ClinicalTrials.gg
Status unknownNCT03274427TIHCCUpdated Sep 15, 2017

Treatment of Intermediate-stage Hepatocellular Carcinoma

A Phase 3 interventional study of Basic drugs therapy of HCC by TACE and Arginine hydrochloride in HCC, sponsored by The First Affiliated Hospital of Zhengzhou University. Status unknown at 1 site in China. Open to participants aged 18 Years to 65 Years. Per ClinicalTrials.gov, last updated 2017-09-15.

Sponsored by The First Affiliated Hospital of Zhengzhou University · Phase 3, Interventional, and Treatment

The sponsor has not verified this record recently (last verified Sep 2017), so the status shown — last known as Recruiting — may be out of date.

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Phase
Phase 3
Study type
Interventional
Enrollment
300
Allocation
Randomized
Ages
18 Years to 65 Years
Sex
All
01

Study summary

The purpose of this study is to evaluate the efficacy and safety of transarterial chemoembolization (TACE) combined with arginine hydrochloride and trimetazidine hydrochloride tablets in the treatment of patients with hepatocellular carcinoma.

Read the detailed description

Hepatocellular carcinoma (HCC) is the sixth most common cancer and the second leading cause of cancer-related deaths in the world. Because HCC is insidious and early diagnosis is difficult, most patients have locally advanced or distant metastasis at the time of diagnosis. So they are not suitable candidates for curative treatments by resection or transplantation. Currently, Sorafenib is the only choice approved by FDA for advanced HCC, although it prolongs the survival for less than 3 months. Transarterial chemoembolization (TACE) is an important method of minimally invasive therapy in the comprehensive treatment of liver cancer. As a kind of combined treatment, it can obviously prolong the survival time of the patients. Recently, metabolomics studies of HCC have shown that typical Warburg effect was observed in hepatoma carcinoma cells. Arginine hydrochloride is a new anticancer drug in the treatment of liver cancer, which is mainly aimed at the pathway of energy metabolism. Trimetazidine hydrochloride may play an anti-tumor role by inhibiting fatty acid oxidation. The investigators have been proceeding this trial to evaluate the efficacy and safety of transarterial chemoembolization (TACE) combined with arginine hydrochloride and trimetazidine hydrochloride tablets in the treatment of patients with hepatocellular carcinoma.

02

Conditions studied

  • HCC
03

In context

Lead sponsor

The First Affiliated Hospital of Zhengzhou University is the lead sponsor of 127 studies on the registry; 74 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years to 65 Years
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

    1. Ages 18-65 years
    1. The diagnosis of HCC: in accordance with "diagnostic and treating standards on primary liver cancer" (2011 Edition) or histological/cytological diagnosis of primary liver cancer
    1. Un-resectable HCC who are eligible for TACE: patients with developing primary liver cancer of Barcelona stage(BCLC) B; multiple nodules (less than 5, the total diameter of less than 20 cm), no invasion, no symptoms; refusing open surgical treatment and volunteering for the treatment
    1. There are CT or MRI
    1. No major vascular invasion or extra hepatic
    1. liver function class A/B(score: ≤7)
    1. Performance status 0 or 1 on the (ECOG) scale in one week before admission
    1. Estimated survival time > 3 months
    1. \<2000 IU/ml(10\^4 copies/ml); or HBV DNA≥2000 IU/ml and are accepting effective antiviral therapy
    1. The major organ function is normal. that is meeting the following standards:

      1. Blood routine examination: (No blood transfusion, no G-CSF and no medication were corrected within 14 days before screening)

        a.HB≥80g/L; b.≥1.5×109/L;c.≥50×109/L;

      2. Biochemical examination: (ALB was not transfused within 14 days before screening) a.ALB ≥29 g/L; b.和AST\<5ULN;c. ≤3ULN;d.creatinine ≤1.5ULN( albumin and bilirubin, two indicators of Child-Pugh liver function class, can only have one for 2 points)
    1. For women of childbearing age, the results of serum/urine pregnancy tests must be negative within 7 days before initiation of treatment. All men and women who participate in the study have to take reliable measures within the trial and eight weeks after the trial is completed
    1. volunteers must signed

