Phase II Randomized, Prospective Trial of Lutetium Lu 177 Dotatate PRRT Versus Capecitabine and Temozolomide in Well-Differentiated Pancreatic Neuroendocrine Tumors
试验速览
- 阶段
- 2 期
- 状态
- 进行中（未招募）
- 入组人数
- 31
- 试验地点
- 342
- 主要终点
- Progression free survival (PFS)
研究概览
简要总结
This phase II trial compares the effect of combination therapy with capecitabine and temozolomide to lutetium Lu 177 dotatate for the treatment of pancreatic neuroendocrine tumors that have spread to other parts of the body (advanced) or that cannot be removed by surgery (unresectable). Temozolomide and capecitabine are considered chemotherapy drugs. Temozolomide is in a class of medications called alkylating agents. It damages the cell's deoxyribonucleic acid and may kill cancer cells. Capecitabine is in a class of medications called antimetabolites. It is taken up by cancer cells and breaks down into fluorouracil, a substance that kills cancer cells. Lutetium Lu 177-dotate is a radioactive drug. It binds to a protein called somatostatin receptor, which is found on some neuroendocrine tumor cells. Lutetium Lu 177-dotatate, builds up in these cells and gives off radiation that may kill them. It is a type of radioconjugate and a type of somatostatin analog. Treatment with lutetium Lu 177 dotatate may be more effective than combination therapy with temozolomide and capecitabine in shrinking or stabilizing cancer in patients with advanced or unresectable neuroendocrine tumors.
详细描述
This phase II trial compares capecitabine and temozolomide to lutetium Lu 177 dotatate for the treatment of pancreatic neuroendocrine tumors that have spread to other parts of the body (advanced) or are not able to be removed by surgery (unresectable). Chemotherapy drugs, such as capecitabine and temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Radioactive drugs, such as lutetium Lu 177 dotatate, may carry radiation directly to tumor cells and may reduce harm to normal cells. The purpose of this study is to find out whether capecitabine and temozolomide or lutetium Lu 177 dotatate may kill more tumor cells in patients with advanced pancreatic neuroendocrine tumors.
The primary and secondary objectives of the study:
PRIMARY OBJECTIVE:
I. To determine the differences in median progression-free survival (PFS) for lutetium Lu 177 dotatate peptide receptor radionuclide therapy (PRRT) when compared to capecitabine and temozolomide (CAPTEM) in patients with locally advanced or metastatic progressive, well-differentiated pancreatic neuroendocrine tumors (pNETs).
SECONDARY OBJECTIVES:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Histologic or pathologic documentation: well-differentiated pancreatic neuroendocrine tumor (G1, G2, or well-differentiated G3) confirmed by local histology and/or pathology
- •Functional or nonfunctional tumors are allowed
- •Patients with poorly differentiated neuroendocrine carcinoma (including large cell histology or small cell histology) are not eligible
- •Stage: locally unresectable or metastatic disease
- •Tumor Site: neuroendocrine tumor of pancreatic primary site
- •Radiologic evaluation: tumor must have shown somatostatin receptor (SSTR) positivity on 68Ga-DOTATATE PET or other SSTR-PET scan in the 12 months prior to registration; however, documentation of SSTR positivity in the 6 months prior to registration is preferred. SSTR positivity is defined as uptake greater than background liver in all measurable lesions
- •Patients are eligible if they meet one of the following criteria:
- •Previously untreated patients with grade 2 or 3 disease AND with symptoms of either disease bulk causing pain, anorexia, early satiety, large effusions/ascites, abdominal pain, abdominal fullness due to hepatomegaly, dyspnea) OR incompletely controlled symptoms of hormone excess despite somatostatin analogue (SSA) and supportive care (including but not limited to: diarrhea, hypercalcemia, hypoglycemia, hyperglycemia, flushing, Cushing's syndrome). Patient may have been started on SSA for up to 2 months for attempted symptom control without disease progression prior to registration
- •Patients previously treated with SSA only
- •Any patient with disease progression by RECIST criteria in < 4 months
- •Patients must have measurable disease per RECIST v1.1 by computer tomography (CT) scan or magnetic imaging (MRI). Any lesions which have undergone percutaneous therapies or radiotherapy after starting protocol therapy should not be considered measurable unless the lesion has clearly progressed since the procedure.
