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Evaluation of Safety, Biodistibution and Sensitivity/Specificity of PET/CT Imaging With 89Zr-TLX250 in Subjects With RCC (ZIRDAC-JP)

Primary Purpose

Carcinoma, Renal Cell, Clear Cell Renal Cell Carcinoma

Status
Completed
Phase
Phase 1
Locations
Japan
Study Type
Interventional
Intervention
89Zr-girentuximab
Sponsored by
Telix International Pty Ltd
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional health services research trial for Carcinoma, Renal Cell focused on measuring clear cell renal cell carcinoma, PET/CT imaging, 89Zr-girentuximab, pharmacokinetics, pharmacodynamics, safety, Diagnostic imaging, 89Zr-TLX250

Eligibility Criteria

20 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Phase 1:

  1. Written and voluntarily given informed consent
  2. Aged ≥20 years at the time of enrollment
  3. Suspected renal cell carcinoma who have been diagnosed with a renal mass by CT or MRI performed within 90 days before screening
  4. Sufficient life expectancy to participate in the study
  5. Consent to practice barrier contraception (condoms) until a minimum of 42 days and 90 days after 89Zr-TLX250 administration in female and male, respectively

Phase 2 Part

  1. Written and voluntarily given informed consent
  2. Aged ≥20 years at the time of enrollment
  3. Imaging evidence of a single indeterminate renal mass of ≤ 7 cm in largest diameter on CT or MRI within 90 days prior to screening
  4. Scheduled for lesion resection as part of regular diagnostic work-up within 90 days from planned 89Zr-TLX250 administration
  5. Sufficient life expectancy to undergo nephrectomy
  6. Consent to practice barrier contraception (condoms) until a minimum of 42 days and 90 days after 89Zr-TLX250 administration in female and male, respectively

Exclusion Criteria:

Commonly applied for Phase 1 part and Phase 2 part

  1. Those who have hypersensitivity to Girentuximab or DFO
  2. Patients with metastatic renal tumor
  3. Patients who need treatment for other active malignancies during the study period
  4. Patients who have undergone chemotherapy, radiation therapy, or immunotherapy within 4 weeks before the administration of the investigational drug, or have continued adverse events of grade 1 (defined in NCI-CTCAE v5.0) or higher
  5. Patients scheduled for anticancer drug treatment during the period from administration of investigational drug to image collection
  6. Patients who have been exposed to mouse or chimeric antibody within the past 5 years
  7. Patients who have been administered some kind of radionuclide earlier than 10 half-lives of the nuclide.
  8. Patients with severe, but not fatal disease, for which the principal investigator / investigator has determined that study participation is not appropriate
  9. Women who are pregnant or breastfeeding. And women with childbearing potential who are not pregnant or breastfeeding but suspected of being pregnant by the blood test at screening and pre-dose (within 24 hours before administration). Pre-dose blood pregnancy test can be replaced with urine test
  10. Patients who have been administered the drug by any clinical study or clinical trial within 30 days before the scheduled administration of the investigational drug
  11. Patients who cannot give legally valid consent by himself / herself
  12. Patients with renal dysfunction whose GFR is 60mL / min / 1.73m2 or less
  13. Patents who are socially vulnerable (e.g., patients in custody)
  14. Others who are judged by the principal investigator or investigator to be inappropriate for participation in this trial Applied only to Phase 2 part 15. Patients whose biopsy is more suitable for pathological diagnosis than partial resection or nephrectomy

Sites / Locations

  • Yokohama City University Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

89Zr-girentuximab

Arm Description

A single administration of 37 Megabecquerel (MBq) (±10%) 89Zr-girentuximab, containing a mass dose of 10 mg of girentuximab

Outcomes

Primary Outcome Measures

Incidence of Treatment-Emergent Adverse events [Safety and Tolerability]
Incidence of abnormal laboratory test results and abnormal vital signs
Determination of the sensitivity and specificity of 89Zr-TLX250 to detect clear cell renal cell carcinoma
The sensitivity and specificity of 89Zr-TLX250 to detect renal cell carcinoma will be established by a diagnostic scan after administration of the investigational product followed by surgery of the indeterminate mass. After surgical removal of the kidney mass , diagnostic histology of the mass will be conducted and used as the "standard of truth" comparator.

