Phase 1 Study of AlphaMedix™ in Adult Subjects With SSTR (+) NET
Primary Purpose
Neuroendocrine Tumor
Status
Unknown status
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
AlphaMedix
Sponsored by
About this trial
This is an interventional treatment trial for Neuroendocrine Tumor focused on measuring somatostatin receptor
Eligibility Criteria
Inclusion Criteria:
- ECOG status 0-2.
- Life expectancy of at least 12 weeks.
- Histologically confirmed diagnosis of SSTR (+) NET, unresectable or metastatic.
- Measurable disease per RECIST 1.1 on CT/MRI scans, defined as at least 1 lesion with ≥ 1 cm in longest diameter (LD) (lymph nodes along short axis).
- Appropriate diagnostic imaging studies, at the discretion of the PI including but not limited to CT, MRI, 18F-FDG PET/CT, NAF PET/CT bone scan, ultrasound, etc. of the tumor region or suspected area within the 4 weeks of dosing day.
- SSTR(+) disease, as evidenced by available FDA approved SSTR imaging (SRI) within 4 weeks prior to the first cycle.
- All FDA-approved therapies for which the subject is eligible have been exhausted.
- Recent blood test results (within 2 weeks pre-dose) as follows: Sufficient bone marrow capacity as defined by white blood cell (WBC) ≥2,500/µl and WBC ≥2,000/µl for subsequent cycles; platelets ≥ 100,000/µl for the first treatment and ≥75,000 for the subsequent therapies, hemoglobin (HgB) ≥8.9 g/dl for the first treatment and 8.0 g/dl for the subsequent therapies, ANC ≥1,500/µl for the first treatment and ≥1,000/µl; for the subsequent therapies; ALT, AST values ≤3 times upper limit of normal (ULN); Bilirubin: ≤3 times ULN; Serum creatinine ≤150 µmol/liter or 1.7 mg/dl; Negative pregnancy test in women capable of child-bearing within 48 hours of administration; Serum albumin > 3.0 g/L (<3.0 g/L may be acceptable at the discretion of PI, if PT, PTT, and INR are within normal range)
Exclusion Criteria:
- Prior whole-body radiotherapy and PRRT using 177Lu/90Y/111In- DOTATATE/DOTATOC or TAT
- Known hypersensitivity to 68Gallium, Octreotate, or any of the excipients of 68Ga-DOTATATE, AA infusion or AlphaMedix™.
- Therapeutic use of any somatostatin analogue, including Sandostatin® LAR (within 28 days) and Sandostatin® (within 1 day) prior to administration of investigational drug.
- Subjects with unusual hematological parameters, including an increased mean corpuscular volume (MCV) (>100,000), and especially in those who had previous chemotherapy, the advice of a hematologist should be sought for adequate further work-up to rule out myelodysplastic syndrome (MDS).
- Any subject who is taking concomitant medications that decrease renal function (such as aminoglycoside antibiotics).
- Female subjects who are pregnant, lactating or women of childbearing potential not willing to practice effective contraceptive techniques during the study period and for 8 weeks post-injection or male subjects who have female partners of childbearing potential not willing to practice abstinence or effective contraception, during the study period and for 8 weeks post-injection.
- Current somatic or psychiatric disease/condition that may interfere with the objectives and assessments of the study.
- Indication for surgical lesion removal with curative potential
- Known brain metastases; unless these metastases have been treated and stabilized 6 months prior to enrollment
- Completion of: (1) cytotoxic chemotherapy for less than 6 weeks; (2) a biological agent for less than 5 half-lives; and (3) radiation therapy for less than 6 weeks prior to study enrolment,
- Uncontrolled congestive heart failure; subjects suspected of having this condition need to show ejection fraction of >55% as determined by multigated acquisition (MUGA) scan.