- •* Lesions must be accurately measured in at least one dimension (longest diameter to be recorded) as >= 1 cm with CT or MRI (or shortest diameter >= 1.5 cm for lymph nodes). Non-measurable disease includes disease smaller than these dimensions or lesions considered truly non- measurable including: leptomeningeal disease, bone metastases, ascites, pleural or pericardial effusion, lymphangitic involvement of skin or lung.
- •No prior temozolomide, dacarbazine, capecitabine, 5-FU, or any PRRT for treatment of the pNET
- •Prior treatment with tyrosine kinase inhibitors (TKIs) such as mammalian target of rapamycin (mTOR) inhibitors (e.g. everolimus, temsirolimus, etc.) or VEGF pathway inhibitors (e.g. sunitinib, pazopanib, cabozantinib, bevacizumab, etc.) are allowed
- •Prior treatment with hepatic intra-arterial embolic therapies is allowed if there is recovery from all toxicities, measurable lesions do not include embolized liver unless there has been clear subsequent progression, all measurable lesions are somatostatin receptor avid, and treatment completed at least 2 months prior to registration
- •Prior treatment with cryoablation or thermal/radiofrequency ablation of metastases is allowed if there is recovery from all toxicities, measurable lesions do not include treated metastases, and treatment completed at least 2 months prior to registration
- •Not pregnant and not nursing, because this study involves an agent that has known genotoxic, mutagenic, and teratogenic effects
- •* Therefore, for women of childbearing potential only, a negative pregnancy test done =< 14 days prior to registration is required
- •Age >= 18 years
- •Eastern Cooperative Oncology Group (ECOG) performance status 0-2
- •Absolute neutrophil count (ANC) >= 1,500/mm^3
- •Platelet count >= 100,000/mm^3
- •Hemoglobin >= 9.0 g/dL
- •Creatinine =< 1.5 x upper limit of normal (ULN) OR calculated (calc.) creatinine clearance >= 30 mL/min (calculated by the Cockcroft-Gault equation)
- •Total bilirubin =< 1.5 x ULN (in patients with liver metastases or known Gilbert's syndrome, total bilirubin must be =< 3.0 x ULN)
- •Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 3.0 x ULN
- •Albumin >= 3.0 g/dL
- •No known brain metastases unless adequately treated, demonstrated to be stable, and off all treatment (including steroids) for at least 2 months prior to registration
- •No uncontrolled congestive heart failure (New York Heart Association [NYHA] II, III, IV).
- •No significant medical, psychiatric, or surgical condition, currently uncontrolled by treatment, which may pose a risk to patient safety
- •No "currently active" second malignancy other than non-melanoma skin cancers or cervical carcinoma in situ. Patients are not considered to have a "currently active" malignancy if they have completed therapy or are on adjuvant hormonal therapy and are free of disease for >= 3 years
- •No known medical condition causing an inability to swallow and no known impairment of gastrointestinal function that may significantly alter the absorption of an oral agent
- •Concurrent somatostatin analog use while on protocol therapy is allowed provided that the patient:
- •Has a functional tumor (evidence of peptide hormones and/or bioactive substances associated with a clinical hormone syndrome such as carcinoid syndrome or Cushing's syndrome)
- •Has been on a stable dose of somatostatin analog therapy for at least three months
- •Has previously demonstrated radiographic disease progression while on somatostatin analog therapy. For subjects receiving lutetium Lu 177 dotatate, there should be a minimum of 28 days between long-acting somatostatin analogue and lutetium Lu 177 dotatate dosing. Short-acting somatostatin analogs should not be administered within 24 hours of lutetium Lu 177 dotatate dosing. Following lutetium Lu 177 dotatate dosing, long-acting somatostatin analogs may be administered between 4 and 24 hours after each dose
排除标准
- 未提供
研究组 & 干预措施
Arm I (lutetium Lu 177 dotatate)
Patients receive lutetium Lu 177 dotatate IV over 30 minutes on day 1 of each cycle. Treatment repeats every 8 weeks for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo collection of blood samples prior to registration, on days 1 and 29 of each cycle, during post-treatment follow-up, and at progressive disease, withdrawal or removal from study. Patients undergo PET prior to registration, and CT and/or MRI prior to registration and then every 3 months until progression.
