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Kaposiform Hemangioendothelioma (KHE)Phase 2/3NCT07656909

Low- vs High-Dose Sirolimus With Prednisolone for KHE and KMP

A Phase 2/3 study testing Sirolimus (RAPAMUNE) in people with Kaposiform Hemangioendothelioma (KHE) and Kasabach Merritt Phenomenon, run by Yi Ji at 1 site in China.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

This randomized clinical trial evaluates if low-dose sirolimus (target trough 4-8 ng/mL) combined with prednisolone is noninferior in efficacy but superior in safety compared to standard high-dose sirolimus (target trough 10-15 ng/mL) combined with prednisolone in pediatric patients with kaposiform… Read more about this study

Who is it for?
Ages 1 day to 18 years
What is being tested?
Sirolimus (RAPAMUNE)
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
76 participants
Where
1 siteChina
Study dates
16 Jun 2026to 31 Dec 2028
Phase
Phase 2/3
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 1 day to 18 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • Presenting a KHE with the following characteristics:
  • Clinical features and histological findings consistent with progressive, non-resectable KHE associated with KMP.
  • Patients must be 0 - 18 years of age at the time of study entry.
  • Without functional impairment requiring treatment of corticosteroid.
  • Organ function requirements:
  • 1 Adequate liver function:
Show all 15Show fewer
  • Total bilirubin less than or equal to 1.5 x upper limit of normal (ULN)for age, and
  • ALT and AST less than or equal to 2.5 x upper limit normal (ULN) for age.
  • 2 Adequate renal function:
  • 0-5 years of age maximum serum creatinine (mg/dL) of 0.8
  • 6-10 years of age maximum serum creatinine (mg/dL) of 1.0
  • 11-15 years of age maximum serum creatinine (mg/dL) of 1.2
  • 16-18 years of age maximum serum creatinine (mg/dL) of 1.5
  • Adequate bone marrow function: Absolute Neutrophil Count (ANC) greater than or equal to 1 x 10 to the ninth/Liter.
  • Consent of parents (or the person having parental authority in families): Signed and dated written informed consent.

Who cannot join

  • Allergy to sirolimus or other rapamycin analogues.
  • Any known evidence of significant local or systemic uncontrolled infection, defined as receiving intravenous antibiotics at the time of randomization.
  • Patients must not be known to be Human Immunodeficiency Virus positive or known immunodeficiency. Testing is not required unless a condition is suspected.
  • Other concurrent severe and/or uncontrolled medical disease which could compromise participation in the study (e.g. uncontrolled diabetes, uncontrolled hypertension, severe malnutrition, chronic liver or renal disease, active upper gastrointestinal tract ulceration).
  • Impairment of gastrointestinal function or chronic gastrointestinal disease that may significantly alter the absorption of sirolimus.
  • Patients who have a history of malignancy.
  • Patients with an inability to participate or to follow the study treatment and assessment plan.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Jiangyuan Zhou, MD contact

13668491160@163.com

China1 site, 1 recruiting
  • West China Hospital of Sichuan University

    Chengdu, Sichuan, 610041

    Yi Ji, PhD, +862885423453, jijiyuanyuan@163.com

    Jiangyuan Zhou, MD, 13668491160@163.com

    Recruiting

Other trials in China

About this study

Official title: Low-dose Versus High-dose Sirolimus Combined With Prednisolone for Kaposiform Hemangioendothelioma With Kasabach-Merritt Phenomenon: a Randomized Noninferiority Trial

This randomized clinical trial evaluates if low-dose sirolimus (target trough 4-8 ng/mL) combined with prednisolone is noninferior in efficacy but superior in safety compared to standard high-dose sirolimus (target trough 10-15 ng/mL) combined with prednisolone in pediatric patients with kaposiform hemangioendothelioma and Kasabach-Merritt phenomenon (KHE with KMP), with participants randomized 1:1 to receive the assigned regimen, undergo routine blood and imaging monitoring, and be evaluated for clinical response and adverse events.

