HYPER-LIV01: Simultaneous Portal and Hepatic Vein Versus Portal Vein Embolizations for Hypertrophy of the Future Liver Remnant

Sponsor
University Hospital, Montpellier (Other)
Overall Status
Unknown status
CT.gov ID
NCT03841305
Collaborator
Federation Francophone de Cancerologie Digestive (Other)
64
12
2
35.1
5.3
0.2

Study Details

Study Description

Brief Summary

The hypothesis is that liver venous deprivation (LVD) could strongly improve hypertrophy of the future remnant liver (FRL) at 3 weeks, as compared to portal vein embolization (PVE) in patient with liver metastases from colo-rectal origin considered as resectable.

Condition or Disease Intervention/Treatment Phase
  • Procedure: Liver preparation before major hepatectomy
Phase 2

Detailed Description

Portal vein embolization (PVE) has been widely used to generate hypertrophy of the nonembolized lobe in patients undergoing major hepatectomy in order to prevent small-for-size remnant liver resulting in post-operative liver insufficiency.

Although PVE is a safe and effective procedure, it does not always induce sufficient hypertrophy of the future remnant liver (FRL) even after a long time. In case of insufficient liver regeneration following PVE, some authors suggested to embolize hepatic vein(s) (Hwang, Ann Surg 2009).

Interestingly, the sequential right hepatic vein embolization (HVE) after right PVE demonstrated an incremental effect on the FRL. Although attractive, this approach requires two different procedures and does not spare time as compared to PVE alone.

To shorten and optimize the phase of liver preparation before surgery,the so-called liver venous deprivation (LVD) technique that combines both PVE and HVE during the same procedure was developed.

The aim of this randomized phase II trial is to compare the percentage of change in FRL volume at 3 weeks after LVD or PVE using MRI or CT-scan.

Study Design

Study Type:
Interventional
Anticipated Enrollment :
64 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Masking:
None (Open Label)
Primary Purpose:
Treatment
Official Title:
Simultaneous Portal and Hepatic Vein Embolization Versus Portal Vein Embolization for Hypertrophy of the Future Liver Remnant Before Major Hepatectomy of Non-cirrhotic Liver : a Multicentric Comparative Randomized Phase II Trial
Actual Study Start Date :
Apr 29, 2019
Anticipated Primary Completion Date :
Oct 1, 2021
Anticipated Study Completion Date :
Apr 1, 2022

Arms and Interventions

Arm Intervention/Treatment
Active Comparator: portal vein embolization

Liver preparation before major hepatectomy : portal vein embolization (PVE) in patient with liver metastases from colo-rectal origin considered as resectable.

Procedure: Liver preparation before major hepatectomy
Simultaneous portal and hepatic vein embolization versus Portal vein embolization, also called venous deprivation OR portal vein embolization.

Experimental: liver venous deprivation

Liver preparation before major hepatectomy : Patients with the liver venous deprivation (LVD) technique that combines both PVE and hepatic vein embolization (HVE) during the same procedure.

Procedure: Liver preparation before major hepatectomy
Simultaneous portal and hepatic vein embolization versus Portal vein embolization, also called venous deprivation OR portal vein embolization.

Outcome Measures

Primary Outcome Measures

  1. increase in volume of the future remnant liver (FRL) [at 3 weeks after liver venous deprivation (LVD) or portal vein embolization (PVE) using MRI or CT-scan]

    The primary outcomes is to compare the increase in volume of the future remnant liver (FRL)

Secondary Outcome Measures

  1. Tolerance [between the day of liver preparation and 90 days after surgery]

    Toxicities are evaluated according to NCI-CTCAE version 4.03 published 14 June 2010

  2. Post-operative mortality [90 days after surgery]

    Post-operative mortality defined as any death within 90 days after surgery or within the hospital stay

  3. Post-operative morbidity [90 days after surgery]

    Post-operative morbidity defined as the percentages of grade I/II/III/IV/V complications according to Clavien-Dindo classification within the 90 days after surgery or within the hospital stay.

  4. Post-hepatectomy liver failure [between the day of the surgery and 90 days after surgery]

    Post-hepatectomy liver failure defined according to the "50-50" criteria or peak bilirubin >7mg/dL.

  5. Rate of non-resectability due to insufficient FRL [between the day of the treatment and the day of the surgery]

    Rate of non-resectability due to insufficient FRL defined as the percentage of patients for whom resection will be not attempted due to insufficient FRL

  6. Rate of non-resectability due to tumor progression [between the day of the treatment and the day of the surgery]

    Rate of non-resectability due to tumor progression defined as the percentage of patients for whom resection will not be attempted due to tumor progression.

