Peptide Receptor Radionuclide Therapy (PRRT) in Tumors With High Expression of Somatostatin Receptors (Phase 2) (FENET-2016)

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ClinicalTrials.gov Identifier: NCT04790708

Recruitment Status : Recruiting

First Posted : March 10, 2021

Last Update Posted : March 10, 2021

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Sponsor:

Information provided by (Responsible Party):

Mirco Bartolomei, University Hospital of Ferrara

Study Description

Brief Summary:

The rationale behind the purpose of this study lays on:

the evidence that PRRT could represent a valuable treatment for the majority of patients with neuroendocrine tumor (NET) in disease progression, operated or inoperable, presenting lesions expressing somatostatin receptors and for which standard treatments are not already available;
the current impossibility of acquiring on the market radiolabelled analogues of somatostatin used for PRRT with marketing authorisation;
the need to collect a larger case history than in previous studies;
the need to stratify the various histotypes based on the response obtained;
the need to define new treatment schemes that guarantee the maximum efficacy and the lowest possible toxicity - with low cumulative (and per cycle) activities radiopharmaceutical and according to the concept of dose hyperfractionation - with a view to an optimal balance between risk and benefit.

Condition or disease	Intervention/treatment	Phase
Neuroendocrine Tumors Peptide Receptor Radionuclide Therapy (PRRT)	Radiation: Lutetium-177 (177Lu)-DOTATOC Radiation: Yttrium-90 (90Y)-DOTATOC Radiation: 177Lu-DOTATOC + 90Y-DOTATOC Radiation: Re-treatment 177Lu-DOTATOC Radiation: Re-treatment 90Y-DOTATOC	Not Applicable

Study Design

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Study Type :	Interventional (Clinical Trial)
Estimated Enrollment :	250 participants
Allocation:	Non-Randomized
Intervention Model:	Parallel Assignment
Masking:	None (Open Label)
Primary Purpose:	Treatment
Official Title:	Peptide Receptor Radionuclide Therapy (PRRT) in Tumors With High Expression of Somatostatin Receptors
Actual Study Start Date :	July 2, 2018
Estimated Primary Completion Date :	June 30, 2023
Estimated Study Completion Date :	June 30, 2023

Resource links provided by the National Library of Medicine

Genetic and Rare Diseases Information Center resources: Neuroendocrine Tumor Neuroepithelioma

