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Study to Evaluate Safety and Dosimetry of Lutathera in Adolescent Patients With GEP-NETs and PPGLs

Primary Purpose

Gastroenteropancreatic Neuroendocrine Tumors, Pheochromocytoma, Paraganglioma

Status
Recruiting
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Lutetium [177Lu] oxodotreotide/dotatate
Sponsored by
Advanced Accelerator Applications
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Gastroenteropancreatic Neuroendocrine Tumors focused on measuring GEP-NET, PPGL, adolescents, pediatric, Lutathera, Lutetium [177Lu] oxodotreotide, Lutetium Lu 177 dotatate, Peptide Receptor Radionuclide Therapy, PRRT

Eligibility Criteria

12 Years - 17 Years (Child)All SexesDoes not accept healthy volunteers

Key Inclusion Criteria:

  1. GEP-NET cohort: presence of metastasized or locally advanced, inoperable (curative intent), histologically proven, G1 or G2 (Ki-67 index =< 20%), well differentiated GEP-NET.

    or PPGL cohort: presence of metastasized or locally advanced, inoperable (curative intent), histologically proven PPGL.

  2. Patients from 12 to < 18 years of age at the time of enrollment.
  3. Expression of somatostatin receptors confirmed by a somatostatin receptor imaging (SRI) modality within 3 months prior to enrollment, with tumor uptake observed in the target lesions more or equal to the normal liver uptake.
  4. Performance status as determined by Karnofsky score >= 50 or Lansky Play-Performance Scale score >= 50.
  5. Parent's ability to understand and the willingness to sign a written informed consent document for adolescents as determined by local regulations. Adolescents will sign assent along with parental/legal guardian consent or will co-sign consent with parent/legal guardian in accordance with local regulation, prior to participation in the study.

Key Exclusion Criteria:

  1. Laboratory parameters:

    1. Estimated creatinine clearance calculated by the Cockroft-Gault method < 70 mL/min
    2. Hb concentration <5.0 mmol/L (<8.0 g/dL); WBC <2x109/L; platelets <75x109/L.
    3. Total bilirubin >3 x ULN for age.
    4. Serum albumin <3.0 g/dL unless prothrombin time is within the normal range.
  2. Established or suspected pregnancy.
  3. Breastfeeding female patients unless they accept to discontinue breastfeeding from the 1st dose until 3 months after the last administration of study drug.
  4. Female patients of child-bearing potential, unless they are using highly effective methods of contraception during treatment and for 6 months after the last dose of Lutathera.
  5. Sexually active male patients, unless they agree to remain abstinent or be willing to use effective methods of contraception.
  6. Patients for whom in the opinion of the investigator other therapeutic options are considered more appropriate than the therapy offered in the study, based on patient and disease characteristics.
  7. Current spontaneous urinary incontinence.
  8. Other known co-existing malignancies except non-melanoma skin cancer and carcinoma in situ of the uterine cervix, unless definitively treated and proven no evidence of recurrence for 5 years.
  9. Hypersensitivity to the study drug active substance or to any of the excipients.
  10. Patients with any other significant medical, psychiatric, or surgical condition, currently uncontrolled by treatment, which may interfere with the completion of the study.
  11. Patient with known incompatibility to CT Scans with I.V. contrast due to allergic reaction or renal insufficiency. If such a patient can be imaged with MRI, then the patient would not be excluded.
  12. Patients who received any investigational agent within the last 30 days.

Sites / Locations

  • University of Iowa Carver College of Medicine
  • University of KentuckyRecruiting
  • Cincinnati Children's HospitalRecruiting
  • Children's Hospital of PhiladelphiaRecruiting
  • Texas's Children HospitalRecruiting
  • University Hospitals Leuven (UZ Leuven)Recruiting
  • CHU de Québec - Université LavalRecruiting
  • Centre Léon BerardRecruiting
  • IEO Istituto Europeo di Oncologia
  • Bambin Gesu' HospitalRecruiting
  • Prinses Maxima (UMC Utrecht)Recruiting
  • Maria Sklodowska-Curie National Research Institute of OncologyRecruiting
  • Coimbra Hospital
  • Hospital Universitari Vall d'HebronRecruiting
  • University Hospital 12 de OctubreRecruiting
  • Karolinska Institutet
  • University College Hospital of LondonRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

GEP-NET and PPGL

Arm Description

All eligible participants will receive Lutathera (7.4 GBq/200 mCi x 4 administrations every 8 weeks; cumulative dose: 29.6 GBq/800 mCi), with a concomitant administration of 2.5% Lysine - Arginine amino acid solution.

