Neoplasms

Urinary Tract, Sexual Organs, and Pregnancy Conditions

All Conditions

Nutritional and Metabolic Diseases

Prostatic Neoplasms

Insulin Resistance

Genital Neoplasms, Male

Urogenital Neoplasms

Genital Diseases

Genital Diseases, Male

Urogenital Diseases

Prostatic Diseases

Male Urogenital Diseases

Hyperinsulinism

Metabolic Diseases

Glucose Metabolism Disorders

All Drugs and Chemicals

Hypoglycemic Agents

Lipid Regulating Agents

Androgens

Insulin

Insulin, Globin Zinc

Pioglitazone

Gemfibrozil

Subjects will self-administer a 30 mg pioglitazone oral tablet daily for 6 months.

For patient taking a diabetic regimen of gemfibrozil, the dose will be 15 mg daily.

Pioglitazone 30 mg

Subjects will self-administer an oral placebo tablet containing cellulose daily for 6 months.

placebo tablet

Prostate cancer is the most common malignancy amongst men in United States. Androgen deprivation therapy (ADT) with long acting gonadotropin releasing hormone agonists is routinely used as adjuvant therapy in intermediate and high risk localized or locally advanced prostate cancer. Since ADT induces insulin resistance and diabetes, it is important that cellular and molecular effects of ADT are investigated to define precisely the mechanisms involved in the pathogenesis of insulin resistance. Pioglitazone, a known insulin sensitizer, may provide amelioration of insulin resistance in these patients.

Investigators plan to conduct a prospective, randomized, double-blind, placebo-controlled trial in 44 men with nonmetastatic prostate cancer who are receiving ADT with long acting GnRH agonist (study group). Study subjects will undergo insulin clamp, subcutaneous fat biopsy, muscle biopsy, have a blood sample taken and fibroscan performed prior to randomization of study drug. They will then be randomized to 30 mg pioglitazone or placebo tablet daily for 6 months. Blood samples will be drawn 2 and 4 months following the initiation of the study drug. The final study visit will be at 6 months. Subjects will undergo clamp, fat biopsy, muscle biopsy, blood sampling, fibroscan and will be discharged from the study.

Insulin Resistance and Androgen Deprivation Therapy

Insulin Resistance in Men With Prostate Cancer on Androgen Deprivation Therapy

The primary endpoint of the study is to detect a difference in insulin sensitivity as measured by whole body glucose uptake during clamps after treatment with pioglitazone as compared to placebo.

A secondary endpoint for the study will be comparison of the relative change from baseline in insulin signaling after pioglitazone or placebo.

St. Louis University

Professor of Medicine

Immune System Diseases

Hypersensitivity

Central Nervous System Stimulants

Tin Fluorides

Nicotine

Varenicline

Nicotinic Agonists

Cholinergic Agents

Neurotransmitter Agents

Varenicline dosing follows the recommended 12 week course: 0.5 milligram mg/day by mouth for Days 1-3, 0.5 mg twice a day for Days 4-7, and 1 mg twice a day thereafter. Participant takes Varenicline 1-10 days after Visit 1.

Starting on Day 8, and then every day after that, participant applies 1 placebo patch each day.

Questionnaire completion 1 to 10 days before first study drug/placebo dose and on Days 8, 17, 24, 31, 38, 52, and 73. On Days 17, 24, 38, and 73, done over the phone.

Counseling sessions performed on Days 8, 17, 24, 31, 38, 52, and 73. On Days 17, 24, 38, and 73, done over the phone. During counseling on Day 8, participant sets a "quit date" for stopping smoking for about 1 week after participant starts taking the study drug/placebo. Some of the counseling sessions may be recorded by video and/or audio tape.

Study staff calls participant 1 day before quit date and 3 days after quit date to check on progress in quitting smoking.

Participant takes placebo tablet 1-10 days after Visit 1. On Days 1-3, participant takes 1 dose of the placebo each morning. Starting on Day 4, and then every day after that, participant takes 1 dose in the morning and 1 dose in the evening.

