Hepatocellular Carcinoma (HCC)IO-MARCNCT07623265
Improving the Use of Immunotherapy to Treat Liver Cancer
A study testing Blood and tissue sample in people with Hepatocellular Carcinoma (HCC), run by Universitaire Ziekenhuizen KU Leuven at 4 sites in Belgium.
Trial summary
This project targets patients with a form of primary liver cancer, specifically "hepatocellular carcinoma". This disease often develops in the context of a chronically diseased liver, caused by viral infections, excessive alcohol consumption, or fatty liver. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Hepatocellular Carcinoma (HCC)
- What is being tested?
- Blood and tissue sample
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 300 participants
- Where
- 4 sitesBelgium
- Study dates
- 4 Mar 2025to Jan 2032
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
- General inclusion Criteria:
- Male or female, age > 18 years
- Diagnosis or suspected diagnosis of hepatocellular carcinoma based on imaging
- Specific inclusion criteria cohort 1 (retrospective/prospective data may be applicable):
- Pathologically confirmed HCC
- Treated with systemic treatment [tyrosine kinase inhibitor (TKI) or immunotherapy (ICI)] in the last 7 years and follow-up data (at least one imaging on treatment) available until 01/01/2025
- Biopsy obtained between 01/01/2018 until 01/01/2025
- Left-over tissue from previous diagnostic biopsies or resection specimens available
- Time between biopsy and initiation of systemic treatment < 1 year
- Ability to sign informed consent for secondary use of archival tissue and data collection for study-specific research for patients who are alive
- Specific inclusion criteria cohort 2 (aHCC \& prospective):
- Suspicion of hepatocellular carcinoma (imaging criteria or recurrent disease of previously treated HCC)
- Indication for tumor biopsy per standard of care
- Eligible for systemic treatment (any) after pathological confirmation of HCC
- Ability to sign informed consent for primary use of tissue and blood samples and data collection for study-specific research
- Specific inclusion criteria cohort 3 (eHCC \& prospective):
- Suspicion of hepatocellular carcinoma (imaging criteria or recurrent disease of previously treated HCC)
- Indication for local treatment (resection or ablation)
- Ability to sign informed consent for primary use of tissue and blood samples and for data collection for study-specific research Due to the observational nature of this study, participation in other (interventional) clinical trials is permitted, if biological materials can be collected per protocol.
- General exclusion criteria:
- Poor liver function and/or performance status which prohibits active treatment
- Pathologically proven other malignancies of the liver, including primary cholangiocarcinoma or liver metastases
- Treatment plan other than systemic treatment or local treatment (resection or ablation), such as TACE, TARE, liver transplantation
Trial locations and contacts
4 sites in 1 country. Contact the study team or a site near you to ask about taking part.
Frederik Peeters, MD contact
Belgium4 sites, 4 recruiting
- Recruiting
UZA
Antwerp
Timon Van Damme, MD, PhD, Timon.vandamme@uza.be
Timon Van Damme, MD, PhD
- Recruiting
Jessa ziekenhuis
Hasselt
Elisabeth Stragier, MD, Elisabeth.stragier@jessazh.be
Elisabeth Stragier, MD
- Recruiting
AZ Groeninge
Kortrijk
Alexander Vanden Bulcke, MD, Alexander.vandenbulcke@azgroeninge.be
Alexander Vandenbulcke, MD
- Recruiting
AZ Delta
Roeselare
Sofie De Meulder, MD, sofie.demeulder@azdelta.be
Sofie De Meulder, MD
About this study
Official title: Optimizing and Improving Immunotherapy for Hepatocellular Carcinoma: the IO-MARC Study
This project targets patients with a form of primary liver cancer, specifically "hepatocellular carcinoma". This disease often develops in the context of a chronically diseased liver, caused by viral infections, excessive alcohol consumption, or fatty liver. Primarily due to the rise of the latter risk factor, liver cancer is one of the few cancer types whose incidence continues to increase globally, year after year. As a result, liver cancer has become the third most common cause of cancer-related deaths worldwide. There exists a significant challenge in reducing the disease on all fronts: prevention, diagnosis, and treatment.
This research aims to personalize the treatment of liver cancer patients, tailoring it to the individual. More specifically, this research seeks to identify patients with immunotherapy-sensitive liver cancer by biomarkers before treatment begins. Determining whether a tumor is immunotherapy-sensitive is internationally recognized as one of the most important challenges within this condition. Based on a combination of existing laboratory techniques on tumor tissue and/or blood, the investigators seek to predict the likelihood of this treatment's success before initiating it. With this knowledge, the investigators could recommend alternative treatments to patients with tumors that are unresponsive. This way, they would also avoid exposure to the side effects of an ineffective therapy.
