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Sorafenib for Hepatopulmonary Syndrome (SHPS)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02021929
Recruitment Status : Terminated
First Posted : December 27, 2013
Results First Posted : April 25, 2019
Last Update Posted : April 25, 2019
National Heart, Lung, and Blood Institute (NHLBI)
Information provided by (Responsible Party):
University of Pennsylvania

Brief Summary:
The main purpose of this clinical trial is to determine the safety and effects of the study drug, sorafenib, in adults diagnosed with hepatopulmonary syndrome (HPS). The study will evaluate how well the drug is tolerated and its effect on the level of oxygen in the blood and the function of the lung vessels.

Condition or disease Intervention/treatment Phase
Hepatopulmonary Syndrome Drug: Sorafenib Drug: Placebo Phase 2

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 28 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Sorafenib in Patients With Hepatopulmonary Syndrome: A Double-Blind Randomized Clinical Trial
Study Start Date : March 2014
Actual Primary Completion Date : January 2018
Actual Study Completion Date : January 2018

Resource links provided by the National Library of Medicine

Drug Information available for: Sorafenib

Arm Intervention/treatment
Experimental: Sorafenib
400 mg (2 capsules) taken by mouth once a day
Drug: Sorafenib

Sorafenib is a kinase inhibitor indicated for the treatment of:

  • Unresectable hepatocellular carcinoma
  • Advanced renal cell carcinoma
  • Locally recurrent or metastatic, progressive, differentiated thyroid carcinoma refractory to radioactive iodine treatment
Other Name: Nexavar

Placebo Comparator: Placebo
2 capsules taken by mouth once a day
Drug: Placebo

Primary Outcome Measures :
  1. Change in Alveolar-arterial Oxygen Gradient Between Sorafenib and Placebo Groups [ Time Frame: Baseline to 12 weeks ]

    Alveolar-arterial oxygen gradient is a calculated measure of oxygenation. It is the difference between the amount of the oxygen in the alveoli and the amount of oxygen in arterial blood.

    Calculation is based on values from an Arterial Blood Gas test. Difference in change in alveolar-arterial oxygen gradient between sorafenib and placebo from baseline to 12 weeks.

Secondary Outcome Measures :
  1. Number of Participants With Improvement in Intrapulmonary Shunting From Baseline to 12 Weeks. [ Time Frame: Baseline to 12 weeks ]

    Intrapulmonary shunting is measured based on results from a saline-bubble echo test.

    Number of participants with measured improvement in intrapulmonary shunting from baseline to 12 weeks in the sorafenib and placebo groups

  2. Change From Baseline in Percentage of Progenitor Cells (Peripheral Blood Mononuclear Cells or PBMCs) [ Time Frame: Baseline to 12 weeks ]

    Progenitor Cells (Peripheral Blood Mononuclear Cells or PBMCs) are obtained and measured from blood samples collected from each participant.

    Difference in change from baseline to 12 weeks in the Percentage of Progenitor Cells between sorafenib and placebo groups.

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   21 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Diagnosis of HPS:

    1. AaPO2 ≥ 15 mm Hg (≥ 20 mm Hg for age > 64 yrs)
    2. Intrapulmonary shunting
    3. Absence of significant restriction (TLC < 70%) or obstruction (FEV1 < 80% & FEV1/FVC < 70%)
    4. Presence of cirrhosis/hepatic fibrosis and/or portal hypertension
  • Child-Pugh class A or B liver disease
  • Platelet count ≥ 30 ×10e9 per liter
  • Hemoglobin ≥ 8.5 g per deciliter
  • International normalized ratio ≤ 2.3
  • Albumin ≥ 2.8 g per deciliter
  • Total bilirubin ≤ 5 mg per deciliter
  • Alanine aminotransferase and aspartate aminotransferase ≤ 5 times the upper limit of the normal range
  • Serum creatinine ≤ 1.5 times the upper limit of the normal range and not receiving dialysis
  • Negative pregnancy test (for women of childbearing potential) at both screening and baseline visits. Post-menopausal women (defined as no menses for one year) and surgically sterilized women are not required to undergo a pregnancy test.
  • Subjects (men and women) of childbearing potential must agree to use medically acceptable contraception beginning at the signing of the Informed Consent Form until at least 14 days after the last dose of study drug.
  • Age ≥ 21 years
  • Ability to provide informed consent

