[177Lu]-NeoB in Patients With Advanced Solid Tumors and With [68Ga]-NeoB Lesion Uptake

Study Overview
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Brief Summary
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The purpose of this first-in-human (FIH) study of [177Lu]-NeoB is to characterize the safety, tolerability, pharmacokinetics (PK) as well as the distribution and radiation dosimetry, and anti-tumor activity of [177Lu]-NeoB in patients with advanced solid tumors known to overexpress GRPR and with [68Ga]-NeoB lesion uptake.

Detailed Description
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This is a Phase I/IIa study which consists of a dose escalation (Phase I) and an expansion part (Phase IIa). Dose escalation (Phase I): Phase I of the study will be conducted in adult patients (age >= 18 years old) with any of the following selected advanced or metastatic solid tumors: breast cancer, lung cancer, prostate cancer, gastrointestinal stromal tumors (GIST), and glioblastoma (GBM) for whom no standard therapy is available, tolerated or appropriate, and with [68Ga]-NeoB lesion uptake as defined in the inclusion criteria. In Phase I, every effort must be made to include at least one patient of each gender (male/female) in each Dose level to obtain dosimetry data for each gender at all Dose levels tested. However, if it is not feasible, at least 3 patients of each gender must be included in the study before reaching the [177Lu]-NeoB Dose level of 100% ECD (Dose level 4) or the MTD/RP2D, whichever is lower. Expansion part (Phase IIa): Phase IIa of the study will be conducted in adult patients (age >= 18 years old) with: For Cohorts A, B, C respectively: Any of the following selected advanced or metastatic solid tumors: breast cancer (HR-positive, HER-2 negative and HER-2 low), prostate cancer, and GIST all showing [68Ga]-NeoB lesion uptake. For Cohort D: Patients affected by any advanced/metastatic solid tumor type suspected to overexpress GRPR including recurrent GBM, and with moderate impaired renal function defined as creatinine clearance (calculated using the Cockcroft-Gault formula, or measured) ≥ 30mL/min and < 60mL/min.

Official Title
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A Phase I/IIa Open-label, Multi-center Study to Evaluate the Safety, Tolerability, Whole-body Distribution, Radiation Dosimetry and Anti-tumor Activity of [177Lu]-NeoB Administered in Patients With Advanced Solid Tumors Known to Overexpress Gastrin-releasing Peptide Receptor (GRPR)

Conditions
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Neoplasms

Intervention / Treatment
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* Drug: [177Lu]-NeoB
* Drug: [68Ga]-NeoB


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Signed informed consent must be obtained prior to participation in the study. Adult patients (age >= 18 years old) with any of the following advanced or metastatic solid tumors: For Phase I: breast cancer, lung cancer, prostate cancer, GIST, GBM For Phase IIa: a. Cohort A: Breast cancer with histology as follows: HR positive with ER > 10% of nuclei stain, HER-2 negative and HER-2 low based on current practice and medical history b. Cohort B: Prostate cancer c. Cohort C: GIST d. Cohort D: Patients affected by any advanced/metastatic solid tumor type suspected to overexpress GRPR including recurrent GBM, and with moderate impaired renal function defined as creatinine clearance (calculated using the Cockcroft-Gault formula, or measured) >= 30 mL/min and < 60 mL/min At least one measurable lesion as per RECIST 1.1, RANO (applicable for GBM only) criteria detected on the low-dose CT/MRI (for GBM MRI only) acquired together with the [68Ga]-NeoB PET. The same identified measurable lesion shows [68Ga]-NeoB uptake on PET/CT or PET/MRI. If the only matching lesion is located in the bone, the patient will still be eligible. Patients for whom no standard therapy is available, tolerated or appropriate in both Phase I and Phase IIa. Specifically in the Phase IIa breast cancer Cohort A, patients need to have completed at least one prior treatment of endocrine therapy (including