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89Zr-DFO*-Trastuzumab PET in Patients With Gastric or Breast Cancer - a Pilot Study (HER Image)

Primary Purpose

Breast Cancer, Metastatic Breast Cancer, HER2-positive Breast Cancer

Status
Recruiting
Phase
Phase 1
Locations
Netherlands
Study Type
Interventional
Intervention
89Zr-DFO*-trastuzumab PET scan
Sponsored by
Amsterdam UMC, location VUmc
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional diagnostic trial for Breast Cancer focused on measuring PET Imaging, HER2, DFO*, trastuzumab

Eligibility Criteria

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

Inclusion Criteria: HER2+ breast cancer with metastatic disease starting (new) systemic treatment or HER2+ metastatic gastric cancer starting (new) systemic treatment. A recent (< 8 weeks of start of study) biopsy confirming HER2+. Able to undergo PET imaging procedures. At least one lesion of at least 1.5 cm amenable for PET imaging Age >18 years of age, willing and able to comply with the protocol as judged by the investigator. Signed written informed consent. Have a World Health Organisation (WHO) performance status of 0-2. Life expectancy of > 3 months. Have measurable disease based on RECIST 1.1. Adequate organ and bone marrow function, as deemed acceptable by the treating physician Women aged <50 years will be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of exogenous hormonal treatments and if they have luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in the post-menopausal range for the site. Women aged ≥ 50 years will be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of all exogenous hormonal treatments, had radiation-induced menopause with last menses >1 year ago, had chemotherapy-induced menopause with last menses >1 year ago. Females on hormone replacement therapy (HRT) and whose menopausal status is in doubt will be required to use one of the contraception methods outlined for women of child-bearing potential if they wish to continue their HRT during the study. Otherwise, they must discontinue HRT to allow confirmation of post-menopausal status prior to study enrolment. For most forms of HRT, at least 2-4 weeks will elapse between the cessation of therapy and the blood draw; this interval depends on the type and dosage of HRT. Following confirmation of their post-menopausal status, they can resume use of HRT during the study without use of a contraceptive method. Female patients of childbearing potential who are sexually active with a non-sterilized male partner must use at least one highly effective method of contraception from the time of screening and must agree to continue using such precautions for 7 months after the last dose of IMP. Female patients must refrain from breastfeeding while on study and for 7 months after the last dose of IMP. Female subjects must not donate, or retrieve for their own use, ova from the time of screening and throughout the study treatment period, and for at least 7 months after the final study drug administration. Exclusion Criteria: Contraindications for systemic treatment (as will be assigned by treating physician). Pregnant or lactating women. Prior allergic reaction to immunoglobulins or immunoglobulin allergy. Inability to comply with study procedures. Has substance abuse or any other medical conditions such as clinically significant cardiac or psychological conditions, that may, in the opinion of the investigator, interfere with the subject's participation in the clinical study or evaluation of the clinical study results.

Sites / Locations

  • AmsterdamUMCRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

89Zr-DFO*-trastuzumab PET

Arm Description

Patients undergoing the 89Zr-DFO*-trastuzumab PET-scans

Outcomes

Primary Outcome Measures

89Zr-DFO*-trastuzumab uptake (standard uptake values (SUVmean, %ID/kg) in normal organs/tissues and bloodpool.
89Zr-trastuzumab uptake (standard uptake values (SUVmean, %ID/kg) in normal organs/tissues and bloodpool in historical controls with HER2+ breast cancer (n = 20) who underwent 89Zr-trastuzumab PET imaging.