Outcomes

Primary Outcome Measures

Absorbed radiation doses in target organ
Absorbed radiation doses in target organ (e.g. kidney and bone marrow) will be evaluated when all GEP-NET patients have completed the 1st treatment of Lutathera and completed the dosimetry assessment.
Incidence of adverse events (AEs) after the 1st treatment cycle
The distribution of adverse events will be done via the analysis of frequencies for treatment emergent Adverse Event (TEAEs), Serious Adverse Event (TESAEs) and Deaths due to AEs, through the monitoring of relevant clinical and laboratory safety parameters.

Secondary Outcome Measures

Incidence of adverse events (AEs) during the short-term follow-up
Cumulative safety of Lutathera in adolescents with SSTR-positive GEP-NETs will be assessed through the incidence of adverse events (AEs) and laboratory toxicities until 6 months after the last Lutathera dose.
Incidence of adverse events (AEs) during the long term follow-up
Long-term safety of Lutathera in adolescents with SSTR-positive GEP-NETs will be evaluated through the incidence of AEs and laboratory abnormalities during the 5-year follow-up after the last Lutathera dose.
Comparative assessment of organ absorbed doses in adolescents and adults
Calculated organ absorbed doses based on imaging radioactivity concentration data from adolescent with SSTR-positive GEP-NETs patients will be compared to the predicted distribution/organ absorbed doses in adult population.
Maximum plasma concentration (Cmax) of Lutetium [Lu 177] dotatate in adolescents and adults
Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. Cmax will be listed and summarized using descriptive statistics.
Time of observed drug concentration occurrence (Tmax) of Lutetium [Lu 177] dotatate in adolescents and adults
Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. Tmax will be listed and summarized using descriptive statistics.
Area Under plasma concentration-time Curve from time 0 to 72 hours (AUC0-72) of Lutetium [Lu 177] dotatate in adolescents and adults
Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. AUC0-72 will be listed and summarized using descriptive statistics.
Total systemic clearance for intravenous administration (CL) of Lutetium [Lu 177] dotatate in adolescents and adults
Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. CL will be listed and summarized using descriptive statistics.
Volume of distribution in the central compartment (V1) of Lutetium [Lu 177] dotatate in adolescents and adults
Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. V1 will be listed and summarized using descriptive statistics.
Volume of distribution in the peripheral compartment (V2) of Lutetium [Lu 177] dotatate in adolescents and adults
Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. V2 will be listed and summarized using descriptive statistics.

Full Information

First Posted
December 16, 2020
Last Updated
June 7, 2023
Sponsor
Advanced Accelerator Applications
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1. Study Identification

Unique Protocol Identification Number
NCT04711135
Brief Title
Study to Evaluate Safety and Dosimetry of Lutathera in Adolescent Patients With GEP-NETs and PPGLs
Official Title
A Multicenter Open-label Study to Evaluate Safety and Dosimetry of Lutathera in Adolescent Patients With Somatostatin Receptor Positive Gastroenteropancreatic Neuroendocrine (GEP-NET) Tumors, Pheochromocytoma and Paragangliomas (PPGL)
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Recruiting
Study Start Date
August 31, 2022 (Actual)
Primary Completion Date
March 20, 2024 (Anticipated)
Study Completion Date
June 26, 2029 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Advanced Accelerator Applications