Read the detailed description

The goal of this randomized clinical trial is to evaluate if low-dose sirolimus combined with prednisolone is noninferior to high-dose sirolimus combined with prednisolone in managing kaposiform hemangioendothelioma complicated by Kasabach-Merritt phenomenon (KHE with KMP) in pediatric patients. In this study, the low-dose regimen targets a sirolimus trough concentration of 4-8 ng/mL, while the standard high-dose regimen targets a trough concentration of 10-15 ng/mL. The main questions it aims to answer are:

Does the combination of low-dose sirolimus (target trough 4-8 ng/mL) and prednisolone achieve a noninferior objective response rate (including platelet count recovery and tumor volume reduction) compared to the high-dose sirolimus (target trough 10-15 ng/mL) and prednisolone combination at the primary endpoint evaluation? Does the low-dose sirolimus combination significantly reduce treatment-related toxicities and adverse events compared to the high-dose sirolimus combination?

Researchers will compare a low-dose sirolimus plus prednisolone arm to a standard high-dose sirolimus plus prednisolone arm to see if lowering the sirolimus dose within this combination regimen can maintain comparable therapeutic control over KMP while minimizing dose-dependent adverse effects.

Participants will:

Be randomized in a 1:1 ratio to receive either oral low-dose sirolimus combined with prednisolone (targeting a trough level of 4-8 ng/mL) or standard high-dose sirolimus combined with prednisolone (targeting a trough level of 10-15 ng/mL).

Undergo regular clinical evaluations, including physical examinations and serial blood tests to monitor peripheral platelet counts and sirolimus trough levels.

Receive routine imaging studies (such as MRI or ultrasound) to assess changes in tumor volume.

Be closely monitored throughout the study period for combination therapy-related side effects and systemic corticosteroid-associated adverse events.

Being tested
Sirolimus (RAPAMUNE)
Medical subject headings
Kaposiform Hemangioendothelioma, Kasabach-Merritt Syndrome

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Sirolimus (RAPAMUNE)Drug

    Participants will receive oral sirolimus in combination with prednisolone. Patients will be randomized in a 1:1 ratio to either a low-dose sirolimus group, with dose adjustments to maintain a target plasma trough concentration of 4-8 ng/mL, or a high-dose sirolimus group, with dose adjustments to maintain a target plasma trough concentration of 10-15 ng/mL. Prednisolone will be administered according to the study protocol and tapered based on clinical response. The total treatment duration will be 12 months.

Study groups in NCT07656909
Study groupRoleWhat they receive
Low-Dose Sirolimus Plus PrednisoloneExperimentalParticipants receive oral sirolimus with dose adjustments to maintain a target plasma trough concentration of 4-8 ng/mL, in combination with prednisolone, for a treatment duration of 12 months.
Receives: Drug: Sirolimus (RAPAMUNE)
High-Dose Sirolimus Plus PrednisoloneActive comparatorParticipants receive oral sirolimus with dose adjustments to maintain a target plasma trough concentration of 10-15 ng/mL, in combination with prednisolone, for a treatment duration of 12 months.
Receives: Drug: Sirolimus (RAPAMUNE)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Proportion of Participants Achieving Platelet Count Recovery

    The proportion of participants who achieve platelet count recovery, defined as a platelet count ≥100 × 10⁹/L without platelet transfusion support, during the study period.

    Measured: 2 months

Secondary outcomes (6)
  1. Proportion of Participants Achieving Fibrinogen Recovery

    The proportion of participants who achieve fibrinogen recovery, defined as a plasma fibrinogen level ≥1.6 g/L without replacement therapy, during the study period.

    Measured: 2 months

  2. Change in D-Dimer Level From Baseline

    Change in plasma D-dimer level from baseline to the specified study assessment time point.