Secondary Outcome Measures

Tumor uptake: 89Zr-DFO*-trastuzumab uptake (SUV, %ID/kg) in tumor lesions
Tumor uptake: 89Zr-trastuzumab uptake (SUV, %ID/kg) in tumor lesions in historical controls with HER2+ breast cancer (n = 20) who underwent 89Zr-trastuzumab PET imaging.
Whole blood pharmacokinetics (PK) of 89Zr-DFO*-trastuzumab (Maximum Plasma Concentration (Cmax) µg/mL)
Whole blood PK of 89Zr-DFO*-trastuzumab (AUC µg/mL × h)
Plasma PK of 89Zr-DFO*-trastuzumab (Cmax in µg/mL)
Plasma PK of 89Zr-DFO*-trastuzumab (AUC µg/mL × h)
Image-derived PK for 89Zr-DFO*-trastuzumab (µg/mL)
For each timepoint, volumes of interest (VOIs) will be delineated in the aorta ascendens, and the activity of the VOI will be calculated afterwards for each timepoint. This calculated activity (in Bq/mL) will then be recalculated to the actual amount of tracer (in µg/mL), which is the image-derived PK.
Literature-derived PK for unlabelled trastuzumab (Cmax in µg/mL)
Literature-derived PK for unlabelled trastuzumab (AUC in µg/mL × day)
Visual PET imaging analysis of tumor uptake of 89Zr-DFO*-trastuzumab and 89Zr-trastuzumab
Tumor-to-blood ratio of 89Zr-DFO*-trastuzumab (whole blood and plasma as well as image derived)
Tumor-to-image derived blood uptake ratio of 89Zr-trastuzumab
HER2 expression measured by IHC on tumor biopsies

Full Information

First Posted
June 30, 2023
Last Updated
July 12, 2023
Sponsor
Amsterdam UMC, location VUmc
Collaborators
AstraZeneca
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1. Study Identification

Unique Protocol Identification Number
NCT05955833
Brief Title
89Zr-DFO*-Trastuzumab PET in Patients With Gastric or Breast Cancer - a Pilot Study
Acronym
HER Image
Official Title
89Zr-DFO*-Trastuzumab PET in Patients With Gastric or Breast Cancer - a Pilot Study
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Recruiting
Study Start Date
June 26, 2023 (Actual)
Primary Completion Date
April 30, 2024 (Anticipated)
Study Completion Date
April 30, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Amsterdam UMC, location VUmc
Collaborators
AstraZeneca

4. Oversight

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

5. Study Description

Brief Summary
The goal of this clinical trial is to test a new PET tracer in patients with HER2-positive breast or gastric cancer. This tracer is made of radioactively labeled trastuzumab, and can show where HER2 is present in the body using a PET-scan. For this research, the investigators make PET-scans in people with HER2-positive, metastasized breast- or gastric cancer. The investigators will investigate if the new HER2-tracer correctly shows all tumor lesions. In the future, this method may be useful to help predict who will benefit from certain HER2-directed therapies. Participants will be injected with the radioactive tracer once. After injection, participants will undergo 3 PET-scans. Each PET-scan will take a maximum of 60 minutes. The PET-scans are on separate days within a week after injection of the tracer (e.g. 1 day, 2 days and 4 days after injection). Furthermore, the investigators will take 7 blood samples (5 mL each). Participants are not required to stay at the hospital. The first 3 participants will undergo an extra PET-scan 1 - 2 hours after injection. The amount of radioactivity injected will be 37 MBq (± 10%).
Detailed Description
Positron emission tomography (PET) imaging with 89Zr-labeled trastuzumab can potentially discriminate between human epidermal growth factor 2 (HER2) positive and HER2-negative lesions in cancer patients. The obvious advantage over tumor biopsies is that PET imaging provides an overview regarding the heterogeneity of HER2-positivity of all lesions in the patient noninvasively at any given time. The use of a tracer with high specificity and low background signal is critical for accurately identifying positive lesions in patients. Earlier studies in patients with HER2-positive (HER2+) breast cancer and gastric cancer using 89Zr-trastuzumab led to the identification of HER2-positive tumor lesions. However, also lesions were missed and false-positive lesions were seen. Previous work has shown that organs like liver and spleen have significant uptake of 89Zr-trastuzumab. In addition, HER2-directed therapy is most effective in HER2-positive tumors, which are defined as immunohistochemistry (IHC) HER2 expression 3+ or HER2 2+ with gene amplification. Tumors with IHC 0, 1+ or 2+ without amplification are considered HER2-negative. To be able to discriminate between these expression levels with PET imaging, an excellent signal to background ratio is required. Recently, an improved 89Zr-labeled trastuzumab tracer has been developed using a different chelator for 89Zr binding, DFO*, which further improves stability of the 89Zr-labeled trastuzumab tracer. 89Zr-DFO*-trastuzumab preclinically shows improved specificity in uptake of tumor lesions while non-tumor related uptake in bone, liver and spleen is reduced, potentially improving the discrimination of HER2-positive tumor lesions in patients. The investigators hypothesize that the improved 89Zr-DFO*-trastuzumab tracer will lead to a reduced background uptake and thus a better discrimination of HER2-positive tumor lesions.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Breast Cancer, Metastatic Breast Cancer, HER2-positive Breast Cancer, Gastric Cancer, Metastatic Gastric Cancer, HER2-positive Gastric Cancer
Keywords
PET Imaging, HER2, DFO*, trastuzumab

