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Trial record 14 of 49 for:    Peptide Receptor | Neuroendocrine Tumors

Dosimetry Guided PRRT With 177Lu-DOTATATE in Children

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ClinicalTrials.gov Identifier: NCT03923257
Recruitment Status : Not yet recruiting
First Posted : April 22, 2019
Last Update Posted : April 23, 2019
Sponsor:
Collaborator:
Advanced Accelerator Applications
Information provided by (Responsible Party):
Sue O'Dorisio, University of Iowa

Brief Summary:
This is a Phase I/II peptide receptor radiotherapy (PRRT) trial of 177Lu-DOTA-OCTREOTATE in children with relapsed or refractory neuroblastoma, neuroendocrine tumors, and pheochromocytoma or paraganglioma.

Condition or disease Intervention/treatment Phase
Neuroendocrine Tumors Neuroblastoma Pheochromocytoma Paraganglioma Drug: 177Lu-DOTA-tyr3-OCTREOTATE Procedure: Peptide Receptor Radiotherapy (PRRT) Phase 1 Phase 2

Detailed Description:

The purpose of this clinical trial is to determine if peptide receptor radiotherapy (PRRT) using 177Lu-DOTA-OCTREOTATE given intravenously in children is an effective treatment and to describe its toxicities.

This study will consists of two groups:

Group A - children age 18 months to 18 years with relapsed or refractory neuroendocrine tumors and pheochromocytoma or paraganglioma.

Group B - children age 6 months to 18 years with relapsed or refractory neuroblastoma.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 74 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase I/II Trial of Peptide Receptor Radiotherapy (PRRT) With 177Lu-DOTA-tyr3 OCTREOTATE (177Lu-DOTATATE) in Children With Neuroendocrine Tumor, Neuroblastoma, or Pheochromocytoma/Paraganglioma
Estimated Study Start Date : July 1, 2019
Estimated Primary Completion Date : December 31, 2021
Estimated Study Completion Date : December 31, 2022


Arm Intervention/treatment
Experimental: PRRT with 177Lu-DOTA-tyr3-OCTREOTATE

177Lu-DOTA-tyr3-OCTREOTATE (177Lu-DOTATATE) and amino acid will be administered intravenously (IV) on Day 1 of each of four treatment cycles, 8 weeks apart.

This study will consists of two groups:

Group A - Children age 18 months to 18 years with relapsed or refractory neuroendocrine tumors and pheochromocytoma or paraganglioma. Children with neuroendocrine tumor, pheochromocytoma or paraganglioma will not have had any previous endoradiotherapy with 90Y-DOTATOC, 131I-MIBG, or 177Lu-DOTATATE.

Group B - Children age 6 months to 18 years with relapsed or refractory neuroblastoma. Children with neuroblastoma may have received previous 131I-MIBG treatment and must have dosimetry estimates of that radiation dose before receiving 177Lu-DOTATATE therapy in this study.

Drug: 177Lu-DOTA-tyr3-OCTREOTATE
This is a peptide receptor radiotherapy that targets somatostatin receptors on tumor cells.
Other Name: Lutathera

Procedure: Peptide Receptor Radiotherapy (PRRT)
PRRT is internal radiation that is individually dosed according to patient body surface area, kidney function and bone marrow status.




Primary Outcome Measures :
  1. Toxicities [ Time Frame: Initiation of treatment through 5 years ]

    To examine the toxicity related to the therapy by measuring the number of treatment related adverse events in patients

    Adverse events will be reported in tabular form by type and grade. Adverse events will be graded according to the most recent CTE guidelines.


  2. Objective Response Rate (ORR) according to RECIST criteria in children [ Time Frame: Initiation of treatment through 5 years ]
    To determine overall response rate (ORR) (complete response [CR] + partial response [PR]) + stable disease [SD] per RECIST v1.1)


Secondary Outcome Measures :
  1. Measure and demonstrate accuracy of radiation dose to kidneys in children based on a single SPECT/CT image of the kidneys plus a single whole body scan [ Time Frame: Initiation of treatment through treatment #4 (approximately 26 weeks) ]

    Six subjects in each group will have whole body imaging and SPECT/CT of kidneys performed at 3-8 hours plus whole body and SPECT at 20-28 hours, 44-52 hours, 92-100 hours and 116-124 hours after the administration of the radiopharmaceutical. Data will be analyzed using method of Madsen[1,2]. Single point dosimetry will be utilized with subsequent cohorts if data demonstrates agreement with adult dosimetry. Biological effective dose (BED) to kidneys will be calculated according to Bodei et al [3].

    The information on renal uptake, renal mass and residence time will be entered into OLINDA software to calculate the radiation dose. If single point dosimetry proves to be accurate, any remaining Phase I subjects and all Phase II subjects will receive single point dosimetry for both renal and bone marrow radiation dose estimation.