Exclusion Criteria:

  • Recent chronic heavy alcohol consumption
  • Enrollment in a clinical trial or concurrent use of another investigational drug or device therapy (i.e., outside of study treatment) during, or within 28 days of screening visit
  • Current hepatic encephalopathy
  • Active infection
  • Diagnosis of portopulmonary hypertension
  • WHO Class IV functional status
  • Congenital long-QT syndrome
  • Subjects who have used strong CYP3A4 inducers (e.g., phenytoin, carbamazepine, phenobarbital, St. John's Wort [Hypericum perforatum], dexamethasone at a dose of greater than 16 mg daily, or rifampin [rifampicin], and/or rifabutin) within 28 days before randomization
  • Subjects who are currently taking Coumadin®(warfarin)
  • Active or clinically significant cardiac disease, including:

    1. Active coronary artery disease
    2. Unstable angina (anginal symptoms at rest), new-onset angina within 12 weeks before randomization, or myocardial infarction within 24 weeks before randomization
  • Liver or other solid organ transplant recipients
  • Expectation of liver transplant within four months of randomization
  • Hepatocellular carcinoma that does not meet all of the following criteria:

    1. Single lesion ≤ 3 cm documented by LIRADS criteria
    2. Complete response to ablative therapy (TACE, RFA, alcohol ablation) using the modified RECIST criteria one month after therapy with no more than two treatments
    3. No other lesions develop after initiation of HCC therapy
  • Uncontrolled hypertension (systolic pressure >140 mm Hg or diastolic pressure > 90 mm Hg on repeated measurement) despite optimal medical management.
  • Any hemorrhage/bleeding event of NCI-Common Toxicity Criteria for Adverse Effects v4.0 Grade 3 or higher within 4 weeks before randomization
  • Presence of a non-healing wound, non-healing ulcer, or bone fracture
  • Women who are pregnant or breast-feeding
  • Major surgery 28 days prior to randomization
  • Subjects with any previously untreated or concurrent cancer except cervical cancer in-situ, treated basal cell carcinoma, or superficial bladder tumor. Subjects surviving a cancer that was curatively treated and without evidence of disease for more than 3 years before randomization are allowed. All cancer treatments (chemotherapy, radiation therapy, surgery, immunotherapy, biologic therapy, or tumor embolization) must be completed at least 3 years prior to study entry (i.e., signature date of the informed consent form).
  • Inability to comply with the protocol and/or not willing or not available for follow-up assessments

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02021929

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United States, Arizona
Mayo Clinic Arizona
Phoenix, Arizona, United States, 85054
United States, Illinois
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States, 60611
United States, Minnesota
Mayo Clinic - Rochester
Rochester, Minnesota, United States, 55905
United States, New York
Columbia University-NewYork-Presbyterian Hospital
New York, New York, United States, 10032
United States, Pennsylvania
University of Pennsylvania - Perelman Center
Philadelphia, Pennsylvania, United States, 19104
United States, South Carolina
Medical University of South Carolina
Charleston, South Carolina, United States, 29424
United States, Texas
University of Texas Health Science Center at Houston Medical School
Houston, Texas, United States, 77030
Sponsors and Collaborators
University of Pennsylvania
National Heart, Lung, and Blood Institute (NHLBI)
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Principal Investigator: Steven M Kawut, MD, MS University of Pennsylvania
  Study Documents (Full-Text)

Documents provided by University of Pennsylvania:
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Responsible Party: University of Pennsylvania Identifier: NCT02021929    
Other Study ID Numbers: 819185
UM1HL116886 ( U.S. NIH Grant/Contract )
First Posted: December 27, 2013    Key Record Dates
Results First Posted: April 25, 2019
Last Update Posted: April 25, 2019
Last Verified: April 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Keywords provided by University of Pennsylvania:
Randomized Controlled Trial
Clinical Trial
Hepatopulmonary Syndrome
Additional relevant MeSH terms:
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Hepatopulmonary Syndrome
Pathologic Processes
Liver Diseases
Digestive System Diseases
Lung Diseases
Respiratory Tract Diseases
Antineoplastic Agents
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action