7. Study Design

Primary Purpose
Diagnostic
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
6 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
89Zr-DFO*-trastuzumab PET
Arm Type
Experimental
Arm Description
Patients undergoing the 89Zr-DFO*-trastuzumab PET-scans
Intervention Type
Diagnostic Test
Intervention Name(s)
89Zr-DFO*-trastuzumab PET scan
Intervention Description
Patients will be administered 37 MBq 89Zr-DFO*-trastuzumab and undergo 3 PET scans on the total body PET scanner at day 1, day 2 and day 4 post-injection (p.i.). The first 3 patients will undergo an additional PET 1-2 h p.i. for dosimetry purposes. Three scans are needed for PK modelling and day 4 p.i. is chosen because it is the same time point as in historical controls. Blood samples for (radioactive) PK analysis will be taken at 10 min, 30 min, 1 h and 2 h p.i., and at every PET scan.
Primary Outcome Measure Information:
Title
89Zr-DFO*-trastuzumab uptake (standard uptake values (SUVmean, %ID/kg) in normal organs/tissues and bloodpool.
Time Frame
SUVmean on day 4 post injection.
Title
89Zr-trastuzumab uptake (standard uptake values (SUVmean, %ID/kg) in normal organs/tissues and bloodpool in historical controls with HER2+ breast cancer (n = 20) who underwent 89Zr-trastuzumab PET imaging.
Time Frame
SUVmean on day 4 post injection.
Secondary Outcome Measure Information:
Title
Tumor uptake: 89Zr-DFO*-trastuzumab uptake (SUV, %ID/kg) in tumor lesions
Time Frame
SUV on day 4 post injection.
Title
Tumor uptake: 89Zr-trastuzumab uptake (SUV, %ID/kg) in tumor lesions in historical controls with HER2+ breast cancer (n = 20) who underwent 89Zr-trastuzumab PET imaging.
Time Frame
SUV on day 4 post injection.
Title
Whole blood pharmacokinetics (PK) of 89Zr-DFO*-trastuzumab (Maximum Plasma Concentration (Cmax) µg/mL)
Time Frame
PK samples are taken at 10, 30, 60 and 120 min post injection, and at 1, 2 and 4 days post injection (at the day of each scan).
Title
Whole blood PK of 89Zr-DFO*-trastuzumab (AUC µg/mL × h)
Time Frame
PK samples are taken at 10, 30, 60 and 120 min post injection, and at 1, 2 and 4 days post injection (at the day of each scan).
Title
Plasma PK of 89Zr-DFO*-trastuzumab (Cmax in µg/mL)
Time Frame
PK samples are taken at 10, 30, 60 and 120 min post injection, and at 1, 2 and 4 days post injection (at the day of each scan).
Title
Plasma PK of 89Zr-DFO*-trastuzumab (AUC µg/mL × h)
Time Frame
PK samples are taken at 10, 30, 60 and 120 min post injection, and at 1, 2 and 4 days post injection (at the day of each scan).
Title
Image-derived PK for 89Zr-DFO*-trastuzumab (µg/mL)
Description
For each timepoint, volumes of interest (VOIs) will be delineated in the aorta ascendens, and the activity of the VOI will be calculated afterwards for each timepoint. This calculated activity (in Bq/mL) will then be recalculated to the actual amount of tracer (in µg/mL), which is the image-derived PK.
Time Frame
Day 1, 2 and 4 post injection (at each scan)
Title
Literature-derived PK for unlabelled trastuzumab (Cmax in µg/mL)
Time Frame
Day of injection till 7 days post injection.
Title
Literature-derived PK for unlabelled trastuzumab (AUC in µg/mL × day)
Time Frame
Day of injection till 7 days post injection.
Title
Visual PET imaging analysis of tumor uptake of 89Zr-DFO*-trastuzumab and 89Zr-trastuzumab
Time Frame
Day 1, 2 and 4 post injection.
Title
Tumor-to-blood ratio of 89Zr-DFO*-trastuzumab (whole blood and plasma as well as image derived)
Time Frame
Day 1, 2 and 4 post injection.
Title
Tumor-to-image derived blood uptake ratio of 89Zr-trastuzumab
Time Frame
Day 1, 2 and 4 post injection.
Title
HER2 expression measured by IHC on tumor biopsies
Time Frame
