Chinese Herbal Medicine, HCC - Hepatocellular Carcinoma, ICG (Indocyanine Green), Overall Survival (All-cause Mortality), Quality of Life
Conditions
Keywords
Hepatocellular Carcinoma(HCC), Chinese herbal medicine, Shuganhuazhuo Formula(SHF), Liver reserve function, Overall survival, Quality of life
Brief summary
Primary liver cancer is a malignant tumor with a very poor prognosis. Hepatocellular carcinoma(HCC) accounts for approximately 80% of cases. Under the current targeted and immunotherapy-based treatment approaches, the overall survival of patients with advanced HCC has improved significantly compared to targeted therapy alone. However, there are still limitations in therapeutic effectiveness. In addition to the tumor burden, liver reserve function is associated with the prognosis of HCC. Cirrhosis, tumor burden, and anti-tumor treatment can all lead to damage to liver reserve function, which in turn leads to a decrease in patient survival. Currently, there are no specific treatments for deteriorating liver reserve function; only symptomatic treatments such as reducing transaminase levels, bilirubin levels, and blood ammonia levels, as well as diuretics, are available. The indocyanine green(ICG) clearance test allows for precise, dynamic, and quantitative measurement of liver clearance function, making it a commonly used method for assessing liver reserve function in clinical practice.Previous studies have confirmed that its test results are closely related to the prognosis of HCC. Shuganhuazhuo Formula(SHF) is a Chinese herbal medicine used to treat advanced HCC with syndrome of Damp-Heat and Blood stasis. It can inhibit necrosis in the livers of mice in experimental models, reduce fibrosis scores, and demonstrate potential therapeutic effects in protecting the liver, reducing oxidative stress, and preventing fibrosis. This study is an open-label randomized controlled trial. Patients with advanced HCC who are receiving second-line or third-line anti-tumor treatment are randomly assigned in a 1:1 ratio to either the control group or the traditional Chinese medicine (TCM) group. The control group receives anti-tumor treatment as recommended by guidelines, while the TCM group receives additional treatment with SHF. SHF involves decocting traditional Chinese medicine ingredients twice daily. Each time, 150 ml of the decoction is prepared and taken orally half an hour after breakfast and dinner. Treatment lasts for 6 months. During this period, the ICG clearance test is performed every 2 months to assess liver reserve function, and quality of life is also evaluated. After the treatment period, follow-ups on survival and safety are conducted every 3 months. This study aims to evaluate the benefits of the SHF in terms of liver reserve function, overall survival, and quality of life in patients with HCC of the syndrome of Damp-Heat and Blood stasis. It also includes exploratory analyses of differences in biomarker expression during treatment.
Interventions
DRUGShuganhuazhuo Formula
The Shuganhuazhuo Formula is composed of the following medicinal materials: Bupleuri Radix (Chaihu), Scutellariae Radix (Huangqin), processed Pinelliae Rhizoma (Fabanxia), Ginseng Radix et Rhizoma (Renshen, sliced), Agrimoniae Herba (Xianhecao), stir-fried Arecae Semen (Chao Binglang), stir-fried Aurantii Fructus (Chao Zhiqiao), Artemisiae Scopariae Herba (Yinchen), and other ingredients.The formula contains no toxic or strongly drastic medicinal substances, and the dosages of all herbal ingredients are within the ranges specified in the Pharmacopoeia of the People's Republic of China (2025, Volume I).
DRUGTargeted therapy
Targeted therapy, with agents including but not limited to regorafenib and apatinib.
DRUGImmunotherapy
Immunotherapy, with agents including but not limited to ramucirumab, pembrolizumab, camrelizumab, and tislelizumab.
DRUGChemotherapy
Chemotherapy, including but not limited to the FOLFOX4 regimen.
PROCEDURETACE
Transcatheter Arterial Chemoembolization(TACE)
PROCEDUREHAIC
Hepatic Arterial Infusion Chemotherapy(HAIC), including but not limited to the FOLFOX regimen.
Sponsors
Xiang-Qian
HerbMed Group Co., Ltd.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
The operators performing indocyanine green testing and those responsible for follow-up of overall survival are masked to treatment assignment.
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
1. According to the National Health Commission(China)'s "Guidelines for the Diagnosis and Treatment of Primary Liver Cancer (2026)", clinically or pathologically diagnosed as primary liver cancer. 2. Barcelona Clinic Liver Cancer (BCLC) stage is C. 3. Planning to receive second-line or third-line anti-tumor therapies. 4. The dominant syndrome in traditional Chinese medicine diagnosis is damp or heat. 5. Age: ≥ 18 years and ≤ 75 years.
Exclusion criteria
1. Expected survival is less than 3 months. 2. Definitive pathological diagnosis of intrahepatic cholangiocarcinoma or combined hepatocellular-cholangiocarcinoma (cHCC-CCA). 3. Comorbid severe heart, liver, kidney dysfunction: 1. heart * New York Heart Association(NYHA) cardiac function \> class II 2. liver * aspartate aminotransferase \> 3 times the upper limit of normal * alanine aminotransferase \> 3 times the upper limit of normal * bilirubin \> 3 times the upper limit of normal 3. kidney * creatinine clearance (Cockcroft-Gault) \< 60 mL/min) 4. Concurrent with other malignant tumors.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Liver reserve function | Through baseline and intervention period, up to 6 months. | Assessment is based on the indocyanine green retention rate at 15 minutes (ICG-R15) from the indocyanine green clearance Test. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival | Through study completion, an average of 2 years. | The time elapsed from the subject's randomization to death due to any cause. |
| Health-related Quality of Life | Through baseline and intervention period, up to 6 months. | Assessment is conducted using the European Organization for Research and Treatment of Cancer's Core Quality of Life Scale (EORTC QLQ-C30) combined with the 18 items of the Hepatocellular Liver Carcinoma-Specific Quality of Life Supplement Module (EORTC QLQ-HCC18). |
Countries
China
Contacts
CONTACTZhen Hongde, Dr.
CONTACTLi Bing, PhD.
STUDY_CHAIRLi Bing, PhD.
HerbMed Group Co., Ltd.
Outcome results
None listed