Starting on Day 8, and then every day after that, participant applies 1 nicotine patch.

Questionnaire completion 1 to 10 days before first study drug/placebo dose and on Days 8, 17, 24, 31, 38, 52, and 73. On Days 17, 24, 38, and 73, done over the phone.

Counseling sessions performed on Days 8, 17, 24, 31, 38, 52, and 73. On Days 17, 24, 38, and 73, done over the phone. During counseling on Day 8, participant sets a "quit date" for stopping smoking for about 1 week after participant starts taking the study drug/placebo.

Study staff calls participant 1 day before quit date and 3 days after quit date to check on progress in quitting smoking.

Varenicline Dosing: 0.5 mg/day by mouth for Days 1-3; 0.5 mg twice a day for Days 4-7, and 1 mg twice a day thereafter.

Starting on Day 8, and then every day after that, participant applies 1, 21 mg nicotine patch for 11 weeks.

Nicotine Patch

Starting on Day 8, and then every day after that, participant applies 1 placebo patch each day for 11 weeks.

Placebo Patch

Participant takes placebo tablet 1-10 days after Visit 1. On Days 1-3, participant takes 1 dose of the placebo each morning. Starting on Day 4, and then every day after that, participant takes 1 dose in the morning and 1 dose in the evening.

Placebo Tablet

Questionnaire completion 1 to 10 days before first study drug/placebo dose and on Days 8, 17, 24, 31, 38, 52, and 73. Questionnaires should take about 30-45 minutes total to complete. On Days 17, 24, 38, and 73, done over the phone.

Questionnaires

Counseling sessions performed on Days 8, 17, 24, 31, 38, 52, and 73. On Days 17, 24, 38, and 73, done over the phone. These sessions take about 15 minutes each time.

Counseling Sessions

Participant asked to watch slides. During the lab session, brain electrical activity checked with an electroencephalogram (EEG). Participant completes computer tasks, including questionnaires, that will measure emotions and attention level. These tasks should take about 90 minutes to complete. The lab session may last up to 2 hours.

Lab Session

Saliva tested to check cotinine level at baseline, on Days 8 and 17, end of treatment visit, and at 3 months and 6 months after quitting smoking.

Saliva Test

Paul Cinciripini, PHD, MS, BS

The goal of this clinical research study is learn if varenicline or the nicotine patch can help people with different types of emotion and attention levels to quit smoking.

Study Groups:

If you agree to take part in this study, you will be randomly assigned (as in the roll of a dice) to 1 of 2 study groups. This is done because no one knows if one study group is better, the same, or worse than the other group. You will have an equal chance of being assigned to Group 1 or 2.

* If you are in Group 1, you will receive varenicline and a placebo patch. A placebo is not a drug. It looks like the study drug but is not designed to treat any disease or illness. It is designed to be compared with a study drug to learn if the study drug has any real effect.
* If you are in Group 2, you will receive an active nicotine patch and a placebo tablet.

Neither you nor the study doctor will know which group you are assigned to. However, if needed for your safety, the study staff will be able to find out what you are receiving (called "unblinding").

Once the study has ended and the Data Safety Monitoring Board (DSMB) at MD Anderson has granted approval, you may be unblinded at your request.

Study Drug Administration:

You will start taking your assigned study drug(s) the day after Visit 1.

You should take varenicline/placebo tablets by mouth with a cup (8 ounces) of water after eating a full meal. On Days 1-3, you will take 1 dose of the study drug each morning. Starting on Day 4, and then every day after that, you will take 1 dose in the morning and 1 dose in the evening (for a total of 2 doses of the study drug each day). You must return any study drug bottles as well as any unused study drug to the study staff at each study visit.

You should apply the nicotine/placebo patch to the upper arm. You should put it in a slightly different place each day to avoid skin irritation. You may take the patch off at night to avoid sleeping problems.

You will be given a study diary to record how many cigarettes you smoke (if any) each day while you are on study.

You must return your study diary and any unused study drugs, patches, and/or containers at each study visit.