CDk4/6i) and at least one prior chemotherapy (unless contraindicated) in the metastatic setting. Patients with prior treatment with trastuzumab deruxtecan, alpelisib or elascestrant are also eligible. In case of confirmed presence of deleterious or suspected deleterious germline BRCA1 or BRCA2 mutation, the patient must also have already received a PARP inhibitor-based therapy. Patient Eastern Cooperative Oncology Group (ECOG) performance status: For Phase I: =< 2, For Phase IIa: =<1 Exclusion Criteria: Patients who have not had resolution, except where otherwise stated in the inclusion/ exclusion criteria, of all clinically significant toxic effects of prior systemic cancer therapy, surgery, or radiotherapy to Grade =<1 (except for alopecia)*. Creatinine clearance (calculated using Cockcroft-Gault formula, or measured) a. For Phase I and Phase IIa (Cohort A, B and C): < 60 mL/min or serum creatinine > 1.5 x ULN* b. For Phase IIa (Cohort D): < 30 mL/min or >= 60 mL/min Platelet count of < 75 x 109/L*† Absolute neutrophil count (ANC) < 1.0 x 109/L*† Hemoglobin < 9 g/dL*† Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 3 x upper limit of normal (ULN) if no demonstrable liver metastases or > 5 x ULN in the presence of liver metastases* Total bilirubin > 1.5 x ULN, except for patients with documented Gilbert's syndrome who are eligible if total bilirubin =< 3 x ULN* Serum amylase and/or lipase > 1.5 x ULN* Known or expected hypersensitivity to [177Lu]-NeoB, [68Ga]-NeoB or any of their excipients. Impaired cardiac function or clinically significant cardiac disease, including any of the following: • Clinically significant and/or uncontrolled heart disease such as congestive heart failure requiring treatment (NYHA grade ≥ 2), uncontrolled arterial hypertension or clinically significant arrhythmia LVEF < 50% as determined by echocardiogram (ECHO)* QTcF >470 msec for females and QTcF >450 msec for males on screening electrocardiogram (ECG) or congenital long QT syndrome Acute myocardial infarction or unstable angina pectoris < 3 months prior to [177Lu]- NeoB (IMP1) administration Patients with diabetes mellitus not stable under current treatment as judged by the investigator or with hyperglycemia >= CTCAE version 5.0 Grade 2*. Patients with history of or ongoing acute or chronic pancreatitis. Concurrent bladder outflow obstruction or unmanageable urinary incontinence. Administration of a radiopharmaceutical with therapeutic intent within a period corresponding to 10 half-lives of the radionuclide used prior to injection of [68Ga]-NeoB (IMP2). Prior External Beam Radiation Therapy (EBRT) to more than 25% of the bone marrow. [223Ra]-therapy within the context of diffuse bone or bone-marrow involvement (i.e., superscan defined as bone scintigraphy in which there is excessive skeletal radioisotope uptake [>20 bone lesions] in relation to soft tissues along with absent or faint activity in the genitourinary tract due to diffuse bone/ bone marrow metastases). [Removed] Patients who have received prior systemic anti-cancer treatment within the following time frames: • Cyclical chemotherapy within a period that is shorter than the cycle length used for that treatment (e.g., 6 weeks for nitrosourea, mitomycin-C) prior to starting [177Lu]- NeoB treatment Biologic therapy (e.g., antibodies), continuous or intermittent small molecule therapeutics, or any other investigational agents within a period which is =< 5 T1/2 or =< 14 days (whichever is shorter) prior to starting [177Lu]-NeoB treatment History of somatic or psychiatric disease/condition that may interfere with the objectives and assessments of the study. Malignant disease, other than that being treated in this study. Exceptions to this exclusion include the following: malignancies that were treated curatively and have not recurred within 2 years prior to [177Lu]-NeoB treatment; completely resected basal cell and squamous cell skin cancers; any malignancy considered to be indolent and that has never required therapy; and completely resected carcinoma in situ of any type. Pregnant or breast-feeding women 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 