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Dosimetry, Safety and Potential Benefit of 177Lu-PSMA-617 Prior to Prostatectomy (LuTectomy)

Primary Purpose

Prostatic Neoplasms

Status
Active
Phase
Phase 1
Locations
Australia
Study Type
Interventional
Intervention
177Lu-PSMA-617
Sponsored by
Peter MacCallum Cancer Centre, Australia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Prostatic Neoplasms focused on measuring 177Lu-PSMA, Prostate Cancer, Radionuclide Therapy, Theranostics, prostate specific membrane antigen

Eligibility Criteria

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

Inclusion Criteria:

  • Patient has provided written informed consent.
  • Male patient aged 18 or over at the time of screening
  • Histologically confirmed adenocarcinoma of the prostate, in a patient scheduled for RP and PLND with curative intent
  • High or high-intermediate risk localised or locoregional prostate cancer (HRCaP) by European Association of Urology (EAU) criteria, including any of the following:

    • PSA > 20 ng/mL
    • ISUP grade group 3-5
    • Clinical T-stage by digital rectal examination (DRE) of T2c or higher
    • N1 disease (involvement of lymph nodes at or below the bifurcation of the common iliac arteries)
    • defined radiologically (CT/ MRI, or PSMA PET).
  • High PSMA avidity on 68Ga-PSMA PET/CT, defined as an SUVmax of ≥ 20
  • Normal baseline haematological function; haemoglobin 13.5-17.5g/dl), total white blood cell count (4-11 x 109/l), platelets (150-400 x 109/l), neutrophils (2-7.5 x 109/l) and lymphocytes (1-4 x 109/l)
  • Normal baseline serum biochemistry; sodium 135-145 nmol/l, potassium 3.5-5 nmol/l, chloride 98-108 nmol/l, urea 3-9.2 nmol/l, creatinine 60-120μmol/l
  • Willing and able to comply with all study requirements including all treatments and required assessments including follow up

Exclusion Criteria:

  • Prostate cancer with significant neuroendocrine or other rare variant pathology
  • Prior treatment for prostate cancer including radiotherapy and/or androgen deprivation therapy.
  • Evidence of metastatic disease involving bone, viscera, or lymph nodes superior to the common iliac bifurcation based on CT, MRI, WBBS or PSMA PET/CT.
  • Renal impairment [GFR < 60mL/min].
  • Sjogren's syndrome.
  • A history of or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the patient's participation for the full duration of the trial, or is not in the best interest of the patient to participate, in the opinion of the treating investigator.

Sites / Locations

  • Peter MacCallum Cancer Centre

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

177Lu-PSMA-617 followed by prostatectomy

Arm Description

177Lu-PSMA-617 followed by prostatectomy

Outcomes

Primary Outcome Measures

To determine the radiation absorbed dose in the prostate and involved lymph nodes following one or two administrations of Lu-PSMA in men with HRCaP prior to radical prostatectomy
Establishing the absorbed radiation dose in the prostate and involved lymph nodes (Gy)

Secondary Outcome Measures

To evaluate the imaging response to therapy using PSMA-PET
PSMA PET response to therapy (complete metabolic response, partial metabolic response, stable metabolic disease, progressive metabolic disease)
To evaluate the biochemical response to therapy
PSA response
To evaluate pathologic response in the prostate following prostatectomy
Pathological response (complete response, minimal residual disease)
To evaluate toxicity of Lu-PSMA
Assessment of toxicity of Lu-PSMA using Common Terminology Criteria for Adverse Events (CTCAE) v5
To evaluate the surgical safety of prostatectomy following Lu-PSMA
Surgical safety will be assessed using using the Clavien-Dindo classification of surgical complications
To evaluate overall health-related Quality of Life (QoL)
QoL indices will be scored using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire
To evaluate prostate cancer health-related Quality of Life (QoL)
QoL indices will be scored using European Organisation for Research and Treatment of Cancer (EORTC) QLQ-PR25 questionnaire
To evaluate patient function and bother after prostatectomy
Indices will be scored using the Expanded Prostate Cancer Index Composite (EPIC)-26 questionnaire