- Carcinoid heart disease: Prior history of torsade de pointe, or congenital long QT syndrome; Conditions with screening ECG repolarization difficult to interpret, or showing significant abnormalities. This includes, but is not limited to: high degree AV block, pacemaker, atrial fibrillation or flutter; QTcF interval > 480 msec on screening ECG; Significant hypokalemia at screening (Potassium <3.5 mMol/L); Significant hypomagnesemia at screening (Mg++ <0.7 mMol/L)
- GFR < 35 mL/min
Sites / Locations
- Excel Diagnostics and Nuclear Oncology CenterRecruiting
- Excel Diagnostics and Nuclear Oncology CenterRecruiting
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
AlphaMedix
Arm Description
There is only a single treatment arm.
Outcomes
Primary Outcome Measures
To determine dose-limiting toxicity (DLT)
DLT is defined as non-hematological toxicity - all Grade 4 and Grade 3 (except alk. phos.) that is not responsive to NMT 72 hours of supportive care - and all hematological toxicity that does not recover to NMT than Grade 2 within 8 wks of dose administration.
To determine the maximum tolerated dose (MTD)
The MTD is the dose level below that which 2 out of 6 subjects in a cohort have DLT.
Secondary Outcome Measures
Partial or complete response assessed by modified RECIST v1.1
CT/MRI or 18FDG-PET/CT (for patients who are FDG-avid at baseline) will be used to measure tumor size
To determine effective blood clearance and cumulative blood activity of 212-Pb
Blood will be taken at Time 0, 1 hr, 4 hr and 24 hr post-injection and measured for activity in an auto gamma counter
To determine the rate and extent of 212-Pb elimination in urine
Bladder will be emptied just prior to injection and qualitative urine collections will be done 0-1 hr, 1-4 hr and 4-24 hr post-injection and measured for activity in an auto gamma counter
Incidence of treatment-related AEs and SAEs as assessed by CTCAE v. 4
AEs will be recorded both spontaneously by the patient and at all safety follow ups (2 wks, 4 wks, 6 wks, 8 wks post each injection and 3 mo, 6 mo, and 10 mo post last injection)
Full Information
NCT ID
NCT03466216
First Posted
January 11, 2018
Last Updated
August 17, 2021
Sponsor
Radiomedix, Inc.
Collaborators
Orano Med LLC
1. Study Identification
Unique Protocol Identification Number
NCT03466216
Brief Title
Phase 1 Study of AlphaMedix™ in Adult Subjects With SSTR (+) NET
Official Title
A Phase 1, Non-Randomized, Open-Label, Dose Escalation, Single-Center Study to Determine the Safety, Bio-distribution, and Preliminary Effectiveness of AlphaMedix™ in Adult Subjects With SSRT(+) NETs.
Study Type
Interventional
2. Study Status
Record Verification Date
August 2021
Overall Recruitment Status
Unknown status
Study Start Date
February 5, 2018 (Actual)
Primary Completion Date
July 1, 2022 (Anticipated)
Study Completion Date
July 1, 2022 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Radiomedix, Inc.
Collaborators
Orano Med LLC
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
AlphaMedix™ (²¹²Pb-DOTAMTATE) is a radiotherapeutic drug indicated in subjects with unresectable, metastatic somatostatin receptor (SSTR) positive neuroendocrine tumors (NETs). Because 212Pb is an in vivo generator of alpha particles, it is particularly suitable for SSTR therapy applications.
This drug addresses an unmet need in the field of peptide receptor radionuclide therapy (PRRT) for NETs. Substitution of an alpha emitter (²¹²Pb) for the beta emitters currently being used (i.e., 177Lu or 90Y) will provide significantly higher Linear Energy Transfer (LET) and a shorter path length. Higher LET particles should cause more tumor cell death. Shorter path length should result in less collateral damage of the normal tissue and therefore less side effects for subjects receiving the drug.
Detailed Description
This dose escalation study will include a maximum of 50 subjects with histologically confirmed NET, a positive somatostatin analogue scan, and no prior history of PRRT therapy.