Study Visits (Visits 1-7):

At every study visit:

* You will complete questionnaires about several topics, including depression, suicide, your smoking behavior, and any effects from the study drug. These questionnaires should take about 30-45 minutes in total to complete.
* You will be giving the opportunity to complete the questionnaires verbally with a study staff member (either on phone or in person depending on the visit number) or electronically on your computer using a website administered by an online survey development company called Qualtrics.
* You will receive counseling about quitting smoking, where you will talk about possible "triggers" for smoking and strategies for dealing with quitting smoking. These sessions will take about 15 minutes each.

At Visits 1, 4 and 6:

* Urine or saliva will be collected for a routine test to check your cotinine, nicotine, and anabasine levels. Cotinine is a chemical released in your body when it breaks down nicotine and will show whether and how much you have recently smoked. Anabasine is used to show if nicotine is found in the blood due to a nicotine replacement therapy or from tobacco use.
* Your CO level and weight. will be measured.
* If you did not have one during screening, you will have a physical exam.
* If you did not complete at one during screening or before Visit 1, you will complete the EEG/lab session.
* If you can become pregnant, urine will be collected for a pregnancy test.
* At V1, if your CO machine tests results are unclear, and the study staff thinks it is appropriate, a NicAlert test will be performed. Urine will be collected for the NicAlert test, which is more sensitive at detecting levels of smoking than the CO machine.

During counseling on Day 8, you will set a "quit date" for stopping smoking for about 1 week after you start taking the study drug/placebo. You should not quit smoking before the quit date. You may also set goals to reduce smoking. You should try to stay smoke-free after the quit date. You will also be given a drug instruction sheet, a card with emergency contact information, and a participant manual to help you follow along with the topics discussed during counseling.

Visits 2, 3, 5 and 7 will be conducted over the phone. You will complete questionnaires about several topics (either on the phone or electronically), including depression, mood, your smoking behavior, and any effects from the study drug. You will also be asked about any drugs you may be taking. Each call should take about 25-45 minutes.

The study staff will call you 1 day before your quit date and 3 days after your quit date to check on your progress in quitting smoking. Each call should take about 10-15 minutes.

Lab Session:

You will take part in a lab session at or before Visit 1 to test your brain activity. You will be asked to watch slides. The slides will include pictures of people, nature, and artwork. Slides showing nude people, medical procedures, and victims of car crashes will also be shown. You will be shown examples of these slides before beginning the procedure and given the opportunity to withdraw from the study.

During the lab session, your brain electrical activity will be checked with an electroencephalogram (EEG). To do this, small sensors will be placed on your scalp and face. You should not drink more than 2 cups of coffee or other caffeinated drinks for at least 2½ hours before the session. At the lab session, you may be asked to smoke a cigarette if the doctor thinks it is needed for you to show your normal smoking behavior.

You will also complete computer tasks, including questionnaires that will measure your emotions and attention level. These tasks should take about 90 minutes to complete.

The lab session may last up to 2 hours.

Ecological Momentary Assessments (EMA):

EMA are used to gather information about your mood and cravings as they happen in your day-to-day life. At your randomization visit, you will be loaned a smart phone device, and will be asked to complete questionnaires on the device at different times everyday throughout the active treatment phase (12 weeks). In these questionnaires, you will be asked about events from the previous day, such as cigarettes per day, alcohol intake, mood, sleep, motivation, and whether you took your prescribed drugs on time. These questionnaires should take up to about 20 minutes per day to complete.

Length of Treatment:

You will receive the study drug/placebo for up to 12 weeks. You will be taken off study early if the doctor thinks it is in your best interest or if you are unable to follow study directions.

Your participation on the study will be over after the follow-up visits.

End-of-Treatment Visit (Visit 8):

After you have finished taking the study drug/placebo, the following tests and procedures will be performed:

* Your CO level will be measured.
* Blood (about 2 teaspoons) will be drawn to check your liver and kidney function.
* Urine or saliva will be collected to measure your nicotine, anabasine, and cotinine level.
* You will complete the same questionnaires you completed at the regular study visits.
* You will receive counseling about quitting smoking.
* If you can become pregnant, urine will be collected for a pregnancy test.

