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Radioimmunotherapy With Lu-177 Labeled 6A10 Fab-fragments in Patients With Glioblastoma After Standard Treatment (RIT in GBM)

Primary Purpose

Glioblastom WHO Grade 4

Status
Recruiting
Phase
Phase 1
Locations
Germany
Study Type
Interventional
Intervention
Lu-177 labeled 6A10-Fab-fragments
Sponsored by
University Hospital Muenster
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Glioblastom WHO Grade 4 focused on measuring Carbonic anhydrase XII (CA XII), Intracavitary radioimmunotherapy, Fab fragment 6A10

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Written patient consent after comprehensive information
  • Age between 18 and 70 years
  • Primary supratentorial glioblastoma, after standard therapy (fluorescence-guided surgery, radio-chemotherapy, concomitant + adjuvant chemotherapy), with no or minimal tumor residue (tumor volume less than 1.0 cm3) at least 6 months after surgery
  • Histological verification of glioblastoma and CA 12-expression of tumor cells confirmed
  • Karnofsky-score ≥ 70
  • Volume of resection cavity 5-25 cm3
  • Male and female patients with reproductive potential must use an approved contraceptive method
  • Pre-menopausal female patients with childbearing potential: a negative serum pregnancy test must be obtained prior to treatment start
  • Adequate bone marrow reserve: white blood cell (WBC) count ≥3000/μl, granulocyte count >1500/μl, platelets ≥100000/μl, hemoglobin ≥ 10 g/dl
  • Adequate liver function: bilirubin < 1.5 times above upper limit of normal range (ULN), alanine transaminase (ALT/SGPT) and aspartate transaminase (AST/SGOT) < 3 times ULN. In the case of documented or suspected Gilbert's disease bilirubin < 3 times ULN.
  • Blood clotting: INR (=PT) and PTT within acceptable limits according to the investigator
  • Adequate renal function: creatinine < 3 times above ULN; eGFR > (or equal) 60 ml/min

Exclusion Criteria:

  • Patient unable to undergo imaging by CT, PET or contrast-enhanced MRI for whatever reason (i.e., pacemaker)
  • GBM with intraventricular access
  • Significant leakage of radioactivity into CSF spaces or ventricles
  • Other invasive malignancy within 2 years (except for non-invasive malignancies such as cervical carcinoma in situ, non-melanomatous carcinoma of the skin or ductal carcinoma in situ of the breast that has/have been surgically cured)
  • Breastfeeding women
  • Past medical history of diseases with poor prognosis, e.g., severe coronary heart disease, heart failure (NYHA III/IV), severe and poorly controlled diabetes, immune deficiency, residual deficits after stroke, severe mental retardation, pre-existing neurological diseases except those related to glioblastoma or other serious concomitant systemic disorders incompatible with the study (at the discretion of the investigator)
  • Any active infection (at the discretion of the investigator)
  • Participation in another clinical trial with therapeutic intervention or use of any other therapeutic interventional agent other than the standard therapy since diagnosis of glioblastoma
  • Allergy against known constituents of study medication

Sites / Locations

  • Klinik für Neurochirurgie des Universitätsklinikums EssenRecruiting
  • Klinik für Nuklearmedizin, Strahlenklinik des Universitätsklinikums EssenRecruiting
  • Klinik für Allgemeine Neurochirurgie des Universitätsklinikums KölnRecruiting
  • Klinik für Nuklearmedizin des Universitätsklinikums KölnRecruiting
  • Klinik für Nuklearmedizin der Universität MünsterRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Lu-177-labeled-6A10Fab-fragments

Arm Description

The patient will receive a predetermined dose of Lu-177-labeled- 6A10Fab-fragments via the intracavitary reservoir. Patients will receive 3 RIT-cycles with an interval of 4 weeks. The total activity, adjusted to the volume of the RC, will be injected in 3 fractions with 50%, 25% and 25% of the total activity to achieve the desired boost to the 2 cm margin.

