- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01967537
Evaluation of 68Gallium-DOTATATE PET/CT for Detecting Neuroendocrine Tumors
Evaluation of (68)Gallium- DOTATATE PET/CT for Detecting Primary and Metastatic Neuroendocrine Tumors
Background:
- Neuroendocrine tumors (NETs) are rare but have been more common over the past decade. The only treatment for NETs is surgery, but most are found when they are too advanced for surgery. Researchers are looking for the best way to find NETs earlier, so that surgery can be successful. They want to test if the study drug can be used along with imaging devices to detect NETs.
Objectives:
- To see how well a new experimental imaging agent, 68Gallium-DOTATATE, detects unknown primary and metastatic NETs in the gastrointestinal system and pancreas.
Eligibility:
- Adults over 10 years old with a suspected NET or family history of NET.
Design:
- Participants will be screened with a medical history and physical exam, and have a blood test.
- Participants will undergo three scans. For all of these, a substance is injected into their body, they lie on a table, and a machine takes images.
- A standard computed tomography (CT) scan of the chest, abdomen, and pelvis.
- An octreotide scintigraphy Single photon emission computed tomography (SPECT)/CT.
- A 68Gallium-DOTATATE positron emission tomography (PET)/CT. The study drug is injected into a vein, usually in the arm. Low-dose X-rays go through the body. For about 40 minutes a large, donut-shaped device takes images of the body. The entire session takes 90 to 120 minutes.
- Researchers will compare images from the three scans.
- Participants will have 1 follow-up visit each year for 5 years. At this visit, they will have a medical exam, blood taken, and a CT scan.
Study Overview
Status
Intervention / Treatment
Detailed Description
Background:
- Neuroendocrine tumors (NETs) are rare malignancies occurring in the gastrointestinal tract, islets of the pancreas, lung, adrenal medulla and thyroid C-cells.
- Their incidence has increased over the last decade, with an incidence of 6 per 100,000 persons a year and they represent 0.46% of all malignancies.
- Most NETs are sporadic, but they can be part of familial cancer syndromes such as multiple endocrine neoplasia type 1 (MEN1), MEN2, and neurofibromatosis type 1 (NF1) or Von Hippel-Lindau (VHL) syndrome.
- Surgical resection remains the only curative treatment option for patients with NETs but 80% of patients are diagnosed with advanced (metastatic, locally inoperable, or recurrent) disease.
- The main prognostic factor in patients with NET is the extent of disease.
- The best imaging technique for detecting unknown primary and metastatic NETs has yet to be determined.
- NET cells express somatostatin receptors that can be targeted with radiolabeled 68Gallium-DOTATATE (Octreotate) for imaging purposes.
- The primary goal of this protocol is to determine the accuracy of a new somatostatin receptor targeted imaging technique, using 68Gallium-DOTATATE PET/CT to detect unknown primary and metastatic NETs.
Objectives:
-To determine the accuracy of 68Gallium-DOTATATE PET/CT scans in detecting unknown primary and metastatic gastrointestinal and pancreatic neuroendocrine tumors.
Eligibility:
Patients with:
- suspicion of NET on axial imaging (CT/magnetic resonance imaging (MRI)/fluorodeoxyglucose-positron emission tomography (FDG PET) and/or
- biochemical evidence of NET (serum/urinary) based on elevated levels of chromogranin A, pancreatic polypeptide, neuron-specific enolase, vasoactive intestinal polypeptide, serotonin (urinary 5-HIAA), gastrin, somatostatin, catecholamines, metanephrines, calcitonin, fasting insulin, C-peptide (proinsulin), glucagon and/or
- familial predisposition to NET in patients with multiple endocrine neoplasia type 1 (MEN1) and VHL.
- Age greater than or equal to 18 years of age.
- Patients must be willing to return to National Institutes of Health (NIH) for follow-up.
Design:
- Prospective study.
- A 68Ga-DOTATATE PET/CT scan will be done in patients with suspicious lesions, unknown primary tumor or metastatic gastrointestinal or pancreatic neuroendocrine disease found on anatomic imaging (CT/MRI) or in patients having biochemically active disease.
- Both functional and non-functional solid tumors will be included in this study. Furthermore, asymptomatic and symptomatic, sporadic and familial cases of NETs (such as Von Hippel-Lindau (VHL), MEN1) will be included.
- Demographic, clinical and pathologic data will be collected from the medical record and patient interview for each patient. Data will be stored in a computerized database.