The biopsies are at most 8 weeks old at the day of injection, and will be compared with the data of the scans from day 1, 2 and 4 post injection.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: HER2+ breast cancer with metastatic disease starting (new) systemic treatment or HER2+ metastatic gastric cancer starting (new) systemic treatment. A recent (< 8 weeks of start of study) biopsy confirming HER2+. Able to undergo PET imaging procedures. At least one lesion of at least 1.5 cm amenable for PET imaging Age >18 years of age, willing and able to comply with the protocol as judged by the investigator. Signed written informed consent. Have a World Health Organisation (WHO) performance status of 0-2. Life expectancy of > 3 months. Have measurable disease based on RECIST 1.1. Adequate organ and bone marrow function, as deemed acceptable by the treating physician Women aged <50 years will be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of exogenous hormonal treatments and if they have luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in the post-menopausal range for the site. Women aged ≥ 50 years will be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of all exogenous hormonal treatments, had radiation-induced menopause with last menses >1 year ago, had chemotherapy-induced menopause with last menses >1 year ago. Females on hormone replacement therapy (HRT) and whose menopausal status is in doubt will be required to use one of the contraception methods outlined for women of child-bearing potential if they wish to continue their HRT during the study. Otherwise, they must discontinue HRT to allow confirmation of post-menopausal status prior to study enrolment. For most forms of HRT, at least 2-4 weeks will elapse between the cessation of therapy and the blood draw; this interval depends on the type and dosage of HRT. Following confirmation of their post-menopausal status, they can resume use of HRT during the study without use of a contraceptive method. Female patients of childbearing potential who are sexually active with a non-sterilized male partner must use at least one highly effective method of contraception from the time of screening and must agree to continue using such precautions for 7 months after the last dose of IMP. Female patients must refrain from breastfeeding while on study and for 7 months after the last dose of IMP. Female subjects must not donate, or retrieve for their own use, ova from the time of screening and throughout the study treatment period, and for at least 7 months after the final study drug administration. Exclusion Criteria: Contraindications for systemic treatment (as will be assigned by treating physician). Pregnant or lactating women. Prior allergic reaction to immunoglobulins or immunoglobulin allergy. Inability to comply with study procedures. Has substance abuse or any other medical conditions such as clinically significant cardiac or psychological conditions, that may, in the opinion of the investigator, interfere with the subject's participation in the clinical study or evaluation of the clinical study results.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Jelijn Knip, MD
Phone
+31 6 21 45 55 45
Email
j.knip1@amsterdamumc.nl
First Name & Middle Initial & Last Name or Official Title & Degree
Hylke Sebus, MD
Phone
+31 6 25 71 60 36
Email
h.j.sebus@amsterdamumc.nl
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
C.W. Menke-van der Houven van Oordt, MD, PhD
Organizational Affiliation
AmsterdamUMC
Official's Role
Principal Investigator
Facility Information:
Facility Name
AmsterdamUMC
City
Amsterdam
State/Province
Noord-Holland
ZIP/Postal Code
1081 HV
Country
Netherlands
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jelijn Knip, MD
Phone
+31 6 21 45 55 45
Email
j.knip1@amsterdamumc.nl
First Name & Middle Initial & Last Name & Degree
Hylke Sebus, MD
Phone
+31 6 25 71 60 36
Email
h.j.sebus@amsterdamumc.nl
First Name & Middle Initial & Last Name & Degree
C.W. Menke-van der Houven van Oordt, MD, PhD

12. IPD Sharing Statement

Plan to Share IPD
Yes

Learn more about this trial

89Zr-DFO*-Trastuzumab PET in Patients With Gastric or Breast Cancer - a Pilot Study

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