Outcomes

Primary Outcome Measures

Maximum Tolerated Dose (MTD)
Determine maximum tolerated dose (MTD) and safety of adjuvant radio-immunotherapy (RIT) with Lu-177 labeled 6A10-Fab-fragments
Safety of the adjuvant radio-immunotherapy
Determining safety by assessing all new neurological, hematological and other AEs CTC grade 2 or higher

Secondary Outcome Measures

Evaluation of pharmacokinetics of Lu-177 labeled 6A10 Fab fragments
Determining absorbed dose to the 2 cm shell of the resection cavity (based on a series of SPECT/CTs of the head 2 ,24 ,48, 72 hours post injection and on day 5-7). Determining absorbed dose values for the kidneys, the liver, the active marrow (based on a series of SPECT/CTs of the abdomen 2 ,24 ,48, 72 hours post injection and on day 5-7)
Progression-free survival (PFS)
Determining 24 weeks Progression-Free-Survival (PFS), defined from the day of inclusion

Full Information

First Posted
July 25, 2022
Last Updated
May 16, 2023
Sponsor
University Hospital Muenster
Collaborators
Isotope Technologies Munich (ITM) Oncologics, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH)
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1. Study Identification

Unique Protocol Identification Number
NCT05533242
Brief Title
Radioimmunotherapy With Lu-177 Labeled 6A10 Fab-fragments in Patients With Glioblastoma After Standard Treatment
Acronym
RIT in GBM
Official Title
A Phase I Trial to Determine the Maximum Tolerated Dose and Patient-specific Dosimetry of Fractionated Intracavitary Radioimmunotherapy With Lu-177 Labeled 6A10 Fab-fragments in Patients With Glioblastoma After Standard Treatment
Study Type
Interventional

2. Study Status

Record Verification Date
May 2022
Overall Recruitment Status
Recruiting
Study Start Date
June 2023 (Anticipated)
Primary Completion Date
September 2023 (Anticipated)
Study Completion Date
December 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University Hospital Muenster
Collaborators
Isotope Technologies Munich (ITM) Oncologics, Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Locoregional, intracavitary radioimmunotherapy (iRIT) with a newly developed radioimmunoconjugate (Lu-177 labeled 6A10-Fab-fragments) will be used to prevent or postpone tumour recurrence in patients with GBM following standard therapy . Following study objectives will be analyzed: Determining the Maximum Tolerated Dose (MTD) Determining safety by assessing all new neurological, hematological and other AEs CTC grade 2 or higher Determining absorbed dose to the 2 cm shell of the resection cavity (based on a series of SPECT/CTs of the head 2h,24h,48h, 72h p.i. and on day 5-7) Determining absorbed dose values for the kidneys, the liver, the active marrow (based on a series of SPECT/CTs of the abdomen 2h,24h,48h, 72h p.i. and on day 5-7) Determining 24 weeks Progression-Free-Survival (PFS), defined from the day of inclusion
Detailed Description
In glioblastoma (GBM), tumour recurrence occurs adjacent to the initial tumor resection cavity in about 85% of cases (Albert et al., 1994; Bashir et al., 1988; Nestler et al., 2015). Therefore, local treatment concepts seem crucial for effective recurrence treatment strategies. We consider locoregional, intracavitary radioimmunotherapy (iRIT) to be a new therapeutic approach to delay or prevent the development of local tumour regrowth in GBM patients. By applying a radioimmunoconjugate (RIC) into the surgically created resection cavity (RC) the blood-brain barrier can effectively be by-passed, allowing the a deposit of high radiation doses locally while sparing sensitive organs like the bone marrow and the kidneys. LuCaFab (Lu-177 labeled 6A10- Fab-fragment) is a carbonic anhydrase XII-specific antibody Fab fragment developed by Helmholtz Munich, labeled with ITM's highly pure medical radioisotope, lutetium-177. (ITM IsotopeTechnologies Munich SE). Patients with GBM after standard therapy (surgery by radio-chemotherapy concomitant and adjuvant chemotherapy) Are eligible for the study. Patients will receive the calculated total doses of Lu-177-labeled 6A10-Fabs in three fractions with an interval of 4 weeks between injections, administered into the tumour cavity via an implanted reservoir. A patient specific dosing strategy will be applied and will depend on the individual RC volume. This investigator-initiated trial is sponsored by the University Hospital Münster, conducted in hospitals in Münster, Essen, Cologne, and the Grosshadern Hospital Munich, and supported by ITM and Helmholtz Munich.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Glioblastom WHO Grade 4
Keywords
Carbonic anhydrase XII (CA XII), Intracavitary radioimmunotherapy, Fab fragment 6A10

