Clinical trial • Phase III • Oncology|Rare Disease

LUTETIUM (177LU) OXODOTREOTIDE for Gastroenteropancreatic neuroendocrine tumour (GEP-NET)|Neuroendocrine tumour

Phase III trial of LUTETIUM (177LU) OXODOTREOTIDE for Gastroenteropancreatic neuroendocrine tumour (GEP-NET)|Neuroendocrine tumour.

Overview

Trial Therapeutic Area
Oncology|Rare Disease
Trial Disease
Gastroenteropancreatic neuroendocrine tumour (GEP-NET)|Neuroendocrine tumour
Trial Stage
Phase III
Drug Modality
Radiopharmaceutical|Peptide/protein/enzyme|Other
Paediatric Trial
Yes
Orphan Drug
Yes

Key dates

Initial CTIS Submission Date
02-05-2024
First CTIS Authorization Date
13-06-2024

Trial design

Randomised, open-label, high-dose octreotide long-acting (sandostatin lar) 60 mg every 4 weeks (comparator arm); octreotide long-acting (sandostatin lar) 30 mg used as best supportive care: 30 mg every 8 weeks during lutathera treatment and every 4 weeks after last lutathera treatment.-controlled, crossover Phase III trial across 20 sites in Spain, Netherlands, Germany and others.

Randomised
Yes
Open Label
Yes
Comparator
High-dose octreotide long-acting (Sandostatin LAR) 60 mg every 4 weeks (comparator arm); Octreotide long-acting (Sandostatin LAR) 30 mg used as best supportive care: 30 mg every 8 weeks during Lutathera treatment and every 4 weeks after last Lutathera treatment.
Crossover
Yes
Target Sample Size
132

Eligibility

Recruits 132 paediatric patients.

Pregnancy Exclusion
Pregnancy or lactation
Vulnerable Population
Vulnerable population selected. Participants may include adolescents (inclusion allows patients ≥15 years of age). Consent: "Patients who have provided a signed informed consent form to participate in the study, obtained prior to the start of any protocol related activities". No specific assent procedures for minors are described in the available documents.

Inclusion criteria

  • {"criterion_text":"- Presence of metastasized or locally advanced, inoperable (curative intent) histologically proven, well differentiated Grade 2 or Grade 3 gastroenteropancreatic neuroendocrine (GEP-NET) tumor diagnosed within 6 months prior to screening.\n- Ki67 index ≥10 and ≤ 55%\n- Patients ≥15 years of age and a body weight of >40 kg at screening\n- Expression of somatostatin receptors on all target lesions documented by CT/MRI scans, assessed by any of the following somatostatin receptor imaging (SRI) modalities within 3 months prior to randomization: [68Ga]-DOTA-TOC (e.g. Somakit-TOC®) PET/CT (or MRI when applicable based on target lesions) imaging, [68Ga]-DOTA-TATE PET/CT (or MRI when applicable based on target lesions) imaging (e.g. NETSPOT®), Somatostatin Receptor scintigraphy (SRS) with [111In]- pentetreotide (Octreoscan® SPECT/CT), SRS with [99mTc]-Tektrotyd, [64Cu]-DOTA-TATE PET/CT (or MRI when applicable based on target lesions)\n- The tumor uptake observed in the target lesions must be > normal liver uptake\n- Karnofsky Performance Score (KPS) ≥60\n- Presence of at least 1 measurable site of disease\n- Patients who have provided a signed informed consent form to participate in the study, obtained prior to the start of any protocol related activities"}