Full Information

First Posted
May 21, 2020
Last Updated
August 17, 2023
Sponsor
Peter MacCallum Cancer Centre, Australia
Collaborators
Movember Foundation, Medical Research Future Fund, Endocyte, E.J. Whitten Foundation Prostate Cancer Research Centre
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1. Study Identification

Unique Protocol Identification Number
NCT04430192
Brief Title
Dosimetry, Safety and Potential Benefit of 177Lu-PSMA-617 Prior to Prostatectomy
Acronym
LuTectomy
Official Title
Study of the Dosimetry, Safety and Potential Benefit of 177Lu-PSMA-617 Radionuclide Therapy Prior to Radical Prostatectomy in Men With High-risk Localised Prostate Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
August 6, 2020 (Actual)
Primary Completion Date
December 22, 2022 (Actual)
Study Completion Date
December 30, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Peter MacCallum Cancer Centre, Australia
Collaborators
Movember Foundation, Medical Research Future Fund, Endocyte, E.J. Whitten Foundation Prostate Cancer Research Centre

4. Oversight

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

5. Study Description

Brief Summary
This clinical trial will evaluate the dosimetry, efficacy and toxicity of Lu-PSMA in men with high PSMA-expressing high-risk localized or locoregional advanced prostate cancer (HRCaP) undergoing radical prostatectomy (RP) and pelvic lymph node dissection (PLND)
Detailed Description
This open label, phase I/II non-randomised clinical trial will evaluate the dosimetry, efficacy and toxicity of Lu-PSMA in men with high PSMA-expressing high-risk localized or locoregional advanced prostate cancer (HRCaP) undergoing radical prostatectomy (RP) and pelvic lymph node dissection (PLND). Patients will receive one or two cycles of 177Lu-PSMA followed by surgery. The primary objective is to determine the radiation absorbed dose in the prostate and involved lymph nodes. Secondary objectives include evaluating imaging response to therapy using PSMA-PET, biochemical response, pathological response, adverse effects of Lu-PSMA and surgical safety, and health-related Quality of Life (QoL).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Prostatic Neoplasms
Keywords
177Lu-PSMA, Prostate Cancer, Radionuclide Therapy, Theranostics, prostate specific membrane antigen

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
20 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
177Lu-PSMA-617 followed by prostatectomy
Arm Type
Experimental
Arm Description
177Lu-PSMA-617 followed by prostatectomy
Intervention Type
Drug
Intervention Name(s)
177Lu-PSMA-617
Other Intervention Name(s)
177Lu-PSMA, [177Lu]Lu-PSMA-617, Lu-PSMA
Intervention Description
Patients 1-10 will be given 5GBq of 177Lu-PSMA. Patients 11-20 will be given 2 cycles of 5GBq of 177Lu-PSMA, separated by 6 weeks.
Primary Outcome Measure Information:
Title
To determine the radiation absorbed dose in the prostate and involved lymph nodes following one or two administrations of Lu-PSMA in men with HRCaP prior to radical prostatectomy
Description
Establishing the absorbed radiation dose in the prostate and involved lymph nodes (Gy)
Time Frame
Determined using imaging at 4, 24 and 96 hrs after administration of Lu-PSMA
Secondary Outcome Measure Information:
Title
To evaluate the imaging response to therapy using PSMA-PET
Description
PSMA PET response to therapy (complete metabolic response, partial metabolic response, stable metabolic disease, progressive metabolic disease)
Time Frame
6 weeks following final administration of Lu-PSMA
Title
To evaluate the biochemical response to therapy
Description
PSA response
Time Frame
6 weeks following final administration of Lu-PSMA
Title
To evaluate pathologic response in the prostate following prostatectomy
Description
Pathological response (complete response, minimal residual disease)
Time Frame
After prostatectomy, approximately 6 weeks from final Lu-PSMA administration
Title
To evaluate toxicity of Lu-PSMA
Description
Assessment of toxicity of Lu-PSMA using Common Terminology Criteria for Adverse Events (CTCAE) v5
Time Frame
Until 8 weeks after prostatectomy
Title
To evaluate the surgical safety of prostatectomy following Lu-PSMA
Description
Surgical safety will be assessed using using the Clavien-Dindo classification of surgical complications
Time Frame
Until 8 weeks after prostatectomy
Title
To evaluate overall health-related Quality of Life (QoL)
Description
QoL indices will be scored using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire
Time Frame
baseline, immediately before 2nd cycle Lu-PSMA, immediately before surgery, 8 weeks post surgery, annually up to 3 years
Title
To evaluate prostate cancer health-related Quality of Life (QoL)
Description
QoL indices will be scored using European Organisation for Research and Treatment of Cancer (EORTC) QLQ-PR25 questionnaire
Time Frame
baseline, immediately before 2nd cycle Lu-PSMA, immediately before surgery, 8 weeks post surgery, annually up to 3 years
Title
To evaluate patient function and bother after prostatectomy
Description
Indices will be scored using the Expanded Prostate Cancer Index Composite (EPIC)-26 questionnaire
Time Frame
baseline, immediately before 2nd cycle Lu-PSMA, immediately before surgery, 8 weeks post surgery, annually up to 3 years
Other Pre-specified Outcome Measures:
Title
To determine the time to biochemical recurrence (BCR) [PSA>0.2 ng/mL post-RP]
Description
Biochemical recurrence (BCR) will be measured from the time of surgery to the first rise of the PSA to ≥0.2 ng/mL
Time Frame
To be determined as it is an exploratory endpoint up to 3 years
Title
To determine the relationship between PSMA PET imaging parameters and absorbed dose
Description
Determination of the relationship between screening PSMA PET imaging parameters including molecular tumour volume parameters and absorbed dose in the prostate and involved lymph nodes
Time Frame
baseline PSMA PET within 45 days of Lu-PSMA administration
Title
To identify tissue and blood and serum biomarkers associated with clinical outcomes
Description
Determination of relevant predictive biomarkers associated with treatment outcomes and response
Time Frame
To be determined as it is an exploratory endpoint up to 3 years