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Sequential Assignment
Model Description
A modified 3+3 design is used. The applied dose of Lu-177-labeled-6A10Fab-fragments to the resection cavity will be escalated in three cohorts until the maximum tolerated dose (MTD) is determined.
Masking
None (Open Label)
Allocation
N/A
Enrollment
15 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Lu-177-labeled-6A10Fab-fragments
Arm Type
Experimental
Arm Description
The patient will receive a predetermined dose of Lu-177-labeled- 6A10Fab-fragments via the intracavitary reservoir. Patients will receive 3 RIT-cycles with an interval of 4 weeks. The total activity, adjusted to the volume of the RC, will be injected in 3 fractions with 50%, 25% and 25% of the total activity to achieve the desired boost to the 2 cm margin.
Intervention Type
Drug
Intervention Name(s)
Lu-177 labeled 6A10-Fab-fragments
Intervention Description
The antibody 6A10 is a specific CA12 Inhibitor, a highly specific glioma cell-associated enzyme; all tumor cells are CA12-positive, while its expression in normal brain is very low, and Lu-177 has a comparable β-emission, but a significantly low γ-Emission.
Primary Outcome Measure Information:
Title
Maximum Tolerated Dose (MTD)
Description
Determine maximum tolerated dose (MTD) and safety of adjuvant radio-immunotherapy (RIT) with Lu-177 labeled 6A10-Fab-fragments
Time Frame
Through study completion, ca 1 ½ years
Title
Safety of the adjuvant radio-immunotherapy
Description
Determining safety by assessing all new neurological, hematological and other AEs CTC grade 2 or higher
Time Frame
Through study completion, ca 1 ½ years
Secondary Outcome Measure Information:
Title
Evaluation of pharmacokinetics of Lu-177 labeled 6A10 Fab fragments
Description
Determining absorbed dose to the 2 cm shell of the resection cavity (based on a series of SPECT/CTs of the head 2 ,24 ,48, 72 hours post injection and on day 5-7). Determining absorbed dose values for the kidneys, the liver, the active marrow (based on a series of SPECT/CTs of the abdomen 2 ,24 ,48, 72 hours post injection and on day 5-7)
Time Frame
After first application: 2 ,24 ,48, 72 hours post injection and on day 5-7. After second and third application.
Title
Progression-free survival (PFS)
Description
Determining 24 weeks Progression-Free-Survival (PFS), defined from the day of inclusion
Time Frame
Through study completion, an average of 18 months
Other Pre-specified Outcome Measures:
Title
Overall survival (OS)
Description
OS is defined as the period of time from the start of a study or the treatment in a study until the death of the patient
Time Frame
2 years from the day of inclusion

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Written patient consent after comprehensive information Age between 18 and 70 years Primary supratentorial glioblastoma, after standard therapy (fluorescence-guided surgery, radio-chemotherapy, concomitant + adjuvant chemotherapy), with no or minimal tumor residue (tumor volume less than 1.0 cm3) at least 6 months after surgery Histological verification of glioblastoma and CA 12-expression of tumor cells confirmed Karnofsky-score ≥ 70 Volume of resection cavity 5-25 cm3 Male and female patients with reproductive potential must use an approved contraceptive method Pre-menopausal female patients with childbearing potential: a negative serum pregnancy test must be obtained prior to treatment start Adequate bone marrow reserve: white blood cell (WBC) count ≥3000/μl, granulocyte count >1500/μl, platelets ≥100000/μl, hemoglobin ≥ 10 g/dl Adequate liver function: bilirubin < 1.5 times above upper limit of normal range (ULN), alanine transaminase (ALT/SGPT) and aspartate transaminase (AST/SGOT) < 3 times ULN. In the case of documented or suspected Gilbert's disease bilirubin < 3 times ULN. Blood clotting: INR (=PT) and PTT within acceptable limits according to the investigator Adequate renal function: creatinine < 3 times above ULN; eGFR > (or equal) 60 ml/min Exclusion Criteria: Patient unable to undergo imaging by CT, PET or contrast-enhanced MRI for whatever reason (i.e., pacemaker) GBM with intraventricular access Significant leakage of radioactivity into CSF spaces or ventricles Other invasive malignancy within 2 years (except for non-invasive malignancies such as cervical carcinoma in situ, non-melanomatous carcinoma of the skin or ductal carcinoma in situ of the breast that has/have been surgically cured) Breastfeeding women Past medical history of diseases with poor prognosis, e.g., severe coronary heart disease, heart failure (NYHA III/IV), severe and poorly controlled diabetes, immune deficiency, residual deficits after stroke, severe mental retardation, pre-existing neurological diseases except those related to glioblastoma or other serious concomitant systemic disorders incompatible with the study (at the discretion of the investigator) Any active infection (at the discretion of the investigator) Participation in another clinical trial with therapeutic intervention or use of any other therapeutic interventional agent other than the standard therapy since diagnosis of glioblastoma Allergy against known constituents of study medication
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Walter Stummer, Prof. Dr.
Phone
0049251/83-47472
Email
walter.stummer@ukmuenster.de
First Name & Middle Initial & Last Name or Official Title & Degree
Nils Warneke, Dr. med.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Walter Stummer, Prof.
Organizational Affiliation
University Hospital Muenster, Klinik und Poliklinik für Neurochirurgie
Official's Role
Principal Investigator
Facility Information:
Facility Name
Klinik für Neurochirurgie des Universitätsklinikums Essen
City
Essen
ZIP/Postal Code
45147
Country
Germany
Individual Site Status
Recruiting
Facility Name
Klinik für Nuklearmedizin, Strahlenklinik des Universitätsklinikums Essen
City
Essen
ZIP/Postal Code
45147
Country
Germany
Individual Site Status
Recruiting
Facility Name
Klinik für Allgemeine Neurochirurgie des Universitätsklinikums Köln
City
Köln
ZIP/Postal Code
50937
Country
Germany
Individual Site Status
Recruiting
Facility Name
Klinik für Nuklearmedizin des Universitätsklinikums Köln
City
Köln
ZIP/Postal Code
50937
Country
Germany
Individual Site Status
Recruiting
Facility Name
Klinik für Nuklearmedizin der Universität Münster
City
Münster
ZIP/Postal Code
48149
Country
Germany
Individual Site Status
Recruiting

