Combined Beta- Plus Auger Electron Therapy Using a Novel Somatostatin Receptor Subtype 2 Antagonist Labelled With Terbium-161 (161Tb-DOTA-LM3) (Beta plus)
Neuroendocrine Neoplasia's (NENs), Gastroenteropancreatic Neuroendocrine Tumour (GEP-NET)
About this trial
This is an interventional basic science trial for Neuroendocrine Neoplasia's (NENs) focused on measuring Somatostatin receptor subtype 2 (SST2), 161Tb-DOTA-LM3, Somatostatin receptor subtype 2 (SST2) antagonist, Peptide receptor radionuclide therapy (PRRT), 177Lu-DOTATOC (177Lu-edotreotide), Auger electrons
Eligibility Criteria
Inclusion Criteria:
- Written consent
- Patients with diagnosed and metastasized secreting and non-secreting GEP-NEN (grade 1 and 2)
- Absence of a curative surgical option
- At least 2 measurable tumours based on RECIST 1.1 (minimal tumour diameter of 1 cm)
- Documentation of a positive 68Ga-DOTATOC/-TATE positron emission tomography (PET)/CT (in vivo detection of SST2 on GEP-NENs)
- Indication for PRRT
- Patient of any gender and of age older than 18
- Female patients of child-bearing age (who are not surgically sterilized or are less than 2 years in their menopause) must use a medically accepted contraceptive and must agree to use it during and till 3 months after the treatment. As acceptable contraceptive count sexual abstinence or double contraceptive methods: hormonal contraceptive (oral, transdermal, implants or injections) in combination with barrier methods (spiral, condom, diaphragm)
- Eastern Cooperative Oncology Group (ECOG) ≤ 2
Blood parameters:
h) Leucocytes ≥ 3*109/L i) Haemoglobin ≥ 90 g/L j) Thrombocytes ≥ 90*109/L k) Estimated glomerular filtration rate ≥ 50 ml/min or Creatinine < 150 μmol/l l) Albumin > 25 g/L m) alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AP): ≤ 5 times upper standard value n) Bilirubin ≤ 2 times upper standard value
Exclusion Criteria:
- Known intolerance against 177Lu, 161Tb, DOTA, TOC, LM3, SST analogues or against one of the components of 177Lu-DOTATOC or 161Tb-DOTA-LM3
- Bone/bone marrow metastases located in the lumbar spine if they affect the bone marrow dose estimation
- Ongoing infection at the screening visit or a serious infection in the past 4 weeks
- Administration of another investigational product in the last 60 days before Visit 1 Day 1
- Prior or planed administration of a therapeutic radio-pharmaceutical during 8 half-lives of the used radio-pharmaceutical's radionuclide, also during the ongoing study
- Any extensive radiotherapy involving bone marrow over the last 3 months before inclusion to the study
- Chemotherapy in the last 4 weeks before inclusion
- Pregnant or breastfeeding female patients. A pregnancy test will be performed in all women of child-bearing age.
- Any uncontrolled significant medical, psychiatric or surgical condition (active infection, unstable angina pectoris, cardiac arrhythmia, poorly controlled hypertension, poorly controlled diabetes mellitus [HbA1c ≥ 9%], uncontrolled congestive heart disease, etc.) or laboratory findings that might jeopardize the patient's safety or that would limit compliance with the objectives and assessments of the study. Any mental conditions which prevent the patient from understanding the type, extent and possible consequences of the study and/or an uncooperative attitude from the patient.
Sites / Locations
- Division of Nuclear Medicine, University Hospital BaselRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Experimental
Experimental
Experimental
Experimental
Phase 0a, Group 1
Phase 0a, Group 2
Phase 0b, Group 1
Phase 0b, Group 2
The first test injection will be with 161Tb-DOTA-LM3; the second one will be with 177Lu-DOTATOC. The ~ 3 therapy cycles will be performed with 177Lu-DOTATOC. Test injection 1: 0.5 - 1 GBq ≤ 100 μg 161Tb-DOTA-LM3 with renal protection Test injection 2 (Cross over): 0.5 - 1 GBq ~ 200 μg 177Lu-DOTATOC with renal protection Not more than 6 weeks later patients will receive ~ 3 treatment cycles with 5.6 - 7.4 GBq 177Lu-DOTATOC in an interval of about 8 weeks (clinically established amount of activity). This is standard of care and not part of the study.
The first test injection will be with 177Lu-DOTATOC; the second one will be with 161Tb-DOTA-LM3. The ~ 3 therapy cycles will be performed with 177Lu-DOTATOC. Test injection 1: Group 2: 0.5 - 1 GBq ~ 200 μg 177Lu-DOTATOC with renal protection Test injection 2 (Cross over): 0.5 - 1 GBq ≤ 100 μg 161Tb-DOTA-LM3 with renal protection Not more than 6 weeks later patients will receive ~ 3 treatment cycles with 5.6 - 7.4 GBq 177Lu-DOTATOC in an interval of about 8 weeks (clinically established amount of activity). This is standard of care and not part of the study.
Both test injections will be with 161Tb-DOTA-LM3 (with different peptide amounts). The ~ 2 therapy cycles will be performed with 161Tb-DOTA-LM3. Test injection 1: ~ 2 GBq ≤ 100 μg 161Tb-DOTA-LM3 with renal protection Test injection 2: ~ 2 GBq ~ 300 μg 161Tb-DOTA-LM3 with renal protection Not more than 6 weeks later patients will receive ~ 2 cycles with ~ 3 GBq 161Tb-DOTA-LM3 in an interval of about 8 weeks if ~2 GBq is well tolerated
Start with the other peptide amount of 161Tb-DOTA-LM3. The ~ 2 therapy cycles will be performed with 161Tb-DOTA-LM3. Test injection 1: ~ 2 GBq ~ 300 μg 161Tb-DOTA-LM3 with renal protection Test injection 2: ~ 2 GBq ≤ 100 μg 161Tb-DOTA-LM3 with renal protection Not more than 6 weeks later patients will receive ~ 2 cycles with ~ 3 GBq 161Tb-DOTA-LM3 in an interval of about 8 weeks if ~2 GBq is well tolerated