Read the detailed description
Multicentric, low-interventional with retrospective and prospective components. No investigational medicinal product (IMP) is involved.
Patient management is standard of care. Prospective tissue collection is done at the time of standard of care diagnostic biopsies or surgical procedures. Blood collection is performed at the time of routine lab evaluations. No additional study visits, venipunctures or other procedures are expected. Three hundred patients will be included in the following three cohorts:
- Cohort 1 - 120 patients: archival tumor tissue of 120 patients previously treated with systemic therapies for hepatocellular carcinoma in the last 5 years will be collected.
- Cohort 2 - 90 patients: prospective tumor tissue and blood samples of 90 patients with advanced HCC and candidate for systemic therapy will be collected.
- Cohort 3 - 90 patients: prospective tumor tissue and blood samples of 90 patients with early HCC and candidate for local treatment will be collected.
Objectives:
- Aim 1: Spatial orientation of cell types of interest in the tumor microenvironment (TME) of HCC using a variety of techniques: multiplex immune histochemistry, spatial proteomics and spatial transcriptomics. Samples from early versus advanced HCC will be used.
- Aim 2: Identification of shared T-cell receptor sequences between PBMCs and tumor tissue using RNA and TCR sequencing. Exploration of the degree of TCR sharing in early and advanced HCC.
- Aim 3: Collecting starting material for TWISTAR, aiming to identify tumor antigens in HCC using a transcriptome-wide screen for T cell antigens.
Our analysis will be powered to identify a difference in progression-free survival between the biomarker positive and negative population with a hazard ratio of 0.6 with a power of 75% and an alpha of 0.05, provided that about 30% of samples are biomarker positive. The historical samples of patients treated with a TKI will serve as a control group to detect an interaction with the biomarker and the treatment effect.
- Conditions
- Hepatocellular Carcinoma (HCC)
- Being tested
- Blood and tissue sample
- Keywords
- Biomarker, Hepatocellular carcinoma, Immunotherapy
- Medical subject headings
- Carcinoma, Hepatocellular
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Blood and tissue sampleOther
Prospective collection of additional blood and tissue samples for study-specific analyses at specific timepoints, at the same time as routine procedures.
| Study group | Role | What they receive |
|---|---|---|
| Cohort 1 | No intervention | Cohort 1 (observational): * Collection of leftover archival tumour tissue of patients with advanced HCC treated with systemic therapies. * No blood collection. * Retrospective and prospective collection of data. |
| Cohort 2 | Other | Cohort 2 (advanced HCC):
* Prospective collection of tumour tissue at the time of standard of care biopsy from advanced HCC patients prior to initiation of a systemic treatment (max 2 needle biopsy cylinders).
* Additional collection of leftover archival tissue from previous biopsies or resection specimens is possible.
* Prospective collection of blood samples at two timepoints (prior to start of systemic treatment and prior to the 2nd therapy cycle). Maximum 30ml of blood per timepoint (3x10ml EDTA tubes).
* Retrospective and prospective collection of data. Receives: Other: Blood and tissue sample |
| Cohort 3 | Other | * Prospective collection of tumour tissue at the time of standard of care biopsy (max 2 needle biopsy cylinders) or surgical treatment (resection or ablation; 2 surgical biopsies or a piece of the resection specimen) from early HCC patients.
* Additional collection of leftover archival tissue from previous biopsies or resection specimens is possible.
* Prospective collection of blood samples at one timepoint (prior to resection or ablation). Maximum 30ml of blood per timepoint (3x10ml EDTA tubes).
* Retrospective and prospective collection of data. Receives: Other: Blood and tissue sample |
What is being measured
The primary outcome is the main question the study is designed to answer.
Spatial orientation
Spatial orientation of cell types of interest in the tumour microenvironment (TME) of HCC using a variety of techniques: multiplex IHC, spatial proteomics and spatial transcriptomics. Samples from early (cohort 3) and advanced HCC (cohort 2) will be used.
Measured: Through study completion, an average of 6 months
TCR sharing
Identification of shared TCR sequences between PBMCs and tumor tissue using RNA and TCR sequencing. Exploration of the degree of TCR sharing in early and advanced HCC.
Measured: Through study completion, an average of 6 months
Antigen identification
The investigators will use tumor tissue and PBMC to construct an antigenic landscape of advanced HCC. To achieve this goal the investigators will use a unique technique called Transcriptome-Wide Screening for T cell Antigen Research (TWISTAR).
