Liver Cancer (BCLC) stage A, B or C * Eastern Cooperative Oncology Group (ECOG) performance status =\< 2 (Karnofsky \>= 60%) * Life expectancy \> 12 weeks as determined by the Investigator * The effects of Y90 Radioembolization on the developing human fetus are unknown. For this reason, female of child-bearing potential (FCBP) must have a negative serum or urine pregnancy test prior to starting therapy * FCBP and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately * A female of childbearing potential (FCBP) is a sexually mature woman who: 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months
Exclusion criteria
* Patients who are definite transplant candidates * Concurrent second malignancy outside of the liver * Infiltrative liver tumor * Previous liver-directed therapy to targeted tumors * BCLC stage D * Bilirubin \> 2 mg/dL for lobar treatment and bilirubin \> 3 mg/dL for segmental or bi-segmental Y90-SIRT * Albumin \< 3 g/dL * Projected lung dose of \> 30 Gy in a single session to the liver after prospective treatment planning * Body mass index (BMI) \> 40
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| To investigate the variability of hypoxia in HCC at baseline as quantified by BOLD MRI | From weeks 1-2 up to 1 year | Threshold \<1.0 R2 tumor to normal ratio (no unit) as a cutoff for hypoxia |
| To investigate the variability of hypoxia in HCC at baseline as quantified by immunohistochemistry | From weeks 1-2 up to 1 year | The staining intensity will be measured and scored with four scales: no staining=0, weak staining=1, moderate staining=2, and strong staining=3. The final staining score will be obtained by stained stumor area% x positive tumor cells % x staining intensity. The tumors will be then categorized as hypoxic (scores 8 to 16) vs. non-hypoxic (scores 0 to 7) (no units). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Determine whether hypoxia is predictor of response in HCC treated with Y90 SIRT | From week 0 up to 1 year | Treatment Response Assessment using mRECIST |
| Treatment response | From week 0 Up to 1 year | Assessed using modified Response Evaluation Criteria in Solid Tumors. |
Countries
United States
Outcome results
None listed