- After their initial on-study evaluation, patients will be staged according to findings on imaging studies with respect to primary tumor site, size and metastases. Surgical resection of NET and/or medical managements will be recommended based on standard practice guidelines. In patients who undergo surgical treatment, the samples will be immediately stored until molecular analysis.
- Follow up will be done yearly for a total duration of 5 years. This includes a yearly imaging study and a biochemical and clinical evaluation, to assess tumor growth and disease progression.
- We estimate that the accrual rate will be 3-10 patients per month; the total accrual period for this study will be 10 months to 3 years.
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
Maryland
-
Bethesda, Maryland, United States, 20892
- National Institutes of Health Clinical Center
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
- INCLUSION CRITERIA:
Patients with (any one of #1, #2, and/or #3):
- Suspicion of neuroendocrine tumors (NET) on axial imaging (computed tomography (CT)/magnetic resonance imaging (MRI)/fluorodeoxyglucose (FDG) positron emission tomography (PET) and/or
- biochemical evidence of neuroendocrine tumor (serum/urinary) based on elevated levels of chromogranin A, pancreatic polypeptide, neuron-specific enolase, vasoactive intestinal polypeptide, serotonin (urinary 5-HIAA), gastrin, somatostatin, catecholamines, metanephrines, calcitonin, fasting insulin, C-peptide (proinsulin), glucagon and/or
- familial predisposition to NET in patients with multiple endocrine neoplasia type 1 (MEN1) and Von Hippel-Lindau (VHL) (symptomatic and/or asymptomatic cases; with biochemical or anatomic imaging evidence of disease).
- Age greater than or equal to 10 years of age.
- For females: Negative urine pregnancy test OR post-menopausal for at least 2 years OR patient has had a hysterectomy.
- Patients must be willing to return to National Institutes of Health (NIH) for follow-up.
- Ability of subject or Legally Authorized Representative (LAR) (if the patient is deemed by the treating physician to be cognitively impaired or questionably impaired in such a way that the ability of the patient to give informed consent is questionable) to understand and the willingness to sign a written informed consent document indicating that they are aware of the investigational nature of this study.
EXCLUSION CRITERIA:
- Patients unwilling to undergo serial non-invasive imaging.
Pregnant or lactating women: Pregnant women are excluded from this study because the effects of (68)Ga-DOTATATE in pregnancy are not known. Because there is an unknown but potential risk for adverse events in nursing infants secondary to administration of
(68)Ga-DOTATATE in the mother, breastfeeding should be discontinued for at least one day if the mother receives (68)Ga-DOTATATE.
- Patients that have recognized concurrent active infection,
- Patients with the use of any investigational product or device, excluding 18F-dihydroxyphenylalanine (F-DOPA) scans, within 30 days prior to dosing.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: 68Gallium DOTATATE imaging
|
Fasting is not required prior to the imaging study.
An IV line with a large bore (21 gauge or more) will be placed preferably in the antecubital vein, and, with the patient supine, around 5mCi of the 68Ga-DOTATATE will be administered intravenously, followed by incubation for approximately 60 minutes.
Then the patient will be positioned in a PET/CT scanner and images from the upper thighs to the base of the skull will be obtained.
In patients with tumor induced osteomalacia, images from the top of the head to the toes will be obtained.
Using 68Gallium DOTATATE
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Lesions Detected Using the 68Gallium-DOTATATE Positron Emission Tomography (PET/Computed Tomography (CT)) Scan
Time Frame: During PET Scan, up to 2 hours annually for up to 5 years
|
Patients with neuroendocrine tumors (NETs) were scanned with the 68Gallium-DOTATATE Positron Emission Tomography (PET/Computed Tomography (CT)) and the number of lesions detected are collected.
|
During PET Scan, up to 2 hours annually for up to 5 years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mean Radiation Activity Between Low Grade and Intermediate Grade Neuroendocrine Tumor
Time Frame: During radioguided surgery, up to 2 hours
|
The radioactivity was assessed using intraoperative radiation detector following the 68Gallium-DOTATATE injection.
Low grade neuroendocrine tumors is defined as tumors with slow cell division determined in histology.
Low grade tumors is associated with the best outcome.
Intermediate grade tumor is defined as the tumor with medium (3-20%) rate of actively dividing cells and is associated with less favorably outcome.
|
During radioguided surgery, up to 2 hours
|
Tumor Volume of Neuroendocrine Tumors Assessed by the 68Gallium-DOTATATE Scan
Time Frame: During radioguided surgery, up to 2 hours
|
Participants were scanned using the 68Gallium-DOTATATE Scan.