干预措施: Quality-of-Life Assessment (Other)
Arm I (lutetium Lu 177 dotatate)
Patients receive lutetium Lu 177 dotatate IV over 30 minutes on day 1 of each cycle. Treatment repeats every 8 weeks for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo collection of blood samples prior to registration, on days 1 and 29 of each cycle, during post-treatment follow-up, and at progressive disease, withdrawal or removal from study. Patients undergo PET prior to registration, and CT and/or MRI prior to registration and then every 3 months until progression.
干预措施: Questionnaire Administration (Other)
Arm II (capecitabine, temozolomide)
Patients receive capecitabine PO BID days 1-14 of each cycle and temozolomide PO QD on days 10-14 of each cycle. Treatment repeats every 4 weeks for up to 12 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo collection of blood samples prior to registration, on day 1 of each cycle, and at progressive disease, withdrawal, or removal from study. Patients undergo PET prior to registration, and CT and/or MRI prior to registration and then every 3 months until progression.
干预措施: Quality-of-Life Assessment (Other)
Arm II (capecitabine, temozolomide)
Patients receive capecitabine PO BID days 1-14 of each cycle and temozolomide PO QD on days 10-14 of each cycle. Treatment repeats every 4 weeks for up to 12 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo collection of blood samples prior to registration, on day 1 of each cycle, and at progressive disease, withdrawal, or removal from study. Patients undergo PET prior to registration, and CT and/or MRI prior to registration and then every 3 months until progression.
干预措施: Capecitabine (Drug)
Arm II (capecitabine, temozolomide)
Patients receive capecitabine PO BID days 1-14 of each cycle and temozolomide PO QD on days 10-14 of each cycle. Treatment repeats every 4 weeks for up to 12 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo collection of blood samples prior to registration, on day 1 of each cycle, and at progressive disease, withdrawal, or removal from study. Patients undergo PET prior to registration, and CT and/or MRI prior to registration and then every 3 months until progression.
干预措施: Temozolomide (Drug)
Arm I (lutetium Lu 177 dotatate)
Patients receive lutetium Lu 177 dotatate IV over 30 minutes on day 1 of each cycle. Treatment repeats every 8 weeks for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo collection of blood samples prior to registration, on days 1 and 29 of each cycle, during post-treatment follow-up, and at progressive disease, withdrawal or removal from study. Patients undergo PET prior to registration, and CT and/or MRI prior to registration and then every 3 months until progression.
干预措施: Lutetium Lu 177 Dotatate (Drug)
结局指标
主要结局
Progression free survival (PFS)
时间窗: Up to 8 years from randomization
Progression free survival (PFS) will be compared between the two treatment arms using Kaplan-Meier methods. The hazard ratio (HR) and median PFS will be estimated along with corresponding 95% confidence intervals.
次要结局
- Progression Free Survival (PFS) at 3 years(At 3 years from randomization)
- Time to progression (TTP)(Up to 8 years from randomization)
- Overall survival (OS)(Up to 8 years from study registration)
- Time-to response(Up to 8 years from randomization)
- Change in Overall Quality of Life Question (Q30) from the EORTC QLQ-C30 questionnaire(At baseline up to 18 months)
- Progression Free Survival (PFS) at 2 years(At 2 years from randomization)
- Objective response rate (ORR)(Up to 8 years from randomization)
- Change in Overall Health Question (Q29) from the EORTC QLQ-C30 questionnaire(At baseline up to 18 months)
- Duration of response(Up to 8 years from randomization)
- Incidence of adverse events(Up to 8 years from randomization)