Exploration of Molecular Biomarkers for Lu-177 DOTATATE Therapy in Midgut Neuroendocrine Tumor

Study Overview
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Brief Summary
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Midgut neuroendocrine tumours present an increasing incidence and poor survival at 5 years with limited therapeutic options for metastatic, non-operable cases. Lu-177 Dotatate, targeting somatostatin receptors, is an internal vectorized radiotherapy using Lu-177, an ideal radionuclide for peptide radionuclide therapy. In NETTER-1 phase III randomized clinical trial, Lu-177 Dotatate proved its superiority in increasing progression free survival for midgut neuroendocrine tumors. This study hypothesize that finding biomarkers of individual radio sensitivity for this type of internal vectorized therapy would allow treatment personalization. The protocol aim at studying transcript variations induced by this therapy.

Detailed Description
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Internal vectorized therapy using Lu-177 Dotatate (abbreviated peptide receptor radionuclide therapy) was recently shown to improve progression free survival and response in metastatic progressive midgut neuroendocrine tumors (NETTER-1 phase III trial). Lu-177 Dotatate is administered as a series of four consecutive intra veinous injections of an activity of 7.4 gigabequerel every 8 weeks. In order to identify potential biomarkers of radio sensitivity to Lu-177 Dotatate, investigators aim to study the stability of gene/miRNA transcripts in the absence of Lu-177 Dotatate or at 6 months after treatment as well as the variations in transcript analysis after 2 Lu-177 Dotatate injections and at the end of the treatment. Transcript variation analysis will be confronted and correlated with peripheral blood pharmacokinetic studies aimed at calculating time activity curves and provide biodosimetry information; other correlations with imaging modalities assessment of dosimetry or disease response to treatment or toxicity effects induced by Lu-177 Dotatate will also be studied.

Official Title
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Pilot Study for Measuring Molecular Biomarkers and Their Capacity to Characterize Radionuclide Therapy With Lu-177 DOTATATE) in Metastatic G1-G2 Neuroendocrine Midgut Tumors

Conditions
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Midgut Neuroendocrine Tumors

Intervention / Treatment
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* Biological: non-drug intervention type


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients ≥18 years old; histopathologically confirmed grade 1-2 midgut neuroendocrine tumor with documented progression during the year preceding inclusion upon RECIST criteria on computerized tomography, Octreoscan or Ga-68 positron emission tomography/computerized tomography Patients having an indication for Lu-177 Dotatate treatment validated during multidisciplinary meeting coordinated by Pr Rosine Guimbaud under RENATEN coordination; Measurable target lesions upon RECIST criteria Patients on somatostatin analogues treatment. Every somatostatin analogue injection should be organized to be administered 24 to 48 hours after each injection of Lu-177 Dotatate. All patients should be in a clinical state allowing them to continue treatment. Social security affiliation is mandatory. Exclusion Criteria: Patients on chemotherapy or other targeted therapy within the 4 months preceding peptide receptor radionuclide therapy Fertile patients refusing active contraception ; pregnancy. Patients with prior chemotherapy or peptide receptor radionuclide therapy administration Patients with uncontrollable psychotic disorders Renal hepatic and medullary insufficiency

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Non-drug intervention type<br>Exploration of gene transcript variation on seriate blood samples before treatment, before and after the 2nd and the 4th Lu-Dotatate injection and before and after the 6 month post treatment follow-up. Measures of stability and reproducibility of selected gene transcripts and miRNA as radio sensitivity genes or progressive metastatic midgut neuroendocrine tumors genetic signatures before and during Lu-177 Dotatate internal vectorized therapy, as well as on the 6-month follow-up. | Biological: non-drug intervention type<br>* 8 peripheral blood samples (8x5ml) will be obtained at different times ; before, during and after treatment<br>* Other names: Blood samples;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Peptide receptor radionuclide therapy radio-induction variation of radiosensibility/reparation genes | Variations in gene transcripts will be registered and processed by a bio-informatician | Change from before at during treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evaluation of gene transcript variations | Analysis of gene transcript variation by quantitative real-time polymerase chain reaction | during treatment and until 48 hours after treatment | 
| Evaluation of interindividual variability with NONMEN software | Analysis of Lu-177 DOTATATE plasma concentration during treatment and 48 hours after treatment | during treatment and until 48 hours after treatment | 
| Evaluation of therapeutic response according to RECIST criteria | Correlation between gene variations and the therapeutic response assessed on RECIST criteria | 6 months post therapy | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Lu-177 Dotatate, transcript analysis and variation, molecular biomarkers, midgut neuroendocrine tumors