Phase I/II Trial of Rhenium 188-P2045 in Small Cell Lung Cancer and Other Advanced Neuroendocrine Carcinomas
Primary Purpose
Small Cell Lung Cancer (SCLC), Neuroendocrine (NE) Tumors, Large Cell Neuroendocrine (NE) Tumors
Status
Withdrawn
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Rhenium Re 188-P2045
Sponsored by
About this trial
This is an interventional treatment trial for Small Cell Lung Cancer (SCLC) focused on measuring Lung cancer, Small cell lung cancer, Neuroendocrine tumor, Rhenium, Re 188-P2045
Eligibility Criteria
Inclusion Criteria:
- Age >/=18 years.
- Advanced, metastatic or locally recurrent, incurable neuroendocrine tumors (small cell lung cancer, extrapulmonary small cell lung cancer, large cell neuroendocrine lung carcinoma pulmonary carcinoid, GI carcinoid tumor
- Symptomatic CNS metastases: must have received therapy (surgery, XRT, gamma knife)
- Asymptomatic CNS metastatic disease: discuss with Study Chair.
- Histologically-or cytologically documented disease.
- Considered incurable by any combination of therapy including surgery, radiation, chemotherapy.
- ECOG Performance status 0-2
- Renal function: creatinine clearance > 40 mg/mlxmin (Cockroft-Gault)
- Adequate organ and marrow function by:
- Absolute neutrophil count (ANC) >/=1,500/mcL.
- Platelets >/= 100,000/mcL.
- Total bilirubin within normal institutional limits (WNL)
- AST (SGOT)/ALT (SPGT) </= 2.5 x upper limit of normal (ULN)
- Women (child-bearing potential) and men must use adequate contraception prior to study entry, for duration of study participation, and 90 days after completion of therapy.
- A female of child-bearing potential is any woman is one who has not undergone a hysterectomy or bilateral oophorectomy; or
- Has not been naturally postmenopausal for at least 12 consecutive months
- Ability to understand and the willingness to sign a written informed consent document.
Exclusion Criteria:
- Merkel cell carcinoma
- Leptomeningeal disease or carcinomatous meningitis
- Chemotherapy or radiotherapy within 3 weeks prior to entering the study or those who have not recovered from adverse events due to agents administered > 3 weeks earlier.
- If the patient was receiving an oral agent, at least 4 half lives should have elapsed.
- Cannot receive any other investigational agent at the time of registration. At least 3 weeks should have elapsed since administration of an IV investigational agent or 4 half lives for an oral investigational agent.
- At least 28 days should have elapsed since administration of a long acting somatostatin analogue.
- Patients with known brain metastases are eligible (see criteria above). Leptomeningeal metastases are not eligible.
- Patients who have received external beam radiation to more than 20% of marrow.
- No prior radiation to the kidneys.
- Prior systemic radiotherapy are not eligible (except for prior I131 for thyroid cancer more than 1 year earlier).
- Receiving long term immunosuppressive medications for rheumatologic or other disease (e.g. low dose methotrexate, mecaptopurine etc).
- History of allergic reactions attributed to compounds of similar chemical or biologic composition to octreotide or other somatostatin analogues.
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
- Pregnant or nursing (due to the potential for congenital abnormalities and the potential of this regimen to harm nursing infants.)
Sites / Locations
- University of Maryland Marlene & Stewart Greenebaum Cancer Center
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Topotecan and Rhenium Re 188 P2045
Arm Description
In the phase II portion of this study, patients will be screened using Technicium Tc99m. Eligible, consented patients will receive Topotecan treatment for three days, at doses of either 1.0 mg/m2 or 1.5 mg/m2. They will then receive a single dose of Rhenium Re 188-P2045, at one of the following dosage levels based on the Phase I Maximum Tolerated Dose (MTD): 40% of MTD; 50% of MTD; 75% of MTD; 85% of MTD or 100% of MTD.
Outcomes
Primary Outcome Measures
Determine Maximum Tolerated Dose (MTD)
To determine, via dose-limiting toxicity (DLT), the maximally tolerated dose (MTD) for Rhenium Re188-P2045 when administered as a single dose in patients with advanced neuroendocrine tumors and SSTR2 expression as determined by Tc99m P2045 scanning.
Secondary Outcome Measures
Overall Response Rate (ORR)
To describe the overall response rate (ORR) after treatment with Re188 P2045 when administered either as a single dose (Phase I) or following topotecan (Phase II) in patients with advanced neuroendocrine tumors and SSTR2 expression as determined by Tc99m P2045 scanning.
Progression Free Survival (PFS) Rate
To describe the progression free survival rate (PFS) of survival after treatment with Re188 P2045 when administered as a single dose or following topotecan in patients with advanced neuroendocrine tumors and SSTR2 expression as determined by Tc99m P2045 scanning
Change in SSTR2 Expression
To describe the change (if any) in SSTR2 expression, as determined by Tc99m P2045 scanning after topotecan administration.
