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Clinical Trial NCT06016855 for Digestive System Neuroendocrine Tumor G1, Digestive System Neuroendocrine Tumor G2, Metastatic Digestive System Neuroendocrine Neoplasm, Metastatic Malignant Neoplasm in the Liver, Pancreatic Neuroendocrine Tumor G1, Pancreatic Neuroendocrine Tumor G2 is recruiting. See the Trial Radar Card View and AI discovery tools for all the details. Or ask anything here.
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Surgical Debulking Prior to Peptide Receptor Radionuclide Therapy in Well Differentiated Gastroenteropancreatic Neuroendocrine Tumors

Recruiting
Clinical Trial NCT06016855 is designed to study Treatment for Digestive System Neuroendocrine Tumor G1, Digestive System Neuroendocrine Tumor G2, Metastatic Digestive System Neuroendocrine Neoplasm, Metastatic Malignant Neoplasm in the Liver, Pancreatic Neuroendocrine Tumor G1, Pancreatic Neuroendocrine Tumor G2. It is a Phase 4 interventional trial that is recruiting, having started on 31 May 2024, with plans to enroll 6 participants. Led by Vanderbilt-Ingram Cancer Center, it is expected to complete by 28 May 2028. The latest data from ClinicalTrials.gov was last updated on 3 July 2024.
Brief Summary
This phase IV trial evaluates how well giving standard of care (SOC) peptide receptor radionuclide therapy (PRRT) after SOC surgical removal of as much tumor as possible (debulking surgery) works in treating patients with grade 1 or 2, somatostatin receptor (SSTR) positive, gastroenteropancreatic neuroendocrine tumors (GEP-NETs) that have spread from where they first started (primary site) to the liver (hepatic metastasis). Lutetium Lu 177 dotatate is a radioactive drug that uses targeted radiation to kill tumor cells. Lutetium Lu 177 dotatate includes a radioactive form (an isotope) of the element called lutetium. This radioactive isotope (Lu-177) is attached to a molecule called dotatate. On the surface of GEP-NET tumor cells, a receptor called a somatostatin receptor binds to dotatate. When this binding occurs, the lutetium Lu 177 dotatate drug then enters somatostatin receptor-positive tumor cells, and radiation emitted by Lu-177 helps kill the cells. Giving lutetium Lu 177 dotatate after surgical debulking may better treat patients with grade 1/2 GEP-NETs
Detailed Description
PRIMARY OBJECTIVES:

I. To measure objective response rate of a combination standard of care treatment in gastroenteropancreatic neuroendocrine tumors by initiating lutetium Lu 177 dotatate within 90 days of surgical debulking.

II. To assess the radiomic profile including somatostatin receptor standardized uptake values (SSTR SUV) of large and non-large tumors in study patients)

III: To assess the safety and tolerability of peptide receptor radionuclide therapy (PRRT) post-surgical debulking in patients on study.

IV. To assess the tumor genomic profile of large, resected tumors from patients and assess for signatures of radioresistance.

OUTLINE:

Patients undergo surgical debulking on day 0 and receive lutetium Lu 177 dotatate (177Lu dotatate) intravenously (IV) over 30 to 40 minutes on day 1 of each cycle. Treatment repeats every 56 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo computed tomography (CT) scan or magnetic resonance imaging (MRI) throughout the trial, and undergo copper Cu 64 dotatate positron emission tomography/CT (dotatate PET/CT) during screening and on study.

After completion of study treatment, patients are followed up at 30-37 days after last dose and then every 3 months for 2 years.

Official Title

Surgical Debulking Prior to Peptide Receptor Radionuclide Therapy (PRRT) in Patients With Well Differentiated Gastroenteropancreatic Neuroendocrine Tumors

Conditions
Digestive System Neuroendocrine Tumor G1Digestive System Neuroendocrine Tumor G2Metastatic Digestive System Neuroendocrine NeoplasmMetastatic Malignant Neoplasm in the LiverPancreatic Neuroendocrine Tumor G1Pancreatic Neuroendocrine Tumor G2
Publications
Scientific articles and research papers published about this clinical trial:
Other Study IDs
NCT ID Number
NCT06016855
Start Date (Actual)
2024-05-31
Last Update Posted
2024-07-03
Completion Date (Estimated)
2028-05-28
Enrollment (Estimated)
6
Study Type
Interventional
PHASE
Phase 4
Status
Recruiting
Primary Purpose
Treatment
Design Allocation
N/A
Interventional Model
Single Group
Masking
None (Open Label)
Arms / Interventions
Participant Group/ArmIntervention/Treatment
ExperimentalTreatment (surgical debulking, 177Lu dotatate)
Patients undergo surgical debulking on day 0 and receive 177Lu dotatate IV over 30 to 40 minutes on day 1 of each cycle. Treatment repeats every 56 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo CT scan or MRI throughout the trial, and undergo dotatate PET/CT during screening and on study.
Tumor Debulking
Undergo surgical debulking
Lutetium Lu 177 Dotatate
Given by IV
Computed Tomography
Undergo Computed Tomography
Magnetic Resonance Imaging
Undergo Magnetic Resonance Imaging
Copper Cu 64 Dotatate
Given by IV
Positron Emission Tomography
Undergo Positron Emission Tomography
Primary Outcome Measures
Outcome MeasureMeasure DescriptionTime Frame
Somatostatin receptor standardized uptake values (SSTR SUV)
SSTR SUV (not limited to but including measures such as SSTR SUV max, SSTR SUV mean) will be estimated for the patients undergoing post-operative research dotatate scans and compared to values from peptide receptor radionuclide therapy (PRRT) eligibility-conferring dotatate scans in these same patients. These quantitative analytics will be performed by central review. Changes in SSTR SUV values will be analyzed with summary statistics.
Up to 2 years
Progression-free survival
Will be estimated by the Kaplan-Meier method.
From the start of PRRT to the date the patient progresses radiographically or succumbs to the disease, assessed up to 2 years
Overall response rate
Will be estimated by measuring the number of patients who achieve a complete response or partial response by Response Evaluation Criteria in Solid Tumors (RECIST 1.1) criteria on restaging computed tomography or magnetic resonance imaging scans =\< 6 months from PRRT completion, from the total number of patients who received the study treatment and possessed measurable disease post-surgical debulking. The number of patients who possessed measurable disease which did not meet RECIST 1.1 eligibility criteria post-surgical debulking will also be recorded.
Up to 2 years
Overall survival
Will be estimated by the Kaplan-Meier method.
From the start of PRRT to the date the patient progresses radiographically or succumbs to the disease, assessed up to 2 years
Incidence of adverse events
Toxicity will be estimated by documenting the grade 3/4 adverse events, according to Common Terminology Criteria for Adverse Events version 5.0, experienced by study patients.
Up to 2 years
Gene mutations
Mutations in genes associated with radioresistance (defined from other malignancies) and other mutations in large resected neuroendocrine tumors will be recorded. Mutations will be described descriptively.
Up to 2 years
Eligibility Criteria