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient has provided written informed consent. Male patient aged 18 or over at the time of screening Histologically confirmed adenocarcinoma of the prostate, in a patient scheduled for RP and PLND with curative intent High or high-intermediate risk localised or locoregional prostate cancer (HRCaP) by European Association of Urology (EAU) criteria, including any of the following: PSA > 20 ng/mL ISUP grade group 3-5 Clinical T-stage by digital rectal examination (DRE) of T2c or higher N1 disease (involvement of lymph nodes at or below the bifurcation of the common iliac arteries) defined radiologically (CT/ MRI, or PSMA PET). High PSMA avidity on 68Ga-PSMA PET/CT, defined as an SUVmax of ≥ 20 Normal baseline haematological function; haemoglobin 13.5-17.5g/dl), total white blood cell count (4-11 x 109/l), platelets (150-400 x 109/l), neutrophils (2-7.5 x 109/l) and lymphocytes (1-4 x 109/l) Normal baseline serum biochemistry; sodium 135-145 nmol/l, potassium 3.5-5 nmol/l, chloride 98-108 nmol/l, urea 3-9.2 nmol/l, creatinine 60-120μmol/l Willing and able to comply with all study requirements including all treatments and required assessments including follow up Exclusion Criteria: Prostate cancer with significant neuroendocrine or other rare variant pathology Prior treatment for prostate cancer including radiotherapy and/or androgen deprivation therapy. Evidence of metastatic disease involving bone, viscera, or lymph nodes superior to the common iliac bifurcation based on CT, MRI, WBBS or PSMA PET/CT. Renal impairment [GFR < 60mL/min]. Sjogren's syndrome. A history of or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the patient's participation for the full duration of the trial, or is not in the best interest of the patient to participate, in the opinion of the treating investigator.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Declan Murphy
Organizational Affiliation
Peter MacCallum Cancer Centre, Australia
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Michael S Hofman
Organizational Affiliation
Peter MacCallum Cancer Centre, Australia
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
John Violet
Organizational Affiliation
Peter MacCallum Cancer Centre, Australia
Official's Role
Principal Investigator
Facility Information:
Facility Name
Peter MacCallum Cancer Centre
City
Melbourne
State/Province
Victoria
ZIP/Postal Code
3000
Country
Australia

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Dosimetry, Safety and Potential Benefit of 177Lu-PSMA-617 Prior to Prostatectomy

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