and for 7 months after study drug discontinuation. Highly effective contraception methods include: True abstinence, when this is in line with the preferred and usual lifestyle of the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods), declaration of abstinence for the duration of exposure to IMPs, and withdrawal are not acceptable methods of contraception. Male or female sterilization. Vasectomised partner is a highly effective birth control method if the partner is the sole sexual partner of the study participant and the vasectomised partner has received medical assessment of the surgical success. Women tubal ligation is an acceptable highly effective contraception method, but surgical sterility is defined as bilateral salpingectomy (or bilateral oophorectomy or hysterectomy). • Combination of any two of the following (a+b or a+c or b+c): Use of oral, injected, or implanted hormonal methods of contraception. In case of use of oral contraception, women should be stable on the same pill for a minimum of 3 months before taking [177Lu]-NeoB treatment. This is not applicable for patients with breast cancer. Placement of an intrauterine device (IUD) or intrauterine system (IUS). IUS is not applicable for patients with breast cancer. Barrier methods of contraception: condom or occlusive cap (diaphragm or cervical/vault caps) with spermicidal foam/gel/film/cream/vaginal suppository. Post-menopausal women are allowed to participate in this study. Women are considered post-menopausal and not of child bearing potential if they have had 12 months of natural (spontaneous) amenorrhea with an appropriate clinical profile (e.g. age appropriate, history of vasomotor symptoms) or six months of spontaneous amenorrhea with serum Follicle- Stimulating Hormone (FSH) levels > 40 mIU/mL [for US only: and estradiol < 20 pg/mL] or have had surgical bilateral oophorectomy or bilateral salpingectomy or hysterectomy or tubal ligation at least six weeks prior to screening. In the case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment is she considered not of childbearing potential. Sexually active males must use a condom during intercourse while taking the drug and for 4 months after stopping treatment and should not father a child in this period. A condom is required to be used also by vasectomized men in order to prevent delivery of the drug via seminal fluid. Female partners of childbearing potential should use highly effective contraceptive methods during and up to 4 months after stopping treatment. Use of other investigational drugs within 30 days prior to informed consent signature. To be considered as valid to determine the eligibility of a patient, exam results of exclusion criteria #2, #3, #4, #5, #6, #7, #8, #10 (except LVEF) and #11 must be collected on or after date of patient's informed consent and must be available in the source documents for monitoring. LVEF evaluation is permitted within 6 weeks prior to IMP1 administration, even if performed outside the screening period as part of standard routine clinical practice of care, before ICF signature. No platelet transfusion, packed red cell transfusion, or G-CSF will be allowed during the selection phase after ICF signature.

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: Treatment
Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Interventional Model Description: Phase I: dose finding to identify Recommended Phase II Dose Phase IIa: preliminary assessment of anti-tumor activity
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Phase I Cohort I<br>[68 Ga]-NeoB: 50 micrograms/dose at screening [177Lu]-NeoB: 50 mCi (1.85 GBq) cycle 1, 60% Estimated Cumulative Dose (ECD) for cycles 2-4, q6w | Drug: [177Lu]-NeoB<br>* [177Lu]-NeoB: peptide receptor radionuclide therapy<br>Drug: [68Ga]-NeoB<br>* [68Ga]-NeoB radioactive diagnostic agent<br>|
| Experimental: Phase I Cohort II<br>[68 Ga]-NeoB: 50 micrograms/dose at screening [177Lu]-NeoB: 60% ECD for 3 cycles (q6w) | Drug: [177Lu]-NeoB<br>* [177Lu]-NeoB: peptide receptor radionuclide therapy<br>Drug: [68Ga]-NeoB<br>* [68Ga]-NeoB radioactive diagnostic agent<br>|
