177Lu-DOTATATE for the Treatment of Stage IV or Recurrent Breast Cancer

Anatomic Stage IV Breast Cancer AJCC v8 Clinical Trial

Official title:

A Phase II Pilot Study of (Lutetium (177Lu)-DOTATATE in Patients With Metastatic Breast Cancer

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT04529044
• Other study ID #: STUDY00019489
• Secondary ID: NCI-2020-04795ST
• Status: Not yet recruiting
• Phase: Phase 2
• Start date: September 1, 2022
• Est. completion date: December 20, 2023

Study information

• Verified date: June 2022
• Source: OHSU Knight Cancer Institute
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This phase II trial investigates how well 177Lu-DOTATATE works in treating patients with breast cancer that is stage IV or has come back (recurrent). 177Lu-DOTATATE may shrink or destroy the tumor or circulating breast cancer stem cells if they show evidence of the SSTR2. 177Lu-DOTATATE is a targeted therapy that uses DOTATATE, linked to a radioactive agent called 177Lu. DOTATATE attaches to tumor cells with SSTR2 and delivers 177Lu to kill them. Giving 177Lu-DOTATATE may help decrease the number and size of tumors and the number of circulating cancer stem cells in patient's blood for the treatment of patients with breast cancer positive for SSTR2.

Description:

PRIMARY OBJECTIVE:

I. Assess objective response in study participants receiving lutetium Lu 177 tetra-azacyclododecanetetra-acetic acid (dota) tyr3-octreotate (tate) (177Lu-DOTATATE) therapy.

SECONDARY OBJECTIVES:

I. Assess the rate of disease control following 177Lu-DOTATATE therapy. II. Evaluate duration of treatment response to 177Lu-DOTATATE. III. Assess progression-free survival (PFS). IV. Assess safety and tolerability of the 177Lu-DOTATATE therapy. V. Evaluate over time the requirements for stable disease.

EXPLORATORY OBJECTIVES:

I. Evaluate changes in the number of circulating SSTR2+ breast cancer cells (including cancer stem cell sub-populations) following 177Lu-DOTATATE treatment.

II. Assess changes in gene profile among SSTR2+ breast cancer cells following 177Lu-DOTATATE treatment.

OUTLINE:

Patients receive 177Lu-DOTATATE intravenously (IV) over 30-40 minutes during weeks 1, 8, 16, and 24 in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 3 months for up to 5 years.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 10
• Est. completion date: December 20, 2023
• Est. primary completion date: December 31, 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 100 Years

Eligibility

Inclusion Criteria:

• Life expectancy of > 6 months, as determined by the investigator

• Ability to understand and the willingness to sign a written informed consent document

• Histologically or cytologically confirmed metastatic breast carcinoma

• Stage IV or recurrent disease with distant metastases

• Female and male patients with breast cancer will be included in the study.

• Participants must have experienced disease progression after at least two lines of standard treatment modalities and/or one prior line of cytotoxic chemotherapy (not just endocrine therapy). Specifically, patients must have received or declined the following therapies: a) HR+/HER2: endocrine therapy and CDK4/6i; b) HER2+: trastuzumab, pertuzumab, T-DM1 and tucatinib; c) TNBC: chemotherapy, immunotherapy (in PD-L1+ tumors). Patients can be consented if they are foregoing treatments known to confer survival advantage.

• Participants must have at least one measurable site of disease as defined by Response Evaluation Criteria in Solid Tumors (RECIST) version (v1).1 that is amendable to biopsy

• Confirmed presence of SSTR based on >50% of leisions with DOTATATE uptake of 68Ga DOTATATE equivalent to the liver.

• Participants must have fully recovered from the acute toxic effects of all prior treatment to grade 1 or less, except alopecia and =< grade 2 neuropathy which are allowed

• Participant must have Eastern Cooperative Oncology Group (ECOG) performance status =< 2

• Participant must consent to undergo a pre-treatment screening biopsy for enrollment

• Hemoglobin >= 8.0 g/dL with no blood transfusion in the past 28 days (measured within 28 days prior to administration of study treatment)

• Absolute neutrophil count (ANC) >= 2.0 x 10^9/L (measured within 28 days prior to administration of study treatment)

• Platelet count >= 75 x 10^9/L (measured within 28 days prior to administration of study treatment)

• Total bilirubin =< 3 x institutional upper limit of normal (ULN) (measured within 28 days prior to administration of study treatment)

• Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =< 2.5 x institutional upper limit of normal (unless liver metastases are present in which case they must be =< 5 x ULN) (measured within 28 days prior to administration of study treatment)

• Serum albumin >= 3.0 g/L, unless prothrombin time or international normalized ratio (INR) value is within the normal range (measured within 28 days prior to administration of study treatment)

• Participants must have serum creatinine =< 1.7 mg/dL, or creatinine clearance estimated of >= 51 mL/min using the Cockcroft-Gault equation or based on a 24 hour urine test (measured within 28 days prior to administration of study treatment)

• Female participants of childbearing potential (FOCBP) must have a negative urine or serum pregnancy test within 72 hours prior to receiving the first dose of study medication. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required

• FOCBP agree to use a highly-effective method of contraception starting with the first dose of study therapy through up to 7 months after the last dose of study therapy

• FOCBP are those who are not proven postmenopausal. Postmenopausal is defined as:

• Amenorrheic for > 24 consecutive months following cessation of exogenous hormonal treatments

• Luteinizing hormone (LH) and Follicle stimulating hormone (FSH) levels in the post menopausal range for women under 50 years of age

