Hyperpolarized 13C-MRI in Patients With Hepatocellular Carcinoma Undergoing Radiotherapy, Atezolizumab, and Bevacizumab

Launched by CHANG GUNG MEMORIAL HOSPITAL · Sep 18, 2024

Keywords

ClinConnect Summary

This clinical trial is studying a new imaging technique, called hyperpolarized carbon-13 MRI, to see how it can help doctors understand how well patients with liver cancer (specifically, hepatocellular carcinoma or HCC) are responding to treatment. The trial will look at patients who are receiving a combination of radiotherapy (a way to target tumors with radiation), and two medications, atezolizumab and bevacizumab, which are designed to help the immune system fight the cancer. Researchers hope that this advanced imaging can provide real-time information about the cancer's metabolism, which could help predict how patients will respond to their treatment and identify any potential side effects.

To participate in the trial, you must be at least 18 years old and have been diagnosed with HCC that cannot be surgically removed. You should also have certain liver function scores and be able to undergo imaging procedures. Participants can expect to undergo some imaging tests and receive the combination treatment while being closely monitored for their health and response to therapy. It’s important to know that this trial is not yet recruiting patients, but it aims to provide valuable insights into improving care for those with liver cancer.

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ALL

Eligibility criteria

• Inclusion Criteria:
• 1. Participants must have diagnosis of HCC that is deemed unsuitable for surgical resection or transplant and will undergo radiotherapy, atezolizumab, and bevacizumab. Participants may have multiple lesions with a total maximal tumor dimension of \< 20 cm, and no one lesion \> 15 cm. Diagnosis should be confirmed by at least 1 criteria listed below:
• • Histologically or cytologically proven diagnosis of HCC.
• • Typical arterial enhancement and delayed washout on multiphasic CT or MRI.
• • 2. Age ≥18 years at the time of signing informed consent document.
• • 3. ECOG performance status 0-1.
• • 4. Barcelona Clinic Liver Cancer (BCLC) stages Intermediate (B) or Advanced (C).
• • 5. Child-Pugh score 5-6 liver function within 28 days of study registration.
• • 6. Documented virology status of hepatitis B virus (HBV), as confirmed by screening HBV serology test.
• • 7. Documented virology status of hepatitis C virus (HCV), as confirmed by screening HCV serology test.
• • 8. Ability to understand and the willingness to sign a written informed consent document
• • 9. Adequate bone marrow, liver, and renal function within 4 weeks before study registration
• • Hemoglobin ≥ 9.0 g/dL
• • Absolute neutrophil count (ANC) ≥ 1,000/mm3
• • Platelet count ≥ 50,000/μL
• • Total bilirubin \< 2.5 mg/dL
• • Serum albumin \>2.8 g/dL
• • Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 3 × upper limit of normal (ULN)
• • Prothrombin time ≤ 6 seconds prolonged
• • Serum creatinine ≤ 1.5 mg/dL
• • 10. The medical team, experienced in liver cancer treatment, has evaluated and confirmed that the benefits outweigh the risks for participants receiving proton or photon radiation therapy combined with atezolizumab and bevacizumab.
• Exclusion Criteria:
• • 1. Prior invasive malignancy unless disease free for a minimum of 2 years
• • 2. Prior radiotherapy to the region of the liver that would result in overlap of radiation therapy fields
• • 3. Prior selective internal radiotherapy/hepatic arterial yttrium therapy, at any time
• • 4. Untreated active hepatitis B or hepatitis C
• • 5. Moderate to severe or intractable ascites
• • 6. Presence of distant metastases
• • 7. Untreated or incomplete treated esophageal or gastric varices
• 8. Severe, active co-morbidity, defined as follows:
• • Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months prior to registration
• • Myocardial infarction within the last 6 months prior to study entry
• • Acute bacterial or fungal infection requiring intravenous antibiotics within 28 days prior to study entry
• • A bleeding episode within 6 months prior to study entry due to any cause.
• • Thrombolytic therapy within 28 days prior to study entry.
• • Known bleeding or clotting disorder.
• • Uncontrolled psychotic disorder
• • 9. Pregnancy or women of childbearing potential and men who are sexually active and not willing/able to use medically acceptable forms of contraception
• • 10. Prior solid organ transplantation.
• • 11. Prior or active autoimmune disease (AID) including autoimmune hepatitis, inflammatory bowel disease, myasthenia gravis, systemic lupus erythematosus, rheumatoid arthritis, antiphospholipid antibody syndrome, Wegener granulomatosis, Sjogren's syndrome, Guillain-Barre syndrome, and multiple sclerosis.
• • 12. Prior or active thrombotic or bleeding disorders, hemoptysis, cerebral vascular accident, significant cardiac disease (ischemic or congestive heart failure), or gastrointestinal perforation.
• • 13. Inability to treat all sites of disease by proton radiotherapy (such as extrahepatic metastases or massive liver tumors whereby the liver constraints cannot be met for covering all sites of liver tumors using radiotherapy.)
• • 14. Known HIV infection.
• • 15. Conditions not suitable for magnetic resonance imaging (MRI) include the presence of strongly magnetic arterial clips in the brain, cardiac pacemakers, cochlear implants, and claustrophobia.
• • 16. Concurrent medical conditions that may impact patients during MRI examination include active infections, symptomatic congestive heart failure, uncontrollable angina, arrhythmias, mental disorders, difficulty breathing, or diarrhea.
• • 17. An endoscopy report within the past six months indicates a high risk for upper gastrointestinal bleeding, and the patient has not received complete treatment for its prevention.
• • 18. Individuals who are allergic to hyperpolarized 13C pyruvate, atezolizumab, bevacizumab, or any ingredients contained in these medications.