Description:
The purpose of this study is to learn about the feasibility and safety of using Peptide
Receptor Radionuclide Therapy (PRRT) before and after surgical removal of a tumor. PRRT
treatment is based on the administration of a radioactive product, 177-Lu
DOTA-0-Tyr3-Octreotate (Lutathera®) and its use before and after surgery is thought to
increase the overall survival benefit for patients with SSTR-positive gastroenteropancreatic
neuroendocrine tumors GEP-NETs.
Title
- Brief Title: Study of PRRT in Metastatic, World Health Organization (WHO) Grade 1 or 2, SSTR Positive, GEP-NET Who Are Candidates for Cytoreductive Surgery
- Official Title: Pilot Phase 1 Study of Perioperative Peptide Receptor Radionuclide Therapy (PRRT) in Metastatic, WHO Grade 1 or 2, SSTR Positive, Gastroenteropancreatic Neuroendocrine Tumors Who Are Candidates for Cytoreductive Surgery
Clinical Trial IDs
- ORG STUDY ID:
IRB- 52341
- SECONDARY ID:
NET0030
- NCT ID:
NCT04609592
Conditions
- Gastroenteropancreatic Neuroendocrine Tumor
Interventions
Drug | Synonyms | Arms |
---|
Lutathera | lutetium Lu 177 dotatate, (Lu 177)-N-[(4,7,10-Tricarboxymethyl-1,4,7,10- tetraazacyclododec-1-yl) acetyl]-D-phenylalanyl-L-cysteinyl-L-tyrosyl-D-tryptophanyl-L-lysyl-L-threoninyl-Lcysteinyl-L-threonine-cyclic (2-7) disulfide., 177 Lu-DOTA-octreotate | Lutathera |
Gallium 68 Dotatate | Gallium-68 DOTA-DPhe1, Tyr3-octreotate | Lutathera |
Purpose
The purpose of this study is to learn about the feasibility and safety of using Peptide
Receptor Radionuclide Therapy (PRRT) before and after surgical removal of a tumor. PRRT
treatment is based on the administration of a radioactive product, 177-Lu
DOTA-0-Tyr3-Octreotate (Lutathera®) and its use before and after surgery is thought to
increase the overall survival benefit for patients with SSTR-positive gastroenteropancreatic
neuroendocrine tumors GEP-NETs.
Detailed Description
Primary Objective(s)
- To assess feasibility and safety of combination of perioperative 177Lu Dotatate and
cytoreductive surgery in metastatic GEP NETs Secondary Objective(s)
- To assess response rate (RR) after 2 cycles 177Lu Dotatate
- To assess recurrence free survival (RFS) of the overall treatment strategy
- To assess overall survival (OS) of the overall treatment strategy
Trial Arms
Name | Type | Description | Interventions |
---|
Lutathera | Experimental | 2 cycles of 177Lu Dotatate, followed by cytoreductive surgery, followed by additional 177Lu Dotatate (up to 2 cycles) for residual disease as determined by 68Ga DOTA TATE PET/CT | - Lutathera
- Gallium 68 Dotatate
|
Eligibility Criteria
Inclusion Criteria:
1. Metastatic gastroenteropancreatic NET with lymph nodes or liver metastases only.
2. WHO Grade 1 or 2, Ki 67 ≤ 20% (to be confirmed at Stanford)
3. Must be a candidate for cytoreductive surgery with the goal of R1 resection as
determined by a multidisciplinary tumor board discussion
4. Measurable disease as determined by RECIST v1.1
5. Confirmed presence of somatostatin receptors on all target lesions as determined by
68Ga DOTA TATE PET scan
6. Patients ≥ 18 years of age.
7. Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≤ 1
8. Appropriate hematologic, liver and kidney function
9. Patients on octreotide long-acting release (LAR) at a fixed dose of 20 mg or 30 mg at
3 to 4 weeks intervals for at least 12 weeks prior to enrollment in the study
Exclusion Criteria:
1. Prior 177Lu Dotatate treatment
2. Any surgery or radiofrequency ablation within 12 weeks prior to enrollment in the
study; or prior radioembolization; chemoembolization; or external beam radiation
therapy (EBRT) to > 25% of bone marrow, at any time
3. Any chemotherapy or targeted therapy (including everolimus and sunitinib) within 4
weeks prior to enrollment in the study
4. Known brain metastases
5. Known bone or peritoneal metastases
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Measure Complication free Surgery |
Time Frame: | 6 months |
Safety Issue: | |
Description: | The feasibility of perioperative 177Lu Dotatate as part of the therapeutic regimen to treat metastatic neuroendocrine tumors (NETs) will be assessed on the basis of number and proportion of participants who undergo 2 cycles of complication free 177Lu Dotatate therapy followed by cytoreductive surgery without complications, expressed as a number without dispersion. Complications are defined as follows.
Radiation fibrosis
Hepatic fibrosis by histologic diagnosis
Hepatic insufficiency
Bowel anastamotic leak (if bowel surgery)
Distal pancreatic leak (if pancreas surgery) |
Secondary Outcome Measures
Measure: | Response Rate (RR) |
Time Frame: | 16 weeks |
Safety Issue: | |
Description: | Response Rate (RR), as defined by the Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 criteria, will be determined after 2 pre operative cycles of 177Lu Dotatate. RR will be assessed as the sum of complete response (CR) and partial response (PR), and expressed as a number without dispersion. RECIST criteria are:
CR = Disappearance of all target lesions
PR = ≥ 30% decrease in the sum of the longest diameter of target lesions
Response Rate (RR) = CR + PR
Progressive disease (PD) = 20% increase in the sum of the longest diameter of target lesions, and/or the appearance of one or more new lesion(s)
Stable disease (SD) = Small changes that do not meet any of the above criteria |
Measure: | Recurrence free Survival (RFS) |
Time Frame: | 1 year |
Safety Issue: | |
Description: | Recurrence free Survival (RFS) is defined as the number and proportion of participants that remain alive from the start of treatment without relapse or recurrence of disease, expressed as a number without dispersion. |
Measure: | Overall Survival (OS) |
Time Frame: | 1 year |
Safety Issue: | |
Description: | Overall survival (OS) is defined as the number and proportion of participants that remain alive from the start of treatment, expressed as a number without dispersion. |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Stanford University |
Last Updated
April 19, 2021