Exclusion criteria

  • {"criterion_text":"- Creatinine clearance <40 mL/min calculated by the Cockroft Gault method\n- Hb concentration <5.0 mmol/L (<8.0 g/dL); WBC <2x10^9/L (2000/mm^3); platelets <75x10^9/L (75x10^3/mm^3)\n- Any previous therapy with Interferons, Everolimus (mTOR-inhibitors), chemotherapy or other systemic therapies of GEP-NET administered for more than 1 month or within 12 weeks prior to randomization in the study\n- Any previous radioembolization, chemoembolization and radiofrequency ablation for GEP-NET\n- Any surgery within 12 weeks prior to randomization in the study\n- Known brain metastases, unless these metastases have been treated and stabilized for at least 24 weeks, prior to screening in the study. Patients with a history of brain metastases must have a head CT or MRI with contrast to document stable disease prior to randomization in the study\n- Uncontrolled congestive heart failure (NYHA II, III, IV). Patients with history of congestive heart failure who do not violate this exclusion criterion will undergo an evaluation of their cardiac ejection fraction prior to randomization via echocardiography. The results from an earlier assessment (not exceeding 30 days prior to randomization) may substitute the evaluation at the discretion of the Investigator, if no clinical worsening is noted. The patient's measured cardiac ejection fraction in these patients must be >40% before randomization\n- QTcF > 470 msec for females and QTcF > 450 msec for males or congenital long QT syndrome\n- Uncontrolled diabetes mellitus as defined by hemoglobin A1c value > 7.5%\n- Hyperkaleamia >6.0 mmol/L (CTCAE Grade 3) which is not corrected prior to study enrolment\n- Any patient receiving treatment with short-acting octreotide, which cannot be interrupted for 24 h before and 24 h after the administration of Lutathera, or any patient receiving treatment with SSAs (eg octreotide long-acting), which cannot be interrupted for at least 6 weeks before the administration of Lutathera\n- Patients with any other significant medical, psychiatric, or surgical condition, currently uncontrolled by treatment, which may interfere with the completion of the study\n- Prior external beam radiation therapy to more than 25% of the bone marrow\n- Current spontaneous urinary incontinence\n- Other known co-existing malignancies except non-melanoma skin cancer and carcinoma in situ of the uterine cervix, unless definitively treated and proven no evidence of recurrence for 5 years\n- Patient with known incompatibility to CT Scans with I.V. contrast due to allergic reaction or renal insufficiency. If such a patient can be imaged with MRI, then the patient would not be excluded\n- Hypersensitivity to any somatostatin analogues, the IMPs active substance or to any of the excipients\n- Patients who have participated in any therapeutic clinical study/received any investigational agent within the last 30 day\n- Total bilirubin >3 x ULN\n- Serum albumin <3.0 g/dL unless prothrombin time is within the normal range\n- Pregnancy or lactation\n- A) Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, are not allowed to participate in this study UNLESS they are using highly effective methods of contraception throughout the study treatment period (including cross- over and re-treatment, if applicable) and for 7 months after study drug discontinuation. B) Sexually active male patients, unless they agree to remain abstinent (refrain from heterosexual intercourse) or be willing to use condoms and highly effective methods of contraception with female partners of childbearing potential or pregnant female partners during the treatment period (including cross-over and re-treatment, if applicable) and for 4 months after study drug discontinuation. In addition, male patients must refrain from donating sperm during this same period\n- Peptide receptor radionuclide therapy (PRRT) at any time prior to randomization in the study\n- Documented RECIST progression to previous treatments for the current GEP-NET at any time prior to randomization\n- Patients for whom in the opinion of the investigator other therapeutic options (eg chemo-, targeted therapy) are considered more appropriate than the therapy offered in the study, based on patient and disease characteristics"}

Endpoints

Primary endpoints

  • {"endpoint_text":"- Progression Free Survival (PFS): Time from randomization to the first line progression (centrally assessed according to RECIST 1.1) or death due to any cause","definition_or_measurement_approach":"Time from randomization to first documented progression or death; progression centrally assessed according to RECIST 1.1."}

Secondary endpoints

  • {"endpoint_text":"- ORR: Rate of patients with best overall response of partial response (PR) or complete response (CR) (centrally assessed according to RECIST 1.1)","definition_or_measurement_approach":"Objective response rate assessed centrally according to RECIST 1.1 (PR or CR)."}
  • {"endpoint_text":"- Time to decline (TTD) by 10 points from baseline in the following scores measured by the EORTC QLQ-C30 questionnaire: global health status, diarrhea, fatigue and pain","definition_or_measurement_approach":"Time from baseline to a 10-point decline from baseline in specified EORTC QLQ-C30 scores (global health status, diarrhea, fatigue, pain)."}

Recruitment

Planned Sample Size
132
Recruitment Window Months
97
Consent Approach
Signed informed consent is required from participants prior to the start of any protocol-related activities: "Patients who have provided a signed informed consent form to participate in the study, obtained prior to the start of any protocol related activities". Subject information and informed consent forms are available in country/language-specific documents (examples in the file list include Dutch, German, Italian, French and English versions). No specific assent procedures for minors are provided in the available materials.

