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Active, Not Recruiting

NCT Number: NCT03017326

Paediatric Hepatic International Tumour Trial

The PHITT trial is an over-arching study for patients with Hepatoblastoma (HB) and Hepatocellular Carcinoma (HCC). This trial will use a risk-adapted approach to the treatment of children diagnosed with HB.

Children with HCC will be included as a separate cohort.

Active, Not Recruiting

This study is active but is not currently recruiting participants.

Key information

Conditions

Hepatoblastoma Adenocarcinoma Carcinoma Carcinoma, Hepatocellular Digestive System Diseases Digestive System Neoplasms Liver Diseases Liver Neoplasms Neoplasms Neoplasms by Histologic Type Neoplasms by Site Neoplasms, Complex and Mixed Neoplasms, Glandular and Epithelial

Age range

Up to 30 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 3

Primary location

St. Anna Kinderspital, Vienna, Austria

Loading trial locations.

About this study

The trial will evaluate whether reducing treatment for low risk HB patients maintains their excellent event free survival (EFS) and decreases acute and long-term toxicity. Intensification of therapy with the use of novel agents will be evaluated in the high risk group. The trial will also compare three different regimens in intermediate risk HB.

Patients with HCC will be divided into groups based on whether the tumour is resectable or unresectable and/or metastatic.

Evaluation of the biology of HB and HCC, using the identification/validation of novel and already reported prognostic biomarkers as well as toxicity biomarkers is a key strand of this trial, so patients in all risk groups can be registered. The trial is also designed to optimise the collection of clinically annotated biologic specimens and establish the world's largest repository of blood and tissue samples from paediatric patients with HB and HCC.

The trial includes 4 randomised comparisons addressing therapeutic questions. For low risk HB patients, outcome with a total of 4 cycles of treatment is not inferior to those receiving a total of 6 cycles of treatment.

For intermediate risk patients, 3 regimens will be compared for outcome and toxicity.

For high risk patients, 2 post induction regimens will be compared for outcome. For resected HCC patients, the addition of GEMOX to PLADO regimen will be compared.

In addition the following will be assessed:

  • To validate a new global risk stratification, defined by Children's Hepatic Tumours International Collaboration (CHIC)
  • To evaluate clinically relevant factors, including the following:
  • Provide a comprehensive and highly-validated panel of diagnostic and prognostic biomarkers
  • Determine if paediatric HCC is a biologically different entity to adult HCC
  • Develop genomic and/or biomarker analysis to predict children who may have an increased risk of developing toxicity with chemotherapy.
  • To establish a collection of clinically and pathologically-annotated biological samples.
  • Evaluate a surgical planning tool for an impact on decision making processes in POST-TEXT III and IV HB

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Clinical diagnosis of HB* and histologically defined diagnosis of HB or HCC.

*Histological confirmation of HB is required except in emergency situations where:

  • a) the patient meets all other eligibility criteria, but is too ill to undergo a biopsy safely, the patient may be enrolled without a biopsy.
  • b) there is anatomic or mechanical compromise of critical organ function by tumour (e.g., respiratory distress/failure, abdominal compartment syndrome, urinary obstruction, etc.)
  • c) Uncorrectable coagulopathy
  • Age ≤30 years
  • Written informed consent for trial entry

Exclusion criteria

  • Any previous chemotherapy or currently receiving anti-cancer agents
  • Recurrent disease
  • Previously received a solid organ transplant; other than orthotopic liver transplantation (OLT).
  • Uncontrolled infection
  • Unable to follow or comply with the protocol for any reason
  • Second malignancy
  • Pregnant or breastfeeding women

Treatment and study plan

Cisplatin

Drug

Arms A and B - cisplatin is used alone Arms C, D, E and F - cisplatin us used in combination

Doxorubicin

Drug

Arms C, D and E used in combination

carboplatin

Drug

Arms C and D used in combination

5Fluorouracil

Drug

Arm C used alone

Vincristine

Drug

Arms C and D used in combination

etoposide

Drug

Arm D used in combination

Irinotecan

Drug

Arm D used in combination

Gemcitabine

Drug

Arm F used in combination

Oxaliplatin

Drug

Arm F used in combination

Sorafenib

Drug

Arm used in combination

Primary outcomes

  1. Event-free survival (EFS)

    Time frame: From date of randomisation (or registration into the trial for non-randomised patients), until date of first failure event, assessed up to 6 years.

    Event-free survival (EFS) is defined as the time from randomisation (or registration into the trial for non-randomised patients) to first failure event. Patients who have not had an event will be censored at their last follow-up date.