Exclusion criteria

Exclusion Criteria:

    1. Diffuse hepatocellular carcinoma
    1. Vascular invasion, including portal vein tumor thrombus
    1. Extra hepatic
    1. Decompensated Cirrhosis: liver function class B/C(score: >8); jaundice; hepatic encephalopathy; ascites; hepatorenal syndrome
    1. With a history of alimentary tract hemorrhage or a definite tendency of gastrointestinal bleeding, such as varices of fundus of stomach and esophagus with bleeding risk; local active ulcer lesions; fecal occult blood ≥(++)
    1. of embolization: patients with severe hepatic flow or portosystemic shunt; the lesion was too large, and the majority of two lobe were occupied by the lesions
    1. Patients whose target lesion has been treated locally: resection of hepatic carcinoma; radio frequency ablation; TACE; local treatment was taken within 4 weeks; patients who have previously been given radiotherapy, chemotherapy, or targeted drugs
    1. Patients with hepatobiliary cell carcinoma, mixed cell carcinoma or lamellar cell carcinoma; in the past (within 5 years) or at the same time suffering from other untreated malignant tumors; excluding cured basal cell carcinoma and carcinoma in situs of cervix
    1. Patients who are undergoing liver transplantation or have a history of organ transplantation(excluding the patient who has undergone liver transplantation before)
    1. Patients with an allergic history of arginine hydrochloride and trimetazidine hydrochloride
    1. The blood pressure can not be reduced to the normal range by the antihypertensive drug treatment in patients with hypertension(systolic pressure>140 mmHg, diastolic pressure>90 mmHg)
    1. Patients with myocardial ischemia or myocardial infarction over grade II or a poorly controlled arrhythmia (including : men ≥ 450 ms; women ≥ 470 ms)
    1. Cardiac functional insufficiency of grade III to IV according to standard; echocardiography: \<50%
    1. Many factors that influence oral medication, such as unable to swallow; chronic diarrhea; intestinal obstruction; the situations which significantly affect the use and absorption of drugs
    1. Abdominal fistula, gastrointestinal perforation, or abdominal abscess occurred within 28 days before participating the study
    1. Dysfunction of blood coagulation(>2.0 or PT> 16s,APTT > 43s、TT > 21s,Fbg \< 2g/L), having a tendency to bleed or undergoing thrombolysis or anticoagulant therapy; ascites with clinical symptoms, that is requiring therapeutic abdominal paracentesis or drainage or Child-Pugh score ≥2
    1. Objective evidence of pulmonary fibrosis history, interstitial pneumonia, pneumoconiosis, radiation pneumonitis, drug associated pneumonia, and severe lung function impairment in the past and at present
    1. Urine routine showed that urine protein ≥++ or the urine protein in 24 hours>1.0 g
    1. Patients who have been treated with potent inhibitors (ketoconazole, itraconazole, voriconazole, ritonavir, clarithromycin, telithromycin, troleandomycin, erythromycin, cimetidine and so on) within 28 days before participating the study, or potent CYP3A4 inducers (dexamethasone, phenytoin, rifampin, rifabutin, carbamazepine, phenobarbitone and so on) within 12 days before participating the study
    1. Pregnant or lactating women; fertile patients who are unwilling or unable to adopt effective
    1. Patients with mental sickness or the history of psychotropic drug abuse
    1. Patients with severe infection (unable to control the infection effectively)
    1. The treatment history affecting this program or its efficacy, such as stem cell transplantation, immune regulation (including and other test regimens) recently (within half a year)
    1. The researchers believe that any other factors unsuitable for entering into the study.
Terms in these criteria, in plain language(19)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Measurable disease

The amount of disease can be tracked with a defined measurement, so the study can see whether it shrinks or grows. It might be a tumour measured on a scan or, in some blood cancers such as myeloma, a marker measured in blood or urine.

The criteria or the study team say which measurement counts — having no tumour visible on a scan does not by itself rule you out.