  2. Measure and demonstrate accuracy of radiation dose to bone marrow in children based on radioactivity in a single blood sample [ Time Frame: Initiation of treatment through treatment #4 (approximately 26 weeks) ]
    Blood dosimetry will be performed as a surrogate of bone marrow dosimetry. Blood samples (1 mL) will be obtained prior to start of amino acid infusion and subsequently in the same time frame with the imaging sessions.

  3. Progression Free Survival (PFS) according to RECIST criteria in children [ Time Frame: Initiation of treatment through 5 years ]
    Progression will be defined using the RECIST 1.1 guidelines. Results are provided in nominal categories (CR, PR, SD, PD) as per RECIST.

  4. Measure effect of PRRT in quality of life with the PROMIS Pediatric Profile v2.0 - Profile-37 [ Time Frame: Initiation of treatment through treatment #4 (approximately 26 weeks) ]
    Parents of participants will be asked to complete the PROMIS Pediatric Profile v2.0 - Profile-37



Information from the National Library of Medicine

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Ages Eligible for Study:   6 Months to 18 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Disease not amenable to standard treatment (nonresectable or disease present after one or more surgeries and/or Sandostatin treatment) or subject has failed existing first line chemotherapy, biologic therapy, targeted agent therapy or radiation therapy.
  • Participation in Iowa Neuroendocrine Tumor Registry.
  • A pathologically confirmed (histology or cytology) Neuroendocrine Tumor (NET), Neuroblastoma (NB), Pheochromocytoma (PCC), or Paraganglioma (PGL).
  • For patients with measurable or evaluable disease: >50% of lesions must demonstrate 68Ga- DOTATATE uptake greater than physiologic liver uptake by visual assessment. At least one lesion must be confirmed by conventional imaging (CT or MRI).
  • For patients with measurable disease, the target lesion is one that either has never received external beam radiation or has been previously irradiated and has since demonstrated progression.
  • For patients with no measurable disease (no measurable target lesions), who have evaluable disease (bone disease, MIBG positive disease, liver metastases not detectable on MRI or CT), the disease must be seen on 68Ga-DOTATATE PET/CT.
  • For patients with neuroblastoma, If the patient has only one MIBG positive lesion and that lesion was radiated, a biopsy or 18FDG PET scan must be done at least 28 days after radiation was completed and must show viable neuroblastoma. Such a lesion is not sufficient for eligibility if no lesions are positive for 68Ga- DOTATATE PET/CT.
  • No previous endogenous radiation with 177Lu-DOTATATE/TOC or 90Y-DOTATATE/TOC within 12 months of most recent treatment. Previous treatment must be limited to ≤40 Gy biologically effective dose (BED) to kidneys and ≤2 Gy to bone marrow; hematopoietic stem cells (HSC) ≥2X106 CD34+ cells/kg must be available if >2 Gy prior exposure to bone marrow.
  • Previous treatment of neuroblastoma with 131I-MIBG must be limited to ≤40 Gy biologically effective dose (BED) to kidneys and ≤3 Gy to bone marrow; hematopoietic stem cells (HSC) ≥2X106 CD34+ cells/kg must be available if >3 Gy prior exposure to bone marrow.
  • Age 18 months-18 years except neuroblastoma with amplified NMYC may be eligible at 6 months.
  • Performance status as determined by Karnofsky ≥60 or Lansky Play Scale ≥60 at the time of study drug administration.

NOTE: Neurologic deficits in patients with brain metastases must have been stable for at least 7 days prior to study enrollment.

  • Completion of validated Pediatric Quality of Life Questionnaire.
  • Within 7 days of study drug administration, must have normal organ and bone marrow function as defined below:

Adequate Bone Marrow Function Defined as:

  • Peripheral absolute neutrophil count (ANC) ≥750/mm3
  • Platelet count ≥75,000/mm3 (transfusion independent, defined as not receiving platelet transfusions for at least 7 days prior to enrollment)
  • Hemoglobin ≥8g/dL

Organ Function Requirements:

  • AST(SGOT)& ALT(SGPT); <10X institutional upper limit of normal for age
  • Total bilirubin; <3X ULN for age
  • Creatinine, BUN, potassium, sodium, chloride, bicarbonate, magnesium, phosphorus, calcium, glucose; Normal for age
  • Glomerular filtration rate (GFR); Nuclear GFR or CrCl ≥ 80 ml/min/1.73m2
  • Urinalysis; No greater than 1+ hematuria or proteinuria

    • The effects of 177Lu-DOTATATE on the developing human fetus are unknown. For this reason and because Class C agents are known to be teratogenic, all subjects capable of becoming pregnant must agree to practice a medically acceptable birth control measure (abstinence, birth control pills, intrauterine devices, vaginal diaphragm, vaginal sponge, or condom with spermicidal jelly) throughout the study and for eight months following the end of the last treatment. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
    • Parent's ability to understand and the willingness to sign a written informed consent document for children ≤7 years of age. Children ≥7 years of age will sign assent along with parental consent or will co-sign consent with parent in accordance with rules of the state in which treatment is received.

