Study of Apatinib After Systemic Therapy in Patients With Hepatocellular Carcinoma(AHELP)

• ClinicalTrials.gov Identifier: NCT02329860
• Recruitment Status: Completed
• First Posted: January 1, 2015
• Results First Posted: January 22, 2024
• Last Update Posted: January 22, 2024
• Sponsor: Jiangsu HengRui Medicine Co., Ltd.
• Collaborator: NanJing PLA 81 Hospital
• Information provided by (Responsible Party): Jiangsu HengRui Medicine Co., Ltd.

Tracking Information

• First Submitted Date: December 30, 2014
• First Posted Date: January 1, 2015
• Results First Submitted Date: April 26, 2023
• Results First Posted Date: January 22, 2024
• Last Update Posted Date: January 22, 2024
• Actual Study Start Date: March 26, 2014
• Actual Primary Completion Date: December 15, 2017 (Final data collection date for primary outcome measure)
• Current Primary Outcome Measures (submitted: July 4, 2017): Overall Survival [ Time Frame: Approximately 36 months ]
• Original Primary Outcome Measures (submitted: December 30, 2014): Overall Survival [ Time Frame: Approximately 30 months ]

Current Secondary Outcome Measures (submitted: April 26, 2023)

• Time to Progression（TTP） [ Time Frame: Approximately 36 months ]
• Progression Free Survival (PFS) [ Time Frame: Approximately 36 months ]
• Objective Response Rate [ Time Frame: Approximately 36 months ]
• Disease Control Rate [ Time Frame: Approximately 36 months ]

Original Secondary Outcome Measures (submitted: December 30, 2014)

• Time to progression [ Time Frame: Approximately 30 months ]
• Progression free survival (PFS) [ Time Frame: Approximately 30 months ]
• Objective tumor response [ Time Frame: Approximately 30 months ]
• Disease control [ Time Frame: Approximately 30 months ]

• Current Other Pre-specified Outcome Measures: Not Provided
• Original Other Pre-specified Outcome Measures: Not Provided

Descriptive Information

• Brief Title: Study of Apatinib After Systemic Therapy in Patients With Hepatocellular Carcinoma(AHELP)
• Official Title: A Randomized, Double Blind, Placebo Controlled, Multicenter Phase III Study (AHELP) of Apatinib in Patients With Hepatocellular Carcinoma After Systemic Therapy（Chemotherapy and/or Targeted Therapy）

Brief Summary

This was a multicenter, randomized, double-blind, phase III trial. This clinical study evaluates the efficacy and safety of Apatinib in patients with advanced liver cancer who have progressed on Systemic Therapy (Chemotherapy and/or Targeted Therapy).

Approximately 400 patients who meet the entry criteria will be randomly assigned in a 2:1 ratio to Apatinib or placebo (1/3 chance to receive placebo).

Primary endpoint of the study is overall survival.

• Detailed Description: Not Provided
• Study Type: Interventional
• Study Phase: Phase 3
• Study Design: Allocation: Randomized; Intervention Model: Parallel Assignment; Masking: Triple (Participant, Care Provider, Investigator); Primary Purpose: Treatment
• Condition: Carcinoma, Hepatocellular

Intervention

• Drug: Apatinib
• Drug: Placebo

Study Arms

• Experimental: Apatinib
  750 mg orally (p.o.) every day (qd), 28 days as one cycle
  Intervention: Drug: Apatinib
• Placebo Comparator: Placebo
  orally (p.o.) every day (qd), 28 days as one cycle
  Intervention: Drug: Placebo

• Publications *: Qin S, Li Q, Gu S, Chen X, Lin L, Wang Z, Xu A, Chen X, Zhou C, Ren Z, Yang L, Xu L, Bai Y, Chen L, Li J, Pan H, Cao B, Fang W, Wu W, Wang G, Cheng Y, Yu Z, Zhu X, Jiang D, Lu Y, Wang H, Xu J, Bai L, Liu Y, Lin H, Wu C, Zhang Y, Yan P, Jin C, Zou J. Apatinib as second-line or later therapy in patients with advanced hepatocellular carcinoma (AHELP): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Gastroenterol Hepatol. 2021 Jul;6(7):559-568. doi: 10.1016/S2468-1253(21)00109-6. Epub 2021 May 8.