Measured: Through study completion, an average of 6 months
Biomarker validation
This study will be used to validate two candidate predictive biomarkers (CD45RA effector-memory CD8 T-cells/PDL1-expressing CXCL10+ macrophages) AND TCR sharing between tumor and blood in relation to response to immunotherapy in HCC.
The investigators will compare the biomarker positive and biomarker negative groups in terms of progression-free survival and overall survival (Kaplan-Meier time-to-event) in the context of known prognostic clinical variables (multivariable cox proportional hazards model).
Measured: 12 months after tissue acquisition
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted3 Jun 2026
- Study start4 Mar 2025
- Primary completionJan 2029 (estimated)
- Study completionJan 2032 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Hepatocellular Carcinoma (HCC)Studies of the same condition, open and under way.
- More trials run by Universitaire Ziekenhuizen KU LeuvenThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Basic science
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Model description
- Three patient cohorts are defined, depending on the therapeutic scenario patients undertake. Patient management is standard of care. No investigational medicinal product (IMP) is involved. Trial is considered low interventional due to addition of extra blood and tissue samples, otherwise would be observational.
- Masking
- None (open label)
- Enrolment
- 300 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Universitaire Ziekenhuizen KU Leuven
- Sponsor type
- University, hospital or other
- Collaborators
- Flemish institute of biotechnology (VIB)
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07623265
- Sponsor's protocol ID
- S69815
- Acronym
- IO-MARC
- Status last verified
- May 2026
- First submitted
- 6 Feb 2025
- Last updated
- 3 Jun 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 3 Jun 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Optimizing and Improving Immunotherapy for Hepatocellular Carcinoma: the IO-MARC Study
- ClinicalTrials.gov ID
- NCT07623265
- Acronym / sponsor ID
- IO-MARC / S69815
- Conditions
- Hepatocellular Carcinoma (HCC)
- Keywords
- Biomarker, Hepatocellular carcinoma, Immunotherapy
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 300 participants (estimated)
- Lead sponsor
- Universitaire Ziekenhuizen KU LeuvenUniversity, hospital or other
- Collaborators
- Flemish institute of biotechnology (VIB)
- Study start
- 4 Mar 2025 (actual)
- Primary completion
- Jan 2029 (estimated)
- Study completion
- Jan 2032 (estimated)
- First posted
- 3 Jun 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This project targets patients with a form of primary liver cancer, specifically "hepatocellular carcinoma". This disease often develops in the context of a chronically diseased liver, caused by viral infections, excessive alcohol consumption, or fatty liver. Primarily due to the rise of the latter risk factor, liver cancer is one of the few cancer types whose incidence continues to increase globally, year after year. As a result, liver cancer has become the third most common cause of cancer-related deaths worldwide. There exists a significant challenge in reducing the disease on all fronts: prevention, diagnosis, and treatment.
This research aims to personalize the treatment of liver cancer patients, tailoring it to the individual. More specifically, this research seeks to identify patients with immunotherapy-sensitive liver cancer by biomarkers before treatment begins. Determining whether a tumor is immunotherapy-sensitive is internationally recognized as one of the most important challenges within this condition. Based on a combination of existing laboratory techniques on tumor tissue and/or blood, the investigators seek to predict the likelihood of this treatment's success before initiating it. With this knowledge, the investigators could recommend alternative treatments to patients with tumors that are unresponsive. This way, they would also avoid exposure to the side effects of an ineffective therapy.
Detailed description
Multicentric, low-interventional with retrospective and prospective components. No investigational medicinal product (IMP) is involved.
Patient management is standard of care. Prospective tissue collection is done at the time of standard of care diagnostic biopsies or surgical procedures. Blood collection is performed at the time of routine lab evaluations. No additional study visits, venipunctures or other procedures are expected. Three hundred patients will be included in the following three cohorts:
- Cohort 1 - 120 patients: archival tumor tissue of 120 patients previously treated with systemic therapies for hepatocellular carcinoma in the last 5 years will be collected.
- Cohort 2 - 90 patients: prospective tumor tissue and blood samples of 90 patients with advanced HCC and candidate for systemic therapy will be collected.
- Cohort 3 - 90 patients: prospective tumor tissue and blood samples of 90 patients with early HCC and candidate for local treatment will be collected.