The study will begin with a single ascending dose (SAD) of AlphaMedix™ administered by IV. Subsequent cohorts will receive an incremental 30% increase that will continue until tumor response or DLT. Once tumor response is observed, the study will convert to a Multiple Ascending Dose (MAD) regimen. The MAD treatment regimen will start with the previous safe cohort's dose and will consist of 3 IV administrations of AlphaMedix™ at 8-week intervals. Subsequent cohorts will receive an incremental 30% increase that will continue until tumor response or DLT.
The primary objective is to assess the safety and dose limiting toxicity (DLT) using ascending doses of AlphaMedix™. The secondary objectives are to determine the pharmacokinetic properties and preliminary effectiveness of AlphaMedix™.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Neuroendocrine Tumor
Keywords
somatostatin receptor
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
33 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
AlphaMedix
Arm Type
Experimental
Arm Description
There is only a single treatment arm.
Intervention Type
Drug
Intervention Name(s)
AlphaMedix
Other Intervention Name(s)
Pb212-octreotide analog
Intervention Description
There is only a single treatment intervention.
Primary Outcome Measure Information:
Title
To determine dose-limiting toxicity (DLT)
Description
DLT is defined as non-hematological toxicity - all Grade 4 and Grade 3 (except alk. phos.) that is not responsive to NMT 72 hours of supportive care - and all hematological toxicity that does not recover to NMT than Grade 2 within 8 wks of dose administration.
Time Frame
8 weeks
Title
To determine the maximum tolerated dose (MTD)
Description
The MTD is the dose level below that which 2 out of 6 subjects in a cohort have DLT.
Time Frame
8 weeks
Secondary Outcome Measure Information:
Title
Partial or complete response assessed by modified RECIST v1.1
Description
CT/MRI or 18FDG-PET/CT (for patients who are FDG-avid at baseline) will be used to measure tumor size
Time Frame
8 weeks after injection
Title
To determine effective blood clearance and cumulative blood activity of 212-Pb
Description
Blood will be taken at Time 0, 1 hr, 4 hr and 24 hr post-injection and measured for activity in an auto gamma counter
Time Frame
24 hours
Title
To determine the rate and extent of 212-Pb elimination in urine
Description
Bladder will be emptied just prior to injection and qualitative urine collections will be done 0-1 hr, 1-4 hr and 4-24 hr post-injection and measured for activity in an auto gamma counter
Time Frame
24 hours
Title
Incidence of treatment-related AEs and SAEs as assessed by CTCAE v. 4
Description
AEs will be recorded both spontaneously by the patient and at all safety follow ups (2 wks, 4 wks, 6 wks, 8 wks post each injection and 3 mo, 6 mo, and 10 mo post last injection)
Time Frame
12 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
ECOG status 0-2.
Life expectancy of at least 12 weeks.
Histologically confirmed diagnosis of SSTR (+) NET, unresectable or metastatic.
Measurable disease per RECIST 1.1 on CT/MRI scans, defined as at least 1 lesion with ≥ 1 cm in longest diameter (LD) (lymph nodes along short axis).
Appropriate diagnostic imaging studies, at the discretion of the PI including but not limited to CT, MRI, 18F-FDG PET/CT, NAF PET/CT bone scan, ultrasound, etc. of the tumor region or suspected area within the 4 weeks of dosing day.
SSTR(+) disease, as evidenced by available FDA approved SSTR imaging (SRI) within 4 weeks prior to the first cycle.
All FDA-approved therapies for which the subject is eligible have been exhausted.
