A Phase 3 interventional study of ThermoDox and Dummy infusion in Hepatocellular Carcinoma, sponsored by Imunon. Completed at 61 sites in 14 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2024-08-20.
Sponsored by Imunon · Phase 3, Interventional, and Treatment
The purpose of this study is to determine whether ThermoDox, a thermally sensitive liposomal doxorubicin, is effective in the treatment of non-resectable hepatocellular carcinoma when used in conjunction with standardized radiofrequency ablation (sRFA).
This is a Phase III, randomized, double blind, dummy controlled safety and efficacy study of ThermoDox plus sRFA compared to sRFA plus dummy infusion using standardized treatment dwell time for solitary HCC lesions ≥ 3.0 cm to ≤ 7.0 cm. An sRFA treatment for this protocol is defined as the dwell time of ≥ 45 minutes measured from the first activation of the RFA probe through removal of the RFA probe after the final ablation cycle or deployment.
The 50 mg/m2 ThermoDox or dummy infusion will be administered IV over 30 minutes. As part of blinded pre-medication ThermoDox treated subjects will receive 20 mg of dexamethasone orally 24 hours prior to the drug infusion for infusion reaction prophylaxis. Subjects on the control arm will receive a matching dummy pre-medication pill orally at 24 hours prior to infusion of the study treatment. Thirty minutes prior to receiving the ThermoDox infusion, subjects will receive a blinded dose of 20 mg of IV dexamethasone, 50 mg IV diphenhydramine and either 50 mg of IV ranitidine or 20 mg of IV famotidine. Subjects on the control arm will receive a masked dummy pre-medication pill orally at 24 hours prior to infusion of the study medication, and a dummy infusion 30 minutes prior to dummy infusion of Sodium Chloride 0.9% or 5% Dextrose (D5W). RFA will be initiated approximately at a minimum of 15 minutes after the initiation of study drug infusion and should be completed no later than 3 hours after study drug infusion initiation. The goal is to reach a > 45 minute dwell time which can be achieved by employing at least four ablation cycles or deployments in order to ablate the tumor as well as a 360º 1.0 cm tumor-free margin surrounding the tumor.with an estimated overall procedure time of less than 3 hours.
A subject who has an incomplete ablation is eligible for 1 retreatment procedure within 21 days after the radiological imaging exam showing residual disease at Day 28. Subjects will be retreated only once with the same RFA equipment and treatment assigned at randomization. Subjects with a complete ablation after retreatment will be followed both for PFS and for OS.
If after 2 ablations the subject has local, distant intrahepatic, or extrahepatic HCC, then the subject will be considered a treatment failure and will have met the PFS endpoint. The subject will be followed for OS every 3 months. Among subjects who are not treatment failures, five repeat treatments are permitted to treat a recurrent lesion or to treat newly-identified local or distant intrahepatic lesions at the Investigator's discretion after the PFS endpoint is reported and with agreement from the Sponsor. The subject must be eligible for retreatment consistent with the safety eligibility criteria and will be retreated with the same randomized treatment.
CT or MRI imaging will be used to assess the effectiveness of the ablation therapy. The blind will be maintained at the level of the imaging reads. Investigator determined radiological progression must be observed and recorded prior to beginning alternate treatments for HCC. Posttreatment imaging will be obtained at months 1, 5, 9, 13, 17, 21, 25, then every 6 months (+/- 2 weeks) until radiological progression is seen. Adverse event assessments and laboratory examinations will occur at each visit. All subjects will be monitored throughout the investigational period.
Patients that meet inclusion/exclusion criteria may be at risk for contrast-induced nephropathy (CIN) when undergoing the required CT with contrast procedures. The investigators must be mindful of the risk factors associated with CIN and employ strategies to reduce the risk of CIN. In subjects with diabetes or borderline renal function (creatinine greater than 1.5 mg/dL) special precautions (e.g. hydration, contrast dose reduction, follow up creatinine determination) should be employed. An accepted procedure is adequate intravenous volume expansion with isotonic saline (1.0 - 1.5 mL/kg per hour) for 3-12 hours before the procedure and continued for 6-24 hours if clinically indicated and based on the treating physician's medical judgment.
All randomized subjects will be followed for safety and overall survival.
Diagnosed with a single HCC lesion ≥ 3.0 cm but ≤ 7.0 cm in maximum diameter based on diagnosis at screening.
Be an appropriate candidate for receiving RFA as a medically indicated treatment as evaluated by the following factors:
Exclusion Criteria:
Baseline laboratories (repeat lab tests are permitted to evaluate eligibility during the Screening Period. Lab results must be within protocol range prior to study treatment.)
Baseline Chemistry
ThermoDox plus standardized RFA using standardized treatment dwell time for solitary HCC lesions ≥ 3.0 cm to ≤ 7.0 cm
Drug: ThermoDox
standardized RFA alone using standardized treatment dwell time for solitary HCC lesions ≥ 3.0 cm to ≤ 7.0 cm
Drug: Dummy infusion
Thermally Sensitive Liposomal Doxorubicin 50 mg/m2 Single 30 minute intravenous infusion
Also known as: Lyso-Thermosensitive Liposomal Doxorubicin (LTLD)
Sodium Chloride 0.9% or 5% Dextrose (D5W), Single 30 minute intravenous infusion
Also known as: Placebo
Overall Survival (OS)
Overall survival is defined as the time (in months) from the date of randomization to the death from any cause or the end of the study.
Time frame: All subjects to be contacted every 3 months after radiological progression for vital status reporting. Subjects were followed for OS up to 68 months from randomization.