Objectives:
- Aim 1: Spatial orientation of cell types of interest in the tumor microenvironment (TME) of HCC using a variety of techniques: multiplex immune histochemistry, spatial proteomics and spatial transcriptomics. Samples from early versus advanced HCC will be used.
- Aim 2: Identification of shared T-cell receptor sequences between PBMCs and tumor tissue using RNA and TCR sequencing. Exploration of the degree of TCR sharing in early and advanced HCC.
- Aim 3: Collecting starting material for TWISTAR, aiming to identify tumor antigens in HCC using a transcriptome-wide screen for T cell antigens.
Our analysis will be powered to identify a difference in progression-free survival between the biomarker positive and negative population with a hazard ratio of 0.6 with a power of 75% and an alpha of 0.05, provided that about 30% of samples are biomarker positive. The historical samples of patients treated with a TKI will serve as a control group to detect an interaction with the biomarker and the treatment effect.
Study design
- Primary purpose
- Basic science
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 3
- Model description
- Three patient cohorts are defined, depending on the therapeutic scenario patients undertake. Patient management is standard of care. No investigational medicinal product (IMP) is involved. Trial is considered low interventional due to addition of extra blood and tissue samples, otherwise would be observational.
| Arm | Type | Receives |
|---|---|---|
| Cohort 1 | No intervention | –Cohort 1 (observational): * Collection of leftover archival tumour tissue of patients with advanced HCC treated with systemic therapies. * No blood collection. * Retrospective and prospective collection of data. |
| Cohort 2 | Other | Other: Blood and tissue sampleCohort 2 (advanced HCC): * Prospective collection of tumour tissue at the time of standard of care biopsy from advanced HCC patients prior to initiation of a systemic treatment (max 2 needle biopsy cylinders). * Additional collection of leftover archival tissue from previous biopsies or resection specimens is possible. * Prospective collection of blood samples at two timepoints (prior to start of systemic treatment and prior to the 2nd therapy cycle). Maximum 30ml of blood per timepoint (3x10ml EDTA tubes). * Retrospective and prospective collection of data. |
| Cohort 3 | Other | Other: Blood and tissue sample* Prospective collection of tumour tissue at the time of standard of care biopsy (max 2 needle biopsy cylinders) or surgical treatment (resection or ablation; 2 surgical biopsies or a piece of the resection specimen) from early HCC patients. * Additional collection of leftover archival tissue from previous biopsies or resection specimens is possible. * Prospective collection of blood samples at one timepoint (prior to resection or ablation). Maximum 30ml of blood per timepoint (3x10ml EDTA tubes). * Retrospective and prospective collection of data. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Blood and tissue sampleProspective collection of additional blood and tissue samples for study-specific analyses at specific timepoints, at the same time as routine procedures. | Other | Cohort 2, Cohort 3 |
Primary outcome
Spatial orientation
Time frame: Through study completion, an average of 6 months
Spatial orientation of cell types of interest in the tumour microenvironment (TME) of HCC using a variety of techniques: multiplex IHC, spatial proteomics and spatial transcriptomics. Samples from early (cohort 3) and advanced HCC (cohort 2) will be used.
TCR sharing
Time frame: Through study completion, an average of 6 months
Identification of shared TCR sequences between PBMCs and tumor tissue using RNA and TCR sequencing. Exploration of the degree of TCR sharing in early and advanced HCC.
Antigen identification
Time frame: Through study completion, an average of 6 months
The investigators will use tumor tissue and PBMC to construct an antigenic landscape of advanced HCC. To achieve this goal the investigators will use a unique technique called Transcriptome-Wide Screening for T cell Antigen Research (TWISTAR).
Biomarker validation
Time frame: 12 months after tissue acquisition
This study will be used to validate two candidate predictive biomarkers (CD45RA effector-memory CD8 T-cells/PDL1-expressing CXCL10+ macrophages) AND TCR sharing between tumor and blood in relation to response to immunotherapy in HCC. The investigators will compare the biomarker positive and biomarker negative groups in terms of progression-free survival and overall survival (Kaplan-Meier time-to-event) in the context of known prognostic clinical variables (multivariable cox proportional hazards model).
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 3 Jun 2026.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Frederik Peeters, MD contact
4 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Blood and tissue sample in people with Hepatocellular Carcinoma (HCC), run by Universitaire Ziekenhuizen KU Leuven at 4 sites in Belgium.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 3 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 4 sites in Belgium. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Jeroen Dekervel, MD (016344225, jeroen.dekervel@uzleuven.be), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Spatial orientation (time frame: Through study completion, an average of 6 months). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Jun 2026.