Pharmacokinetics of IA and IV Ga68-PSMA-11 Infusion

Prostate Adenocarcinoma Clinical Trial

Official title:

Pharmacokinetic Comparison of Selective Prostatic Arterial and Intravenous PSMA Radioligand Infusions in Treatment-Naïve Prostate Cancer Patients

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04976257
• Other study ID #: 21921
• Secondary ID: NCI-2021-06580
• Status: Completed
• Phase: Early Phase 1
• Start date: October 13, 2021
• Est. completion date: March 22, 2023

Study information

• Verified date: April 2023
• Source: University of California, San Francisco
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Prostate-specific membrane antigen (PSMA) agents have shown promise in detecting and treating prostate cancer. Gallium-68-labeled PSMA-11 (68Ga-PSMA-11) is a radioactive agent that binds to prostate cancer cells and can be imaged using positron emission tomography (PET) scanners that detect radioactivity in the body. This early phase I study will use PET to determine if delivering 68Ga-PSMA-11 directly into the prostatic artery (intra-arterial (IA) administration) results in greater uptake in the prostate than delivering 68Ga-PSMA-11 into a vein in the arm (intravenous (IV) administration).

Description:

PRIMARY OBJECTIVE: I. To compare the maximum standardized uptake value (SUVmax) in tumoral regions-of-interest during prostatic arterial and intravenous 68Ga-PSMA-11 infusions. SECONDARY OBJECTIVES: I. To compare the tumoral time-activity curves for selective prostatic arterial and intravenous 68Ga-PSMA-11 infusions. II. To study PSMA receptor saturation kinetics during selective prostatic arterial infusion of 68Ga-PSMA-11 (obtained only from arterial time activity curves [TACs] ipsilateral to the side of infusion). OUTLINE: Patients receive 68Ga-PSMA-11 IV over 30 minutes and undergo dynamic PET imaging over infusion period and for 15 minutes after on day 1. 1-14 days later, patients undergo pelvic angiogram and prostatic arterial catheterization. Patients then receive 68Ga-PSMA-11 IA over 30 minutes and undergo dynamic PET imaging over infusion period and for 15 minutes after. After completion of study, patients are followed up with 24 hours after the IA infusion and PET scan.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 5
• Est. completion date: March 22, 2023
• Est. primary completion date: March 22, 2023
• Accepts healthy volunteers: No
• Gender: Male
• Age group: 18 Years to 80 Years

Eligibility

Inclusion Criteria:

• Age greater than or equal to 18 years and less than or equal to 80 years.
• Children are excluded from this study because the disease does not occur in children
• Individuals from age 76 to age 80 must have a prior CT of the abdomen and pelvis within 5 years of first PSMA scan demonstrating non-occlusive pelvic atherosclerosis, regardless of smoking status
• Individuals over the age of 80 are excluded from this study to improve the likelihood of a catheterizable prostatic artery, given the higher rates of occlusive atherosclerosis with advanced age
• Ability to provide informed consent
• Biopsy-proven unilateral or bilateral prostate adenocarcinoma, any stage (any N or any M)
• Large tumor burden, characterized by either
• A discrete lesion with maximal tumor diameter >= 2.0cm on at least one affected side, documented on prostate magnetic resonance imaging (MRI) or Transrectal ultrasound (TRUS) within 4 months of first scan.
• Infiltrative disease with primary pattern Gleason 4 adenocarcinoma in at least 4 of 6 sextant core biopsy locations on at least one affected side, documented in a surgical pathology report within 4 months of first scan.
• Gleason score >= 4+4
• Cancer of the Prostate Risk Assessment (CAPRA) score >= 6

Exclusion Criteria:

• Body mass index (BMI) > 35 kg/m^2
• Prior treatment for prostate cancer, or any use of anti-androgen therapy within 3 months of first scan
• History of any pelvic radiotherapy
• Severe atherosclerosis from prior CT imaging study, or greater than 10 pack-year smoking history if no prior imaging available.
• Stage IV or V chronic kidney disease by estimated glomerular filtration rate (eGFR) within 45 days of first scan
• Platelet count < 50 x 10^9/L and/or international normalized ratio > 1.5
• Severe allergy to iodinated contrast
• Active urinary tract infection or recent episode of prostatitis within 1 month of first scan
• Inability to tolerate prolonged supine positioning

