Overview

This clinical trial will test whether a short infusion of a drug called angiotensin II (AT-II) can make a liver cancer treatment work better. The drug is given directly into the artery that supplies blood to the liver, right before a treatment called yttrium-90 (90Y) radioembolization.

The main questions it aims to answer are:

• Does angiotensin II help more of the radioactive beads reach the tumor and less reach the healthy parts of the liver?
• Is it safe to add angiotensin II to the standard radioembolization treatment? What will participants do?
• First visit (work-up): Participants will have the standard preparation for radioembolization. A small test dose of radioactive tracer technetium 99mTc macroaggregated albumin (99mTc-MAA) will be injected into the liver through an artery. On the same day, a single-photon emission computed tomography (SPECT)/CT scan will be performed to see how the tracer distributes in the liver and if there are depositions outside the liver. If everything looks good, the participant will return for treatment in 2-3 weeks.
• Second visit (treatment): Participants will receive the actual radioembolization treatment. At each injection site in the liver, first angiotensin II is administered, immediately followed by the injection of the radioactive beads (90Y microspheres). If the treatment requires injections in multiple locations, the participant will receive angiotensin II at each spot.
• After treatment: Participants will receive a Positron Emission Tomography (PET)/CT scan so the research team can see where the radioactive beads went. This will be compared to the distribution of the radioactive tracer (99mTc-MAA) from the first SPECT/CT scan (performed without angiotensin II) to measure how much angiotensin II helped target the tumor.

All monitoring (including blood pressure, heart rate, oxygen saturation, and breathing rate) takes place during the procedure as part of routine care, and there are no extra hospital visits beyond what is normally required for radioembolization.

Eligibility

Inclusion criteria:

• Patients diagnosed with primary or metastatic liver tumors (any histological type).
• A clinical indication for radioembolization.
• Liver tumors with a diameter ≥ 2 cm.
• Age ≥ 18 years.
• Competent and able to provide own informed consent (no legally designated representative).
• Written informed consent.

Exclusion criteria:

• Any serious comorbidity preventing the safe administration of angiotensin II (AT-II). This includes:
  1. Uncontrolled hypertension.
  2. Treatment with ≥ 3 antihypertensive drugs.
  3. Arterial (cerebro-)vascular or venous thromboembolic event within the past 6 months.
• Current use of angiotensin-converting enzyme (ACE) inhibitors.
• Current use of angiotensin II receptor blockers (ARBs).
• Known hypercoagulable state (i.e., thrombophilia).
• History of severe peripheral vascular disease.
• Known hypersensitivity to the active substance in Giapreza: angiotensin II.
• Known hypersensitivity to any of the excipients in Giapreza: mannitol, sodium hydroxide or hydrochloric acid.
• Any serious and/or chronic liver disease preventing the safe administration of radioembolization.
• Uncorrectable extrahepatic deposition of scout dose activity; activity in the falciform ligament, portal lymph nodes, and gallbladder is accepted.
• Pregnancy or breastfeeding.
• Body weight over 150 kg (because of maximum table load).
• Known severe allergy to intravenous contrast fluids.
• Participation in another investigational study which may compromise any endpoint of the study.
• Any other significant comorbidity or medical condition that may compromise the safety of radioembolization.