    Measured: 2 months

  3. Change in KHE Tumor Volume From Baseline

    Response to therapy was measured by volumetric magnetic resonance imaging (MRI) analyses were performed at baseline and 6 and 12 months after treatment and were independently assessed by 2 radiologists. Changes in KHE size were classified as further growth (increase of ≥10%), no change (<10% increase and <10% decrease), partial involution (decrease of ≥10% and <75%), nearly complete involution (decrease of ≥75% and <100%), or complete involution (100%). Photographs of the mixed KHE were taken at months 0, 6 and 12 by a medical photographer.

    Measured: 6 and 12 months

  4. The changes in the patient's symptoms and/or complications.

    Improvement in the range of motion.

    Measured: 6 and 12 months

  5. Frequency of adverse events

    Frequency of adverse events (e.g. gastrointestinal disorders, blood and lymphatic system disorders, metabolic disorders or other abnormal laboratory results, skin disorders and general disorders, etc.) collected by investigator and reported by parents. All adverse events were collected and graded according to Common Terminology Criteria for Adverse Events, version 4.0 (CTCAE v4.0). The causality of the adverse event was determined by the multidisciplinary staff and was classified as definitively not related, probably not related, possibly related, probably related, or definitively related. Any dose reductions, interruptions, or cessations enacted at the discretion of the investigators were recorded.

    Measured: 12 months

  6. Quality of life (QOL) in patients.

    Pediatric Quality of Life Inventory (PedsQLTM) 4.0 Genetic Core Infant Scales (<2 years) or Pediatric Quality of Life Inventory (PedsQLTM) 4.0 Genetic Core Scales (2-18 years) were used.

    Measured: 12 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted18 Jun 2026
  2. Study start16 Jun 2026 (estimated)
  3. Primary completion31 Dec 2027 (estimated)
  4. Study completion31 Dec 2028 (estimated)

Resources

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 2/3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
76 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07656909
Sponsor's protocol ID
RCT20260615
Status last verified
Jun 2026
First submitted
15 Jun 2026
Last updated
18 Jun 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Lauven PM, Schwilden H, Stoeckel H. Threshold hypnotic concentration of methohexitone. Eur J Clin Pharmacol. 1987;33(3):261-5. doi: 10.1007/BF00637559.

    PubMed 3691614
  • Ji Y, Chen S, Yang K, Zhou J, Zhang X, Jiang X, Xu X, Lu G, Qiu L, Kong F, Zhang Y. A prospective multicenter study of sirolimus for complicated vascular anomalies. J Vasc Surg. 2021 Nov;74(5):1673-1681.e3. doi: 10.1016/j.jvs.2021.04.071. Epub 2021 May 31.

    PubMed 34082006
  • Wada Y, Iijima K, Yonezawa T. [The effects of nitroglycerin induced hypotension on the tissue blood flow in dogs under halothane anesthesia]. Masui. 1985 Sep;34(9):1208-15. No abstract available. Japanese.

    PubMed 3936944
  • Zhou J, Yang K, Dai S, Qiu T, Zhang X, Gong X, Chen S, Ji Y. Clinical features and management of kaposiform hemangioendothelioma and tufted angioma: Similarities and differences. J Am Acad Dermatol. 2022 Jul;87(1):172-174. doi: 10.1016/j.jaad.2021.07.012. Epub 2021 Jul 14. No abstract available.

    PubMed 34273457
  • Zhou J, Qiu T, Zhang Z, Lan Y, Huo R, Xiang B, Chen S, Qiu L, Xia C, Xu X, Li J, Ma Y, Yao W, Wang Z, Dong C, Qin Z, Tai M, Guo L, He X, Gu S, Li L, Hou F, Cai Y, Wang H, Wang J, Jiang X, Zheng J, Li K, Ji Y. Consensus statement for the diagnosis, treatment, and prognosis of kaposiform hemangioendothelioma. Int J Cancer. 2025 May 15;156(10):1986-1994. doi: 10.1002/ijc.35344. Epub 2025 Jan 20.

