High Grade Glioma
Conditions
Brief summary
This interventional, clinical pilot-study will initiate and evaluate 68Ga/177Lu-PSMA theranostics in Norway as treatment alternative for patients with recurrent grade 3 and grade 4 gliomas. The main goal is to improve existing diagnostic and therapeutic methods in glioma management, and introduce a novel, well-tolerated radionuclide treatment that possibly can increase the overall survival and quality of life for a patient group that today have very short expected survival and no standard recommended therapy.
Detailed description
Patients demonstrating a high tumor uptake of 68Ga-PSMA on the diagnostic PET/MRI examination in the screening part of the study are eligible for a standard of 3 cycles, with a possible extension to maximum number of 6 cycles, of 177Lu-PSMA radionuclide therapy sessions. SPECT/CT will be performed after each cycle of treatment for dosimetry calculations, while 68Ga-PSMA PET/MRI, quality-of-life schemes and clinical examinations will be used to monitor therapeutic effects during the therapy cycles and up to 1.5 year after treatment initiation. The main endpoints of the study are progression-free survival and overall survival.
Interventions
RADIATION177Lu-PSMA I&T
Patients demonstrating a high tumor uptake of 68Ga-PSMA on the diagnostic PET/MRI examination in the screening part of the study are eligible for a standard of 3 cycles, with a possible extension to maximum number of 6 cycles, of 177Lu-PSMA radionuclide therapy sessions. SPECT/CT will be performed after each cycle of treatment for dosimetry calculations, while 68Ga-PSMA PET/MRI, quality-of-life schemes and clinical examinations will be used to monitor therapeutic effects during the therapy cycles and up to 1.5 year after treatment initiation. The main endpoints of the study are progression-free survival and overall survival.
Sponsors
St. Olavs Hospital
Norwegian University of Science and Technology
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Patients with recurrent grade 3 and grade 4 glioma will be recruited for treatment with 177Lu-PSMA.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* A previous diagnosis of histologically confirmed WHO grade 3 or grade 4 glioma * Radiologically (MRI) confirmed tumor relapse/progression ≥ 12 weeks since completed radiotherapy or suspicion of recurrence where inclusion in the theranostic part of study could be indicated * Must be ≥ 18 years old * Written informed consent for study participation * Negative pregnancy test no longer than 14 days prior to enrollment * Life expectancy \> 12 weeks * Karnofsky performance status ≥ 70% (must be able to care for self after radionuclide therapy) * High tumor uptake on diagnostic imaging with 68Ga -PSMA. * Tumor not amendable for radiotherapy or surgery, and treating oncologist think that there are no other preferable systemic therapy options (e.g temozolomide, PCV or lomustine monotherapy). * Women of childbearing potential (WOCBP) defined as fertile, following menarche and until becoming post-menopausal unless permanently sterile must use adequate contraception. Permanent sterilization methods include hysterectomy, bilateral salpingectomy or bilateral oophorectomy. Adequate contraception in the current study will be the following: o Combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation: * Intravaginal * transdermal * Progestogen-only hormonal contraception associated with inhibition of ovulation: * oral * injectable * implantable * intrauterine device (IUD) * intrauterine hormone-releasing system ( IUS) * bilateral tubal occlusion * vasectomised partner * sexual abstinence * Patient accept not to receive any other tumor directed treatment before 8 weeks after each 177Lu-PSMA injection.
Exclusion criteria
* Estimated GFR \< 30 mL/min * Platelet count \<75 x109 /L * White blood cells ≤ 2.5 x 109/L * Neutrophil count \< 1.5 x109 /L * Hb \< 8.0 g/dL * Albumin ≤ 25 g/L * Uncontrollable symptomatic epilepsy refractory to standard medication * Pacemakers or defibrillators not compatible with 3T MRI * No ability to obtain informed consent (e.g. due to severe dysphasia or cognitive deficits). * Breastfeeding * Pregnancy * Hypersensitivity to the active substance or to any of the excipients * Urinary and fecal incontinence (patient cannot have diaper needs) * Significant medical or psychiatric illness that, in the investigator's opinion, would compromise the patient's ability to tolerate this therapy * If previous radiotherapy and/or radionuclide therapy have resulted in absorbed doses \>=23 Gy to any of the kidneys, or \>= 25 Gy to any of the parotids, an individual assessment will be made by the nuclear medicine physician and medical physicist if patient can be included to the therapy part of the study. * Concurrent investigational drugs or experimental therapy must be stopped at least 4 weeks prior to study entry * Unwilling to accept potential challenge with xerostomia
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of adverse events | 6 months after end of therapy | Type, frequency and severity of adverse events assessed with the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. |
| Evaluation of efficacy of 177Lu- PSMA | 6 months after commencement of therapy | Progression free survival (6 months) determined from date of commencement of 177Lu-PSMA therapy |
| Adverse events | Day 1 and 6 months after end of therapy | Change in score in the modified RAI-6 questionnaire. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Evaluate radiation dose to tumor and critical organs | 7 days after commencement of therapy | Calculation of absorbed doses to the tumor and kidneys, parotid glands, sublingual glands, submandibular glands, lacrimal glands, liver, spleen and red marrow for each therapy cycle as well as accumulated doses for all therapy cycles. |
| Tumor response | 8 weeks | Tumor responses as assessed by contrast enhanced MRI according to response assessment in neuro oncology (RANO) criteria (50) (Attachment 3) and volume measurements. |
| Nano score | 8 weeks | Neurologic exam (nano score) |
| Health related quality of life | 8 weeks | Health-related quality of life EQ-5D scores |
| Karnofsky performance status | 8 weeks | Karnofsky performance status |
| PSMA uptake versus progression free survival | 8 weeks | Correlate 68Ga-PSMA uptake (SUV) to overall and image-based progression free survival. |
| Pretherapeutic PSMA uptake versus accumulated doses | 8 weeks | Evaluate the possible correlation between the pretherapeutic uptake of 68Ga -PSMA (SUV) in tumors and salivary glands to accumulated doses received from therapeutic 177Lu-PSMA. |
| Tumor-to-parotis ratio threshold for indication of 177Lu-PSMA therapy | 8 weeks | Establish an appropriate indication for 177Lu-PSMA therapy by measuring tumor:parotis-ratios in 68Ga-PSMA PET scans. |
| Change in PSMA uptake during treatment period versus overall survival | 8 weeks | Measure changes in uptake (SUV) of 68Ga-PSMA during the treatment period and correlate to overall survival in order to evaluate the role of post-therapeutic 68Ga-PSMA PET in monitoring disease. |
Countries
Norway
Contacts
PRINCIPAL_INVESTIGATORTora Solheim, MD/PhD
St. Olavs hospital/NTNU
Outcome results
None listed