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Phase II Randomized Trial Evaluating the Administration of Sorafenib or Pravastatin or Association Sorafenib-pravastatin or Best Supportive Care for the Palliative Treatment of Hepatocellular Carcinoma in Patient With CHILD B Cirrhosis


Phase 2
18 Years
N/A
Open (Enrolling)
Both
Hepatocellular Carcinoma, CHILD B

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Trial Information

Phase II Randomized Trial Evaluating the Administration of Sorafenib or Pravastatin or Association Sorafenib-pravastatin or Best Supportive Care for the Palliative Treatment of Hepatocellular Carcinoma in Patient With CHILD B Cirrhosis


The incidence of Hepatocellular Carcinoma (HCC) is currently increasing in Europe and in
France. It almost always occurs on liver disease and in 80 to 90% of cases, at least in
France, on liver with cirrhosis. If curative treatment may be proposed for some "small" HCC
(transplantation, resection, percutaneous destruction), about 2 / 3 of patients, which
represents nearly 4,000 new cases per year in France, are not eligible for such treatment.
The palliative management of patients with advanced and symptomatic disease is complex and
requires treatment combining anti-tumor activity and safety in patients with impaired liver
functions. Indeed, in most cases the palliative treatment of HCC is applied to patients with
altered liver function (stage B of the Child-Pugh classification).

To date, the proposed treatment in France for such patients is based on best supportive
care.

The objective of this study is to assess the interest in this situation of 2 molecules -
taken alone or in combination:

- Sorafenib, the reference in the palliative treatment of advanced hepatocellular
carcinoma (Stage C of the BCLC classification). Yet the safety and efficacy of
sorafenib in patients with altered liver function (CHILD B) are not clearly defined and
its use remains discouraged by French recommendations in these patients.

- Pravastatin whose interest in the palliative treatment of HCC was suggested by several
phase II studies with a good safety profile in cirrhotic patients.

In this French multicenter open randomized study, 160 patients will be included in 4 arms
(40/arms): sorafenib, pravastatin, pravastatin + sorafenib, and supportive care.

The aim of this phase II multicenter study is to select the two best arms for further Phase
III study in order to identify a reference treatment in this palliative situation.


Inclusion Criteria:



- Male and female subjects > 18 years age

- Hepatocellular carcinoma histologically diagnosed or in case of inability to perform a
histology by non invasive radiological criteria in presence of known cirrhosis: (i)
Hepatic lesion measuring between 1 and 2 cm in diameter : CT-scan + MRI (eventually an
Ultrasound contrast) : HCC diagnosed with contrast uptake in the arterial phase and rapid
wash out in the venous /late phase on two imaging techniques.

(ii)Hepatic lesion with a diameter > 2 cm : CT-scan or MRI +alpha fetoprotein : HCC
diagnosed with contrast uptake in the arterial phase and a rapid wash out in the venous
/late phase or a alpha fetoprotein > 200µg/L

- Patient not eligible for curative treatment (transplantation, resection, destruction
or percutaneous chemo-embolization) or HCC still evolving after failure of a specific
treatment

- Score CHILD B

- ECOG performance status 0/1/2

- Score BCLC B or C

- Adequate haematologic function with haemoglobin > 8 g/dl, platelet count > 50000x
109/L, absolute neutrophil count > 1000 / mm3

- Creatinine < 2 times the upper limit of normal

- Written informed consent

Exclusion Criteria:

- Any condition that is unstable or could jeopardize the safety of the subject and
their compliance in the study

- Pregnancy

- Myocardial infarction less than 6 months, uncontrolled hypertension, congestive heart
failure(NYHA class > 2) , anti- arrhythmic treatment other than beta-blockers or
digoxin

- Digestive bleeding within 30 days before inclusion

- Hepatic transplantation

- Patients receiving or having received a statine for less than 6 months before HCC
diagnostic

- Prior use of sorafenib

- Psychiatric illness/social situations that would limit compliance with study
requirements.

- Previous or concurrent cancer, except cervical carcinoma in situ, treated basal cell
carcinoma, superficial bladder tumor. Any cancer curatively treated > 5 years prior
to entry is permitted

- Known or suspected history of allergy to sorafenib or pravastatin.

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Time to radiologic progression

Outcome Time Frame:

Every 4 weeks (CT-scan or MRI) until progression of HCC or date of last news (for patients alive or dead without progression)

Safety Issue:

No

Principal Investigator

Jean-Frédéric BLANC, MD-PhD

Investigator Role:

Principal Investigator

Investigator Affiliation:

University Hospital, Bordeaux

Authority:

France: Afssaps - Agence française de sécurité sanitaire des produits de santé (Saint-Denis)

Study ID:

CHUBX 2010/22

NCT ID:

NCT01357486

Start Date:

November 2011

Completion Date:

February 2014

Related Keywords:

  • Hepatocellular Carcinoma
  • CHILD B
  • Hepatocellular Carcinoma
  • CHILD B
  • palliative management
  • Sorafenib
  • Pravastatin
  • Carcinoma
  • Fibrosis
  • Carcinoma, Hepatocellular

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