    PubMed 39831682
  • Zhou J, Lan Y, Qiu T, Zhang Z, Gong X, Zhang X, Yang C, Zhou Z, Zhang Y, Yang M, Fu J, He C, Peng Q, Hu F, Xia C, Kong F, Chen S, Ji Y. Efficacy and safety of high-vs low-dose sirolimus in patients with kaposiform hemangioendothelioma: A randomized clinical trial. J Am Acad Dermatol. 2025 Jul;93(1):124-131. doi: 10.1016/j.jaad.2025.03.023. Epub 2025 Mar 17.

    PubMed 40107509
  • Zhou J, Ji Y. Kaposiform hemangioendothelioma. J Am Acad Dermatol. 2026 Mar 12:S0190-9622(26)00396-8. doi: 10.1016/j.jaad.2026.03.020. Online ahead of print. No abstract available.

    PubMed 41831614
  • Ji Y, Chen S, Zhou J, Yang K, Zhang X, Xiang B, Qiu T, Gong X, Zhang Z, Lan Y, Hu F, Kong F, Qiu Q, Zhang Y. Sirolimus plus prednisolone vs sirolimus monotherapy for kaposiform hemangioendothelioma: a randomized clinical trial. Blood. 2022 Mar 17;139(11):1619-1630. doi: 10.1182/blood.2021014027.

    PubMed 35030255
  • Rossler J, Baselga E, Davila V, Celis V, Diociaiuti A, El Hachem M, Mestre S, Haeberli D, Prokop A, Hanke C, Loichinger W, Quere I, Baumgartner I, Niemeyer CM, Kapp FG. Severe adverse events during sirolimus "off-label" therapy for vascular anomalies. Pediatr Blood Cancer. 2021 Aug;68(8):e28936. doi: 10.1002/pbc.28936. Epub 2021 Feb 13.

    PubMed 33580918
  • Croteau SE, Liang MG, Kozakewich HP, Alomari AI, Fishman SJ, Mulliken JB, Trenor CC 3rd. Kaposiform hemangioendothelioma: atypical features and risks of Kasabach-Merritt phenomenon in 107 referrals. J Pediatr. 2013 Jan;162(1):142-7. doi: 10.1016/j.jpeds.2012.06.044. Epub 2012 Aug 4.

    PubMed 22871490
  • Ji Y, Chen S, Xiang B, Li K, Xu Z, Yao W, Lu G, Liu X, Xia C, Wang Q, Li Y, Wang C, Yang K, Yang G, Tang X, Xu T, Wu H. Sirolimus for the treatment of progressive kaposiform hemangioendothelioma: A multicenter retrospective study. Int J Cancer. 2017 Aug 15;141(4):848-855. doi: 10.1002/ijc.30775. Epub 2017 May 26.

    PubMed 28486787
  • Wang Z, Yao W, Sun H, Dong K, Ma Y, Chen L, Zheng S, Li K. Sirolimus therapy for kaposiform hemangioendothelioma with long-term follow-up. J Dermatol. 2019 Nov;46(11):956-961. doi: 10.1111/1346-8138.15076. Epub 2019 Sep 5.

    PubMed 31489702
  • Ji Y, Chen S, Yang K, Xia C, Li L. Kaposiform hemangioendothelioma: current knowledge and future perspectives. Orphanet J Rare Dis. 2020 Feb 3;15(1):39. doi: 10.1186/s13023-020-1320-1.

    PubMed 32014025

Questions about this trial

What is this clinical trial studying?

A Phase 2/3 study testing Sirolimus (RAPAMUNE) in people with Kaposiform Hemangioendothelioma (KHE) and Kasabach Merritt Phenomenon, run by Yi Ji at 1 site in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 15 inclusion and 7 exclusion criteria. 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 18 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 1 site in China. 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.

What does this combined phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

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 Yi Ji, PhD (02885423453, jijiyuanyuan@163.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Proportion of Participants Achieving Platelet Count Recovery (time frame: 2 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07656909, which also lists 13 linked publications.

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 18 Jun 2026.

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