Follow-Up Visits (Visits 9 and 10):

At about 3 and 6 months after you have stopped smoking, the following tests and procedures will be performed:

* Your CO level will be measured.
* Urine or saliva will be collected to measure your nicotine, anabasine, and cotinine level.
* You will complete the same questionnaires you completed at the regular study visits.

This is an investigational study. Varenicline and the nicotine patch are both FDA approved and commercially available to help people stop smoking. The study doctor can explain how the study drugs are designed to work.

Up to 160 participants will be enrolled in this portion of the study. All will take part at MD Anderson.

Reward Sensitivity and Pharmacotherapy for Smoking Cessation

The Effects of Behavioral Counseling Plus Nicotine Replacement Therapy (NRT) or Varenicline on Smoking Cessation Among Smokers High and Low in Intrinsic Reward Sensitivity

Continuous abstinence over the last 4 weeks of treatment (i.e. EOT-end of treatment) will serve as the primary outcome measure. Saliva will be collected to measure cotinine level.

For prolonged abstinence, relapse defined by 7 or more consecutive days of smoking or smoking at least 1 cigarette over two consecutive weeks from the end of the grace period to a future time point (e.g., EOT, 3- and 6- months post-quit date).

NAL PHARMA

Pfizer

M.D. Anderson Cancer Center

Symptoms and General Pathology

Respiratory Tract (Lung and Bronchial) Diseases

Recurrence

Carcinoma, Non-Small-Cell Lung

Lung Neoplasms

Carcinoma

Carcinoma, Bronchogenic

Bronchial Neoplasms

Respiratory Tract Neoplasms

Thoracic Neoplasms

Lung Diseases

Respiratory Tract Diseases

Antineoplastic Agents

Amino Acids

Gefitinib

Tyrosine Kinase Inhibitors

Protein Kinase Inhibitors

Enzyme Inhibitors

Tyrosine

180 mg BPI-7711 capsule + 250mg gefitinib placebo tablet, QD

180 mg BPI-7711 placebo capsule + 250mg gefitinib tablet, QD

BPI-7711

Placebo capsule

Yuankai Shi

A randomized, double-blind, positive controlled phase III study to evaluate the efficacy and safety of BPI-7711 capsule in locally advanced or recurrent/metastatic treatment-naïve non-small cell lung cancer patients with EGFR mutation

This is a Phase III clinical study, which aims to compare the efficacy and safety of BPI-7711 capsule and gefitinib tablet in the treatment of initially-treated patients with locally advanced or recurrent metastatic with EGFR mutation.

A Study of BPI-7711 Capsule in Non-small Cell Lung Cancer Patients

A Randomized, Double-blind, Positive Controlled Phase III Study to Evaluate the Efficacy and Safety of BPI-7711 Capsule in Locally Advanced or Recurrent/Metastatic Treatment-naïve Non-small Cell Lung Cancer Patients With EGFR Mutation

Progression-free survival evaluated by Blinded Independent Center Review

Progression-free survival evaluated by investigators

Beta Pharma Shanghai

Substance Related Disorders

Behaviors and Mental Disorders

Nervous System Diseases

Neoplasm Metastasis

Cancer Pain

Pain

Marijuana Abuse

Neoplastic Processes

Neurologic Manifestations

Analgesics

Central Nervous System Depressants

Pharmaceutical Solutions

Anticonvulsants

Psychotropic Drugs

Oxycodone

Cannabidiol

Analgesics, Opioid

Dronabinol

Narcotics

Spray Placebo + Tablet Placebo

Spray Placebo is a nanoparticle water soluble solution without cannabinoids containing a small amount of hemp seed oil (for fragrance purposes only) as defined by Australian Office of Drug Control (ODC) (https://www.odc.gov.au/hemp-products). One dose is equivalent to 2 actuations of the pump delivering 280 µL volume.

Tablet Placebo will be identical to the Oxycontin tablets.

