Transcatheter Arterial Chemoembolization Therapy In Combination With Sorafenib (TACTICS)

• ClinicalTrials.gov Identifier: NCT01217034
• Recruitment Status: Unknown
• First Posted: October 8, 2010
• Last Update Posted: October 31, 2017
• Sponsor: Kindai University
• Information provided by (Responsible Party): Masatoshi Kudo, Kindai University

Study Description

Brief Summary:

The purpose of this study is to evaluate the safety and efficacy of the combination therapy with Transcatheter Arterial Chemoembolization (TACE) and sorafenib compared to TACE alone in patients with unresectable hepatocellular carcinoma (HCC) who are not candidates for surgical resection or percutaneous ablation therapy.

Condition or disease	Intervention/treatment	Phase
Hepatocellular Carcinoma; Unresectable Hepatocellular Carcinoma; Carcinoma, Hepatocellular; Liver Neoplasm	Drug: TACE with sorafenib; Procedure: TACE alone	Phase 2

Detailed Description:

TACE with sorafenib Group

Sorafenib will be administrated at a dose of 400mg o.d. before the first TACE. After 2days drug rest, TACE will be conducted. Sorafenib will be resumed at a dose of 400mg o.d. from 3 days after TACE(the resumption day can be postponed until 21 days after TACE). When tolerability is confirmed at 1 week after resumption, the dose of sorafenib will be increased to 400mg b.i.d. When tumor increases, TACE will be repeated.

Control group

TACE will be conducted at scheduled day. When tumor increases, TACE will be repeated.

The treatment regimen will be continued until untreatable progression which is defined as follows:

• Child-Pugh grade C
• Tumor growth (125 percent from baseline status)
• Vascular invasion(Vp3,Vp4)
• Extra hepatic spread which size is more than 10mm

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 228 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Phase II Study: Transcatheter Arterial Chemoembolization Therapy In Combination With Sorafenib (TACTICS)
• Study Start Date: October 2010
• Estimated Primary Completion Date: March 2018
• Estimated Study Completion Date: March 2018

Arms and Interventions

Arm	Intervention/treatment
Experimental: TACE with sorafenib; TACE(on demand) with sorafenib till untreatable progression	Drug: TACE with sorafenib; Sorafenib will be administrated at a dose of 400mg o.d. before the first TACE. After 2days drug rest, TACE will be conducted. Sorafenib will be resumed at a dose of 400mg o.d. from 3 days after TACE(the resumption day can be postponed until 21 days after TACE). When tolerability is confirmed at 1 week after resumption, the dose of sorafenib will be increased to 400mg b.i.d. When tumor increases, TACE will be repeated.; Other Name: TACE with Nexavar
Active Comparator: TACE alone; TACE(on demand) till unreatable progression	Procedure: TACE alone; TACE will be conducted at scheduled day. When tumor increases, TACE will be repeated.; Other Name: TACE

Outcome Measures

Primary Outcome Measures :

1. Progression Free Survival [ Time Frame: every 8 week ]
   Patients will be evaluated for these endpoints every 8 weeks
2. Overall Survival [ Time Frame: every 8 week ]
   The overall survival is defined as time from randomization to death due to any cause, and will be evaluated every 8 weeks in the protocol treatment, and every one year in the follow-up period,respectively.

Secondary Outcome Measures :