Secondary Outcome Measures

Phase 1: Evaluation of the radioactivity distribution and biodistribution/tumor uptake
Whole body PET/CT imaging (from the base of skull to the thigh) performed post-injection using non-contrast-enhanced and low-dose CT for absorption correction.
Phase 1: Assessment of tumor uptake
This outcome will be evaluated by determining the absorbed dose after injection with 89Zr-TLX250 in identifiable tumor regions taking into account the tumor volume estimated from imaging performed prior to participation to the study.
Phase 2: To evaluate positive predictive value (PPV) of 89Zr-girentuximab PET/CT imaging to detect ccRCC in patients with indeterminate solid renal masses
Positive predictive value (PPV) in detecting ccRCC by PT/CT imaging using 89Zr-TLX250 in subjects with undiagnosed solid renal mass
Phase 2: To evaluate negative predictive value (NPV) of 89Zr-girentuximab PET/CT imaging to detect ccRCC in patients with indeterminate solid renal masses
Negative predictive value (NPV) using 89Zr-TLX250 in subjects with undiagnosed solid renal mass
To evaluate accuracy of 89Zr-girentuximab PET/CT imaging to detect ccRCC in patients with indeterminate solid renal masses
Determine accuracy in detecting ccRCC by PT/CT imaging using 89Zr-TLX250 in subjects with undiagnosed solid renal mass
Phase 2: To evaluate the correlation between 89Zr- girentuximab SUVs and degree of histological carbonic anhydrase IX (CAIX) expression
This outcome will be assessed on all patients. The counts derived from the PET/CT imaging of the renal lesion will be compared with the amount of CAIX expressed in the histologically extracted sample
Phase 2: To evaluate inter-reader variability of diagnostic assessments of 89Zr- girentuximab PET/CT images, when performed by multiple readers
This outcome will be conducted on all patients. Three blinded readers operating independently will be used to read each patient PET/CT image and determine if the target lesion is positive for Zr89. A comparison of findings will then be made between the readers for each patient individually.
Phase 2: Assessment of differences in a same reader
The difference in evaluations of 89Zr-TLX250 PET/CT images by a same reader is assessed with the use of Cohen's κ coefficient.

Full Information

First Posted
July 14, 2020
Last Updated
August 18, 2021
Sponsor
Telix International Pty Ltd
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1. Study Identification

Unique Protocol Identification Number
NCT04496089
Brief Title
Evaluation of Safety, Biodistibution and Sensitivity/Specificity of PET/CT Imaging With 89Zr-TLX250 in Subjects With RCC
Acronym
ZIRDAC-JP
Official Title
Open-label Phase I of 89Zr-girentuximab (89Zr-TLX250) to Assess the Safety, Biodistribution, Pharmacokinetics and Sensitivity/Specificity of PET/CT Images in Patients With Suspected Renal Cell Carcinoma Including Clear Cell Renal Cell Carcinoma (ZIRDAC-JP Study)
Study Type
Interventional

2. Study Status

Record Verification Date
October 2020
Overall Recruitment Status
Completed
Study Start Date
August 1, 2020 (Actual)
Primary Completion Date
October 27, 2020 (Actual)
Study Completion Date
April 6, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Telix International Pty Ltd