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
This is a multicenter, open-label, single-arm study to evaluate the safety and dosimetry of Lutathera in adolescent patients 12 to <18 years old with somatostatin receptor positive GEP-NETs and PPGLs. The study will enroll at least 8 patients in the GEP-NET cohort and as many adolescents with PPGL as possible in the exploratory PPGL cohort.
Detailed Description
The study schedule for each patient consists of the screening period (up to 2 weeks) followed by the treatment period (4 treatment administrations at 8-week interval), and the follow-up period (5 years). The treatment period will consist of 4 Lutathera treatments administered at 8-week intervals. Lutathera administration will occur on Week 1 Day 1 of each cycle. Each patient will receive a total of 4 doses of Lutathera (7.4 GBq/200 mCi x 4 administrations every 8 weeks; cumulative dose: 29.6 GBq/800 mCi). An infusion of 2.5% Lysine - Arginine amino acid (AA) solution will be co-administered with each Lutathera dose for renal protection according to the approved Lutathera local prescribing information. An antiemetic will be administered prior to infusion of the AA solution for prevention of infusion-related nausea and vomiting. The dosimetry and PK assessments will be performed during the first week after the 1st Lutathera dose, i.e. one time during the study treatment period for each patient. The dosimetry analysis will allow for estimation from the 1st Lutathera administration of the cumulative absorbed radiation dose from 4 Lutathera doses and also for taking a decision on the next dose levels. In the exceptional circumstances when dosimetry cannot be performed in a particular patient after the first Lutathera dose, it should be completed as soon as feasible upon a later dose. In order to minimize risk for each study subject, an accelerated analysis of dosimetry and safety data will be performed for each patient in the study, to enable the Investigator to take a decision for the subsequent Lutathera doses. The results of dosimetry assessments (imaging and blood dosimetry) will be provided to the investigators for their evaluation prior to administration of subsequent therapeutic cycles in each patient. A total follow-up period of 5 years (60 months) after the last Lutathera dose will take place for each patient who received at least one dose of Lutathera. This follow-up period will be comprised of a short-term follow-up of 6 months to evaluate cumulative Lutathera toxicities, followed by a long-term follow up of another 54 months. An external Data and Safety Monitoring Board (DSMB) will also operate in the study to evaluate accumulating safety and dosimetry data, to ensure the safety of adolescents enrolled in the study, and to provide recommendations to investigators as well as to the clinical team in charge of conducting the study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Gastroenteropancreatic Neuroendocrine Tumors, Pheochromocytoma, Paraganglioma
Keywords
GEP-NET, PPGL, adolescents, pediatric, Lutathera, Lutetium [177Lu] oxodotreotide, Lutetium Lu 177 dotatate, Peptide Receptor Radionuclide Therapy, PRRT

