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Carcinoma, Hepatocellular

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Sorafenib

Protein Kinase Inhibitors

Enzyme Inhibitors

Unresectable hepatoma, unsuitable for transarterial embolization or local failure after transarterial embolization

Radiotherapy: 46 Gy to 60 Gy prescribed to involved hepatic tumor Sorafenib: 2 tablet of sorafenib (200mg) twice daily (totally 800mg per day)

Radiotherapy combined with sorafenib

Shang-Wen Chen, MD

Li-Ching Lin, MD

Jeng-Fong Chiou, MD;PhD

Jen-Fong Chiou, MD;PhD

This study aims to test the efficacy of combined radiotherapy and sorafenib in patients with locally advanced hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is a common cause of cancer mortality in Asia. Most patients present with intermediate or advanced disease. Percutaneous ethanol injection, radiofrequency ablation, and transcatheter arterial chemoembolization (TACE) are not considered as a curative treatment and have achieved very limited success in eradicating large HCC. With the development of new radiotherapy (RT) technique, RT can be more safely given to patients with larger tumor burden. Thus, TACE combined with RT has been suggested for treating large HCC. Based on the results of these studies, RT could achieve a tumor response rate of 50 % to 70 %. However, it has not been definitively shown to prolong the overall or disease-free survival due to lack of a phase III clinical trial. In contrast, a retrospective clinical investigation with molecular study suggests that sublethal dose of RT promoted HCC growth outside RT field.

Two phase III trials were shown to be efficacious and well-tolerated in patients with advanced HCC. Median overall survival was significantly 2 to 3 months longer in the sorafenib group than that in the placebo. It is interesting to recognize the combined therapeutic effect of RT with sorafenib. Based on several preclinical experiments, tumor angiogenesis inhibitors seem to be synergistic with irradiation when using before RT, concurrently with RT, or after RT. Thus, we design a single-arm phase II clinical trial to investigate the efficacy of combined RT with sorafenib.

The eligibility criteria are patients with unresectable HCC; good performance status; no prior radiotherapy for the liver; clinical measurable tumor; good liver function and good compliance. After entering this study, the testee will receive RT to hepatic tumor with concurrently sorafenib with a dose of 400 mg twice daily. Hepatic RT will be performed with a daily fraction size of 2.0 to 2.5 Gy to a total dose of 46 Gy to 60 Gy. After RT, maintenance sorafenib with a dose of 400 mg twice daily will be ongoing. Sorafenib will be continued until the occurrence of clinical or radiologic progression, or the occurrence of either unacceptable adverse events or death. Minimum maintenance duration of 6 months is recommended, but not mandatory. The primary end points are response rate and toxicities profile. The secondary endpoints are time to radiological progression interval (TRPI), overall survival, and quality of life assessment.

Combined Radiotherapy and Sorafenib in Patients With Hepatoma

1. Response rate at 1-month and 6-month after radiotherapy.
2. Toxicities profile of combinede treatment

1. Time-to radiological progression interval
2. 2-year overall survival
3. 2-year progression-free survival
4. Quality of life

China Medical University Hospital

Shang-Wen Chen

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Combined Radiotherapy and Sorafenib in Patients With Hepatoma	NCT01319942	Hepatocellular ...	Radiotherapy co...	20 Years - 69 Years	China Medical University Hospital
Combined Radiotherapy and Sorafenib in Patients With Hepatoma	NCT01319942	Hepatocellular ...	Radiotherapy co...	20 Years - 69 Years	China Medical University Hospital

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