| Experimental: Phase I Cohort III<br>[68 Ga]-NeoB: 50 micrograms/dose at screening [177Lu]-NeoB: 80% ECD for 3 cycles (q6w) | Drug: [177Lu]-NeoB<br>* [177Lu]-NeoB: peptide receptor radionuclide therapy<br>Drug: [68Ga]-NeoB<br>* [68Ga]-NeoB radioactive diagnostic agent<br>|
| Experimental: Phase I Cohort IV<br>[68 Ga]-NeoB: 50 micrograms/dose at screening [177Lu]-NeoB: 100% ECD for 3 cycles (q6w) | Drug: [177Lu]-NeoB<br>* [177Lu]-NeoB: peptide receptor radionuclide therapy<br>Drug: [68Ga]-NeoB<br>* [68Ga]-NeoB radioactive diagnostic agent<br>|
| Experimental: Phase I Cohort V<br>[68 Ga]-NeoB: 50 micrograms/dose at screening [177Lu]-NeoB: 120% ECD for 3 cycles (q6w) | Drug: [177Lu]-NeoB<br>* [177Lu]-NeoB: peptide receptor radionuclide therapy<br>Drug: [68Ga]-NeoB<br>* [68Ga]-NeoB radioactive diagnostic agent<br>|
| Experimental: Phase I Cohort VI<br>[68 Ga]-NeoB: 50 micrograms/dose at screening [177Lu]-NeoB: 100% ECD for 2 cycles (q6w) | Drug: [177Lu]-NeoB<br>* [177Lu]-NeoB: peptide receptor radionuclide therapy<br>Drug: [68Ga]-NeoB<br>* [68Ga]-NeoB radioactive diagnostic agent<br>|
| Experimental: Phase I Cohort VII<br>[68 Ga]-NeoB: 50 micrograms/dose at screening [177Lu]-NeoB: 120% ECD for 2 cycles (q6w) | Drug: [177Lu]-NeoB<br>* [177Lu]-NeoB: peptide receptor radionuclide therapy<br>Drug: [68Ga]-NeoB<br>* [68Ga]-NeoB radioactive diagnostic agent<br>|
| Experimental: Phase IIa<br>[68 Ga]-NeoB: 50 micrograms/dose at screening [177Lu]-NeoB: dose TBD based on Cohorts I-VI, 3 cycles q6w | Drug: [177Lu]-NeoB<br>* [177Lu]-NeoB: peptide receptor radionuclide therapy<br>Drug: [68Ga]-NeoB<br>* [68Ga]-NeoB radioactive diagnostic agent<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Phase I: Incidence of dose limiting toxicities (DLTs) of [177Lu]-NeoB | A dose-limiting toxicity (DLT) is defined as a clinically relevant adverse event or abnormal laboratory value where the relationship to study treatment cannot be ruled out, and which is unrelated to disease, disease progression, intercurrent illness, or concomitant medications that occurs within the DLT monitoring period and meets any of the criteria included in Table 6-3 (Criteria for defining dose-limiting toxicities). | 18 months | 
| Phase I: Determination of Maximum Tolerated Dose (MTD)/ Recommended phase two dose (RP2D) of [177Lu]-NeoB | The maximum tolerated dose (MTD) and/or the recommended phase II dose (RP2D) of [177Lu]-NeoB will be identified: MTD is defined as the lowest single dose at which 33% or more of the patients experienced a DLT during the first cycle (6 weeks). RP2D is defined as the single dose level below the MTD. The number of cycles recommended for Phase II will be defined based on the cumulative dose toxicities reported during Phase I. | 18 months | 
| Phase IIa (Cohorts A, B and C): Disease Control Rate (DCR) | DCR is defined as the proportion of patients who have a best overall response of complete response (CR), partial response (PR) or who have stable disease (SD) for >= 20 weeks as assessed by RECIST 1.1 for solid tumors. | 18 months | 
| Phase IIa (Cohort D): Absorbed radiation doses of [177Lu]-NeoB in organs and tumor lesions | Absorbed radiation doses in organs and tumor lesions will be summarized with descriptive statistics. Lesion number will be assigned by dosimetry expert. | 18 months | 
| Phase IIa (Cohort D): Concentration of [177Lu]-NeoB in blood over time and derived PK parameters | Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. Concentration of [177Lu]-NeoB will be listed and summarized using descriptive statistics. | 18 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Phase I: Tissue Activity Curves (ACs) | Tissue activity curves (ACs) will be generated from the amount of radioactivity in one given tissue at a given moment over the amount of radioactivity present in the blood at that given moment. | 18 months | 
| Phase I: Time Activity Curves (ACs) | Time Activity Curves (ACs) describe the percentage of the activity injected versus time. | 18 months | 
| Phase I: Absorbed radiation doses of [177Lu]-NeoB in critical organs | Absorbed radiation doses in critical organs (e.g. kidneys, bone marrow, pancreas) will be summarized with descriptive statistics. Lesion number will be assigned by dosimetry expert. | 18 months | 