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
GEP-NET and PPGL
Arm Type
Experimental
Arm Description
All eligible participants will receive Lutathera (7.4 GBq/200 mCi x 4 administrations every 8 weeks; cumulative dose: 29.6 GBq/800 mCi), with a concomitant administration of 2.5% Lysine - Arginine amino acid solution.
Intervention Type
Drug
Intervention Name(s)
Lutetium [177Lu] oxodotreotide/dotatate
Other Intervention Name(s)
Lutathera
Intervention Description
Radiopharmaceutical solution for infusion (7.4 GBq of Lutathera per 30 ml vial)
Primary Outcome Measure Information:
Title
Absorbed radiation doses in target organ
Description
Absorbed radiation doses in target organ (e.g. kidney and bone marrow) will be evaluated when all GEP-NET patients have completed the 1st treatment of Lutathera and completed the dosimetry assessment.
Time Frame
Up to 8 days after the first Lutetium [Lu 177] dotatate dose
Title
Incidence of adverse events (AEs) after the 1st treatment cycle
Description
The distribution of adverse events will be done via the analysis of frequencies for treatment emergent Adverse Event (TEAEs), Serious Adverse Event (TESAEs) and Deaths due to AEs, through the monitoring of relevant clinical and laboratory safety parameters.
Time Frame
Up to 8 weeks after the first Lutetium [Lu 177] dotatate dose
Secondary Outcome Measure Information:
Title
Incidence of adverse events (AEs) during the short-term follow-up
Description
Cumulative safety of Lutathera in adolescents with SSTR-positive GEP-NETs will be assessed through the incidence of adverse events (AEs) and laboratory toxicities until 6 months after the last Lutathera dose.
Time Frame
Up to 6 months after the last Lutetium [Lu 177] dotatate dose
Title
Incidence of adverse events (AEs) during the long term follow-up
Description
Long-term safety of Lutathera in adolescents with SSTR-positive GEP-NETs will be evaluated through the incidence of AEs and laboratory abnormalities during the 5-year follow-up after the last Lutathera dose.
Time Frame
Up to 5 years after the last Lutetium [Lu 177] dotatate dose
Title
Comparative assessment of organ absorbed doses in adolescents and adults
Description
Calculated organ absorbed doses based on imaging radioactivity concentration data from adolescent with SSTR-positive GEP-NETs patients will be compared to the predicted distribution/organ absorbed doses in adult population.
Time Frame
Up to 8 days after the first Lutetium [Lu 177] dotatate dose
Title
Maximum plasma concentration (Cmax) of Lutetium [Lu 177] dotatate in adolescents and adults
Description
Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. Cmax will be listed and summarized using descriptive statistics.
Time Frame
Day 1 (0, 2, 6 hours post infusion), Day 2 (24 hours post infusion), Day 4 (72 hours post infusion)
Title
Time of observed drug concentration occurrence (Tmax) of Lutetium [Lu 177] dotatate in adolescents and adults
Description
Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. Tmax will be listed and summarized using descriptive statistics.
Time Frame
Day 1 (0, 2, 6 hours post infusion), Day 2 (24 hours post infusion), Day 4 (72 hours post infusion)
Title
Area Under plasma concentration-time Curve from time 0 to 72 hours (AUC0-72) of Lutetium [Lu 177] dotatate in adolescents and adults
Description
Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. AUC0-72 will be listed and summarized using descriptive statistics.
Time Frame
Day 1 (0, 2, 6 hours post infusion), Day 2 (24 hours post infusion), Day 4 (72 hours post infusion)
Title
Total systemic clearance for intravenous administration (CL) of Lutetium [Lu 177] dotatate in adolescents and adults
Description
Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. CL will be listed and summarized using descriptive statistics.
Time Frame
Day 1 (0, 2, 6 hours post infusion), Day 2 (24 hours post infusion), Day 4 (72 hours post infusion)
Title
Volume of distribution in the central compartment (V1) of Lutetium [Lu 177] dotatate in adolescents and adults
Description
Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. V1 will be listed and summarized using descriptive statistics.
Time Frame
Day 1 (0, 2, 6 hours post infusion), Day 2 (24 hours post infusion), Day 4 (72 hours post infusion)
Title
Volume of distribution in the peripheral compartment (V2) of Lutetium [Lu 177] dotatate in adolescents and adults
Description
Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. V2 will be listed and summarized using descriptive statistics.
Time Frame
Day 1 (0, 2, 6 hours post infusion), Day 2 (24 hours post infusion), Day 4 (72 hours post infusion)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
12 Years
Maximum Age & Unit of Time
17 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Key Inclusion Criteria: GEP-NET cohort: presence of metastasized or locally advanced, inoperable (curative intent), histologically proven, G1 or G2 (Ki-67 index =< 20%), well differentiated GEP-NET. or PPGL cohort: presence of metastasized or locally advanced, inoperable (curative intent), histologically proven PPGL. Patients from 12 to < 18 years of age at the time of enrollment. Expression of somatostatin receptors confirmed by a somatostatin receptor imaging (SRI) modality within 3 months prior to enrollment, with tumor uptake observed in the target lesions more or equal to the normal liver uptake. Performance status as determined by Karnofsky score >= 50 or Lansky Play-Performance Scale score >= 50. Parent's ability to understand and the willingness to sign a written informed consent document for adolescents as determined by local regulations. Adolescents will sign assent