Recent blood test results (within 2 weeks pre-dose) as follows: Sufficient bone marrow capacity as defined by white blood cell (WBC) ≥2,500/µl and WBC ≥2,000/µl for subsequent cycles; platelets ≥ 100,000/µl for the first treatment and ≥75,000 for the subsequent therapies, hemoglobin (HgB) ≥8.9 g/dl for the first treatment and 8.0 g/dl for the subsequent therapies, ANC ≥1,500/µl for the first treatment and ≥1,000/µl; for the subsequent therapies; ALT, AST values ≤3 times upper limit of normal (ULN); Bilirubin: ≤3 times ULN; Serum creatinine ≤150 µmol/liter or 1.7 mg/dl; Negative pregnancy test in women capable of child-bearing within 48 hours of administration; Serum albumin > 3.0 g/L (<3.0 g/L may be acceptable at the discretion of PI, if PT, PTT, and INR are within normal range)
Exclusion Criteria:
Prior whole-body radiotherapy and PRRT using 177Lu/90Y/111In- DOTATATE/DOTATOC or TAT
Known hypersensitivity to 68Gallium, Octreotate, or any of the excipients of 68Ga-DOTATATE, AA infusion or AlphaMedix™.
Therapeutic use of any somatostatin analogue, including Sandostatin® LAR (within 28 days) and Sandostatin® (within 1 day) prior to administration of investigational drug.
Subjects with unusual hematological parameters, including an increased mean corpuscular volume (MCV) (>100,000), and especially in those who had previous chemotherapy, the advice of a hematologist should be sought for adequate further work-up to rule out myelodysplastic syndrome (MDS).
Any subject who is taking concomitant medications that decrease renal function (such as aminoglycoside antibiotics).
Female subjects who are pregnant, lactating or women of childbearing potential not willing to practice effective contraceptive techniques during the study period and for 8 weeks post-injection or male subjects who have female partners of childbearing potential not willing to practice abstinence or effective contraception, during the study period and for 8 weeks post-injection.
Current somatic or psychiatric disease/condition that may interfere with the objectives and assessments of the study.
Indication for surgical lesion removal with curative potential
Known brain metastases; unless these metastases have been treated and stabilized 6 months prior to enrollment
Completion of: (1) cytotoxic chemotherapy for less than 6 weeks; (2) a biological agent for less than 5 half-lives; and (3) radiation therapy for less than 6 weeks prior to study enrolment,
Uncontrolled congestive heart failure; subjects suspected of having this condition need to show ejection fraction of >55% as determined by multigated acquisition (MUGA) scan.
Carcinoid heart disease: Prior history of torsade de pointe, or congenital long QT syndrome; Conditions with screening ECG repolarization difficult to interpret, or showing significant abnormalities. This includes, but is not limited to: high degree AV block, pacemaker, atrial fibrillation or flutter; QTcF interval > 480 msec on screening ECG; Significant hypokalemia at screening (Potassium <3.5 mMol/L); Significant hypomagnesemia at screening (Mg++ <0.7 mMol/L)
GFR < 35 mL/min
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Susan Cork
Phone
713-781-6200
Ext
3203
Email
scork@exceldiagnostics.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Rodolfo Nunez, MD
Organizational Affiliation
Excel Diagnostics and Nuclear Oncology Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Excel Diagnostics and Nuclear Oncology Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77042
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ebrahim S Delpassand, MD
Phone
713-499-9733
Email
edelpassand@exceldiagnostics.com
First Name & Middle Initial & Last Name & Degree
Afshin Shafie, MD
First Name & Middle Initial & Last Name & Degree
Cristin Dickerson, MD
First Name & Middle Initial & Last Name & Degree
Rodolfo Nunez, MD
First Name & Middle Initial & Last Name & Degree
Rouzbeh Esfandiari, MD
Facility Name
Excel Diagnostics and Nuclear Oncology Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77042
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Susan S Cork
Phone
713-341-3203
Email
scork@exceldiagnostics.com
First Name & Middle Initial & Last Name & Degree
Rodolfo Nunez, MD
First Name & Middle Initial & Last Name & Degree
Rouzbeh Esfandiari, MD
12. IPD Sharing Statement
Plan to Share IPD
Undecided
Learn more about this trial
Phase 1 Study of AlphaMedix™ in Adult Subjects With SSTR (+) NET
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