NanaBis™ + Tablet Placebo

NanaBis™ is a nanoparticle water soluble equimolar solution of d9-THC and CBD. One dose is equivalent to 2 actuations of the pump delivering 280 µL volume containing 2.5 mg d9-THC and 2.5 mg CBD. The dose administered will be 1 - 3.5 doses (2 sprays to 7 sprays) per 4 hours unless asleep.

Spray Placebo + Oxycodone CR

Spray Placebo is a nanoparticle water soluble solution without cannabinoids containing a small amount of hemp seed oil (for fragrance purposes only) as defined by Australian ODC (https://www.odc.gov.au/hemp-products). One dose is equivalent to 2 actuations of the pump delivering 280 µL volume.

Oxycodone controlled release (CR) used as a comparator will be Oxycontin tablets 10 mg - 70 mg po bd.

NanaBis™ is a nanoparticle water soluble equimolar solution of d9-THC \& CBD. One dose is equivalent to 2 actuations of the pump delivering 280 µL volume containing 2.5 mg d9-THC and 2.5 mg CBD

NanaBis™

Oxycodone CR tablet is an opioid agonist supplied in 10 mg, 15 mg, 20 mg, 30 mg,40 mg, 60 mg and 80 mg tablets for oral administration. The tablet strengths describe the amount of oxycodone per tablet as the hydrochloride salt.

Oxycodone CR

Placebo comparator used against both NanaBis™ and Oxycodone depending on randomisation of arms.

Placebo Spray

Oxycodone immediate release (IR) tablet or capsule or oral solution used as breakthrough analgesia.

Oxycodone IR

Prof. Luis Vitetta

Dr. Michael Lyon

This is a multi-centre, long term, double blind, clinical protocol for NanaBis™ as a monotherapy treatment in participants 18-75 years of age with cancer related pain.

This trial uses an alternative method to demonstrate the analgesic efficacy of NanaBis™ as a monotherapy in cancer participants. Proving analgesic efficacy requires demonstrating that (i) the analgesic is significantly better than placebo and (ii) that the magnitude of the improvement is clinically important. The latter is standardly done by measuring the change in pain levels from a baseline (no analgesia) to the end of a treatment period. A 30% decrease in the Numerical Pain Rating Scale (NPRS) has been correlated with participants reporting a moderate improvement in their pain and this was adopted as the standard method of demonstrating a clinically important magnitude of improvement. In this strategy, the measure of analgesic efficacy is the proportion of participants in the treatment group whose pain is adequately treated (responders). A responder is defined as a patient who completes the treatment phase with an acceptable level of pain (NPRS ≤ 5) and without requiring excessive amounts of rescue (breakthrough analgesia) medication. Unlimited breakthrough analgesia (Oxycodone) is allowed throughout the study; however, excessive use will result in discontinuation. Comparison of the proportion of responders in the NanaBis™ arm and placebo arms will determine if NanaBis™ is significantly better than placebo. Demonstrating that the proportion of responders in the NanaBis™ arm is non-inferior to the Oxycodone controlled release (CR) comparator arm will determine if the magnitude of improvement (provided by NanaBis™) is clinically important because Oxycodone CR has been established as the benchmark analgesic that provides a clinically important effect.

NanaBis™ an Oro-buccal Administered delta9-Tetrahydrocannabinol (d9-THC) & Cannabidiol (CBD) Medicine for the Management of Bone Pain From Metastatic Cancers

NanaBis™ an Oro-buccal Administered Equimolar d9-THC & CBD Formulation as Monotherapy for Management of Opioid Requiring Bone Pain Due to Metastatic Cancer: Phase 3 Multi Centre Blinded Randomized Withdrawal Active & Placebo Controlled Trial

To demonstrate that at the end of the 6-week study period the proportion of responders in the NanaBis™ group shows significant change than the proportion of responders in the placebo group.

A responder is defined as a participant who completes the maintenance phase with an acceptable level of pain (NPRS is equal to 5) and without requiring excessive amounts of rescue (breakthrough analgesia) medication.

NPRS Assessment \[Time Frame: Baseline and then twice daily for the duration of the study\].

