Clinical trial NCT05557708: A Safety Study of 212Pb-Pentixather Radioligand Therapy
Official title: Phase 1 Trial of Dosimetry Guided 212Pb-pentixather Radioligand Therapy in Patients With Atypical Lung Carcinoids and Neuroendocrine Carcinomas
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: EARLY_PHASE1
Conditions: Carcinoid Tumor Lung
Neuroendocrine Tumor of the Lung
Carcinoma, Small-Cell Lung
Keywords: radioligand therapy
pentixather
Lead 203
Lead 212
alpha therapy
dosimetry
Lead sponsor: University of Iowa
Sponsor class: OTHER
Collaborators: name: National Institutes of Health (NIH)
name: National Cancer Institute (NCI)
name: Holden Comprehensive Cancer Center
First posted: 2022-09-28
Enrollment: 20
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SEQUENTIAL
Primary purpose: TREATMENT

Brief summary: This is a first-in-human clinical trial evaluating the safety of an alpha-radiation treatment (Lead-212 labelled Pentixather) in patients who have been diagnosed with, and previously treated, for atypical carcinoid lesions of the lung.

Detailed description: This is a study to determine what dose is acceptably safe for further testing.

In this study, participants are asked to:

* undergo SPECT/CT imaging with Lead-203 Pentixather (a radiotracer) to ensure the tumor lesions have the needed receptors
* undergo serial blood sampling for during and after the SPECT/CT scan for radiation and dosimetry calculations (to determine how much of the Lead-212 Pentixather to administer)
* receive up to 2 infusions of arginine \& lysine as a kidney protectant
* receive up to 2 infusions of Lead-212 Pentixather, 6 weeks between each infusion
* undergo imaging at 3 months post treatment to determine disease response

Eligibility criteria: Inclusion Criteria:

* ability to provide independent consent
* adequate bone marrow function (platelet count ≥ 100,000; hemoglobin of ≥ 10 g/dL; neutrophil count ≥ 1,500 cells/mm3)
* adequate kidney function (creatinine clearance of ≥ 50 mL/min using the Cockcroft-Gault equation
* adequate liver function (serum bilirubin ≤ 3x the upper limit of normal, AST ≤ 5x the upper limit of normal, and ALT ≤ 5x the upper limit of normal)
* failed initial therapy or declined further therapy known to confer benefit
* have at least one lesion ≥ 2 cm that is positive for CXCR4 as demonstrated by Lead-203 Pentixather SPECT/CT

Exclusion Criteria:

* major surgery within 4 weeks of consent
* antoher investigational agent within 4 weeks of consent
* uncontrolled illness including, but not limited to, ongoing or active infection that would necessitate a delay in therapy or cause a hospital admission, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, hepatic cirrhosis or severe impairment, or psychiatric illness/social situations that would limit compliance with study requirements.
* prior solid organ transplant
* cytotoxic or antineoplastic therapy within 21 days of consent (42 days for nitrosoureas)
* antibody therapy within the 21 days of consent
* allogenic bone marrow or stem cell transplant, or any stem cell infusion, within 84 days of consent
* pregnancy
* breastfeeding
* refusal to comply with birth control requirements during study

Primary outcomes:
measure: Determine the recommended phase 2 dose of 212-Lead Pentixather
timeFrame: 3 months
Secondary outcomes:
measure: Determine the targeting of atypical pulmonary neuroendocrine tumor and/or neuroendocrine carcinoma lesions with 203-Lead Pentixather SPECT/CT
timeFrame: baseline
measure: Determine tumor response
timeFrame: 3 months
Other outcomes:
Locations:
city: Iowa City
country: United States
facility: The University of Iowa Theranostics Center
state: Iowa
Study officials:
affiliation: University of Iowa
name: Yusuf Menda, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Schottelius M, Osl T, Poschenrieder A, Hoffmann F, Beykan S, Hanscheid H, Schirbel A, Buck AK, Kropf S, Schwaiger M, Keller U, Lassmann M, Wester HJ. [177Lu]pentixather: Comprehensive Preclinical Characterization of a First CXCR4-directed Endoradiotherapeutic Agent. Theranostics. 2017 Jun 11;7(9):2350-2362. doi: 10.7150/thno.19119. eCollection 2017.
citation: Buck AK, Serfling SE, Lindner T, Hanscheid H, Schirbel A, Hahner S, Fassnacht M, Einsele H, Werner RA. CXCR4-targeted theranostics in oncology. Eur J Nucl Med Mol Imaging. 2022 Oct;49(12):4133-4144. doi: 10.1007/s00259-022-05849-y. Epub 2022 Jun 8.
citation: Serfling SE, Lapa C, Dreher N, Hartrampf PE, Rowe SP, Higuchi T, Schirbel A, Weich A, Hahner S, Fassnacht M, Buck AK, Werner RA. Impact of Tumor Burden on Normal Organ Distribution in Patients Imaged with CXCR4-Targeted [68Ga]Ga-PentixaFor PET/CT. Mol Imaging Biol. 2022 Aug;24(4):659-665. doi: 10.1007/s11307-022-01717-1. Epub 2022 Mar 21.