Neuroendocrine Neoplasms
Conditions
Keywords
[68Ga]Ga-DOTA-TATE, Neuroendocrine Neoplasms (NENs), Positron Emission Tomography (PET), Computerized Tomography (CT), PET/CT, Diagnostic performance, Sensitivity, Specificity
Brief summary
The purpose of this study was to evaluate the diagnostic performance of \[68Ga\]Ga-DOTA-TATE Positron Emission Tomography (PET)/Computerized Tomography (CT) imaging compared with conventional imaging (CIM) as standard of truth in patients with neuroendocrine neoplasms (NENs) and healthy volunteers (HVs). The data from this study was collected in order to provide the evidence for diagnosis of \[68Ga\]Ga-DOTA-TATE PET/CT imaging in patient with NENs in Japan.
Detailed description
A total of 71 participants (48 patients with confirmed/suspected NENs and 23 HVs) were enrolled to ensure that at least 70 participants (47 patients with confirmed/suspected NENs and 23 HVs) were evaluable for the co-primary endpoints. All enrolled participants were administered \[68Ga\]Ga-DOTA-TATE and PET/CT scan. The co-primary endpoints of the subject-level sensitivity and the subject-level specificity were assessed by comparing the central reading results of the \[68Ga\]Ga-DOTA-TATE PET/CT scan to the central reading results of Conventional imaging (CIM).
Interventions
Single intravenous injection of \[68Ga\]Ga-DOTA-TATE determined by body weight (2 Mega-Becquerel (MBq) / kilogram (kg) (0.054 Millicurie (mCi)/kilogram (kg)) of body weight up to a maximum total dose of 200 MBq (5.4 mCi)) at the imaging day (Day 1).
DRUG68Ge/68Ga Generator
Radionuclide generator
Sponsors
Novartis Pharmaceuticals
Eckert & Ziegler Radiopharma GmbH
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 100 Years
Healthy volunteers
Yes
Inclusion criteria
Key Inclusion Criteria: 1. Signed informed consent must have been obtained prior to participation in the study 2. Participants must have been adults \>= 18 years of age 3. ECOG performance status 0-2 4. For patient with NENs only: Participants were to be confirmed NENs based on histopathology, imaging and other relevant examination, or with suspected NENs which localization could not have been confirmed by CIM 5. For HVs only: Male or female participant in good health condition as determined by no clinically significant findings from medical history, physical examination, vital signs, lab test and ECG 6. Women of childbearing potential must havehad a negative urine or blood pregnancy test. Key
Exclusion criteria
1. Inability to complete the needed investigational and conventional imaging due to any reason (severe claustrophobia, inability to lie still for the entire imaging time, etc.) 2. Any additional medical condition, serious intercurrent illness, concomitant cancer or other extenuating circumstance that, in the opinion of the Investigator, would indicate a significant risk to safety or impair study participation 3. Known allergy, hypersensitivity, or intolerance to \[68Ga\]Ga-DOTA-TATE and \[111In\]In-Pentetreotide 4. Therapeutic use of any somatostatin analogue except for the following washout period * Short-acting analogs of somatostatin can be used up to 24 hours before injection of \[68Ga\]Ga-DOTA-TATE. * Long-acting analogs of somatostatin can be used up to 28 days before injection of \[68Ga\]Ga-DOTA-TATE. 5. Prior administration of a radiopharmaceutical unless 10 or more half-lives have elapsed before injection of \[68Ga\]Ga-DOTA-TATE 6. Use of other investigational drugs within 30 days before screening 7. Participants who were pregnant. 8. Participants who were lactating.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of [68Ga]Ga-DOTA-TATE Negative Participants (TN Participants) Among CIM Negative Participants (TN or FP Participants) | Day 1 | Subject-level specificity is defined as the proportion of \[68Ga\]Ga-DOTA-TATE PET/CT imaging negative participants (i.e. TN participants) among CIM negative participants (i.e. TN or FP participants). * TN participants were those who did not show any lesions based on both \[68Ga\]Ga-DOTA-TATE PET/CT imaging and CIM by central read. * FP participants were those who showed at least one lesion based on \[68Ga\]Ga-DOTA-TATE PET/CT imaging but did not show any lesions based on CIM by central read. True Positive \[TP\] False Positive \[FP\] False Negative \[FN\] True Negative \[TN\] |