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
89Zr-TLX250 is a carbonic anydrase IX (CAIX)-targeted imaging agent that is under clinical development as a non-invasive diagnostic imaging agent for teh detection of clear cell renal cell carcinoma (ccRCC). The Phase 1 study part of this study is to confirm the safety/tolerability and to evaluate the pharmacokinetics (PK) and pharmacodynamics (PD) in subjects with suspected renal cell carcinoma (RCC) including clear cell renal cell carcinoma. The Phase 2 component of the study is to to evaluate the sensitivity/specificity of using 89Zr-TLX250 PET/CT images to detect RCC and ccRCC in patients with suspected RCC.
Detailed Description
Phase 1: The phase 1 component of this study will be conducted in in 6-10 subjects at one study center, with the objective of confirming the safety/tolerability and the whole-body dose distribution of 89Zr-TLX250. 89Zr-TLX250 will be administered via a single IV injection (at least 3 min) at an activity dose of 37 MBq (± 10%) and at a dose of 10 mg (±10%). After the enrollment of 6 subjects, if the male-to-female ratio is different from the Japanese epidemiological RCC data (male-to-female ratio ≒ 2:1 in 2017), more subjects, up to 10 subjects in total, are to be enrolled. Blood sampling for pharmacokinetic analysis will be is performed at 0.5, 1, 2, 4, 24, 72 h and during the Day 5 ± 2 imaging visit. The dose distribution will be determined using low-dose, non-contrast-enhanced CT whole body imaging at 0.5, 4, 24, 72 h and Day 5 ± 2. Diagnostic images will be acquired on Day 3 and Day 5 ± 2 using whole body PET/CT-imaging where individual organs will be assessed using Medical Internal Radiation Dose (MIRD) method. Seven days after the Day 5 ± 2 imaging visit, patients will attend a follow-up visit to conduct safety evaluations and to undergo blood sampling for HACA measurement. Phase 2: The phase 2 component of this study will be conducted after the completion of the phase 1 study in 6-10 patients. This part of the study is equivalent to a phase 2, open-label, multi-center (2-5 sites) to assess the sensitivity/specificity of PET/CT images in subjects with suspected but not definitely diagnosed RCC including ccRCC. The study is intended to evaluate the sensitivity and specificity of PET/CT test as a non-invasive test with the CAIX-targeted imaging agent 89Zr-TLX250. The study will include patients who are scheduled to undergo a partial or total nephrectomy. Patients with an indeterminate renal mass with the longest diameter of 7cm or less, by diagnostic imaging, will receive a single administration of 37 MBq (+/- 10%) 89Zr-TLX250. Imaging will then be conducted Day 5 ± 2 post administration. The partial/total nephrectomy will be performed at institutional discretion any time following the PET/CT imaging visit, but no later than 90 days post administration of 89Zr-TLX250. Histological tumour samples will be prepared and used for histological diagnosis of the renal mass (ccRCC or non-ccRCC) read by a central laboratory. Image data analyses will be performed by a central image core lab. Qualitative visual analysis (presence or absence of localised 89Zr-TLX250 uptake inside or in vicinity of renal lesion, as seen on contrast-enhanced CT or MRI), will be used to assess test performance or 89Zr-TLX-250 PET/CT imaging to non-invasively detect ccRCC, using histological results from the central histological reference laboratory as standard of truth.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Carcinoma, Renal Cell, Clear Cell Renal Cell Carcinoma
Keywords
clear cell renal cell carcinoma, PET/CT imaging, 89Zr-girentuximab, pharmacokinetics, pharmacodynamics, safety, Diagnostic imaging, 89Zr-TLX250

7. Study Design

Primary Purpose
Health Services Research
Study Phase
Phase 1
Interventional Study Model
Sequential Assignment
Model Description
open-label, safety, pharmacokinetic, diagnostic, prospective, multi-center
Masking
None (Open Label)
Allocation
N/A
Enrollment
6 (Actual)