The NPRS questionnaire is completed by the participant to determine their pain intensity. The NPRS is an 11-point scale scored from '0-10'. A score of '0' being no pain and a score of '10' being the most intense pain imaginable. Participants select the value that is most in line with the intensity of pain they have experienced in the last 24 hours.

To demonstrate that at the end of the 6-week study period the proportion of responders in the NanaBis™ group is similar to the proportion of responders in the Oxycodone group determined by pain levels recorded using NPRS.

A responder is defined as a participant who completes the maintenance phase with an acceptable level of pain (NPRS is equal to 5) and without requiring excessive amounts of rescue (breakthrough analgesia) medication.

NPRS Assessment \[Time Frame: Baseline and then twice daily for the duration of the study\].

The NPRS questionnaire is completed by the participant to determine their pain intensity. The NPRS is an 11-point scale scored from '0-10'. A score of '0' being no pain and a score of '10' being the most intense pain imaginable. Participants select the value that is most in line with the intensity of pain they have experienced in the last 24 hours.

To demonstrate that at the end of the 6-week study period the Health-Related Quality of Life scores in the NanaBis™ treated group are significantly changed than in the Placebo group and is similar to the Oxycodone CR treated group.

Quality of life as assessed by the EORTC-QLQ-C30 validated questionnaire \[ Time Frame: Baseline and then weekly during the maintenance phase of the study and at then weeks 7 and 18 of the Open Label Extension\].

The EORTC-QLQ-C30 is validated questionnaire answered by participants to assess the quality of life of cancer patients. It assesses important functioning domains (e.g. physical, emotional, role) and common cancer symptoms (e.g. fatigue, pain, nausea/vomiting, appetite loss).

NPRS Assessment \[Time Frame: Baseline and then twice daily for the duration of the study\].

The NPRS questionnaire is completed by the participant to determine their pain intensity. The NPRS is an 11-point scale scored from '0-10'. A score of '0' being no pain and a score of '10' being the most intense pain imaginable. Participants select the value that is most in line with the intensity of pain they have experienced in the last 24 hours.

To demonstrate that at the end of the 6-week study period that NanaBis™ is safe and tolerable.

Safety and tolerability will be assessed via standardised adverse events, Serious adverse events, Deaths, UKU - Side Effects Rating Scale (UKU), Local Adverse Events Charts and patient medical records.

Adverse events, serious adverse events and deaths will be summarised by treatment arm.

Does the daily use of NanaBis™ oro-buccal spray reduce the severity of Treatment-Emergent Adverse Events (safety and tolerability). \[Time Frame: Baseline and then weekly for the duration of the study\].

Changes in validated UKU scale range is 0 to 3 for rating the degree of severity (mild, moderate or severe) and a second scale for the investigator that assigns a casual relationship of improbable, possible or probable.

To demonstrate that at the end of the 6-week study period that after unblinding, half or more of the NanaBis™ treated group prefer further treatment with NanaBis™ in the open label extension phase (note that all participants will be all offered open label extension if appropriate).

George Clinical Pty Ltd

WriteSource Medical Pty Ltd

Medlab Clinical

Digestive System Diseases

Infections

Rare Diseases

Death

Liver Cirrhosis

Carcinoma, Hepatocellular

Hepatitis A

Hepatitis C

Hepatitis

Hepatitis C, Chronic

Fibrosis

Neoplasms, Glandular and Epithelial

Neoplasms by Histologic Type

Liver Diseases

Gastrointestinal Diseases

Adenocarcinoma

Liver Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Communicable Diseases

Blood-Borne Infections

Hepatitis, Viral, Human

Virus Diseases

Flaviviridae Infections

RNA Virus Infections

Hepatitis, Chronic

Chronic Disease

Disease Attributes

Chronic Graft Versus Host Disease

Metformin

1000 mg (2x500 mg) at morning and 1000 mg (2x500 mg) at afternoon (2000 mg per day)

Metformin daily during 36 months

2 tablets at morning and 2 tablets at afternoon 4 tablets per day

Dominique Roulot, MD

Metformin treatment during 36 months could be associated with decreased risk of HCC occurrence and liver related death in patients with compensated HCV cirrhosis and insulinoresistance.