Recruitment Information

• Recruitment Status: Completed
• Actual Enrollment (submitted: July 4, 2017): 400
• Original Estimated Enrollment (submitted: December 30, 2014): 360
• Actual Study Completion Date: August 14, 2019
• Actual Primary Completion Date: December 15, 2017 (Final data collection date for primary outcome measure)

Eligibility Criteria

Inclusion Criteria:

1. ≥ 18 years old.
2. Conform to the clinical diagnosis standard strictly or histological or cytological confirmation of HCC (hepatocellular carcinoma) who cannot benefit from treatments of established efficacy with higher priority such as resection, local ablation,and with at least one uni-dimensional measurable lesion by computed tomography (CT) scan or magnetic resonance imaging (MRI) according to RECIST 1.1.
3. Failure or intolerance to prior treatment with chemotherapy and/or targeted therapy (Failure is defined as documented radiological progression according to the radiology charter. Intolerance is defined as ≥ grade 4 hematologic toxicities, ≥ grade 3 non-hematologic toxicities ≥ grade 2 heart, liver or kidney damage).
4. Systemic therapy must have been completed ≥2 weeks before randomization (AEs due to prior treatment ≤ grade 1).
5. Liver function status Child-Pugh Class A or B (score≤7).
6. Barcelona Clinic Liver Cancer stage Category B or C.
7. Eastern Cooperative Oncology Group Performance Status of 0 or 1 within 1 week before randomization.
8. Life expectancy of at least 12 weeks.
9. HBV DNA ≤ 2000IU/ml or 1×10E+4 copy/ml.

10. Adequate bone marrow, liver and renal function as assessed by the following laboratory tests conducted within 1 week before randomization.

    HB ≥ 90g/L; ANC≥1.5×10E+9/L; PLT≥80×10E+9/L; ALB ≥ 29g/L; ALT and AST < 5×ULN; TBIL ≤1.5×ULN; Cr ≤1.5×ULN

11. Women of childbearing potential and men must agree to use adequate contraception .

Exclusion Criteria:

1. Any local treatment (included but not limited: resection, radiotherapy, TAE, TACE, TAI, RFA or PEI) within 4 weeks of randomization.
2. Known hepatic duct carcinoma, mixed cell carcinoma or fibrolamellar hepatocellular carcinoma, known history or suffering from other cancer(except of cured skin basal cell carcinoma or carcinoma in situ of cervix).
3. Patients who will receive liver transplantation.
4. Ascites with clinical symptoms, i.e. require Abdominal paracentesis or drainage treatment such as or Child-Pugh Score>2.
5. Hypertension and unable to be controlled within normal level following treatment of anti-hypertension agents (systolic blood pressure > 140 mmHg, diastolic blood pressure > 90 mmHg).
6. Suffered from grade II or above myocardial ischemia or myocardial infarction, uncontrolled arrhythmias (including QT interval male ≥ 450 ms, female≥ 470 ms).
7. Grade III-IV cardiac insufficiency, according to NYHA criteria or echocardiography check: LVEF<50%.
8. Factors to affect oral administration（such as Patients unable to swallow oral medications, chronic diarrhea and ileus etc. situations evidently affect drug oral medication and absorption）.
9. Previous digestive tract bleeding history within 6 months or evident gastrointestinal bleeding tendency, such as,：Esophageal varices with bleeding risk, local active ulcerative lesions, fecal occult blood≥（++）；if fecal occult blood（+），gastroscope check is required.
10. The Within 28 days ahead of randomization, experience abdomen fistula, gastrointestinal perforation, or abdominal abscess
11. Coagulation abnormalities (INR > 1.5 x ULN, or PT > ULN +4 seconds), with bleeding tendency or are receiving thrombolytic or anticoagulant therapy;
12. Occurrence of central nervous system metastatic or known brain metastatic;
13. Objective evidence of previous or current pulmonary fibrosis history, interstitial pneumonia, Pneumoconiosis, radiation pneumonitis, drug-related pneumonia, Pulmonary function damaged seriously etc.
14. Proteinuria ≥ (++) or 24 hours total urine protein > 1.0 g.
15. Received powerful inhibitor of CYP3A4 within 7 days or powerful inducer of CYP3A4 within 12 days before randomization.
16. Pregnant or breast-feeding women; patients with fertility will not or there is no way to adopt effective contraceptive measures.
17. Mental disorders history, or Psychotropic drug abuse history.
18. Patients who has bone metastasis, has received Palliative radiotherapy (radiotherapy area > 5% marrow area).

Sex/Gender

• Sexes Eligible for Study: All

• Ages: 18 Years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Contacts: Contact information is only displayed when the study is recruiting subjects
• Listed Location Countries: China

Administrative Information

• NCT Number: NCT02329860
• Other Study ID Numbers: APTN-III-HCC
• Has Data Monitoring Committee: No
• U.S. FDA-regulated Product: Not Provided
• IPD Sharing Statement: Not Provided
• Current Responsible Party: Jiangsu HengRui Medicine Co., Ltd.
• Original Responsible Party: Same as current
• Current Study Sponsor: Jiangsu HengRui Medicine Co., Ltd.
• Original Study Sponsor: Same as current
• Collaborators: NanJing PLA 81 Hospital
• Investigators: Not Provided
• PRS Account: Jiangsu HengRui Medicine Co., Ltd.
• Verification Date: July 2017