Exclusion Criteria:

  • Pregnant women are excluded from this study because 177Lu-DOTATATE is a Class C agent with potential teratogenic or abortifacient effects.
  • Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with 177Lu-DOTATATE, breastfeeding should be discontinued until 3 months after the last administration of study drug.
  • Major surgery within 8 weeks of study drug administration.
  • External beam radiation to both kidneys (scatter doses of <500 cGy to a single kidney or radiation to ˂50% of a single kidney is acceptable).
  • Prior PRRT with 90Y-DOTATOC (TATE) or 177Lu-DOTATOC (TATE) for this malignancy within 12 months of first study dose.
  • Another investigational drug within 8 weeks of study drug administration.
  • Concurrent, malignant disease for which patient is on active therapy.
  • Another significant medical, psychiatric, or surgical condition which is currently uncontrolled by treatment and which would likely affect the subject's ability to complete this protocol.
  • Subjects who have received Sandostatin LAR or long-acting lanreotide in the past 28 days must be appropriately delayed. Subjects may be maintained on short acting octreotide during the time from last injection of long-acting somatostatin analogue until 18-24 hrs prior to injection of study drug.
  • Known antibodies to Octreotide, Lanreotide, or DOTATATE or history of allergic reactions attributed to compounds of similar chemical or biologic composition to 177Lu-DOTATATE.
  • Uncontrolled illness including, but not limited to ongoing or active infection, uncontrolled diabetes mellitus, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, hepatic cirrhosis or severe impairment, or psychiatric illness/social situations that would limit compliance with study requirements.
  • Corticosteroids: Patients receiving corticosteroids who have not been on a stable or decreasing dose of corticosteroid for at least 7 days prior to enrollment are not eligible. If used to modify immune adverse events related to prior therapy, ≥ 14 days must have elapsed since last dose of corticosteroid
  • Patients who have received a prior solid organ transplantation are not eligible
  • Patients will be excluded if they have a known allergy to any of the drugs used in the study
  • Prior Therapy:

    • Cytotoxic chemotherapy or other anti-cancer agents known to be myelosuppressive. At least 21 days after the last dose of cytotoxic or myelosuppressive chemotherapy (42 days if prior nitrosourea).
    • Anti-cancer agents not known to be myelosuppressive (e.g. not associated with reduced platelet or ANC counts): ≥ 7 days after the last dose of agent.
    • Antibodies: ≥ 21 days must have elapsed from infusion of last dose of antibody, and toxicity related to prior antibody therapy must be recovered to Grade ≤ 1.
    • Hematopoietic growth factors: ≥ 14 days after the last dose of a long-acting growth factor (e.g. Peg-Filgrastim) or 7 days for short-acting growth factor. For agents that have known adverse events occurring beyond 7 days after administration, this period must be extended beyond the time during which adverse events are known to occur. The duration of this interval must be discussed with the study chair and the study-assigned Research Coordinator.
    • Interleukins, Interferons and Cytokines (other than Hematopoietic Growth Factors): ≥ 21 days after the completion of interleukins, interferon or cytokines (other than Hematopoietic Growth Factors)Stem cell Infusions (with or without TBI).
    • Allogeneic (non-autologous) bone marrow or stem cell transplant, or any stem cell infusion including donor lymphocyte infusion or boost infusion: ≥ 84 days after stem cell infusion
    • Evidence of GVHD.
    • Autologous stem cell infusion including boost infusion: ≥ 42 days; cellular therapy: ≥ 42 days after the completion of any type of cellular therapy (e.g. modified T cells, NK cells, dendritic cells, etc.).

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03923257


Contacts
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Contact: M. Sue O'Dorisio, MD, PhD 319-335-7234 sue-odorisio@uiowa.edu
Contact: Silvia Ghobrial, MD silvia-ghobrial@uiowa.edu

Locations
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United States, Iowa
University of Iowa Hospitals and Clinics Not yet recruiting
Iowa City, Iowa, United States, 52242
Contact: M. Sue O'Dorisio, MD, PhD    319-335-7234    sue-odorisio@uiowa.edu   
Contact: Silvia Ghobrial, MD       silvia-ghobrial@uiowa.edu   
Sponsors and Collaborators
Sue O'Dorisio
Advanced Accelerator Applications
Investigators
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Principal Investigator: M. Sue O'Dorisio, MD, PhD University of Iowa

Publications:
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Responsible Party: Sue O'Dorisio, Professor, University of Iowa
ClinicalTrials.gov Identifier: NCT03923257     History of Changes
Other Study ID Numbers: 201812772
First Posted: April 22, 2019    Key Record Dates
Last Update Posted: April 23, 2019
Last Verified: April 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Neuroendocrine Tumors
Carotid Body Tumor
Neuroectodermal Tumors, Primitive, Peripheral
Neuroectodermal Tumors, Primitive
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue
Neuroblastoma
Pheochromocytoma
Paraganglioma
Paraganglioma, Extra-Adrenal
Octreotide
Gastrointestinal Agents
Antineoplastic Agents, Hormonal
Antineoplastic Agents