This study is an ancillary of the observational study from the CIRVIR cohort in which more than 1200 patients with compensated HCV cirrhosis are currently included.

participating centers : 26

Hepatocellular carcinoma (HCC) is currently the first cause of death of patients with compensated HCV cirrhosis.Despite progresses,existing therapies are limited in their ability to prevent recurrences. Even diagnosed at early stage, long-term prognosis remains poor due to the high rate of recurrence after local treatments. Liver transplantation the only long-term curative treatment is limited by advanced age, comorbidities or the shortage of the graft It concerns less than 5 % of HCC patients . Therefore, the best approach to reduce mortality remains the reduction of HCC incidence.

Abundant observational studies have related a relation between insulinoresistance occurrence and outcome of many cancers. The level of IR assessed by the HOMA index have been recognized as an independent predictive factor of HCC occurrence in patients with compensated viral C cirrhosis. Metformin, a Type 2 diabetic treatment drug, inhibits hepatic gluconeogenesis and increases the stimulation of the glucose uptake in muscle.

Independently of its' anti diabetic effects, Metformin is credited of anti tumoral, anti oxidant, anti inflammatory, and anti angiogenic properties.

Amount epidemiological and experimental data have demonstrated the anti tumoral and chemopreventive effect of metformin in certain cancers.

From our cohort of patients with compensated HCV cirrhosis and not treated by insulin, we have observed that the level of IR assessed by the HOMA was a strong and independent risk factor of HCC occurrence and liver related death. We have also observed in our cohort of diabetic patients with compensated HCV cirrhosis, that treatment by Metformin was associated with a decreased risk of HCC occurrence and liver related death.

HYPOTHESIS

Treatment with metformin could decreased the HCC occurrence and liver related death or transplantation.

MAIN OBJECTIVE

Evaluation the impact of Metformin treatment on HCC occurrence and liver related death in patients with compensated HCV cirrhosis and Insulinoresistance SECONDARY OBJECTIVE

* Occurrence of decompensation of the cirrhosis (ascite, sepsis, encephalopathy, haemorrhage)
* Evaluation of the treatment tolerance

MAIN CRITERION JUDGMENT

Rate of HCC occurrence or liver related-death or transplantation.

SECONDARY CRITERION JUDGMENT

* Occurrence of decompensation of the cirrhosis (ascite, sepsis, encephalopathy, haemorrhage),
* Tolerance

STUDY ASSESSMENTS

The patient of CIRVIR cohort meeting the inclusion criteria will be invited to participate to this study.

During their next visit, the hepatologist, will give full verbal and written information regarding the objective procedures of the study and the possible benefice and side effects of the treatment. A write informed consent will be obtained from all patients who agree to participate to the study.

The treatment period will begin following randomization. On day M0 baseline measurements will be taken and recorded, and metformin administration will be begun. In order to optimize the treatment tolerance, it will be suggested to the patients to take the pill during or at the end of the lunch. During the first week, the posology of the placebo and metformin will be 500 mg at the breakfast. After, the posology will be increased every week as follow: 500 mg morning and afternoon, then 1000 mg morning and afternoon (2000 mg per day). In case of intolerance, the maximum posology tolerated will be maintained. In fact regarding the primary data of the trial regarding the effect of metformin on colonic polyp, it seems possible that low dose of metformin are potentially active This treatment will continue until the end of the study.

FOLLOW UP

Patients will be seen at one month and followed every 3 months. Clinical evaluation and HCC screening are planed In CIRVIR cohort study, Every 6 months.

Duration of Treatment per patient:

• 36 months

Duration of Trial Recruitment:

• 24 months

PARTICIPATING CENTERS : 26

NUMBER OF SUBJECT

In order to demonstrate a reduction of 40% (HR 0.6) of events under metformin vs placebo with 80% power and 5% two-sided alpha risk, 200 patients per arm are necessary.A sample size reassessment will be made after 50% and 75% of patients included based on predictive power calculation.