8. Arms, Groups, and Interventions

Arm Title
89Zr-girentuximab
Arm Type
Experimental
Arm Description
A single administration of 37 Megabecquerel (MBq) (±10%) 89Zr-girentuximab, containing a mass dose of 10 mg of girentuximab
Intervention Type
Diagnostic Test
Intervention Name(s)
89Zr-girentuximab
Other Intervention Name(s)
89Zr-TLX250, 89Zr-DFO-TFP-girentuximab (GTX)
Intervention Description
A single dose of 37 MBq (±10%) is administered. The dose per dose is equivalent to girentuximab 10 mg (±10%).
Primary Outcome Measure Information:
Title
Incidence of Treatment-Emergent Adverse events [Safety and Tolerability]
Description
Incidence of abnormal laboratory test results and abnormal vital signs
Time Frame
90 days
Title
Determination of the sensitivity and specificity of 89Zr-TLX250 to detect clear cell renal cell carcinoma
Description
The sensitivity and specificity of 89Zr-TLX250 to detect renal cell carcinoma will be established by a diagnostic scan after administration of the investigational product followed by surgery of the indeterminate mass. After surgical removal of the kidney mass , diagnostic histology of the mass will be conducted and used as the "standard of truth" comparator.
Time Frame
90 days
Secondary Outcome Measure Information:
Title
Phase 1: Evaluation of the radioactivity distribution and biodistribution/tumor uptake
Description
Whole body PET/CT imaging (from the base of skull to the thigh) performed post-injection using non-contrast-enhanced and low-dose CT for absorption correction.
Time Frame
0.5, 4, 24, and 72 hours and Day 5 ± 2
Title
Phase 1: Assessment of tumor uptake
Description
This outcome will be evaluated by determining the absorbed dose after injection with 89Zr-TLX250 in identifiable tumor regions taking into account the tumor volume estimated from imaging performed prior to participation to the study.
Time Frame
Day 3-5
Title
Phase 2: To evaluate positive predictive value (PPV) of 89Zr-girentuximab PET/CT imaging to detect ccRCC in patients with indeterminate solid renal masses
Description
Positive predictive value (PPV) in detecting ccRCC by PT/CT imaging using 89Zr-TLX250 in subjects with undiagnosed solid renal mass
Time Frame
At end of study , on average of 5 months
Title
Phase 2: To evaluate negative predictive value (NPV) of 89Zr-girentuximab PET/CT imaging to detect ccRCC in patients with indeterminate solid renal masses
Description
Negative predictive value (NPV) using 89Zr-TLX250 in subjects with undiagnosed solid renal mass
Time Frame
At end of study , on average of 5 months
Title
To evaluate accuracy of 89Zr-girentuximab PET/CT imaging to detect ccRCC in patients with indeterminate solid renal masses
Description
Determine accuracy in detecting ccRCC by PT/CT imaging using 89Zr-TLX250 in subjects with undiagnosed solid renal mass
Time Frame
At end of study , on average of 5 months
Title
Phase 2: To evaluate the correlation between 89Zr- girentuximab SUVs and degree of histological carbonic anhydrase IX (CAIX) expression
Description
This outcome will be assessed on all patients. The counts derived from the PET/CT imaging of the renal lesion will be compared with the amount of CAIX expressed in the histologically extracted sample
Time Frame
Within 90 days
Title
Phase 2: To evaluate inter-reader variability of diagnostic assessments of 89Zr- girentuximab PET/CT images, when performed by multiple readers
Description
This outcome will be conducted on all patients. Three blinded readers operating independently will be used to read each patient PET/CT image and determine if the target lesion is positive for Zr89. A comparison of findings will then be made between the readers for each patient individually.
Time Frame
This analysis will be conducted through study completion, on average of 5 months
Title
Phase 2: Assessment of differences in a same reader
Description
The difference in evaluations of 89Zr-TLX250 PET/CT images by a same reader is assessed with the use of Cohen's κ coefficient.
Time Frame
This analysis will be conducted through study completion, on average of 5 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
20 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Phase 1: Written and voluntarily given informed consent Aged ≥20 years at the time of enrollment Suspected renal cell carcinoma who have been diagnosed with a renal mass by CT or MRI performed within 90 days before screening Sufficient life expectancy to participate in the study Consent to practice barrier contraception (condoms) until a minimum of 42 days and 90 days after 89Zr-TLX250 administration in female and male, respectively Phase 2 Part Written and voluntarily given informed consent Aged ≥20 years at the time of enrollment Imaging evidence of a single indeterminate renal mass of ≤ 7 cm in largest diameter on CT or MRI within 90 days prior to screening Scheduled for lesion resection as part of regular diagnostic work-up within 90 days from planned 89Zr-TLX250 administration Sufficient life expectancy to undergo nephrectomy Consent to practice barrier contraception (condoms) until a minimum of 42 days and 90 days after 89Zr-TLX250 administration in female and male, respectively Exclusion Criteria: Commonly applied for Phase 1 part and Phase 2 part Those who have hypersensitivity to Girentuximab or DFO Patients with metastatic renal tumor Patients who need treatment for other active malignancies during the study period Patients who have undergone chemotherapy, radiation therapy, or immunotherapy within 4 weeks before the administration of the investigational drug, or have continued adverse events of grade 1 (defined in NCI-CTCAE v5.0) or higher Patients scheduled for anticancer drug treatment during the period from administration of investigational drug to image collection Patients who have been exposed to mouse or chimeric antibody within the past 5 years Patients who have been administered some kind of radionuclide earlier than 10 half-lives of the nuclide. Patients with severe, but not fatal disease, for which the principal investigator / investigator has determined that study participation is not appropriate Women who are pregnant or breastfeeding. And women with childbearing potential who are not pregnant or breastfeeding but suspected of being pregnant by the blood test at screening and pre-dose (within 24 hours before administration). Pre-dose blood pregnancy test can be replaced with urine test Patients who have been administered the drug by any clinical study or clinical trial within 30 days before the scheduled administration of the investigational drug Patients who cannot give legally valid consent by himself / herself Patients with renal dysfunction whose GFR is 60mL / min / 1.73m2 or less Patents who are socially vulnerable (e.g., patients in custody) Others who are judged by the principal investigator or investigator to be inappropriate for participation in this trial Applied only to Phase 2 part 15. Patients whose biopsy is more suitable for pathological diagnosis than partial resection or nephrectomy
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Noboru Nakaigawa, MD, PhD
Organizational Affiliation
Yokohama City University Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Yokohama City University Hospital
City
Yokohama City
State/Province
Kanagawa
ZIP/Postal Code
236-0004
Country
Japan

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Evaluation of Safety, Biodistibution and Sensitivity/Specificity of PET/CT Imaging With 89Zr-TLX250 in Subjects With RCC

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