Metastases

Cancer that has spread from where it began to other parts of the body. “Metastatic” cancer is cancer that has spread this way.

Child-Pugh class

A score of how well the liver works in people with liver disease such as cirrhosis: class A is mild, B moderate and C severe.

ECOG performance status

A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.

0
Fully active, no restrictions.
1
Limited in strenuous activity, but walking and able to do light work, such as housework or office work.
2
Walking and able to look after yourself, but unable to work; up and about more than half of waking hours.
3
Able to look after yourself only in part; in bed or a chair more than half of waking hours.
4
Unable to look after yourself at all; in bed or a chair all day.

Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.

Hepatitis B tests

Hepatitis B is a virus that infects the liver. These are separate tests: HBsAg positive usually means a current infection (a recent vaccination can briefly cause it too); total anti-HBc (HBcAb) positive means an infection now or in the past; HBV DNA measures how much virus is in the blood.

Some studies accept a past infection if HBV DNA is undetectable, sometimes with antiviral medicine during the study. Check what this study allows.

Absolute neutrophil count (ANC)

The number of neutrophils, white blood cells that help fight infection, in a given amount of blood. Too few raises the risk of infection.

It is a count, not a percentage of the white cells. Limits are written in units that mean the same: ≥ 1.5 × 10⁹/L is ≥ 1,500 per mm³ (µL). Each lab has its own reference range.

Platelets

Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

Bilirubin

A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.

Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Relapsed and refractory

Relapsed: the illness came back after treatment had worked. Refractory: it did not respond to treatment, or stopped responding while still on it.

Contraindication

A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.

QT and QTc

On an ECG, the QT interval is the time the heart’s lower chambers take to activate electrically and recover in each beat. QTc is that time adjusted for heart rate (QTcF by Fridericia’s formula, QTcB by Bazett’s). Some medicines lengthen it, and a long QTc can raise the risk of a dangerous heart rhythm.

The study may name a correction formula and a limit in milliseconds, often around 450–480.

NYHA class (heart failure)

The New York Heart Association’s four classes of how much heart failure limits physical activity.

I
No limits: ordinary activity causes no undue tiredness or breathlessness.
II
Slight limits: comfortable at rest, ordinary activity causes symptoms.
III
Marked limits: comfortable at rest, less than ordinary activity causes symptoms.
IV
Symptoms even at rest; any activity makes them worse.

Studies set their own limit — many outside heart failure leave out class III–IV, while heart failure studies may ask for a particular class. Check the class this study names.

LVEF (left ventricular ejection fraction)

The share of blood the heart’s main pumping chamber (the left ventricle) pushes out with each beat, measured by an echocardiogram (heart ultrasound) or a MUGA scan. About 50–70% is normal.

INR, PT and aPTT (clotting tests)

Blood tests of how long blood takes to clot. The INR is the prothrombin time (PT) put on a common scale; about 1 is usual for someone not taking a blood thinner.

Criteria often make an exception for people on a blood thinner such as warfarin, whose INR is raised on purpose.

CYP3A (CYP3A4) inhibitors and inducers

CYP3A is a group of enzymes, mainly CYP3A4, in the liver and gut that break down many medicines. Some medicines, supplements and foods (grapefruit, St John’s wort) slow them down or speed them up, which changes how much of a study drug stays in the body.

Studies list them so they can be avoided or switched; bring a list of everything you take, including supplements.

PD-1, PD-L1 and checkpoint inhibitors

PD-1, PD-L1 and CTLA-4 are proteins that act as brakes on the immune system. Checkpoint inhibitors, such as pembrolizumab or nivolumab, block them so the immune system can attack a cancer.

PD-L1 can also be measured in a tumour sample. Some scores count stained tumour cells only (TPS); others also count certain immune cells (CPS). The study names the score and the minimum it uses.

05

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
300 participants (estimated)

Study arms

  • Experimental
    One-drug Regimes

    Basic drugs therapy of HCC by TACE.

