Hepatocellular Carcinoma
Conditions
Keywords
Hepatocellular carcinoma, Adjuvant therapy, Overall survival, Liver resection, Combined therapy
Brief summary
Hepatocellular carcinoma is prone to invade the portal vein and form portal vein thrombosis, and patients in this period are directly included in the advanced stages, i.e. Barcelona clinical liver cancer stage C. For the treatment of PVTT, there are differences between Eastern and Western guidelines, with systemic drugs being the standard of care in Western countries, while surgical treatment is often actively practiced in the Asia-Pacific region. More research is needed to explore the differences between these two approaches.
Detailed description
Hepatocellular carcinoma is prone to invade the portal vein and form portal vein thrombosis, and patients in this period are directly included in the advanced stages, i.e. Barcelona clinical liver cancer stage C. For the treatment of PVTT, there are differences between Eastern and Western guidelines, with systemic drugs being the standard of care in Western countries, while surgical treatment is often actively practiced in the Asia-Pacific region. In recent years, breakthroughs have been made in the treatment of advanced HCC, and systemic drug combinations such as PD-1 inhibitors combined with targeted therapies, and local area therapy combined with systemic therapy have shown excellent anti-tumor effects. Postoperative adjuvant therapy is also advancing, and the combination of adjuvant systemic medications for patients after PVTT has also been effective in reducing postoperative recurrence. Which approach is better for PVTT patients needs to be explored in depth. We launched the CHALLENGE-01 study in October 2023. The study consists of two phases: the first phase involves retrospective data collection from 2019 to 2023 and prospective follow-up of survival information. Specifically, the liver resection+ PD-1 inhibitor + lenvatinib (LRPL) cohort included 225 cases, the TACE + PD-1 inhibitor + lenvatinib (TPL) cohort included 205 cases, and the surgery-only treatment cohort included 200 cases as an additional control group. Data analysis from the first phase of the study showed that the median follow-up times for the LRPL and TPL cohorts were 31.6 months and 22.5 months, respectively. Based on retrospective cohort data, we calculated the sample size required for the prospective study (446) and formally initiated the second-phase prospective clinical trial in January 2024. The study completed the required enrollment from nine centers in China by December 31, 2024, but has not yet reached the primary endpoint (OS).
Interventions
PROCEDURELiver resection
Patients in the intervention group received liver resection and postoperative adjuvant therapy
PROCEDURELocoregional therapy
Patients in the control group received locoregional therapy and systemic therapy
Sponsors
Chen Xiaoping
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Aged 18-75 years * Pathological type is HCC, and with PVTT * No extrahepatic HCC * Eastern Cooperative Oncology Group (ECOG) performing status of 0-1 and Child-Pugh grade A for the liver resection group * ECOG performing status of 0-2 and Child-Pugh grade A-B for the locoregional-based group * Adequate hematologic and organ function
Exclusion criteria
* Any history of other malignant tumors or recurrent HCC * Any acute active infectious diseases, active or history of autoimmune disease, or immune deficiency * Any persistent serious liver resection or locoregional therapy-related complications * Esophageal and/or gastric variceal bleeding within 6 months * Inability or refusal to comply with the treatment and monitoring * Participation in other clinical trials
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall survival | From date of include in this research until the date of death from any cause, whichever came first, assessed up to 60 months. | Overall survival was defined as the period from study inclusion until death from any cause. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Adverse effects | 12 months | Adverse reactions are defined as any reaction during treatment that is inconsistent with the purpose of the treatment. |
Countries
China
Outcome results
None listed