along with parental/legal guardian consent or will co-sign consent with parent/legal guardian in accordance with local regulation, prior to participation in the study. Key Exclusion Criteria: Laboratory parameters: Estimated creatinine clearance calculated by the Cockroft-Gault method < 70 mL/min Hb concentration <5.0 mmol/L (<8.0 g/dL); WBC <2x109/L; platelets <75x109/L. Total bilirubin >3 x ULN for age. Serum albumin <3.0 g/dL unless prothrombin time is within the normal range. Established or suspected pregnancy. Breastfeeding female patients unless they accept to discontinue breastfeeding from the 1st dose until 3 months after the last administration of study drug. Female patients of child-bearing potential, unless they are using highly effective methods of contraception during treatment and for 6 months after the last dose of Lutathera. Sexually active male patients, unless they agree to remain abstinent or be willing to use effective methods of contraception. Patients for whom in the opinion of the investigator other therapeutic options are considered more appropriate than the therapy offered in the study, based on patient and disease characteristics. Current spontaneous urinary incontinence. Other known co-existing malignancies except non-melanoma skin cancer and carcinoma in situ of the uterine cervix, unless definitively treated and proven no evidence of recurrence for 5 years. Hypersensitivity to the study drug active substance or to any of the excipients. Patients with any other significant medical, psychiatric, or surgical condition, currently uncontrolled by treatment, which may interfere with the completion of the study. Patient with known incompatibility to CT Scans with I.V. contrast due to allergic reaction or renal insufficiency. If such a patient can be imaged with MRI, then the patient would not be excluded. Patients who received any investigational agent within the last 30 days.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Novartis Pharmaceuticals
Phone
1-888-669-6682
Email
Novartis.email@novartis.com
First Name & Middle Initial & Last Name or Official Title & Degree
Novartis Pharmaceuticals
Phone
+41613241111
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Novartis Pharmaceuticals
Organizational Affiliation
Novartis Pharmaceuticals
Official's Role
Study Director
Facility Information:
Facility Name
University of Iowa Carver College of Medicine
City
Iowa City
State/Province
Iowa
ZIP/Postal Code
52242
Country
United States
Individual Site Status
Withdrawn
Facility Name
University of Kentucky
City
Lexington
State/Province
Kentucky
ZIP/Postal Code
40536
Country
United States
Individual Site Status
Recruiting
Facility Contact:
Phone
504-278-0134
Email
amanchauhan@uky.edu
First Name & Middle Initial & Last Name & Degree
Aman Chauhan, Dr
Facility Name
Cincinnati Children's Hospital
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45229-3039
Country
United States
Individual Site Status
Recruiting
Facility Contact:
Phone
513-636-4266
Email
brian.weiss@cchmc.org
First Name & Middle Initial & Last Name & Degree
Brian Weiss, Dr
Facility Name
Children's Hospital of Philadelphia
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Individual Site Status
Recruiting
Facility Contact:
Phone
267-425-0126
Email
LAETSCHT@CHOP.EDU
First Name & Middle Initial & Last Name & Degree
Theodore Laetsch, Dr
Facility Name
Texas's Children Hospital
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Individual Site Status
Recruiting
Facility Contact:
Phone
832-824-4646
Email
jhfoster@txch.org
First Name & Middle Initial & Last Name & Degree
Jennifer Foster, Dr
Facility Name
University Hospitals Leuven (UZ Leuven)
City
Louvain
Country
Belgium
Individual Site Status
Recruiting
Facility Name
CHU de Québec - Université Laval
City
Québec
Country
Canada
Individual Site Status
Recruiting
Facility Name
Centre Léon Berard
City
Lyon
Country
France
Individual Site Status
Recruiting
Facility Name
IEO Istituto Europeo di Oncologia
City
Milano
Country
Italy
Individual Site Status
Withdrawn
Facility Name
Bambin Gesu' Hospital
City
Roma
Country
Italy
Individual Site Status
Recruiting
Facility Name
Prinses Maxima (UMC Utrecht)
City
Utrecht
Country
Netherlands
Individual Site Status
Recruiting
Facility Name
Maria Sklodowska-Curie National Research Institute of Oncology
City
Gliwice
Country
Poland
Individual Site Status
Recruiting
Facility Name
Coimbra Hospital
City
Coimbra
Country
Portugal
Individual Site Status
Withdrawn
Facility Name
Hospital Universitari Vall d'Hebron
City
Barcelona
Country
Spain
Individual Site Status
Recruiting
Facility Name
University Hospital 12 de Octubre
City
Madrid
Country
Spain
Individual Site Status
Recruiting
Facility Name
Karolinska Institutet
City
Stockholm
Country
Sweden
Individual Site Status
Withdrawn
Facility Name
University College Hospital of London
City
London
Country
United Kingdom
Individual Site Status
Recruiting

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Novartis is committed to sharing with qualified external researchers, access to patient-level data and supporting clinical documents from eligible studies. These requests are reviewed and approved by an independent review panel on the basis of scientific merit. All data provided is anonymized to respect the privacy of patients who have participated in the trial in line with applicable laws and regulations. This trial data availability is according to the criteria and process described on www.clinicalstudydatarequest.com

Learn more about this trial

Study to Evaluate Safety and Dosimetry of Lutathera in Adolescent Patients With GEP-NETs and PPGLs

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