• Radiation-induced oophorectomy with last menses > 1 year ago

• Chemotherapy-induced menopause with > 1 year interval since last menses

• Surgical sterilization (bilateral oophorectomy or hysterectomy or tubal ligation)

Exclusion Criteria:

• Currently participating and receiving study therapy or has participated in a study of an investigational agent and received study therapy or used an investigational device within 4 weeks of first dose of 177Lu- DOTATATE treatment

• Individuals in the follow-up phase of a prior investigational study may participate as long as it has been 4 weeks since last dose of the previous investigational agent or device

• Prior external beam radiation therapy to more than 25% of the bone marrow

• Other malignancy unless curatively treated with no evidence of disease for >= 5 years except: adequately treated non-melanoma skin cancer or curatively treated in situ cancer of the cervix

• Known brain metastases, unless these metastases have been treated and stabilized

• Peptide receptor radionuclide therapy at any time prior to study enrollment

• Known hypersensitivity to somatostatin analogues or any component of the 68Ga- DOTATATE or 177Lu- DOTATATE formulations

• Patients with uncontrolled infection will not be enrolled until infection is treated per provider discretion

• Uncontrolled intercurrent illness including, but not limited to, symptomatic congestive heart failure, unstable angina pectoris, serious cardiac arrhythmia, myocardial infarction within 6 months prior to enrollment, New York Heart Association (NYHA) class III or IV heart failure

• Uncontrolled diabetes mellitus as defined by a fasting blood glucose >2x ULN

• Any patient receiving treatment with short-acting somatostatin analogs, which cannot be interrupted for both 24 hours before and after the administration of 177Lu, or any patient receiving treatment with long-acting release somatostatin analogs that cannot be interrupted for at least 4 weeks before the administration of 177Lu- DOTATATE

• Any surgery or radiofrequency ablation within 12 weeks prior to enrollment in the study; or prior radioembolization; chemoembolization; or external beam radiation therapy (EBRT) to > 25% of bone marrow, at any time

• Any chemotherapy or targeted therapy within 4 weeks prior to enrollment in the study

• Current spontaneous urinary incontinence making impossible the safe administration of the radioactive study agent

• Any psychiatric illness that prevents patient from informed consent process

• Any concurrent condition that, in the Investigator's opinion, would jeopardize the safety of the patient or compliance with the protocol

• Participant is pregnant or breastfeeding, or expecting to conceive within the projected duration of the trial, starting with the screening visit through 6 months after the last dose of trial treatment

Related Conditions & MeSH terms

• Anatomic Stage IV Breast Cancer AJCC v8
• Breast Neoplasms
• Carcinoma
• Metastatic Breast Carcinoma
• Prognostic Stage IV Breast Cancer AJCC v8
• Recurrent Breast Carcinoma

Intervention

Drug:
• Lutetium Lu 177 Dotatate
Given IV

Locations

Country	Name	City	State
United States	OHSU Knight Cancer Institute	Portland	Oregon

Sponsors (3)

Lead Sponsor	Collaborator
OHSU Knight Cancer Institute	Novartis, Oregon Health and Science University

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Percent difference in circulating SSTR2+ breast cancer cell populations		Baseline to completion of study therapy (up to 3 months after last dose)
Other	Percent difference in gene expression of SSTR2+ breast cancer cell populations	Change in the number of circulating breast cancer stem/progenitor cells (BCSCs), change in BCSCs with SSTR2 expression, and change in metastatic tumor gene expression profiles between baseline and completion of 177Lu- DOTATATE treatment or progression (whichever occurs first) will be summarized using descriptive statistics and compared with paired t-tests. If normal distribution assumptions for a paired t-test are violated, a non-parametric method such as Wilcoxon signed rank test will be considered. An exploratory data analysis will be performed to characterize underlying association between circulating BCSCs and measures of clinical benefit (e.g., ORR, PFS) of 177Lu- DOTATATE treatment.	Baseline to completion of study therapy (up to 3 months after last dose)
Primary	Objective response rate (ORR)	Using the intent to treat (ITT) set and the efficacy analysis set, each ORR will be reported as a point estimate along with a 2-sided 95% exact confidence interval (CI).	Up to 3 months post-therapy
Secondary	Disease control rate (DCR)	A point estimate and 2-sided 95% CI will be provided for the DCR, defined as the proportion of participants achieving a complete response (CR), partial response (PR), or stable disease (SD) (as assessed by the investigator per Response Evaluation Criteria in Solid Tumors [RECIST] version [v]1.1).	Up to 3 months post-therapy
Secondary	Duration of response (DOR)	DOR will be plotted with cumulative incidence function curves (one curve for recurrence and one curve for non-relapse death).	Up to 12 months post-therapy
Secondary	Progression-free survival	The estimated distribution of PFS will be plotted using a Kaplan Meier curve and reported with median survival and a 95% CI.	Up to 12 months post-therapy
Secondary	Incidence of adverse events (AEs)	The severity of the AE will be assessed by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Study drug-related AEs are those assessed by investigator as definitely or probably related. Using the safety analysis set, the incidence of treatment emergent adverse events (TEAEs) and non-treatment-related AEs will be determined for study participants who receive at least one dose of lutetium Lu 177 dotatate (177Lu- DOTATATE). The point estimate and 95% CI will be reported for overall toxicities as well as for each major organ category.	Up to 3 months post-therapy
Secondary	Duration of stable disease		Up to 12 months post-therapy