1. Time To Progression [ Time Frame: every 8 weeks ]
   Time to progression is defined as time from randomization to radiological progression and will be evaluated every 8 week.
2. Objective Response Rate [ Time Frame: 4week after TACE ]
   Objective Response Rate is defined as best response
3. Tumor markers [ Time Frame: every 4 weeks ]
   Change of tumor markers
4. Safety [ Time Frame: every 4 weeks ]
   Number of participants with adverse events as a measure of safety and tolerability(According to Common Terminology Criteria for Adverse Events (CTCAE) version 4.0)
5. Time To Untreatable Progression(TTUP) [ Time Frame: every 8 week till untreatable progression, assessed up to 100 months ]
   Time to untreatable progression is defined as time from randomization to untreatable progression and will be evaluated every 8 week.
6. Time to Child-Pugh C [ Time Frame: every 8 week till liver deterioration to Child-Pugh C, assessed up to 100 months ]
   Time to Child-Pugh C is defined as time from randomization to Child-Pugh C and will be evaluated every 8 week.
7. Time to intrahepatic tumor progression [ Time Frame: every 8 week till intrahepatic tumor progression, assessed up to 100 months ]
   Time to intrahepatic tumor progression is defined as time from randomization to intrahepatic tumor progression and will be evaluated every 8 week.
8. Time to vascular invasion [ Time Frame: every 8 week till vascular invasion, assessed up to 100 months ]
   Time to vascular invasion is defined as time from randomization to vascular invasion and will be evaluated every 8 week.
9. Time to Extrahepatic spread [ Time Frame: every 8 week till extrahepatic spread, assessed up to 100 months ]
   Time to extrahepatic spread is defined as time from randomization to extrahepatic spread and will be evaluated every 8 week.

Eligibility Criteria

• Ages Eligible for Study: 20 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Patients aged 20 Years or over
2. Patients who were fully informed of the study beforehand and signed the informed consent to participate in the study.
3. Patients who are expected to live more than 12 weeks.
4. Patients diagnosed with typical HCC by biopsy,cytology, or diagnostic imaging such as dynamic CT(MRI).Typical HCC is defined by AASLD criteria.
5. Patients in whom complete resection of the tumor by hepatectomy or complete tumor necrosis by local tumor necrosis therapy(RFA) cannot be expected to succeed.
6. Patients with tumors which are confirmed to the liver and can be treated by TACE(the maximum diameter equal to or less than 10cm,and the maximum number of nodule equal to or less than 10).
7. Patients with viable and measurable target lesion.
8. patients with no or one history of TACE therapy.
9. patients with an ECOG PS(Performance Status) Score of 0 or 1.
10. patients with Child-Pugh class A.

11. Patients with laboratory values that meet the following criteria:

    1. Hemoglobin ≥ 8.5 g/dl
    2. Granulocytes ≥ 1500/mm3
    3. Platelet count ≥ 50,000 /mm3
    4. Total serum bilirubin ≤ 3 mg/dl
    5. AST and ALT ≤ 6 times upper limits of normal
    6. Serum creatinine ≤ 1.5 times upper limits of normal

Exclusion Criteria:

1. History of malignant tumor, excluding the following cases:

   1. Curatively treated early stage cancer with a low risk of recurrence ,such as carcinoma in situ of the cervix, basal cell carcinoma, superficial bladder tumor, and early gastric cancer.
   2. Malignant tumor that was curatively treated more than 3 years prior to study entry and has not recurred since then

2. Cardiac disease that meet any of the following criteria:

   1. NYHA Class III or higher congestive heart failure
   2. History of symptomatic coronary artery disease or myocardial infarction within 6 months before enrollment
   3. Arrhythmia requiring control by antiarrhythmic drugs such as beta-blockers or digoxin
3. Serious and active infection, except for HBV and HCV
4. History of HIV infection
5. Renal dialysis
6. Diffuse tumor lesion
7. Extrahepatic metastasis
8. Vascular invasion
9. Intracranial tumor
10. Preexisting or history of hepatic encephalopathy
11. Clinically uncontrolled ascites or pleural effusion
12. Clinically severe gastrointestinal bleeding within 4 weeks of the start of treatment
13. Esophageal and/or gastric varices which has high risk of bleeding
14. History of thrombosis and/or embolism within 6 months of the start of treatment