    Device: Basic drugs therapy of HCC by TACE

  • Experimental
    Two-Drug Regimens

    Basic drugs therapy of HCC by TACE; Arginine hydrochloride

    Device: Basic drugs therapy of HCC by TACE · Drug: Arginine hydrochloride

  • Experimental
    Three-Drug Regimens

    Basic drugs therapy of HCC by TACE; Arginine hydrochloride;Trimetazidine hydrochloride

    Device: Basic drugs therapy of HCC by TACE · Drug: Arginine hydrochloride · Drug: Trimetazidine hydrochloride

Interventions

  • DeviceBasic drugs therapy of HCC by TACE

    Basic drugs include: 1. Molecular targeted drugs for HCC:apatinib; 2. Antiviral drugs (ETV or TDF) should be given to patients who were infected with HBV or HCV; 3. Patients with liver dysfunction should be treated with conventional hepatoprotective agents drugs (including glycyrrhizin, reduced glutathione, vitamin C,etc); 4. Patients with ascites symptoms should be treated with furosemide and spironolactone according to the urine volume, and they also should be treated with proton pump inhibitors in the prevention of gastrointestinal bleeding; 5. Other basic diseases were treated routinely.

    Also known as: TACE

  • Arginine hydrochloride injection 5g/dose; 40g/d; ivgtt; sustained medication for 24 days; drug withdrawal for 4 days.

    Also known as: AH

  • Trimetazidine hydrochloride, 20mg/tablet, 40mg, twice a day.

    Also known as: TH

06

What researchers measure

Primary outcomes

  1. Progression-free Survival

    Time from start of treatment until the first documented event of symptomatic progression or death.

    Time frame: 24 months

Secondary outcomes

  1. Overall Survival

    from start of treatment to death from any cause, or last known date of survival

    Time frame: 36 months

  2. large vascular invasion or extrahepatic metastasis (MVI/EHV)

    The effect on large vascular invasion or extrahepatic metastasis (MVI/EHV)

    Time frame: 24 months

  3. Disease Control Rate (DCR)

    the percentage of patients with advanced or metastatic cancer who have achieved complete response, partial response and stable disease

    Time frame: 28 days

  4. Objective Response Rate(ORR)

    Proportion of patients with reduction in tumor burden of a predefined amount

    Time frame: 28 days

  5. biomarker

    decrease in tumor markers

    Time frame: approximately 24 months

  6. quality of life

    The overall enjoyment of life.

    Time frame: approximately 36 months

07

Study locations

1 of 1 sites recruiting
  • The First Affiliated Hospital of Zhengzhou University
    Zhengzhou, Henan 450000, China
    Recruiting
08

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reached

Started Jul 2017 (actual). Primary completion is estimated for Jul 2021, 48 months after the start.

How these figures are worked out, and which studies are left out of them.

Registered
Aug 27, 2017
First posted
Sep 7, 2017
StartActual
Jul 18, 2017
Primary completionEst.
Jul 2021
CompletionEst.
Jul 2021
Last update
Sep 15, 2017
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Sep 15, 2017, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
09

Registry details

Key details

Study ID
NCT03274427
Collaborators
First Affiliated Hospital of Xinjiang Medical University, Luoyang Central Hospital, Nanyang Central Hospital, Anyang Tumor Hospital, Shenma Medical Group General Hospital, First People's Hospital of Shangqiu, Jiaozuo third people's hospital
Responsible party
Zujiang YU (The director of infectious diseases department, The First Affiliated Hospital of Zhengzhou University) — Principal investigator
First posted
Sep 7, 2017
Start date
Jul 18, 2017
Primary completion
Jul 2021 (estimated)
Completion
Jul 2021 (estimated)
Last update
Sep 15, 2017

Study contacts

Zujiang Yu, Pro,Dr
Contact
johnyuem@zzu.edu.cn
0086-0371-67966942
Zujiang Yu
principal investigator · The First Affiliated Hospital of Zhengzhou University

Oversight

FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is status unknown, as verified in Sep 2017. You cannot join it, but the record below documents what was studied.

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Studies of the drugs tested here: Arginine · Trimetazidine

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