Correlation: Pre-therapy SSTR2 Expression vs. ORR and PFS
Calculate potential correlation between pre-therapy SSTR2 expression, as determined by Tc99m P2045 imaging, and patient Overall Response Rate (ORR) up to 5 years post treatment. Calculate potential correlation between pre-therapy SSTR2 expression, as determined by Tc99m P2045 imaging, and patient Progression Free Survival (PFS) up to 5 years post treatment.
Full Information
NCT ID
NCT02030184
First Posted
January 6, 2014
Last Updated
October 15, 2019
Sponsor
University of Maryland, Baltimore
1. Study Identification
Unique Protocol Identification Number
NCT02030184
Brief Title
Phase I/II Trial of Rhenium 188-P2045 in Small Cell Lung Cancer and Other Advanced Neuroendocrine Carcinomas
Official Title
Phase I/II Dose Escalation Trial of Rhenium 188-P2045 in Small Cell Lung Cancer and Other Advanced Neuroendocrine Carcinomas as a Single Agent and in Combination With Topotecan
Study Type
Interventional
2. Study Status
Record Verification Date
October 2019
Overall Recruitment Status
Withdrawn
Why Stopped
PI has left the study institution.
Study Start Date
June 2017 (Anticipated)
Primary Completion Date
June 2019 (Anticipated)
Study Completion Date
June 2021 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Maryland, Baltimore
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
There are two parts to this trial. The first study will evaluate increasing doses of Re188 P2045 in patients with advanced small cell lung cancer that has recurred after initial therapy or in patients with other advanced neuroendocrine cancers that have progressed after therapy.
Re188 P2045 is designed to attach to type 2 somatostatin receptors that are frequently expressed in those cancers and then the radioactivity from Re188 will kill the cancer cell. Only patients who have cancers that can be seen when Tc99 P2045 is administered (also seeks out the SSTR2, but Tc99 images, but does not treat the cells) will be treated.
Therefore, this approach maximizes the possibility that patients will benefit from treatment in that only those who have cancers that have the target will undergo treatment. The primary purpose of this study will be to determine the highest dose of Re188 P2045 that can be safely administered.
The second study will open after the conclusion of the first. Patients will first undergo the scan with Tc99 P2045 and then be treated with topotecan for three days. Topotecan is a standard chemotherapy drug that is approved for second line therapy for small cell and frequently used for other neuroendocrine cancers. Following that, patients will then be re-evaluated with the Tc99 P2045 scan and if it demonstrates that the tumor is positive for SSTR2, then patients will receive Re188 P2045. The goal of this study is to determine the highest dose of Re188 P2045 that can be safely administered after topotecan as well as to determine if topotecan will increase the chance that the tumor will express SSTR2.
Detailed Description
This trial will be conducted patients with small cell lung cancer and other neuroendocrine cancers. These include extrapulmonary small cell, gastrointestinal carcinoid tumors that arise from pulmonary lesions, and large cell neuroendocrine (NE) tumors.
First, the dose-limiting toxicity (DLT) and maximally tolerated dose (MTD) for Rhenium Re188-P2045 alone will be determined when it is administered as a single dose, at 80, 90, 130, 170, 210 or (up to) 250 mCi/m2.
Subsequently, in the second study Rhenium Re 188-P2045 will be administered at 40, 50, 75, 85 and up to 100 per cent of the MTD determined in the first study, as a single agent or following 3 daily topotecan treatments (at 1.0 or 1.5 mg/m2) in patients with advanced neuroendocrine tumors and SSTR2 expression as determined by Technicium (Tc) Tc99m P2045 scanning.
The overall response and survival rates of patient treated with Rhenium Re188 P2045 when administered as a single dose or following topotecan will be measured.
The change (if any) in SSTR2 expression, as determined by Tc99m P2045 scanning after topotecan administration will also be determined . The correlation of pre-therapy SSTR2 expression (as determined by Tc99m P2045 scan) with overall response and survival rates will be calculated.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Small Cell Lung Cancer (SCLC), Neuroendocrine (NE) Tumors, Large Cell Neuroendocrine (NE) Tumors
Keywords
Lung cancer, Small cell lung cancer, Neuroendocrine tumor, Rhenium, Re 188-P2045
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
0 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Topotecan and Rhenium Re 188 P2045
Arm Type
Experimental
Arm Description
In the phase II portion of this study, patients will be screened using Technicium Tc99m. Eligible, consented patients will receive Topotecan treatment for three days, at doses of either 1.0 mg/m2 or 1.5 mg/m2. They will then receive a single dose of Rhenium Re 188-P2045, at one of the following dosage levels based on the Phase I Maximum Tolerated Dose (MTD): 40% of MTD; 50% of MTD; 75% of MTD; 85% of MTD or 100% of MTD.