    Failure events are:

    • progression of existing disease or occurrence of disease at new sites,
    • death from any cause prior to disease progression,
    • diagnosis of a second malignant neoplasm.

  2. Response in HCC is defined as complete (CR) or partial (PR) response according to RECIST version 1.1 criteria

    Time frame: From date of screening assessment until date of first response assessment, up to 63 days in Group F

    Response in HCC is defined as complete (CR) or partial (PR) response according to RECIST version 1.1 criteria. The assessment will be performed after 3 cycles of PLADO, or 4 cycles of PLADO+S/GEMOX+S in Group F. Patients who are not assessable for response - e.g. because of early stopping of treatment or death - will be assumed to be non-responders.

Secondary outcomes

  1. Failure-free survival (FFS)

    Time frame: From date of randomisation (or registration into the trial for non-randomised patients) until date of first failure event, or date of last follow up assessment, assessed up to 6 years.

    Failure-free survival (FFS) is defined as the time from randomisation (or registration into the trial for non-randomised patients) to first failure event. Patients who have not had an event will be censored at their last follow-up date.

    Failure events are:

    • progression of existing disease or occurrence of disease at new sites,
    • death from any cause prior to disease progression,
    • diagnosis of a second malignant neoplasm. failure to go to resection.

  2. Overall survival (OS)

    Time frame: From date of randomisation (or registration for non-randomised patients) until date of death from any cause, or date of last follow up assessment, assessed up to 6 years.

    Overall survival (OS) is defined as the time from randomisation (or registration for non-randomised patients) to death from any cause. Patients who have not died will be censored at their last follow-up date.

  3. Toxicity categorized and graded using Common Terminology Criteria for Adverse Events (CTCAE)

    Time frame: From date of start of randomised treatment until date 30 days after last treatment.

    Toxicity will be recorded in relation to each cycle of randomised treatment and will be categorized and graded using Common Terminology Criteria for Adverse Events (CTCAE)

  4. Chemotherapy-related cardiac, nephro- and oto-toxicity using Common Terminology Criteria for Adverse Events (CTCAE)

    Time frame: From date of start of randomised treatment until date 30 days after last treatment.

    Chemotherapy-related cardiac, nephro- and oto-toxicity will be recorded in relation to each cycle of treatment and will be categorized and graded using Common Terminology Criteria for Adverse Events (CTCAE)

  5. Hearing loss according to the SIOP Boston Scale

    Time frame: From date of registration until date of last follow up assessment, or date of death, assessed up to 6 years.

    Hearing loss will be measured according to the SIOP Boston Scale for oto-toxicity. The assessment will be performed at end of treatment (EOT) and follow up

  6. Best Response

    Time frame: From date of first treatment until the date of last treatment, or until the date of first documented progression or date of death, assessed up to 6 months.

    Best Response is defined as CR or PR and is based on radiological response (RECIST v1.1) and Alpha Fetoprotein (AFP) decline. Best Response will be measured throughout treatment period. Patients who are not assessable for response - e.g. because of early stopping of treatment or death - will be assumed to be non-responders.

  7. Surgical resectability defined as complete resection, partial resection or transplant

    Time frame: From date of registration until date of last follow up assessment, or date of death, assessed up to 6 years.

    Surgical resectability is defined as complete resection, partial resection or transplant

  8. Adherence to surgical guidelines

    Time frame: From date of registration until date of last follow up assessment, or date of death, assessed up to 6 years.

    Adherence to surgical guidelines is defined as the local clinician's surgical decision to resect or not compared to the current SIOPEL surgical guidelines.

Sponsors and collaborators

Lead sponsor

University of Birmingham

Other

Collaborators

  • Andaluz Health Service
  • Bambino Gesù Hospital and Research Institute
  • Children's University Hospital, Ireland
  • Cliniques universitaires Saint-Luc- Université Catholique de Louvain
  • Experimental Cancer Medicine Centres
  • Fundació Institut Germans Trias i Pujol
  • Gothia Forum - Center for Clinical Trial
  • Ludwig-Maximilians - University of Munich
  • Medical University of Gdansk
  • Motol University Hospital
  • Newcastle University
  • Princess Maxima Center for Pediatric Oncology
  • Rennes University Hospital
  • Swiss Pediatric Oncology Group
  • The Leeds Teaching Hospitals NHS Trust
  • University Hospital Munich
  • University Hospital Tuebingen
  • University Hospital, Bonn
  • University of Kiel
  • University of Oslo
  • University of Padova
  • XenTech, Evry

Registry information

Acronym: PHITT

Important dates

Study start
2017
Primary completion
2026
Study completion
2027
First posted
Jan 11, 2017
Registry last updated
May 13, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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