U.S. FDA Resources

Arms and Interventions

Arm	Intervention/treatment
Experimental: Midgut NETs 75 patients affected by non-functional and functional NETs arising from: stomach, duodenum, jejunum, ileum, colon and rectum.	Radiation: Lutetium-177 (177Lu)-DOTATOC 5 cycles of 3,7 e 5,55 gigabequerel (GBq) of 177Lu-DOTATOC every 8-10 weeks. Cumulative activity: 18,5 e 27,75 GBq Other Name: "MONO" Radiation: Yttrium-90 (90Y)-DOTATOC 5 cycles of 1,85 e 2,775 GBq of 90Y-DOTATOC every 8-10 weeks. Cumulative activity: 9,25 e 13,875 GBq Radiation: 177Lu-DOTATOC + 90Y-DOTATOC 3 cycles of 3,7 e 5,55 GBq of 177Lu-DOTATOC alternated with 2 cycles of 1,85 e 2,775 GBq of 90Y-DOTATOC every 8-10 weeks. Cumulative activity: 18,5 e 27,75 GBq of 177Lu-DOTATOC and 9,25 e 13,875 GBq of 90Y-DOTATOC Other Name: "DUO" Radiation: Re-treatment 177Lu-DOTATOC 3 cycles of 3,7 e 5,55 GBq of 177Lu-DOTATOC every 8-10weeks. Cumulative activity: 11,1 e 16,65 GBq of 177Lu-DOTATOC Radiation: Re-treatment 90Y-DOTATOC 3 cycles of 1,85 e 2,775 GBq of 90Y-DOTATOC every 8-10 weeks Cumulative activity: 5,55 e 8,325 GBq of 90Y-DOTATOC
Experimental: Pancreatic NETs 75 patients affected by non-functional and functional NETs arising from Pancreas.	Radiation: Lutetium-177 (177Lu)-DOTATOC 5 cycles of 3,7 e 5,55 gigabequerel (GBq) of 177Lu-DOTATOC every 8-10 weeks. Cumulative activity: 18,5 e 27,75 GBq Other Name: "MONO" Radiation: Yttrium-90 (90Y)-DOTATOC 5 cycles of 1,85 e 2,775 GBq of 90Y-DOTATOC every 8-10 weeks. Cumulative activity: 9,25 e 13,875 GBq Radiation: 177Lu-DOTATOC + 90Y-DOTATOC 3 cycles of 3,7 e 5,55 GBq of 177Lu-DOTATOC alternated with 2 cycles of 1,85 e 2,775 GBq of 90Y-DOTATOC every 8-10 weeks. Cumulative activity: 18,5 e 27,75 GBq of 177Lu-DOTATOC and 9,25 e 13,875 GBq of 90Y-DOTATOC Other Name: "DUO" Radiation: Re-treatment 177Lu-DOTATOC 3 cycles of 3,7 e 5,55 GBq of 177Lu-DOTATOC every 8-10weeks. Cumulative activity: 11,1 e 16,65 GBq of 177Lu-DOTATOC Radiation: Re-treatment 90Y-DOTATOC 3 cycles of 1,85 e 2,775 GBq of 90Y-DOTATOC every 8-10 weeks Cumulative activity: 5,55 e 8,325 GBq of 90Y-DOTATOC
Experimental: Bronchial NETs 25 patients affected by non-functional and functional Bronchial NETs.	Radiation: Lutetium-177 (177Lu)-DOTATOC 5 cycles of 3,7 e 5,55 gigabequerel (GBq) of 177Lu-DOTATOC every 8-10 weeks. Cumulative activity: 18,5 e 27,75 GBq Other Name: "MONO" Radiation: Yttrium-90 (90Y)-DOTATOC 5 cycles of 1,85 e 2,775 GBq of 90Y-DOTATOC every 8-10 weeks. Cumulative activity: 9,25 e 13,875 GBq Radiation: 177Lu-DOTATOC + 90Y-DOTATOC 3 cycles of 3,7 e 5,55 GBq of 177Lu-DOTATOC alternated with 2 cycles of 1,85 e 2,775 GBq of 90Y-DOTATOC every 8-10 weeks. Cumulative activity: 18,5 e 27,75 GBq of 177Lu-DOTATOC and 9,25 e 13,875 GBq of 90Y-DOTATOC Other Name: "DUO" Radiation: Re-treatment 177Lu-DOTATOC 3 cycles of 3,7 e 5,55 GBq of 177Lu-DOTATOC every 8-10weeks. Cumulative activity: 11,1 e 16,65 GBq of 177Lu-DOTATOC Radiation: Re-treatment 90Y-DOTATOC 3 cycles of 1,85 e 2,775 GBq of 90Y-DOTATOC every 8-10 weeks Cumulative activity: 5,55 e 8,325 GBq of 90Y-DOTATOC
Experimental: Sympathetic-Adrenergic axis NEts 25 patients affected by non-functional and functional: Pheochromocytoma, Paraganglioma and Neuroblastoma	Radiation: Lutetium-177 (177Lu)-DOTATOC 5 cycles of 3,7 e 5,55 gigabequerel (GBq) of 177Lu-DOTATOC every 8-10 weeks. Cumulative activity: 18,5 e 27,75 GBq Other Name: "MONO" Radiation: Yttrium-90 (90Y)-DOTATOC 5 cycles of 1,85 e 2,775 GBq of 90Y-DOTATOC every 8-10 weeks. Cumulative activity: 9,25 e 13,875 GBq Radiation: 177Lu-DOTATOC + 90Y-DOTATOC 3 cycles of 3,7 e 5,55 GBq of 177Lu-DOTATOC alternated with 2 cycles of 1,85 e 2,775 GBq of 90Y-DOTATOC every 8-10 weeks. Cumulative activity: 18,5 e 27,75 GBq of 177Lu-DOTATOC and 9,25 e 13,875 GBq of 90Y-DOTATOC Other Name: "DUO" Radiation: Re-treatment 177Lu-DOTATOC 3 cycles of 3,7 e 5,55 GBq of 177Lu-DOTATOC every 8-10weeks. Cumulative activity: 11,1 e 16,65 GBq of 177Lu-DOTATOC Radiation: Re-treatment 90Y-DOTATOC 3 cycles of 1,85 e 2,775 GBq of 90Y-DOTATOC every 8-10 weeks Cumulative activity: 5,55 e 8,325 GBq of 90Y-DOTATOC
Experimental: Other Nets 25 patients affected by non-functional and functional NETs arising from Skin, Thyroid (medullary thyroid and anaplastic cancer) and Parathyroids.	Radiation: Lutetium-177 (177Lu)-DOTATOC 5 cycles of 3,7 e 5,55 gigabequerel (GBq) of 177Lu-DOTATOC every 8-10 weeks. Cumulative activity: 18,5 e 27,75 GBq Other Name: "MONO" Radiation: Yttrium-90 (90Y)-DOTATOC 5 cycles of 1,85 e 2,775 GBq of 90Y-DOTATOC every 8-10 weeks. Cumulative activity: 9,25 e 13,875 GBq Radiation: 177Lu-DOTATOC + 90Y-DOTATOC 3 cycles of 3,7 e 5,55 GBq of 177Lu-DOTATOC alternated with 2 cycles of 1,85 e 2,775 GBq of 90Y-DOTATOC every 8-10 weeks. Cumulative activity: 18,5 e 27,75 GBq of 177Lu-DOTATOC and 9,25 e 13,875 GBq of 90Y-DOTATOC Other Name: "DUO" Radiation: Re-treatment 177Lu-DOTATOC 3 cycles of 3,7 e 5,55 GBq of 177Lu-DOTATOC every 8-10weeks. Cumulative activity: 11,1 e 16,65 GBq of 177Lu-DOTATOC Radiation: Re-treatment 90Y-DOTATOC 3 cycles of 1,85 e 2,775 GBq of 90Y-DOTATOC every 8-10 weeks Cumulative activity: 5,55 e 8,325 GBq of 90Y-DOTATOC
Experimental: Cancers of Unknown Primary Origin (CUP) NETs 25 patients affected by non-functional and functional unknown primary NETs	Radiation: Lutetium-177 (177Lu)-DOTATOC 5 cycles of 3,7 e 5,55 gigabequerel (GBq) of 177Lu-DOTATOC every 8-10 weeks. Cumulative activity: 18,5 e 27,75 GBq Other Name: "MONO" Radiation: Yttrium-90 (90Y)-DOTATOC 5 cycles of 1,85 e 2,775 GBq of 90Y-DOTATOC every 8-10 weeks. Cumulative activity: 9,25 e 13,875 GBq Radiation: 177Lu-DOTATOC + 90Y-DOTATOC 3 cycles of 3,7 e 5,55 GBq of 177Lu-DOTATOC alternated with 2 cycles of 1,85 e 2,775 GBq of 90Y-DOTATOC every 8-10 weeks. Cumulative activity: 18,5 e 27,75 GBq of 177Lu-DOTATOC and 9,25 e 13,875 GBq of 90Y-DOTATOC Other Name: "DUO" Radiation: Re-treatment 177Lu-DOTATOC 3 cycles of 3,7 e 5,55 GBq of 177Lu-DOTATOC every 8-10weeks. Cumulative activity: 11,1 e 16,65 GBq of 177Lu-DOTATOC Radiation: Re-treatment 90Y-DOTATOC 3 cycles of 1,85 e 2,775 GBq of 90Y-DOTATOC every 8-10 weeks Cumulative activity: 5,55 e 8,325 GBq of 90Y-DOTATOC