We estimated that 5% of patients will not tolerate the treatment in the first month, and that 5% more will be lost to follow or not compliant to treatment during the follow up period. Therefore, the number of patients to be included is 222 patients per group.

STATISTICAL ANALYSIS

Clinical data of all the patients will be prospectively collected in a computerized database

Populations analyzed The main analysis will be based on the intent-to-treat population (ITT) of all randomized patients

In addition an explanatory analysis (PP) of all patients randomized \& treated without major protocol violations/deviations will be carried out. Pre-defined major protocol violations/deviations are:

1. missing data for the primary efficacy endpoints
2. no study drug received
3. violation of inclusion criteria
4. Additional protocol violations will be possibly defined during the blind data review

Statistical tests. Main criterion: rate of HCC occurrence and liver related-death or transplantation.

The cumulative incidence of HCC and liver-related death or transplantation will be compared according to metformin treatment at inclusion using the log-rank test.

In addition, univariate Cox regression models will be used to identify predictive factors of primary endpoint.

For each endpoint, variables with a P value less than 0.10 in the univariate analysis predicting outcomes will be entered into stepwise Cox regression multivariate models. For sensitivity analyses, the incidence of HCC will be also adjusted on usual risk factors. The same models considering competing risks will be tested using the Fine and Gray test.

Secondary criteria : Occurrence of decompensation of the cirrhosis (ascite, sepsis, encephalopathy, haemorrhage).

Comparisons between groups will be performed first in a univariate manner using the χ2 test or the Fisher-exact tests. Multiple logistic regression models will be used to assessed a possible difference between groups when adjusted on parameters known or identified during the study as possibly affecting these outcomes.

Primary Prevention Hepatocellular Carcinoma by Metformin

PRIMARY PREVENTION OF HEPATOCELLULAR CARCINOMA BY METFORMIN IN PATIENTS WITH VIRAL C CIRRHOSIS : PROSPECTIVE MULTICENTER STUDY, RANDOMIZED CONTROL TRIAL. Ancillary Study of the ANRS CO12 CirVir Cohort

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Insulin Resistance and Androgen Deprivation Therapy	NCT04995978	Prostate Cancer Insulin Resista...	Pioglitazone 30... placebo tablet	18 Years - 85 Years	St. Louis University
Reward Sensitivity and Pharmacotherapy for Smoking Cessation	NCT02162849	Tobacco Use Ces...	Varenicline Nicotine Patch Placebo Patch Placebo Tablet Questionnaires Counseling Sess... Lab Session Saliva Test	18 Years - 75 Years	M.D. Anderson Cancer Center
A Study of BPI-7711 Capsule in Non-small Cell Lung Cancer Patients	NCT03866499	NSCLC	BPI-7711 Gefitinib Placebo Tablet Placebo capsule	18 Years -	Beta Pharma, Inc.
NanaBis™ an Oro-buccal Administered delta9-Tetrahydrocannabinol (d9-THC) & Cannabidiol (CBD) Medicine for the Management of Bone Pain From Metastatic Cancers	NCT04808531	Cancer Related ...	NanaBis™ Oxycodone CR Placebo Spray Placebo Tablet Oxycodone IR	18 Years - 75 Years	Medlab Clinical
Reward Sensitivity and Pharmacotherapy for Smoking Cessation	NCT02162849	Tobacco Use Ces...	Varenicline Nicotine Patch Placebo Patch Placebo Tablet Questionnaires Counseling Sess... Lab Session Saliva Test	18 Years - 75 Years	M.D. Anderson Cancer Center
Primary Prevention Hepatocellular Carcinoma by Metformin	NCT02319200	Hepatocellular ... Hepatitis C, Ch... Cirrhosis	Metformin placebo tablet	18 Years - 77 Years	Assistance Publique - Hôpitaux de Paris
A Study of Two Different Doses of Cabozantinib (XL184) in Progressive, Metastatic Medullary Thyroid Cancer	NCT01896479	Medullary Thyro...	Cabozantinib (X... Cabozantinib (X... Placebo tablet Placebo capsule	18 Years -	Exelixis

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