| Subject-level Sensitivity | Day 1 | Subject-level sensitivity is defined as the proportion of \[68Ga\]Ga-DOTA-TATE PET/CT imaging positive participants (i.e. TP participants) among CIM positive participants (i.e. TP or FN participants). True Positive \[TP\] False Positive \[FP\] False Negative \[FN\] True Negative \[TN\] Sensitivity = TP / (TP + FN) |
| Subject-level Specificity | Day 1 | Subject-level specificity is defined as the proportion of \[68Ga\]Ga-DOTA-TATE PET/CT imaging negative participants (i.e. TN participants) among CIM negative participants (i.e. TN or FP participants). True Positive \[TP\] False Positive \[FP\] False Negative \[FN\] True Negative \[TN\] Specificity = TN / (TN + FP). |
| Number of [68Ga]Ga-DOTA-TATE Positive Participants (TP Participants) Among CIM Positive Participants (TP or FN Participants) | Day 1 | Subject-level sensitivity is defined as the proportion of \[68Ga\]Ga-DOTA-TATE PET/CT imaging positive participants (i.e. TP participants) among CIM positive participants (i.e. TP or FN participants). * TP participants were those who showed at least one lesion based on both \[68Ga\]Ga-DOTA-TATE PET/CT imaging and CIM by central read. * FN participants were those who did not show any lesions based on \[68Ga\]Ga-DOTA-TATE PET/CT imaging but showed at least one lesion based on CIM by central read. True Positive \[TP\] False Positive \[FP\] False Negative \[FN\] True Negative \[TN\] |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Subject-level PPV | Day 1 | Subject-level positive predictive values (PPV) is defined as the proportion of TP participants among \[68Ga\]Ga-DOTA-TATE PET/CT imaging positive participants (i.e. TP or FP participants). PPV (Subject-level positive predictive values) = TP / (TP + FP) |
| Subject-level NPV | Day 1 | Subject-level NPV was defined as the proportion of TN participants among \[68Ga\]Ga-DOTA-TATE PET/CT imaging negative participants (i.e. TN or FN participants). NPV (Subject-level negative predictive values) = TN / (TN + FN) |
| Participants Who Have Consistent Results (i.e. TP or TN Participants) Among All Participants Assessed by [68Ga]Ga-DOTA-TATE PET/CT Imaging and CIM - Subject-level Accuracy | Day 1 | Subject-level accuracy is defined as the proportion of TP and TN participants among all patients in the EFF (i.e. TP+TN+FP+FN participants). Accuracy = (TP + TN) / (TP + TN + FP + FN). |
| Region-level Sensitivity | Day 1 | Region-level sensitivity is defined as the proportion of \[68Ga\]Ga-DOTA-TATE PET/CT imaging positive regions (TP regions) among CIM positive regions (i.e. TP or FN regions). Sensitivity = TP / (TP + FN) |
| Region-level Specificity | Day 1 | Region-level specificity is defined as the proportion of \[68Ga\]Ga-DOTA-TATE PET/CT imaging negative regions (TN regions) among CIM negative regions (i.e. TN or FP regions). Specificity = TN / (TN + FP) Note: Even when a participant is categorized as positive in subject-level, he/she can still have negative results in region-level. e.g. When only Liver is positive and other regions are negative, the participant is categorized as positive in subject-level. As all participants had at least one CIM-negative region and were included in the table, the number of participants analyzed is 71. |
| Region-level Positive Predictive Values (PPV) | Day 1 | Region-level PPV is defined as the proportion of regions which are positive on both \[68Ga\]Ga-DOTA-TATE PET/CT imaging and CIM (TP regions) among \[68Ga\]Ga-DOTA-TATE PET/CT imaging positive regions (i.e. TP or FP regions). Region-level positive predictive values (PPV) = TP / (TP +FP) |
| Region-level Negative Predictive Values (NPV) | Day 1 | Region-level NPV is defined as the proportion of regions which are negative on both \[68Ga\]Ga- DOTA-TATE PET/CT imaging and CIM (TN regions) among \[68Ga\]Ga-DOTA-TATE PET/CT imaging negative regions (i.e. TN or FN regions). Region-level negative predictive values (NPV) = TN / (TN + FN) Note: Even when a participant is categorized as positive in subject-level, he/she can still have negative results in region-level. e.g. When only Liver is positive and other regions are negative, the participants is categorized as positive in subject-level. As all participants had at least one negative region by Ga-DOTA-TATE PET/CT and were included in the table, the number of participants analyzed = 71. |