Outcome Measures

Primary Outcome Measures :

Disease Control Rate [ Time Frame: 12 months ]
Post-treatment evaluation will be performed with:
- a clinical examination;
- a comparative morphological re-evaluation, using version 1.1 of Response evaluation criteria in solid tumors (RECIST criteria) on Computed Tomography (CT);
- a comparative functional re-evaluation, performed both on 18F-2-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission computed tomography (PET/CT) and Gallium-68 (68Ga)-DOTATOC PET/CT using visual and semi-quantitative parameters (such as SUVmax).
Based on all these parameters, Disease Control Rate will be labelled as: Complete Response (CR), Partial Response (PR), Stable Disease (SD), or Progression Disease (PD).

Secondary Outcome Measures :

Progression Free Survival [ Time Frame: 6 months ]
Progression free survival is defined as the time intercurrent from treatment start to the date of first observation of documented disease progression or death due to any cause.
Overall Survival [ Time Frame: 6 months ]
Overall survival is defined as the time intercurrent from treatment start to the date of death due to any cause, or the date of last contact.
Evaluation of PRRT Safety [ Time Frame: 6 months ]
The evaluation of Treatment-Emergent Adverse Events, defined as any G3/G4 toxicity. The evaluation will be performed during every treatment cycle and after 12, 18, 24, 30, 36 and 42 months after the last treatment cycle and will be based on version 4.0 of Common Terminology Criteria for Adverse Events (CTC-AE) toxicity criteria.
Evaluation of Quality of Life [ Time Frame: 6 months ]
Quality of Life (QoL) will be evaluated with quality of life questionnaire, version 3 (QLQ-C30) by European Organisation for Research and Treatment of Cancer (EORTC). The questionnaire includes five functional scales, three symptom scales, a global health status / QoL scale, and six single items.