Progression-free Survival (PFS)
The protocol incorporates modified RECIST developed for HCC clinical research as a basis to evaluate tumor response. PFS here is defined as the time (in months) from the date of randomization to the first date on which one of the following occurs (as determined by CT or MRI scan): * Death of any cause * Treatment failure (inability to achieve CR after two RFA ± ThermoDox treatment sessions) * Progression due to local tumor recurrence after initial CR * Progression due to distant intrahepatic tumor recurrence * Progression due to extrahepatic tumor recurrence
Time frame: CT or MRI scan (Chest, Abdomen, Pelvis) done at Baseline and Day 28. Additional imaging done at months 5, 9, 13, 17, 21, 25, then every 6 months until disease progression is seen. Study subjects were followed up to 63 months after randomization.
| Milestone | ThermoDox 50 mg/m2 | Dummy Infusion |
|---|---|---|
| Started | 277 | 277 |
| Completed | 187 | 178 |
| Not completed | 90 | 99 |
| Withdrew: Death | 78 | 82 |
| Withdrew: Withdrawal by subject | 9 | 11 |
| Withdrew: Lost to follow-up | 2 | 4 |
| Withdrew: Noncompliance | 1 | 2 |
Overall survival is defined as the time (in months) from the date of randomization to the death from any cause or the end of the study.
| Months | ThermoDox 50 mg/m2 | Dummy Infusion |
|---|---|---|
| Overall Survival (OS) | 58.06 (45.53 to NA) | NA (47.93 to NA) |
The protocol incorporates modified RECIST developed for HCC clinical research as a basis to evaluate tumor response. PFS here is defined as the time (in months) from the date of randomization to the first date on which one of the following occurs (as determined by CT or MRI scan): * Death of any cause * Treatment failure (inability to achieve CR after two RFA ± ThermoDox treatment sessions) * Progression due to local tumor recurrence after initial CR * Progression due to distant intrahepatic tumor recurrence * Progression due to extrahepatic tumor recurrence
| Months | ThermoDox 50 mg/m2 | Dummy Infusion |
|---|---|---|
| Progression-free Survival (PFS) | 19.31 (15.72 to 25.20) | 16.78 (12.86 to 21.32) |
Collected over Assess adverse events (AEs) through Day 28 following study treatment. AEs after Day 28 evaluated as possibly, probably or definitely related to the study treatment or the RFA procedure were recorded at any point during the trial and are to be followed until resolution or the patient is clinically stable. In general, all subjects were followed up to 68 months for AE's.. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| ThermoDox 50 mg/m2 | 78/277 (28.2%) | 73/274 (26.6%) | 265/274 (96.7%) |
| Dummy Infusion | 82/277 (29.6%) | 33/273 (12.1%) | 216/273 (79.1%) |
| Event | ThermoDox 50 mg/m2 | Dummy Infusion |
|---|---|---|
| NeutropeniaBlood and lymphatic system disorders | 21/274 | 1/273 |
| Febrile NeutropeniaBlood and lymphatic system disorders | 11/274 | 0/273 |
| PyrexiaGeneral disorders | 2/274 | 6/273 |
| Pleural EffusionRespiratory, thoracic and mediastinal disorders | 0/274 | 4/273 |
| PneumoniaInfections and infestations | 4/274 | 3/273 |
| Neutrophil Count DecreasedInvestigations | 4/274 | 0/273 |
| White Blood Cell Count DecreasedInvestigations | 3/274 | 0/273 |
| Liver AbscessInfections and infestations | 2/274 | 2/273 |
| SepsisInfections and infestations | 2/274 | 2/273 |
| Alanine Aminotransferase IncreasedInvestigations | 0/274 | 2/273 |
| Event | ThermoDox 50 mg/m2 | Dummy Infusion |
|---|---|---|
| AlopeciaSkin and subcutaneous tissue disorders | 142/274 | 1/273 |
| NeutropeniaBlood and lymphatic system disorders | 136/274 | 5/273 |
| Neutrophil Count DecreasedInvestigations | 73/274 | 4/273 |
| White Blood Cell Count DecreasedInvestigations | 66/274 | 3/273 |
| Aspartate Aminotransferase IncreasedInvestigations | 35/274 | 58/273 |
| PyrexiaGeneral disorders | 28/274 | 52/273 |
| Alanine Aminotransferase IncreasedInvestigations | 36/274 | 45/273 |
| Abdominal PainGastrointestinal disorders | 28/274 | 44/273 |
| Abdominal Pain UpperGastrointestinal disorders | 39/274 | 39/273 |
| Procedural PainInjury, poisoning and procedural complications | 22/274 | 28/273 |
Baseline participants represent the intent-to-treat (ITT) population.
| Age, Continuous(years) | ThermoDox 50 mg/m2 | Dummy Infusion | Total |
|---|---|---|---|
| Median | 62 (28 to 86) | 62 (36 to 90) | 62 (28 to 90) |
| Sex: Female, Male(Participants) | ThermoDox 50 mg/m2 | Dummy Infusion | Total |
|---|---|---|---|
| Female | 54 | 65 | 119 |
| Male | 223 | 212 | 435 |
| Race (NIH/OMB)(Participants) | ThermoDox 50 mg/m2 | Dummy Infusion | Total |
|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 |
| Asian | 265 | 257 | 522 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 0 | 0 | 0 |
| White | 12 | 19 | 31 |
| More than one race | 0 | 1 | 1 |
| Unknown or Not Reported | 0 | 0 | 0 |
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