Hepatocellular Carcinoma, Portal Vein Tumor Thrombus, Systemic Therapy
Conditions
Keywords
Advanced hepatocellular carcinoma, Lenvatinib, Sintilimab, Camrelizumab, Tislelizumab, Transjugular intrahepatic portosystemic shunt, Main trunk portal vein tumor thrombus
Brief summary
Hepatocellular carcinoma (HCC) with main trunk portal vein tumor thrombus (PVTT) has poor prognosis. The main lethiferous factor is the upper gastrointestinal hemorrhage by PVTT-related portal hypertension, then the second is the tumor-caused death. It is vital to prevent the portal hypertension by PVTT.
Detailed description
Portal hypertension by main trunk portal vein tumor thrombus (PVTT) is a severe disease. Patients usually die of gastrointestinal hemorrhage rather than tumor progression. It is vital to prevent the portal hypertension. Transjugular intrahepatic portosystemic shunt (TIPS) is an effective method to alleviate the portal pressure. Then the risk of gastrointestinal hemorrhage is decreased which provides an opportunity for system therapy. In this study, the investigators explore the TIPS combined with Lenvatinib and PD-1 inhibitor for advanced hepatocellular carcinoma with main trunk portal vein tumor thrombus. The investigators aim to add clinical evidence for this subtype of advanced HCC.
Interventions
A needle punctured the portal vein through the transjugular approach. After a successful puncture, the parenchymal tract was dilated, and covered stents were introduced. The specifications of the covered stents were 8 mm × 50 mm, 8 mm × 60 mm, 8 mm × 70 mm, and 8 mm × 80 mm. All of the diameters of the bare stents were 8 mm, and the lengths were 50-80 mm. The portal vein pressure was measured before and after shunt creation. After the insertion of TIPS, all of the participants received a diuretic treatment and a salt-limited diet.
DRUGLenvatinib
12 mg (body weight ≥60 kg) , 8 mg (body weight \<60 kg
DRUGPD-1 inhibitor
Tislelizumab (200mg intravenously every 3 weeks), Sintilimab (200mg intravenously every 3 weeks), Camrelizumab (200mg intravenously every 3 weeks)
Sponsors
Chinese PLA General Hospital
Sun Yat-sen University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
TIPS procedure
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
1. diagnosis of primary HCC, confirmed histologically or clinically according to the criteria of the American Association for the Study of Liver Diseases; 2. presence of PVTT with III-IV grade by Cheng's criteria; 3. having PVTT induced portal hypertension; 4. with or without PVTT induced acute variceal bleeding; 5. metastases with limited five sites and no more two organs involved; 6. Number of Intrahepatic tumors were no more than five; 7. receipt of Lenvatinib and PD-1 inhibitor as the first-line systemic therapy; 8. classified as Child-Pugh class A or B and having an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 2; 9. no history of other malignancies; 10. agreed to participated in this clinical trial; 11. Hemameba ≥3.0 x109/L, neutrophil ≥1.5x109/L, hemoglobin≥10.0 g/L, platelet≥100x 109/L, ALT; AST; bilirubin ≤1.5-fold normal, GFR≥60ml/min.
Exclusion criteria
1. recurrent HCC; 2. PVTT at I-II grade by Cheng's criteria; 3. age \< 18 years or \> 75 years; 4. advanced HCC with more than five metastases; 5. Number of Intrahepatic tumors were more than five; 6. no response to Lenvatinib; 7. life expectancy less than 3 months.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rates of gastrointestinal hemorrhage | 6 months | atients occur gastrointestinal hemorrhage within 6 months after TIPS. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free-Survival (PFS) | 12 months | Progression was defined as progressive disease by independent radiologic review |
| Overall survival (OS) | 24 months | OS is the length of time from the date of inclusion until death from any cause. |
| Objective response rate (ORR) | 6 months | ORR, as determined based on tumor response according to RECIST 1.1, is defined as the proportion of all included patients whose best overall response (BOR) is either a complete response or partial response. |
| Adverse events | 24 months | Safety will be evaluated according to the NCI CTCAE Version 4.03. All observations |
Countries
China
Contacts
Primary ContactQunfang Zhou, MD
Backup ContactFeng Duan, MD
Outcome results
None listed