| Phase I: Urinary excretion of [177Lu]-NeoB | Urine samples will be collected over specified time intervals and analyzed for radioactivity using a gamma counter. The radioactivity excreted in urine will be summarized using descriptive statistics. | 18 months | 
| Phase I: Half-life of [177Lu]-NeoB in blood | Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. The half-live will be listed and summarized using descriptive statistics. | 18 months | 
| Phase I: Residence time of [177Lu]-NeoB in organs and tumor lesions | Residence time in organs and tumors lesions will be summarized with descriptive statistics. Lesion number will be assigned by dosimetry expert. | 18 months | 
| Phase I: Individual objective response and Duration of Response (DOR) | DOR is defined as the duration of time between the date of first documented response (CR or PR) in soft tissue according to PCWG3 modified RECIST 1.1, and the date of first documented progression or death due to any cause. | 18 months | 
| Phase IIa (Cohorts A, B and C): Absorbed radiation doses of [177Lu]-NeoB in organs and tumor lesions | Absorbed radiation doses in organs and tumor lesions will be summarized with descriptive statistics. Lesion number will be assigned by dosimetry expert. | 18 months | 
| Phase IIa (Cohorts A, B and C): Concentration of [177Lu]-NeoB in blood over time and derived PK parameters | Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. Concentration of [177Lu]-NeoB will be listed and summarized using descriptive statistics. | 18 months | 
| Phase IIa (Cohorts A, B and C): Changes from baseline in European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) | The QLQ-C30 is composed of both multi-item scales and single-item measures. These include five functional scales, three symptom scales, a global health status / QoL scale, and six single items. Each of the multi-item scales includes a different set of items - no item occurs in more than one scale. All of the scales and single-item measures range in score from 0 to 100. A higher score for the functioning scales and global health status denote a better level of functioning (i.e. a better state of the patient), while higher scores on the symptom and single-item scales indicate a higher level of symptoms (i.e. a worse state of the patient). | 18 months | 
| Phase IIa (Cohorts A, B and C): Objective Response Rate (ORR) | ORR is defined as the proportion of participants with Best Overall Response (BOR) of Complete Response (CR) or Partial Response (PR) according to PCWG3 modified RECIST 1.1. | 18 months | 
| Phase IIa (Cohorts A, B and C): Duration of Response (DOR) | DOR is defined as the duration of time between the date of first documented response (CR or PR) in soft tissue according to PCWG3 modified RECIST 1.1, and the date of first documented progression or death due to any cause. | 18 months | 
| Phase IIa (Cohorts A, B and C): Progression Free Survival (PFS) | PFS is defined as the time from date of start of treatment to the date of progression, defined as the first documented progression or death for any cause. | Week 20, Month 6, Month 9 and Month 12 | 
| Phase IIa (Cohorts A, B and C): Overall Survival (OS) | Overall survival (OS) is defined as the time from the date of start of treatment to the date of death due to any cause. | 18 months | 
| Phase I and Phase IIa: Adverse Events [177Lu]-NeoB | The distribution of adverse events will be done via the analysis of frequencies for treatment emergent Adverse Event (TEAEs), Serious Adverse Event (TESAEs) and Deaths due to AEs, through the monitoring of relevant clinical and laboratory safety parameters. | 18 months | 
| Phase I and Phase IIa: Adverse Events - [68Ga]-NeoB | The distribution of adverse events will be done via the analysis of frequencies for treatment emergent Adverse Event (TEAEs), Serious Adverse Event (TESAEs) and Deaths due to AEs, through the monitoring of relevant clinical and laboratory safety parameters. | 18 months | 
| Phase I and Phase IIa: Dose interruptions and modifications |  | 18 months |