Neuroendocrine Tumor Grade 2, Neuroendocrine Tumors
Conditions
Brief summary
This is a Phase 2 evaluation of hepatic-progression free survival among patients with Grade 2 liver-dominant NET metastases undergoing combination therapy with CapTem and Y90 radioembolization.The hypothesis is to confirm safety and to assess if disease control is improved relative to expectation from either therapy alone. A Grade 3 arm was added in 2025.
Detailed description
Patients with liver-dominant Grade 2/3 NET metastases from any primary will start CapTem and undergo simulation angiography for radioembolization planning during the first cycle. If they tolerate CapTem and are not excluded from radioembolization, then TARE will be performed on Day 7 of Cycle 2, with additional TARE of Day 7 of cycle 3 or 4 as needed to treat the entire tumor burden. Patients will remain on CapTem until progression or intolerance. Primary outcome measure is hepatic progression-free survival.
Interventions
Capecitabine 750 mg/m2 twice daily orally for 14 days
temozolomide 200 mg/m2 orally on Days 10-14, with 14 days between cycles
COMBINATION_PRODUCTtransarterial radioembolization
Trans-arterial radioembolization (TARE) on Day 7 of cycle 2 and, if needed for the other lobe, Day 7 of either cycle 3 or 4.
Sponsors
Abramson Cancer Center at Penn Medicine
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients with confirmed diagnosis of histologic grade 2 or 3 well differentiated neuroendocrine tumor with unresectable liver metastases (primary tumor or other extrahepatic disease may be present) * Patients with at least one measurable liver metastases, with size \> 1cm (RECIST criteria) * Patients with liver dominant disease defined as ≥50% tumor body burden confined to the liver * Liver tumor burden does not exceed 50% of the liver volume * Patent main portal vein * At least 4 weeks since last administration of last chemotherapy and /or radiotherapy * Age \>18 years. * Life expectancy of greater than 6 months. * ECOG performance status 0-2. * Adequate liver function as measured by: Total bilirubin ≤ 2.0mg/dl, ALT, AST ≤5 times ULN, albumin ≥2.5g/dl. * Patients must have adequate organ and marrow function as defined below: * platelets \>100,000/mcL (may be corrected by transfusion) * serum creatinine \< 2.0 mg/dl * INR \<1.6, (may be corrected by transfusion) * Ability to understand and the willingness to sign a written informed consent document. * Women of child bearing potential and fertile men are required to use effective contraception (negative urine or serum βHCG for women of child-bearing age)
Exclusion criteria
* Contraindications to capecitibine or temozolomide * Contraindicated for both contrast-enhanced MRI and CT * Patients previously treated with transarterial embolization (with or without chemotherapy) or with radioembolization (Y-90 microspheres) * Contraindication for radioembolization procedures: * excessive hepatopulmonary shunt as determined by the investigator * inability to deliver Y90 microspheres without risk of non-target embolization of extra-hepatic structures * Subjects consenting to the trial who fail their simulation angiography will be removed from the study and replaced. * Patients may not be receiving any other investigational agents. * Absolute contraindication to intravenous iodinated contrast (Hx of significant previous contrast reaction, not mitigated by appropriate pre-medication). * Choledochoenteric anastomosis, transpapillary stent or sphincterotomy of duodenal papilla; * Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements. * Pregnant and lactating women are ineligible
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Intra-hepatic progression-free survival | 2 years. Time from initiation of study therapy until first documented intra-hepatic disease progression, death due to any cause or last scan date that documented intra-hepatic progression-free status. | Intra-hepatic progression-free survival by RECIST 1.0 is defined as the time from initiation of study therapy until first documented intra-hepatic disease progression, death due to any cause or last scan date that documented intra-hepatic progression-free status. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intra-hepatic tumor responses by RECIST | 2 years. from time of initiation of study therapy until subject comes off of study, or study closes | Intra-hepatic tumor responses will be evaluated by RECIST. |
| Intra-hepatic tumor responses by EASL | 2 years. from time of initiation of study therapy until subject comes off of study, or study closes | Intra-hepatic tumor responses will be evaluated by EASL criteria. |
| extra-hepatic tumor responses | 2 years. from time of initiation of study therapy until subject comes off of study, or study closes | extra-hepatic tumor responses will be evaluated by RECIST. |
| Overall Progression free survival | 2 years. time from initiation of study therapy until first documented intra- or extra-hepatic disease progression, death due to any cause or last scan date that documented progression-free status | Overall progression-free survival is defined as the time from initiation of study therapy until first documented intra- or extra-hepatic disease progression, death due to any cause or last scan date that documented progression-free status |
| Number of participants with hepatic toxicities | From period of enrollment to 24 months after last treatment | Hepatic toxicities will be individually assessed by NCI CTCAE Version 4. |
| Change in CgA over time | Tumor markers will be assessed at baseline and then every 3 months for 24 months. | The primary marker is CgA. Additional cancer site-specific (i.e., gastrinoma) markers may also be assayed. |
| Quality of Life by European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for Neuroendocrine tumor | Quality of life will be measured at baseline and then every 3 months for 24 months . | Quality of Life will be measure by a validated NET-specific instrument, EORTC. Scale is 0-100, higher scores indicate worse symptoms/functioning |
| Number of participants with systemic toxicities | From period of enrollment to 24 months after last treatment | Systemic toxicities will be individually assessed by NCI CTCAE Version 4. |
Countries
United States
Contacts
Primary ContactMichael Soulen, MD
Backup ContactVeronica Faris
Outcome results
None listed