  7. Rate of per-operative difficulties [between the day of the surgery and 90 days after surgery]

    Rate of per-operative difficulties defined as the percentage of patients for whom per-operative difficulties are encountered by the surgeon

  8. Blood loos, operating time, transfusion [the day of the surgery]

    Blood loss are evaluated in mL. Operating time avec evaluated in minutes and transfusion are evaluated by number of packed red blood cells

  9. R0 resection rate [the day of the surgery]

    Rate of R0 resection defined as no microscopic tumor residual

  10. R1 resection rate [the day of the surgery]

    Rate of R1 resection defined as the percentage of patients resected with margin <1mm

  11. Pre and post-operative liver volumes [Baseline, week 1, week 3 then every 2 weeks until surgery or week 7 and 4 weeks after surgery]

    Pre and post-operative liver volumes will be evaluated through CT or MRI acquisitions by calculating whole liver, tumor and FRL volumes

  12. Recurrence-free survival [90 days after surgery]

    Recurrence-free survival defined as the time from date of randomization to date of recurrence or death from their tumor. Patients alive will be censored at the date of last news.

  13. Overall survival [Between the liver preparation and 90 days after surgery]

    Overall survival defined as the time from date of randomization to date of death from any cause. Patients alive will be censored at the date of last news.

  14. Evaluation of pre and post-operative liver function [Baseline, week 1, week 3 then every 2 weeks until surgery or week 7 and 4 weeks after surgery]

    Evaluation of pre and post-operative liver function will be evaluated using 99mTc mebrofenine scintigraphy through SPECT/CT acquisitions by calculating mebrofenin clearance in %/min/m² of whole liver and FRL at the same time points as CT/MRI

  15. To search for biomarkers predictive of liver hypertrophy/regeneration and immune cell response [The day of liver preparation, on day 1, day 2 and day 3 after liver preparation and the day of surgery]

    Biomarkers predictive of liver hypertrophy/regeneration are evaluated by blood samples and liver biopies

Eligibility Criteria

Criteria

Ages Eligible for Study:
18 Years and Older
Sexes Eligible for Study:
All
Accepts Healthy Volunteers:
No
Inclusion Criteria:
  • Liver metastases from colo-rectal origin considered as resectable (as validated by a multidisciplinary committee with at least one senior hepatic surgeon) provided sufficient FRL volume

  • Percentage of FRL volume < 30%

  • Age ≥ 18 years

  • General health status World Health Organisation 0,1

  • Estimated life expectancy > 3 months

  • Patients whose biological parameters are :

  • Platelets ≥100,000/mm3,

  • Polynuclear neutrophils ≥ 1000/mm3,

  • Hemoglobin≥ 9g/dL (even transfused patients can be included)

  • Creatininemia < 1.5 times the normal value

  • Creatinine clearance > 30 milliliters (mL)/min

  • Bilirubinemia ≤ 1,5 times the normal value

  • liver transaminases ≤ 5 times the normal value

  • prothrombin rate > 70%

  • Reference liver CT-Scan or MRI done during the 30 days preceding PVE or LVD.

  • Written informed consent

  • National health insurance cover

Exclusion criteria

  • Patient with cirrhosis

  • Presence of clinical ascites

  • Ongoing participation or participation within the 21 days prior to inclusion in the study in another therapeutic trial with an experimental drug

  • Serious non-stabilized disease, active uncontrolled infection or other serious underlying disorder likely to prevent the patient from receiving the treatment

  • Pregnancy (betaHCG positive), breast-feeding or the absence of effective contraception for women of child-bearing age

  • Contraindication for the MRI : Pacemaker or neurosensorial stimulator or implantable defibrillator, cochlear implant, ferromagnetic foreign body similar to the nervous structure.

  • Allergy or contra-indication to iodine contrast agents (thyrotoxicosis, allergy to the active substance or excipients)

  • Treatment with anticoagulants (heparin or AVK) that cannot be interrupted for 48 hours

  • Treatment with anti-platelets that cannot be interrupted for 5 days for aspirin or Plavix

  • Legal incapacity (persons in custody or under guardianship)

  • Deprived of liberty Subject (by judicial or administrative decision)

  • Impossibility to sign the informed consent document or to adhere to the medical follow-up of the trial for geographical, social or psychological reasons

Contacts and Locations

Locations

Site City State Country Postal Code
1 CHU de Montpellier Montpellier Hérault France 34295
2 CHU d'Angers Angers France 49933
3 Bordeaux University Hospital Bordeaux France
4 CHU de Dijon Dijon France 21079
5 CHU de Grenoble Grenoble France 38043
6 Hospices Civils de Lyon Lyon France 69317
7 Centre Léon Berard Lyon France 69373
8 CHU de Nice Nice France 06202
9 APHP - Cochin hospital Paris France
10 CHU de Poitiers Poitiers France 80000
11 Hôpital Paul Brousse Villejuif France 94800
12 Institut Gustave Roussy Villejuif France 94805

Sponsors and Collaborators

  • University Hospital, Montpellier
  • Federation Francophone de Cancerologie Digestive

Investigators

None specified.

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.
Responsible Party:
University Hospital, Montpellier
ClinicalTrials.gov Identifier:
NCT03841305
Other Study ID Numbers:
  • RECHMPL18_0025
  • UF 7595
First Posted:
Feb 15, 2019
Last Update Posted:
Apr 27, 2020
Last Verified:
Apr 1, 2020
Studies a U.S. FDA-regulated Drug Product:
No
Studies a U.S. FDA-regulated Device Product:
No
Keywords provided by University Hospital, Montpellier
Additional relevant MeSH terms:

Study Results

No Results Posted as of Apr 27, 2020