Geography

Total Number Of Sites
20
Total Number Of Participants
90

Spain

Earliest CTIS Part Ii Submission Date
26-03-2024
Latest Decision Or Authorization Date
13-06-2024
Processing Time Days
79
Number Of Sites
2
Number Of Participants
35

Sites

Site Name
Hospital Universitario Ramon Y Cajal
Department Name
72402: Oncología
Contact Person Name
Teresa Alonso Gordoa
Contact Person Email
talonso@oncologiahrc.com
Site Name
Hospital Universitari Vall D Hebron
Department Name
72404: Oncología Médica
Contact Person Name
Jaume Capdevila Castillón
Contact Person Email
jcapdevila@vhio.net

Netherlands

Earliest CTIS Part Ii Submission Date
26-03-2024
Latest Decision Or Authorization Date
13-02-2025
Processing Time Days
324
Number Of Sites
2
Number Of Participants
9

Sites

Site Name
Erasmus Universitair Medisch Centrum Rotterdam (Erasmus MC)
Department Name
52801: Endocrinology
Contact Person Name
Johannes Hofland
Contact Person Email
j.hofland@erasmusmc.nl
Site Name
Universitair Medisch Centrum Utrecht
Department Name
52802: Oncology
Contact Person Name
Marnix Lam
Contact Person Email
M.Lam@umcutrecht.nl

Germany

Earliest CTIS Part Ii Submission Date
26-03-2024
Latest Decision Or Authorization Date
13-02-2025
Processing Time Days
324
Number Of Sites
2
Number Of Participants
16

Sites

Site Name
Universitaetsklinikum Erlangen AöR
Department Name
27601: Medizinische Klinik 1
Contact Person Name
Marianne Pavel
Contact Person Email
marianne.pavel@uk-erlangen.de
Site Name
Universitaetsklinikum Essen AöR
Department Name
27603: Klinik für Nuklearmedizin
Contact Person Name
Ken Herrmann
Contact Person Email
ken.herrmann@uk-essen.de

Italy

Earliest CTIS Part Ii Submission Date
26-03-2024
Latest Decision Or Authorization Date
13-02-2025
Processing Time Days
324
Number Of Sites
8
Number Of Participants
18

Sites

Site Name
Istituto Europeo Di Oncologia S.r.l.
Department Name
38002: Divisione di Oncologia Medica Gastrointestinale e Tumori Neuroendocrini
Contact Person Name
Nicola Fazio
Contact Person Email
nicola.fazio@ieo.it
Site Name
Azienda Ospedaliero-Universitaria Di Bologna IRCCS Istituto Di Ricerca E Di Cura A Carattere Scientifico
Department Name
38003: Dipartimento Oncologia ed Ematologia U.O.C di Oncologia Medica
Contact Person Name
Davide Campana
Contact Person Email
davide.campana@unibo.it
Site Name
Azienda Ospedaliero-Universitaria Sant Andre
Department Name
38004: U.O.C. Malattie dell'Apparato Digerente e del Fegato
Contact Person Name
Francesco Panzuto
Site Name
Fondazione IRCCS Istituto Nazionale Dei Tumori
Department Name
38005: S.C. di Medicina Nucleare Dipartimento Diagnostica per mmagini e Radioterapia
Contact Person Name
Marco Maccauro
Site Name
IRCCS Istituto Nazionale Tumori Fondazione Pascale
Department Name
38001:OncSperSarcomi Tumori RariDip.Corp-s RicAssistOnco-Emat,Neop.Mesenc.Muscolo-Schel.adulto diagn
Contact Person Name
Salvatore Tafuto
Contact Person Email
s.tafuto@istitutotumori.na.it
Site Name
Azienda USL IRCCS Di Reggio Emilia
Department Name
38006: S.C. Medicina Nucleare Dip Oncologico e Tecnologie Avanzate
Contact Person Name
Angelina Filice
Contact Person Email
Angelina.Filice@ausl.re.it
Site Name
Istituto Romagnolo Per Lo Studio Dei Tumori Dino Amadori IRST S.r.l.
Department Name
38007: S.C. Medicina Nucleare e Terapia Metabolica
Contact Person Name
Maddalena Sansovini
Site Name
IRCCS Ospedale Policlinico San Martino
Department Name
38008: U.O. Clinica Endocrinologica Dipartimento di Medicina Interna e Specialità Mediche (DIMI)
Contact Person Name
Diego Ferone
Contact Person Email
ferone@unige.it

France

Earliest CTIS Part Ii Submission Date
26-03-2024
Latest Decision Or Authorization Date
21-03-2025
Processing Time Days
360
Number Of Sites
6
Number Of Participants
12