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
29571067
Citation
Fiedler L, Kellner M, Gosewisch A, Oos R, Boning G, Lindner S, Albert N, Bartenstein P, Reulen HJ, Zeidler R, Gildehaus FJ. Evaluation of 177Lu[Lu]-CHX-A''-DTPA-6A10 Fab as a radioimmunotherapy agent targeting carbonic anhydrase XII. Nucl Med Biol. 2018 May;60:55-62. doi: 10.1016/j.nucmedbio.2018.02.004. Epub 2018 Mar 4.
Results Reference
background
PubMed Identifier
31682835
Citation
Alterio V, Kellner M, Esposito D, Liesche-Starnecker F, Bua S, Supuran CT, Monti SM, Zeidler R, De Simone G. Biochemical and Structural Insights into Carbonic Anhydrase XII/Fab6A10 Complex. J Mol Biol. 2019 Dec 6;431(24):4910-4921. doi: 10.1016/j.jmb.2019.10.022. Epub 2019 Nov 1.
Results Reference
background
PubMed Identifier
21298264
Citation
Battke C, Kremmer E, Mysliwietz J, Gondi G, Dumitru C, Brandau S, Lang S, Vullo D, Supuran C, Zeidler R. Generation and characterization of the first inhibitory antibody targeting tumour-associated carbonic anhydrase XII. Cancer Immunol Immunother. 2011 May;60(5):649-58. doi: 10.1007/s00262-011-0980-z. Epub 2011 Feb 5.
Results Reference
background
PubMed Identifier
24030978
Citation
Gondi G, Mysliwietz J, Hulikova A, Jen JP, Swietach P, Kremmer E, Zeidler R. Antitumor efficacy of a monoclonal antibody that inhibits the activity of cancer-associated carbonic anhydrase XII. Cancer Res. 2013 Nov 1;73(21):6494-503. doi: 10.1158/0008-5472.CAN-13-1110. Epub 2013 Sep 12.
Results Reference
background
PubMed Identifier
16212811
Citation
Proescholdt MA, Mayer C, Kubitza M, Schubert T, Liao SY, Stanbridge EJ, Ivanov S, Oldfield EH, Brawanski A, Merrill MJ. Expression of hypoxia-inducible carbonic anhydrases in brain tumors. Neuro Oncol. 2005 Oct;7(4):465-75. doi: 10.1215/S1152851705000025.
Results Reference
background
PubMed Identifier
30426805
Citation
Supuran CT. Carbonic anhydrase inhibitors as emerging agents for the treatment and imaging of hypoxic tumors. Expert Opin Investig Drugs. 2018 Dec;27(12):963-970. doi: 10.1080/13543784.2018.1548608. Epub 2018 Nov 22.
Results Reference
background

Learn more about this trial

Radioimmunotherapy With Lu-177 Labeled 6A10 Fab-fragments in Patients With Glioblastoma After Standard Treatment

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