| Region-level Accuracy | Day 1 | Region-level accuracy is defined as the proportion of regions which are CIM and \[68Ga\]Ga-DOTA-TATE PET/CT imaging positive (TP regions) or negative (TN regions) among regions detected by CIM and \[68Ga\]Ga-DOTA-TATE PET/CT imaging (i.e. TP+TN+FP+FN regions). Accuracy = (TP + TN) / (TP + TN + FP + FN). |
| Region-level True Positive | Day 1 | TP regions were the regions which showed at least one lesion based on both \[68Ga\]Ga-DOTA-TATE PET/CT imaging and CIM by central read |
| Region-level False Negative | Day 1 | FN regions were the regions which did not show any lesions based on \[68Ga\]Ga-DOTA-TATE PET/CT imaging but show at least one lesion based on CIM by central read. |
| Region-level False Positive | Day 1 | FP regions were the regions which showed at least one lesion based on \[68Ga\]Ga-DOTA-TATE PET/CT imaging but do not showed any lesion based on CIM by central read. |
| Region-level True Negative | Day 1 | TN regions were the regions which did not show any lesion based on both \[68Ga\]Ga-DOTA-TATE PET/CT imaging and CIM by central read. |
| Inter-reader Variability (%) on [68Ga]Ga-DOTA-TATE PET/CT Imaging | Day 1 | Inter-reader variability for \[68Ga\]Ga-DOTA-TATE PET/CT imaging is defined as agreement rate among reader determinations. As assessed by Fleiss' Kappa statistics. Inter-reader variability (%) and its normality 95% CI is presented. |
| Incidence of Treatment Emergent Adverse Event (TEAE) Within 8 Days After [68Ga]Ga-DOTATATE Administration | For treated pts: AEs are reported from the single dose of study treatment plus 8 days post treatment, up to a maximum timeframe of 9 days. For HV pts: AEs are reported from the study start plus 8 days, up to a maximum timeframe of 9 days. | An adverse event (AE) is any untoward medical occurrence (e.g., any occurrence of unfavorable and unintended sign(s), symptom(s) or medical condition, including abnormal laboratory findings, or worsening of any pre-existing sign(s), symptom(s) or medical condition) in a participant after providing written informed consent for participation in the study. Therefore, an AE may or may not be temporally or causally associated with the use of any treatment used in this study. This includes events reported by the participant (or, when appropriate, by a caregiver, surrogate, or the participant's legally authorized representative). |
| Area Under the Concentration-time Curve From Time Zero (Pre-dose) Extrapolated to Infinite Time (AUCinf) of [68Ga]Ga-DOTA-TATE [Mass-based Concentration] | Day 1 (5 min, 15 min, 30 min, 45 min, 60 min, 120 min, 180 min) | Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. AUC(0-inf) will be listed and summarized using descriptive statistics. |
| Area Under the Serum Concentration-time Curve From Time Zero to the Time of Last Quantifiable Concentration (AUClast) of [68Ga]Ga-DOTA-TATE [Mass-based Concentration] | Day 1 (5 min, 15 min, 30 min, 45 min, 60 min, 120 min, 180 min) | Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. AUClast will be listed and summarized using descriptive statistics. |
| Observed Maximum Plasma Concentration (Cmax) of [68Ga]Ga-DOTA-TATE [Mass-based Concentration] | Day 1 (5 min, 15 min, 30 min, 45 min, 60 min, 120 min, 180 min) | Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. Cmax will be listed and summarized using descriptive statistics. |
| Time of Maximum Observed Drug Concentration Occurrence (Tmax) of [68Ga]Ga-DOTA-TATE [Mass-based Concentration] | Day 1 (5 min, 15 min, 30 min, 45 min, 60 min, 120 min, 180 min) | Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. Tmax will be listed and summarized using descriptive statistics. |
| Terminal Elimination Half-life (T1/2) of [68Ga]Ga-DOTA-TATE [Mass-based Concentration] | Day 1 (5 min, 15 min, 30 min, 45 min, 60 min, 120 min, 180 min) | Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. The half-live will be listed and summarized using descriptive statistics. |
| Total Systemic Clearance for Intravenous Administration (CL) of [68Ga]Ga-DOTA-TATE [Mass-based Concentration] | Day 1 (5 min, 15 min, 30 min, 45 min, 60 min, 120 min, 180 min) | Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. CL will be listed and summarized using descriptive statistics. |