Related Conditions & MeSH terms

• Prostate Adenocarcinoma
• Prostate Carcinoma
• Prostatic Neoplasms
• Stage IIC Prostate Cancer AJCC v8
• Stage III Prostate Cancer AJCC v8
• Stage IIIA Prostate Cancer AJCC v8
• Stage IIIB Prostate Cancer AJCC v8
• Stage IIIC Prostate Cancer AJCC v8
• Stage IV Prostate Cancer AJCC v8
• Stage IVA Prostate Cancer AJCC v8
• Stage IVB Prostate Cancer AJCC v8

Intervention

Procedure:
• Angiogram
Undergo angiogram
• Catheterization
Undergo prostatic arterial catheterization

Drug:
• Gallium Ga-labeled PSMA-11
Given IV and IA

Procedure:
• Positron Emission Tomography
Undergo PET scan

Locations

Country	Name	City	State
United States	University of California San Francisco	San Francisco	California

Sponsors (2)

Lead Sponsor	Collaborator
Ryan Kohlbrenner, MD	Radiological Society of North America

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Maximum standardized uptake value (SUVmax)	A two-sided paired t-test will determine whether the ipsilateral SUVmax values obtained during selective arterial 68Ga-PSMA-11 infusions are greater than those obtained during venous infusions. A similar paired analysis will be made during arterial infusions to compare tumoral regions of interest (ROIs) ipsilateral and contralateral to the side of the infusion. Means/medians, ranges/standard deviations will be calculated for each endpoint.	Day 1 and from Day 2 up to Day 15 (2 days total)
Secondary	Comparison of Mean SUV (SUVmean)	Paired t-tests will determine whether SUVmean is different for intra-arterial (IA) time activity curves (TACs) when compared to intravenous (IV) TACs. Means/medians, ranges/standard deviations will be calculated for each endpoint.	Day 1 and from Day 2 up to Day 15 (2 days total)
Secondary	Comparison of Time to SUVmax (TSUV)	Paired t-tests will determine whether TSUV is different for IA TACs when compared to IV TACs. Means/medians, ranges/standard deviations will be calculated for each endpoint.	Day 1 and from Day 2 up to Day 15 (2 days total)
Secondary	Comparison of Area under the curve (AUC)	Paired t-tests will determine whether AUCs are different for IA TACs when compared to IV TACs. Means/medians, ranges/standard deviations will be calculated for each endpoint.	Day 1 and from Day 2 up to Day 15 (2 days total)
Secondary	Comparison of Rate of 68Ga-PSMA-11 uptake	To assess whether the rate of uptake is significantly different with selective arterial infusion, a two-sided paired t-test will compare the slopes for Selective arterial infusion, tumor ipsilateral to the side of radiotracer injection (IAIpsi) curves and Intravenous infusion, tumor ipsilateral to the side of corresponding arterial injection (IVIpsi) curves during each of the nine time intervals. Selective arterial infusion, tumor contralateral to the side of radiotracer injection (IACont) slopes will be similarly compared to those acquired from corresponding Intravenous infusion, tumor contralateral to the side of corresponding arterial injection (IVCont) data. Means/medians, ranges/standard deviations will be calculated for each endpoint.	Day 1 and from Day 2 up to Day 15 (2 days total)
Secondary	Comparison of Time to early saturation effects	Specific to the IAIpsi TACs, the time to early saturation effects (Tese) will represent the time at which the second derivative of the curve becomes negative (i.e. when concavity in the curve is first noted). For the purposes of Tese, the aforementioned curve partitioning method will not be used. Descriptive statistics of Tese will be established, along with statistics for the corresponding mass dose administered (MDese) at Tese. Means/medians, ranges/standard deviations will be calculated for each endpoint.	1 day
Secondary	Comparison of Mass dose at saturation	Descriptive statistics of Tese will be established, along with statistics for the corresponding mass dose administered (MDese) at Tese. Means/medians, ranges/standard deviations will be calculated for each endpoint.	Day 1 and from Day 2 up to Day 15 (2 days total)
Secondary	Comparison of Mean SUV during 15-minute washout (SUVwashout)	The mean SUVwashout and its standard deviation will be calculated for the 15-minute post-injection periods.	1 day