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Phase III Multi-Centre Open-Label Randomized Controlled Trial of Selective Internal Radiation Therapy (SIRT) Versus Sorafenib in Locally Advanced Hepatocellular Carcinoma (SIRveNIB)

Phase 3
18 Years
Open (Enrolling)
Hepatocellular Carcinoma

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Trial Information

Phase III Multi-Centre Open-Label Randomized Controlled Trial of Selective Internal Radiation Therapy (SIRT) Versus Sorafenib in Locally Advanced Hepatocellular Carcinoma (SIRveNIB)

Hepatocellular carcinoma (HCC) is the 5th most common cancer worldwide but unfortunately
between 70 - 80% of all HCC are in the Asia-Pacific because of the prevalence of chronic
viral hepatitis in the region. The increase in the prevalence of chronic hepatitis C in the
Western world however predicts that HCC will similarly be an important cause of death there
in the next 20 years.

Only 15-20% of HCC are today potentially curable by surgery at the time of diagnosis.
Another 10-15% of patients may benefit from potentially curative locally ablative therapy
such as radio-frequency ablation. Prognosis in the majority of patients has been dismal as
conventional systemic therapies have been largely inefficacious. The first successfully
trialed systemic targeted therapy, sorafenib (2007) prolonged survival by a modest average
of 3 months in patients with good underlying liver function.

While the liver is radio-sensitive, external beam radiation causes significant
radio-toxicity. To overcome this, selective internal radiation therapy (SIRT) was developed
to deliver a radiation source directly to liver cancer via the arterial route. Sir-sphere is
radioactive yttrium on a 90 micro-meter diameter resin carrier and is an established therapy
in colorectal metastasis. Sir-sphere has been reported to cause significantly tumour
regression in HCC.

This study will evaluate the efficacy of SIRT using SIR-Spheres yttrium-90 microspheres
compared to sorafenib in the treatment of patients with locally advanced primary HCC.

Inclusion Criteria:

- Disease must be locally advanced as defined by BCLC (B) intermediate stage or BCLC
(C) advanced stage without extra-hepatic disease (only with branch portal vein

- Willing, able and mentally competent to provide written informed consent prior to any
testing undertaken for this study protocol, including screening tests and evaluations
that are not considered to be part of the subject's routine care.

- Aged 18 years/older (either gender).

- Unequivocal diagnosis of HCC.

- HCC not amenable to surgical resection or immediate liver transplantation, or cannot
be optimally treated with local ablative techniques such as RFA, consistent with the
practice of the clinical trial centre.

- Measurable disease, defined as at least one lesion that can be accurately measured in
at least one dimension (longest diameter to be recorded) as ≥ 10 mm with spiral CT
scan or MRI.

- ECOG performance status 0-1.

- Child-Pugh A-B (up to 7 points)

- Adequate haematological, renal and hepatic function as follows:

- Leukocytes ≥ 2,500/μL

- Platelets ≥ 80,000/μL

- Haemoglobin > 9.5g/dL

- Total bilirubin < 2.0mg/dL

- INR ≤ 2.0

- ALP ≤ 5 x institutional ULN

- AST and ALT ≤ 5 x institutional ULN

- Albumin ≥ 2.5g/dL

- Creatinine ≤ 2.0mg/dL

- Life expectancy of at least 3 months without any active treatment.

- Suitable for protocol treatment as determined by clinical assessment undertaken by
the Investigator.

- Female patients must be either postmenopausal or, if premenopausal, must have a
negative pregnancy test and agree to use 2 forms of contraception if sexually active
during their study participation.

- Male patients must be surgically sterile, or if sexually active and having a
pre-menopausal female partner then must be using an acceptable form of contraception.

Exclusion Criteria:

- Have had more than 2 administrations of hepatic artery directed therapy.

- Subjects who have had hepatic artery directed therapy done < 4 weeks prior to study

- Have had systemic chemotherapy for HCC except for prior adjuvant or neoadjuvant
therapy given more than 6 months from enrolment.

- have had prior treatment with Sorafenib or VEGF inhibitors.

- Prior hepatic radiation therapy for HCC or other malignancy.

- Currently receiving any other investigational agents for the treatment of their

- Has intractable clinical ascites (in spite of optimal diuretic treatment) or any
other clinical signs of liver failure, on physical examination.

- Complete main portal vein thrombosis.

- Any metastatic disease (local-regional lymph nodes measuring less than 2 cm in
greatest diameter or lung nodules measuring less than 1 cm are not contraindications
as per Investigator discretion).

- Any other concurrent malignancy, except for adequately treated basal cell or squamous
cell skin cancer, in situ cervical cancer, or other cancer for which the patient has
been disease-free for at least 5 years.

- Presence of clinical signs of CNS metastases due to their poor prognosis and because
progressive neurologic dysfunction would confound the evaluation of neurologic and
other adverse events.

- Uncontrolled inter-current illness including, but not limited to, ongoing or active
infection (except viral hepatitis), symptomatic congestive heart failure, unstable
angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that
would limit compliance with study requirements.

- Any of the following contraindications to angiography and selective visceral

- Bleeding diathesis, not correctable by the standard forms of therapy.

- Severe peripheral vascular disease that would preclude arterial catheterization.

- Portal hypertension with hepato-fugal flow as documented on baseline spiral CT scan.

- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to SIR-Spheres or Sorafenib.

- Inability or unwillingness to understand or sign a written informed consent document.

- Female subjects who are pregnant or currently breastfeeding.

- Female subjects, unless postmenopausal or surgically sterile, unwillingness to
practice effective contraception, as per Investigator discretion during the study.
The rhythm method is not to be used as the sole method of contraception.

- Male subjects, unwillingness to practice effective contraception (per Investigator
discretion) while taking part in this study, because the effect of the SIR-Spheres
treatment on sperm or upon the development of an unborn child are unknown.

- Current enrolment in any other investigational therapeutic drug or device study.

Type of Study:


Study Design:

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Overall Survival

Outcome Description:

Overall Survival is defined as the time from the date of randomisation to the date of death due to any cause. All patients will be followed up until death to compare the overall survival between the two treatments. 2 years is an estimated time frame.

Outcome Time Frame:

2 years

Safety Issue:


Principal Investigator

Pierce KH Chow, MBBS, PhD

Investigator Role:

Study Chair

Investigator Affiliation:

Singapore General Hospital


Singapore: Health Sciences Authority

Study ID:




Start Date:

July 2010

Completion Date:

July 2015

Related Keywords:

  • Hepatocellular Carcinoma
  • Hepatocellular Carcinoma
  • Randomized
  • Open-label
  • Multi-Centre
  • Phase III
  • Sorafenib
  • SIR-Spheres
  • Carcinoma
  • Carcinoma, Hepatocellular