Intervention Type
Drug
Intervention Name(s)
Rhenium Re 188-P2045
Other Intervention Name(s)
Study B
Intervention Description
Topotecan at 1.0 mg/m2 or 1.5 mg/m2 for 3 days, followed by single dose of Rhenium Re 188-P2045, at one of the following dosage levels based on the Phase I Maximum Tolerated Dose (MTD): 40% of MTD; 50% of MTD; 75% of MTD; 85% of MTD or 100% of MTD.
Primary Outcome Measure Information:
Title
Determine Maximum Tolerated Dose (MTD)
Description
To determine, via dose-limiting toxicity (DLT), the maximally tolerated dose (MTD) for Rhenium Re188-P2045 when administered as a single dose in patients with advanced neuroendocrine tumors and SSTR2 expression as determined by Tc99m P2045 scanning.
Time Frame
28 days
Secondary Outcome Measure Information:
Title
Overall Response Rate (ORR)
Description
To describe the overall response rate (ORR) after treatment with Re188 P2045 when administered either as a single dose (Phase I) or following topotecan (Phase II) in patients with advanced neuroendocrine tumors and SSTR2 expression as determined by Tc99m P2045 scanning.
Time Frame
5 Years
Title
Progression Free Survival (PFS) Rate
Description
To describe the progression free survival rate (PFS) of survival after treatment with Re188 P2045 when administered as a single dose or following topotecan in patients with advanced neuroendocrine tumors and SSTR2 expression as determined by Tc99m P2045 scanning
Time Frame
5 years
Title
Change in SSTR2 Expression
Description
To describe the change (if any) in SSTR2 expression, as determined by Tc99m P2045 scanning after topotecan administration.
Time Frame
3 Days
Title
Correlation: Pre-therapy SSTR2 Expression vs. ORR and PFS
Description
Calculate potential correlation between pre-therapy SSTR2 expression, as determined by Tc99m P2045 imaging, and patient Overall Response Rate (ORR) up to 5 years post treatment. Calculate potential correlation between pre-therapy SSTR2 expression, as determined by Tc99m P2045 imaging, and patient Progression Free Survival (PFS) up to 5 years post treatment.
Time Frame
5 years
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Age >/=18 years.
Advanced, metastatic or locally recurrent, incurable neuroendocrine tumors (small cell lung cancer, extrapulmonary small cell lung cancer, large cell neuroendocrine lung carcinoma pulmonary carcinoid, GI carcinoid tumor
Symptomatic CNS metastases: must have received therapy (surgery, XRT, gamma knife)
Asymptomatic CNS metastatic disease: discuss with Study Chair.
Histologically-or cytologically documented disease.
Considered incurable by any combination of therapy including surgery, radiation, chemotherapy.
ECOG Performance status 0-2
Renal function: creatinine clearance > 40 mg/mlxmin (Cockroft-Gault)
Adequate organ and marrow function by:
Absolute neutrophil count (ANC) >/=1,500/mcL.
Platelets >/= 100,000/mcL.
Total bilirubin within normal institutional limits (WNL)
AST (SGOT)/ALT (SPGT) </= 2.5 x upper limit of normal (ULN)
Women (child-bearing potential) and men must use adequate contraception prior to study entry, for duration of study participation, and 90 days after completion of therapy.
A female of child-bearing potential is any woman is one who has not undergone a hysterectomy or bilateral oophorectomy; or
Has not been naturally postmenopausal for at least 12 consecutive months
Ability to understand and the willingness to sign a written informed consent document.
Exclusion Criteria:
Merkel cell carcinoma
Leptomeningeal disease or carcinomatous meningitis
Chemotherapy or radiotherapy within 3 weeks prior to entering the study or those who have not recovered from adverse events due to agents administered > 3 weeks earlier.
If the patient was receiving an oral agent, at least 4 half lives should have elapsed.
Cannot receive any other investigational agent at the time of registration. At least 3 weeks should have elapsed since administration of an IV investigational agent or 4 half lives for an oral investigational agent.
At least 28 days should have elapsed since administration of a long acting somatostatin analogue.
Patients with known brain metastases are eligible (see criteria above). Leptomeningeal metastases are not eligible.
Patients who have received external beam radiation to more than 20% of marrow.
No prior radiation to the kidneys.
Prior systemic radiotherapy are not eligible (except for prior I131 for thyroid cancer more than 1 year earlier).
Receiving long term immunosuppressive medications for rheumatologic or other disease (e.g. low dose methotrexate, mecaptopurine etc).
History of allergic reactions attributed to compounds of similar chemical or biologic composition to octreotide or other somatostatin analogues.
Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
Pregnant or nursing (due to the potential for congenital abnormalities and the potential of this regimen to harm nursing infants.)
Facility Information:
Facility Name
University of Maryland Marlene & Stewart Greenebaum Cancer Center
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21201
Country
United States
12. IPD Sharing Statement
Learn more about this trial
Phase I/II Trial of Rhenium 188-P2045 in Small Cell Lung Cancer and Other Advanced Neuroendocrine Carcinomas
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