Eligible Ages
Adult, Older Adult
Minimum Age
18 Years
Eligible Sexes
All
  • Signed and dated written informed consent
  • Male or female >= 18 years of age on the day of signing informed consent
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 or 2
  • Histologically confirmed well-differentiated gastrointestinal or pancreatic neuroendocrine tumor that is grade 1 or grade 2 (Ki-67 =< 20%)
  • Somatostatin receptor avidity of known or suspected neuroendocrine tumor (NET) lesion(s) assessed by a baseline copper-64 dotatate PET/CT scan performed within 6 months (180 days) prior to surgical debulking on study day 0. The somatostatin receptor avidity of the majority of suspected NET lesion(s) must be >= normal liver uptake
  • Patient must have hepatic metastasis or hepatic metastases. Provided required hepatic metastatic disease is present, patient can also have any other site or sites of metastatic disease
  • White blood cell count (WBC) >= 2000/uL (resulted =< 90 days prior to surgical debulking on day 0 of participation in this study)
  • Platelets >= 75,000/uL (resulted =< 90 days prior to surgical debulking on day 0 of participation in this study)
  • Hemoglobin >= 8.0 g/dL (resulted =< 90 days prior to surgical debulking on day 0 of participation in this study)
  • Creatinine clearance (CrCl) >= 30 mL/minute (as calculated by the Cockcroft-Gault Formula with estimated creatinine clearance rate [eCCR] >= 30 mL/min required for eligibility inclusion; or calculated/measured by an alternative established institutional standard consistently applied across participants at the site) (resulted =< 90 days prior to surgical debulking on day 0 of participation in this study)
  • Total bilirubin =< 3.0 times institutional upper limit of normal (ULN) (resulted =< 90 days prior to surgical debulking on day 0 of participation in this study)
  • Serum albumin >= 3.0 g/dL unless the prothrombin time is within normal range (resulted =< 90 days prior to surgical debulking on day 0 of participation in this study)
  • Women must not be breastfeeding and further agree to not breastfeed during treatment with lutetium Lu 177 dotatate; and for at least 2.5 months after patient's final dose of lutetium Lu 177 dotatate
  • A woman of childbearing potential (WOCBP) - must have a negative serum or urine pregnancy test resulted within 28 days prior to initiation of first dose of lutetium Lu 177 dotatate on cycle 1, day 1; and must agree to follow instructions for using acceptable contraception from the time of signing consent, and until 7 months after her final dose of lutetium Lu 177 dotatate
  • A man able to father children who is sexually active with a WOCBP must agree to follow instructions for using acceptable contraception, from the time of signing consent, and until 4 months after his final dose of lutetium Lu 177 dotatate

  • Patient has any tumor > 3 cm deemed to be inoperable
  • Patient has disease which is considered to be completely surgically resectable
  • Patient has grade 3 neuroendocrine neoplasm (well-differentiated or poorly-differentiated tumor)
  • Prior receipt of peptide receptor radionuclide therapy (PRRT)
  • Patient possesses untreated or growing brain metastases (growth within 90 days prior to surgical debulking on day 0 of participation in this study)
  • Unstable angina, congestive heart failure with New York Heart Association (NYHA) functional classification III or IV, or uncontrolled symptomatic cardiac arrythmia
  • Any other significant medical, psychiatric, or surgical condition, currently uncontrolled by treatment, which in the judgment of the patient's study physician may reasonably be expected to interfere with patient's completion of the study
Vanderbilt-Ingram Cancer Center logoVanderbilt-Ingram Cancer Center
Study Responsible Party
Kamran Idrees, Principal Investigator, Associate Professor of Surgery, Vanderbilt-Ingram Cancer Center
Study Central Contact
Contact: Vanderbilt-Ingram Services for Timely Access, 800-811-8480, [email protected]
1 Study Locations in 1 Countries

Tennessee

Vanderbilt University/Ingram Cancer Center, Nashville, Tennessee, 37203, United States
Vanderbilt-Ingram Service for Timely Access, Contact, 800-811-8480, [email protected]
Kamran Idrees, MD, Principal Investigator
Recruiting