| Volume of Distribution During the Terminal Phase Following Intravenous Elimination (Vz) of [68Ga]Ga-DOTA-TATE [Mass-based Concentration] | Day 1 (5 min, 15 min, 30 min, 45 min, 60 min, 120 min, 180 min) | Venous whole blood samples will be collected for activity-based pharmacokinetics characterization. Vz will be listed and summarized using descriptive statistics. |
| Lesion-level Concordance Rate for SSTR Between [68Ga]Ga-DOTA-TATE PET/CT Imaging Local Read and Local Histopathology Result Among Lesions That Local Histopathology Result Are Available | Day 1 to Day 30 | The lesion-level concordance rate for SSTR between \[68Ga\]Ga-DOTA-TATE PET/CT imaging local read and local histopathology result among legions which is available, will be calculated. The rate is defined as the proportion of lesions which are positive or negative on both local read of \[68Ga\]Ga-DOTA-TATE PET/CT imaging and local histopathology among lesions detected by local histopathology. |
| Number of Participants Who Underwent a Change in Intended Treatment Plan Attributed to the [68Ga]Ga-DOTA-TATE PET/CT Imaging as Assessed by Pre and Post Imaging Questionnaires | Before and after imaging on Day 1 | Numbers of participants for each intended treatment plan collected from physician at pre and post \[68Ga\]Ga-DOTA-TATE PET/CT imaging will be summarized. |
| Lesion-level Concordance Rate for SSTR Between [68Ga]Ga-DOTA-TATE PET/CT Imaging Local Read and Local Histopathology Result Among Lesions That Local Histopathology Result Are Available - Concordance Rate | Day 1 to Day 30 | The lesion-level concordance rate for SSTR between \[68Ga\]Ga-DOTA-TATE PET/CT imaging local read and local histopathology result among legions which is available, will be calculated. The rate is defined as the proportion of lesions which are positive or negative on both local read of \[68Ga\]Ga-DOTA-TATE PET/CT imaging and local histopathology among lesions detected by local histopathology. |
| Inter-reader Agreement on [68Ga]Ga-DOTA-TATE PET/CT Imaging | Day 1 | The assessment of \[68Ga\]Ga-DOTA-TATE PET/CT images set was compared among the 3 independent readers. |
| Number of Participants Who Are Positive on Both [68Ga]Ga-DOTA-TATE PET/CT Imagings and CIM (TP Participants) Among Participants Who Are Positive on [68Ga]Ga-DOTA TATE PET/CT Imaging (TP or FP Participants) | Day 1 | Subject-level positive predictive values (PPV) is defined as the proportion of TP participants among \[68Ga\]Ga-DOTA-TATE PET/CT imaging positive participants (i.e. TP or FP participants). |
| Number of Participants Who Are Negative on Both [68Ga]Ga-DOTA-TATE PET/CT Imaging and CIM (TN Participants) Among Participants Who Are Negative on [68Ga]Ga-DOTA-TATE PET/CT Imaging (TN or FN Participants) | Day 1 | Subject-level NPV was defined as the proportion of TN participants among \[68Ga\]Ga-DOTA-TATE PET/CT imaging negative participants (i.e. TN or FN participants). |
Countries
Japan
Contacts
STUDY_DIRECTORNovartis Pharmaceuticals
Novartis Pharmaceuticals
Participant flow
Recruitment details
This study was not designed to compare efficacy between NEN patients and HVs, but rather to assess sensitivity and specificity of Ga-DOTA-TATE PET/CT imaging against the CIM in the population which includes both of CIM positive and negative.
Pre-assignment details
Therefore, efficacy results related to the diagnostic performance are presented as a single combined population of NEN patients and HVs. Baseline characteristics, other efficacy (e.g. number of lesions), safety, and PK results are presented separately due to the differences between the NEN patient and HV populations. These approaches are as per the protocol and the statistical analysis plan.
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 1 Participants |
| Age, Categorical Between 18 and 65 years | 22 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 23 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 0 Participants |
| Sex: Female, Male Female | 23 Participants |
| Sex: Female, Male Male | 13 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 48 | 0 / 23 |
| other Total, other adverse events | 8 / 48 | 2 / 23 |
| serious Total, serious adverse events | 2 / 48 | 0 / 23 |
Outcome results
None listed