15. History of receiving any of the following therapies:

    1. Systemic chemotherapy for advanced HCC(including sorafenib therapy)
    2. Local therapy, such as radiofrequency ablation, TACE, or hepatic arterial infusion within 3 months of the start of treatment
    3. Current treatment with CYP3A4 inducing agents
    4. Invasive surgery within 4 weeks of the start of treatment
    5. History of allogenic transplantation
    6. History of bone marrow transplant or haemopoietic stem cell transplant within 4 weeks of the start of this study
16. Unable to take oral medications
17. Gastrointestinal problems that may affect absorption or pharmacokinetics of the study drugs
18. Use of drugs that may affect absorption or pharmacokinetics of the study drugs
19. Concurrent disease or disability that may affect evaluation of the effects of the study drugs
20. Enrollment in another study within 4 weeks of study entry
21. Female patients who are pregnant, lactating, possibly pregnant, or planning to become pregnant
22. Risk of allergic reactions to the study drugs
23. Drug abuse or other physical, psychological , or social problems that may interfere with the participation in the study or evaluation of study results
24. Any condition that could jeopardize the safety of the patient or their compliance in the study

Contacts and Locations

Locations

Japan

Kinki University Hospital

Osaka-Sayama, Osaka, Japan, 589-8511

Sponsors and Collaborators

Kindai University

Investigators

• Principal Investigator: Masatoshi Kudo, Professor; Kindai University

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Kudo M, Ueshima K, Ikeda M, Torimura T, Tanabe N, Aikata H, Izumi N, Yamasaki T, Nojiri S, Hino K, Tsumura H, Kuzuya T, Isoda N, Moriguchi M, Aino H, Ido A, Kawabe N, Nakao K, Wada Y, Ogasawara S, Yoshimura K, Okusaka T, Furuse J, Kokudo N, Okita K, Johnson PJ, Arai Y. Final Results of TACTICS: A Randomized, Prospective Trial Comparing Transarterial Chemoembolization Plus Sorafenib to Transarterial Chemoembolization Alone in Patients with Unresectable Hepatocellular Carcinoma. Liver Cancer. 2022 Feb 10;11(4):354-367. doi: 10.1159/000522547. eCollection 2022 Jul.

Kudo M, Ueshima K, Ikeda M, Torimura T, Tanabe N, Aikata H, Izumi N, Yamasaki T, Nojiri S, Hino K, Tsumura H, Kuzuya T, Isoda N, Yasui K, Aino H, Ido A, Kawabe N, Nakao K, Wada Y, Yokosuka O, Yoshimura K, Okusaka T, Furuse J, Kokudo N, Okita K, Johnson PJ, Arai Y; TACTICS study group. Randomised, multicentre prospective trial of transarterial chemoembolisation (TACE) plus sorafenib as compared with TACE alone in patients with hepatocellular carcinoma: TACTICS trial. Gut. 2020 Aug;69(8):1492-1501. doi: 10.1136/gutjnl-2019-318934. Epub 2019 Dec 4.

• Responsible Party: Masatoshi Kudo, Professor, Kindai University Faculty of Medicine, Department of Gastroenterology and Hepatology, Kindai University
• ClinicalTrials.gov Identifier: NCT01217034
• Other Study ID Numbers: JLOG 1001 trial
• First Posted: October 8, 2010
• Last Update Posted: October 31, 2017
• Last Verified: October 2017

Keywords provided by Masatoshi Kudo, Kindai University:

Transcatheter arterial chemoembolization; TACE; sorafenib; Time to untreatable progression; TTUP

Additional relevant MeSH terms:

Carcinoma; Carcinoma, Hepatocellular; Liver Neoplasms; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type; Neoplasms; Adenocarcinoma; Digestive System Neoplasms; Neoplasms by Site; Digestive System Diseases; Liver Diseases; Sorafenib; Chlorotrianisene; Antineoplastic Agents; Protein Kinase Inhibitors; Enzyme Inhibitors; Molecular Mechanisms of Pharmacological Action; Estrogens, Non-Steroidal; Estrogens; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Physiological Effects of Drugs; Antineoplastic Agents, Hormonal