AvidinOX + [177Lu]DOTA-biotin (or 177Lu-ST2210) Complex in Patients With Liver Metastases From Colorectal Cancer

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT02053324
Recruitment Status : Recruiting
First Posted : February 3, 2014
Last Update Posted : June 14, 2017
Information provided by (Responsible Party):
sigma-tau i.f.r. S.p.A.

Brief Summary:

The purpose of the study is to assess a new treatment for patients with liver tumor metastases from colorectal cancer. The treatment has never been used in humans before. The treatment foresees the use of two compounds: AvdinOX and [177Lu]DOTA-biotin.

AvidinOX is a new compound, essentially a natural protein obtained from hen eggs, while [177Lu]DOTA-biotin is a new chemical compound resulting from the combination of the DOTA-biotin (also deriving from a natural vitamin which is biotin) with the 177Lutetium, an atom which emits radiation.

AvidinOX will be injected directly into the metastases in the liver and [177Lu]DOTA-biotin will be injected into the arm vein.

One specific property of AvidinOX is that it chemically links to the tumor tissues when it is injected while maintaining the capacity to take up [177Lu]DOTA-biotin. Once locally bound in tumor tissue, AvidinOX becomes an "artificial receptor" for intravenously injected [177Lu]DOTA-biotin, which allows an internal radiation therapy of the tumor tissue.

The treatment of liver metastases with local injection of AvidinOX and the following intra-venous injection of [177Lu]DOTA-biotin could be simpler and more tolerable than the current available treatments.

Condition or disease Intervention/treatment Phase
Liver Metastases Combination Product: AvidinOX/ST2210 Phase 1

Detailed Description:

Primary objectives

  1. To identify the Maximum Tolerated Dose (MTD) of 177Lu-ST2210 after prior intra-lesional injection of AvidinOX in the liver.
  2. To assess safety and tolerability of intra-lesionally injected AvidinOX + IV injected 177Lu-ST2210
  3. To evaluate intra-lesional distribution and retention of AvidinOX + 177Lu-ST2210 complex in liver metastases
  4. To evaluate systemic biodistribution and pharmacokinetics of 177Lu-ST2210 and {AvidinOX + 177Lu-ST2210}- complex

Secondary objectives

  1. To evaluate proportional 177Lu-ST2210 tumor binding, as a function of total tumor load, and AvidinOX dose injected
  2. To demonstrate AvidinOX post-deposition reactivity with 177Lu-ST2210 over time
  3. To evaluate whole body dosimetry of IV 177Lu-ST2210 after prior AvidinOX injection (radiation safety dosimetry)
  4. To record individual tumor dosimetry
  5. To evaluate preliminary efficacy of {AvidinOX + 177Lu-ST2210}-complex in reducing tumor size
  6. To evaluate whole body safety dosimetry and dose linearity of IV administered 177Lu-ST2210 after prior intra-lesional injection of AvidinOX
  7. To evaluate pharmacokinetics of ST2210 in plasma and urine

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 30 participants
Intervention Model: Single Group Assignment
Intervention Model Description: 3+3 dose escalation design
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Dose Escalation Study to Evaluate Safety, Tolerability, Pharmacokinetics, Dosimetry, Maximum Tolerated Dose and Preliminary Efficacy of Intra-lesionally Injected AvidinOX, Followed by Systemic IV Administration of Escalating Doses of [177Lu]DOTA-biotin in Patients With Liver Metastases From Colorectal Cancer
Actual Study Start Date : November 11, 2013
Estimated Primary Completion Date : February 2018
Estimated Study Completion Date : December 2018

Resource links provided by the National Library of Medicine

Drug Information available for: Biotin

Arm Intervention/treatment
Experimental: AvidinOX/ST2210
AvidinOX/ST2210 - vial containing 22.5 mg AvidinOX + vials containing 10 ml of water for injection (WFI) for the reconstitution in a clear solution with an AvidinOX concentration of 3 mg/ml. One Intralesion administration of a volume of reconstituted AvidinOX equal to 15 % of the lesion volume followed by intravenous infusion of 177Lu-ST2210 Diagnostic dose : 10 ml, 250 MBq±10%177Lu, approximately 1 mg ST2210, 100 mg/mL ascorbic acid, followed by intravenous infusion of a therapeutic dose: 25 ml, escalating 177Lu dose starting at 5 Gigabequerel (GBq) ±10%with escalation steps of 2.5 GBq up to 15 GBq ±10%, approximately 1 mg ST2210, 100 mg/ml ascorbic acid
Combination Product: AvidinOX/ST2210
One intralesion injection of AvidinOX followed by an intravenous infusion of ST2210

Primary Outcome Measures :
  1. Dose Limiting Toxicity evaluated using NCI Common Toxicity Criteria (CTCAE 4.03) [ Time Frame: up to six weeks ]

Secondary Outcome Measures :
  1. Adverse Events [ Time Frame: up to 1 year ]

Other Outcome Measures:
  1. tumor response [ Time Frame: 1 year ]
    Tumor response according to Response Evaluation Criteria in Solid Tumors (RECIST)

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Male or female ≥ 18 years of age
  2. Liver metastases from histologically confirmed colorectal cancer and at least one liver metastasis ≥ 1 cm (measurable disease), which is chemo-resistant, not eligible for curative surgery and suitable for intra-lesional injection as assessed by the investigator.
  3. Total liver tumor burden requiring ≤ 75 ml AvidinOX
  4. Maximum of 9 liver metastases
  5. Eastern Cooperative Oncology Group (ECOG) performance status of ≤ 2
  6. Life expectancy of at least 3 months.
  7. Clotting parameters as follows, with local normal ranges to be taken as reference:

    • Prothrombin Time (Quick).Patients showing an increase of the Upper Limit of the Normal (ULN) range of about 20% can also be considered for inclusion.
    • International Normalised Ratio (INR). Patients showing an increase of the ULN of about 20% can also be considered for inclusion
    • Activated Partial Thromboplastin Time (aPTT). Patients showing an increase of the ULN of about 20% can also be considered for inclusion
    • Fibrinogen. Patients showing a decrease of the Lower Limit of the Normal range (LLN) of about 20% can also be considered for inclusion.
  8. Haematological, liver and renal function test results ≤ grade 2 toxicity (according to US National Cancer Institute's "Common Terminology Criteria for Adverse Events v4.03 [CTCAE]"), i.e.:

    • Haematology:

      • Haemoglobin ≥ 8 g/dl
      • White blood cell count ≥ 2 x 109/L
      • Platelets ≥ 80x 109/L
    • Liver:

      • Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Alkaline Phosphatase (AP) ≤ 5 times upper limit of normal
      • Bilirubin ≤ 3 times upper limit of normal
    • Renal:

      • Urine protein dipstick: 0
      • estimated Glomerular Filtration Rate (eGFR)> 30 ml/min/1.73 m2 (with CKD-EPI formula)
  9. Written informed consent

Exclusion Criteria:

  1. Known hypersensitivity to Avidin or AvidinOX (e.g. hen egg)
  2. Known hypersensitivity to ST2210(DOTA biotin) or any excipient.
  3. Life limiting metastases outside the liver. Metastases outside the liver are allowed only in case the residual metastases (after liver treatment) are amenable to further treatments (e.g. surgical removal)
  4. Presence of unreachable (e.g. located in a region in the liver that cannot be reached by needle, or too close to major blood vessels or adjacent to main organs) or untreatable hepatic lesions so that the benefit from the treatment of the treatable lesions does not justify patient's inclusion
  5. Active infection at screening or history of severe infection within the previous 3 months, if clinically relevant at screening as considered by the investigator
  6. Known human immunodeficiency virus (HIV) positive serology or chronically active hepatitis B or C.
  7. Administration of another investigational medicinal product within 30 days before the screening period.
  8. Previous treatment with Selective Internal Radiation Therapy (SIRT) spheres or any radiopharmaceutical within a period corresponding to 8 half-lives of the radionuclide used for labeling the respective radiopharmaceutical prior to the administration of study drug.
  9. Women of child-bearing potential. A permanent postmenopausal status must be proven as follows: history of hysterectomy or hormone analysis in serum: estradiol < 20 pg/ml and follicle stimulating hormone (FSH) > 40 IU/L, or amenorrhea starting at least 1 year prior to the study start andnegativeβHCG .
  10. Men unwilling to use appropriate contraceptive methods during the study and up to six months after the end of the study
  11. Inability or unwillingness to be catheterized
  12. History of somatic or psychiatric disease/condition that may interfere with the objectives of the study
  13. Clinically significant illness or clinically relevant trauma within 15 days before the screening period
  14. Patient who underwent chemotherapy, radiation therapy within 15 days before the screening period

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 identifier (NCT number): NCT02053324

Contact: VALENTINI GIOVANNI, M.D. +39-06-91391 ext 3916

Allgemeines Krankenhaus Wien Recruiting
Wien, Austria, 1090
Contact: HAUG ALEXANDER, M.D.    +43 1 40400 ext 39360   
Principal Investigator: HAUG ALEXANDER, M.D.         
Ospedale S. Maria Goretti Recruiting
Latina, Rome, Italy, 04100
Contact: CIANNI ROBERTO, M.D.    +39 0773 655 3659   
Principal Investigator: CIANNI ROBERTO, M.D.         
Ospedale dell' Angelo di Mestre Recruiting
Mestre, Venice, Italy, 30174
Contact: SICOLO MICHELE, M.D.    +39 041 965 7626 ext 7629   
Principal Investigator: SICOLO MICHELE, M.D.         
S. Andrea Hospital Recruiting
Rome, Italy, 00189
Contact: SCOPINARO FRANCESCO, M.D.    +39 06 337 75538   
Principal Investigator: SCOPINARO FRANCESCO, M.D.         
Universtitätsspital Basel Withdrawn
Basel, Switzerland, 4031
Sponsors and Collaborators
sigma-tau i.f.r. S.p.A.
Principal Investigator: Alexander Haug, MD Allgemeines Krankenhaus Wien (Austria)
Principal Investigator: Andreas Wicki, MD Universitatsspital Basel (Switzerland)
Principal Investigator: Francesco Scopinaro, MD St. Andrea Hospital Rome (Italy)
Principal Investigator: Roberto Cianni, MD S Maria Goretti Hospital - Latina (Italy)
Principal Investigator: Michele Sicolo, MD Dell'Angelo Hospital - Mestre (Italy)

Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: sigma-tau i.f.r. S.p.A. Identifier: NCT02053324     History of Changes
Other Study ID Numbers: AvOX/ST2210-CR-12-001
2012-005577-32 ( EudraCT Number )
First Posted: February 3, 2014    Key Record Dates
Last Update Posted: June 14, 2017
Last Verified: June 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Keywords provided by sigma-tau i.f.r. S.p.A.:

Additional relevant MeSH terms:
Colorectal Neoplasms
Neoplasm Metastasis
Liver Neoplasms
Intestinal Neoplasms
Gastrointestinal Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Digestive System Diseases
Gastrointestinal Diseases
Colonic Diseases
Intestinal Diseases
Rectal Diseases
Neoplastic Processes
Pathologic Processes
Liver Diseases
Vitamin B Complex
Growth Substances
Physiological Effects of Drugs