All of the scales and single-item measures range in score from 0 to 100. A high scale score represents a higher response level.

Eligibility Criteria

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

Criteria

Inclusion Criteria:

1. Age ≥18 years, of both sexes, of any ethnicity;
2. Cyto-histological and immunohistochemical diagnosis of NET;
3. Evaluation of the cell proliferation index by studying Ki-67 and / or E3 ubiquitin-protein ligase (MIB-1).
4. Illness measurable according to RECIST 1.1 criteria by imaging conventional (CT with contrast medium or MRI with contrast medium) not earlier than two months with respect to enrollment;
5. Elevated expression of somatostatin receptors documented by PET-CT with 68Ga-DOTATOC in the target lesion (s). It is defined as "high expression of somatostatin receptors "a ratio of Maximum standardized uptake value (SUVmax) lesion / Mean standardized uptake value (SUVmean) muscle ≥ 4: 1 calculated with semi-quantitative analysis on examination PET-CT with 68Ga-DOTATOC;
6. Dosage of Chromogranin A (and any other specific markers) not prior to two months of enrollment;
7. Evaluation of glucose metabolism in the target lesion (s) by PET-CT with 18F-FDG;
8. Preserved haematological, hepatic and renal parameters, in particular: white blood cells ≥2500 / μL; platelets ≥ 90000 / μL; hemoglobin ≥ 9 gr / dL; creatinine ≤ 2 mg / dL; bilirubin ≤ 2.5 mg / dL
9. Eastern Cooperative Oncology Group (ECOG) performance status ≤2;
10. Life expectancy ≥ 6 months;
11. Stable or progressive disease, at any stage, both in operated patients that inoperable;
12. Absence of standard treatments already documented and of equal effectiveness;
13. Absence of surgical, chemotherapy and / or radiotherapy treatments for at least 30 days. On the other hand, patients in therapy with somatostatin analogues or biologics, such as mechanistic target of rapamycin (m-TOR) inhibitors;
14. Voluntary participation in the study by signing the consent form informed, after reading and complete understanding of the information notes.

Exclusion Criteria:

1. Lack of the requirements listed above;
2. State of pregnancy;
3. Breastfeeding and relative refusal to suspend breastfeeding;
4. Participation in another therapeutic experimental clinical protocol in the four weeks prior to the PRRT;
5. Bone marrow invasion of disease> 25% confirmed;
6. Previous extensive radiotherapy treatments.

Contacts and Locations

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): NCT04790708

Contacts

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Contact: Mirco Bartolomei, MD	0532236082	m.bartolomei@ospfe.it
Contact: Licia Uccelli, PhD	0532237462	licia.uccelli@unife.it

Locations

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Italy
University Hospital of Ferrara	Recruiting
Ferrara, Italy, 44124
Contact: Mirco Bartolomei, MD 0532-236082 m.bartolomei@ospfe.it
Contact 0532-236387 medicina.nucleare@ospfe.it

Sponsors and Collaborators

University Hospital of Ferrara

More Information

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Layout table for additonal information

Responsible Party:	Mirco Bartolomei, MD, Director of Nuclear Medicine Unit, University Hospital of Ferrara
ClinicalTrials.gov Identifier:	NCT04790708
Other Study ID Numbers:	160990 2016-005129-35 ( EudraCT Number )
First Posted:	March 10, 2021 Key Record Dates
Last Update Posted:	March 10, 2021
Last Verified:	March 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD:	Yes

Layout table for additional information

Studies a U.S. FDA-regulated Drug Product:	No
Studies a U.S. FDA-regulated Device Product:	No
Product Manufactured in and Exported from the U.S.:	No

Keywords provided by Mirco Bartolomei, University Hospital of Ferrara:


Neuroendocrine Tumors 90Y 177Lu PRRT

Additional relevant MeSH terms:

Layout table for MeSH terms

Neuroendocrine Tumors Neoplasms Neuroectodermal Tumors Neoplasms, Germ Cell and Embryonal Neoplasms by Histologic Type Neoplasms, Nerve Tissue Octreotide	Edotreotide Radiopharmaceuticals Molecular Mechanisms of Pharmacological Action Gastrointestinal Agents Antineoplastic Agents, Hormonal Antineoplastic Agents

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