Sites

Site Name
Hospital Edouard Herriot
Department Name
25003
Contact Person Name
Laura GERARD
Contact Person Email
laura.gerard@chu-lyon.fr
Site Name
Hopital Beaujon
Department Name
25001
Contact Person Name
Louis De Mestier
Contact Person Email
louis.demestier@aphp.fr
Site Name
Hospital Hotel Dieu
Department Name
25005
Contact Person Name
Catherine Ansquer
Site Name
Institut Gustave Roussy
Department Name
25002: Méd.Nuclé Et Cancér Et Endo
Contact Person Name
Eric Baudin
Contact Person Email
eric.baudin@gustaveroussy.fr
Site Name
Hospices Civils De Lyon
Department Name
25003: "Service de de Médecine Nucléaire "
Contact Person Name
Laura GERARD
Contact Person Email
laura.gerard@chu-lyon.fr
Site Name
Institut Regional Du Cancer De Montpellier
Department Name
25004: Oncologie Medicale - Cancerolo
Contact Person Name
Emmanuel Deshayes

Sponsor

Primary sponsor

Full Name
Advanced Accelerator Applications
Organisation Type
Pharmaceutical company
Country Of Registered Address
France

Contract research organisations

Name
Eresearchtechnology Inc.
Responsibilities
sponsorDuties codes: 13
Name
Parexel International (IRL) Limited
Responsibilities
sponsorDuties codes: 1,12,2,3,5,6,7
Name
Voiant LLC
Responsibilities
sponsorDuties codes: 13
Name
Charles River Laboratories Montreal ULC
Responsibilities
Central Pharmacokinetic assessment (determination of Octreotide in Human Plasma)

Third parties

  • {"country":"United States","full_name":"Eresearchtechnology Inc.","duties_or_roles":"sponsorDuties codes: 13","organisation_type":"Pharmaceutical company"}
  • {"country":"Ireland","full_name":"Parexel International (IRL) Limited","duties_or_roles":"sponsorDuties codes: 1,12,2,3,5,6,7","organisation_type":"Pharmaceutical company"}
  • {"country":"United States","full_name":"Voiant LLC","duties_or_roles":"sponsorDuties codes: 13","organisation_type":"Pharmaceutical company"}
  • {"country":"Canada","full_name":"Charles River Laboratories Montreal ULC","duties_or_roles":"Central Pharmacokinetic assessment (determination of Octreotide in Human Plasma)","organisation_type":"Pharmaceutical company"}

Investigational products

Investigational Product Name
Lutathera 370 MBq/mL solution for infusion
Active Substance
LUTETIUM (177LU) OXODOTREOTIDE
Modality
Radiopharmaceutical
Routes Of Administration
Intravenous
Route
Intravenous
Authorisation Status
Authorised (EU/1/17/1226/001)
Orphan Designation
Yes
Starting Dose
7.4 GBq
Dose Levels
7.4 GBq x 4 administrations (cumulative dose: 29.6 GBq)
Frequency
4 administrations every 8±1 weeks
Maximum Dose
59.2 GBq (max total per product entry)
Investigational Product Name
SANDOSTATIN LAR 30 mg powder and solvent for suspension for injection
Active Substance
OCTREOTIDE
Modality
Peptide/protein/enzyme
Routes Of Administration
Intramuscular
Route
Intramuscular
Authorisation Status
Authorised (MA1249/00605)
Starting Dose
30 mg
Dose Levels
30 mg (also available in 10 mg and 20 mg formulations)
Frequency
As used in study: 30 mg every 8 weeks during Lutathera treatment and every 4 weeks after last Lutathera treatment
Maximum Dose
Max daily dose 60 mg; max total dose 1950 mg (product entries)
Investigational Product Name
SANDOSTATIN LAR 10 mg powder and solvent for suspension for injection
Active Substance
OCTREOTIDE
Modality
Peptide/protein/enzyme
Routes Of Administration
Intramuscular
Route
Intramuscular
Authorisation Status
Authorised (MA1249/00603)
Starting Dose
10 mg
Dose Levels
10 mg formulation
Maximum Dose
Max daily dose 60 mg; max total dose 1950 mg (product entries)
Investigational Product Name
SANDOSTATIN LAR 20 mg powder and solvent for suspension for injection
Active Substance
OCTREOTIDE
Modality
Peptide/protein/enzyme
Routes Of Administration
Intramuscular
Route
Intramuscular
Authorisation Status
Authorised (MA1249/00604)
Starting Dose
20 mg
Dose Levels
20 mg formulation
Maximum Dose
Max daily dose 60 mg; max total dose 1950 mg (product entries)
Investigational Product Name
LysaKare 25 g/25 g solution for infusion
Active Substance
L-LYSINE HYDROCHLORIDE, L-ARGININE HYDROCHLORIDE
Modality
Other
Routes Of Administration
Intravenous
Route
Intravenous
Authorisation Status
Authorised (EU/1/19/1381/001)
Maximum Dose
8 DF dosage form (max total per product entry)
Combination Treatment
Yes

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