Tumor volume more than 7ml is associated with shorter time to disease progression.
Tumor volume more than 36 ml is associated with shorter disease specific survival.
|
During radioguided surgery, up to 2 hours
|
Median Radioactivity of Tumors With High Expression of Somatostatin Receptor 2 Compared to Tumors With Intermediate Expression of Somatostatin Receptor 2
Time Frame: During PET Scan, up to 2 hours annually
|
High expression of somatostatin receptor 2 (SSTR2) is based on the intensity grading on immunohistochemistry. High SSTR2 expression may be associated with well-differentiated tumor and high avidity on DOTATATE scan, compared to intermediate or low expression of SSTR that can be seen in poorly differentiated and often aggressive neuroendocrine tumors.
Because the correlation can only be from the comparison of preoperative DOTATATE and the tumors that were removed, it is a one time analysis.
Subsequent DOTATATE studies are for surveillance and follow up for disease progression or recurrence.
|
During PET Scan, up to 2 hours annually
|
The Number of Tumors Identified in Participants by the Radiation Detector During Radio-guided Surgery Using 68Gallium-DOTATATE
Time Frame: Radio-guided surgery, up to 2 hours
|
Radio-guided surgery in neuroendocrine tumors using 68Gallium-DOTATATE was performed to detect tumors in the stomach and small bowel neuroendocrine tumors, pancreas, metastatic sites to lymph nodes and liver, and pheochromocytoma or paraganglioma.
The number of tumors identified by the radiation detector were assessed.
|
Radio-guided surgery, up to 2 hours
|
Count of Participants With Serious and Non-serious Adverse Events Assessed by the Common Terminology Criteria in Adverse Events (CTCAE v4.0)
Time Frame: Date treatment consent signed to date off study, approximately 50 months and 17 days.
|
Here is the count of participants with serious and non-serious adverse events assessed by the Common Terminology Criteria in Adverse Events (CTCAE v4.0).
A non-serious adverse event is any untoward medical occurrence.
A serious adverse event is an adverse event or suspected adverse reaction that results in death, a life threatening adverse drug experience, hospitalization, disruption of the ability to conduct normal life functions, congenital anomaly/birth defect or important medical events that jeopardize the patient or subject and may require medical or surgical intervention to prevent one of the previous outcomes mentioned.
|
Date treatment consent signed to date off study, approximately 50 months and 17 days.
|
Collaborators and Investigators
Sponsor
Publications and helpful links
General Publications
- Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer. 2003 Feb 15;97(4):934-59. doi: 10.1002/cncr.11105.
- Tsikitis VL, Wertheim BC, Guerrero MA. Trends of incidence and survival of gastrointestinal neuroendocrine tumors in the United States: a seer analysis. J Cancer. 2012;3:292-302. doi: 10.7150/jca.4502. Epub 2012 Jul 1.
- Lawrence B, Gustafsson BI, Chan A, Svejda B, Kidd M, Modlin IM. The epidemiology of gastroenteropancreatic neuroendocrine tumors. Endocrinol Metab Clin North Am. 2011 Mar;40(1):1-18, vii. doi: 10.1016/j.ecl.2010.12.005.
Helpful Links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Cardiovascular Diseases
- Vascular Diseases
- Nervous System Diseases
- Neoplasms by Histologic Type
- Neoplasms
- Congenital Abnormalities
- Genetic Diseases, Inborn
- Neuroectodermal Tumors
- Neoplasms, Germ Cell and Embryonal
- Neoplasms, Nerve Tissue
- Abnormalities, Multiple
- Neurocutaneous Syndromes
- Ciliopathies
- Angiomatosis
- Neuroendocrine Tumors
- Von Hippel-Lindau Disease
Other Study ID Numbers
- 130193
- 13-C-0193
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Neuroendocrine Tumors
-
Jiangsu HengRui Medicine Co., Ltd.RecruitingAdvanced Gastroenteropancreatic Neuroendocrine TumorChina
-
Jiangsu HengRui Medicine Co., Ltd.Not yet recruitingAdvanced Gastroenteropancreatic Neuroendocrine Tumor
-
National Health Research Institutes, TaiwanNational Taiwan University Hospital; Mackay Memorial Hospital; China Medical... and other collaboratorsRecruitingNeuroendocrine Tumors,GastroenteropancreaticTaiwan
-
Grupo Espanol de Tumores NeuroendocrinosActive, not recruitingNeuroendocrine Tumors | Neuroendocrine Neoplasm | Gastroenteropancreatic Neuroendocrine TumorSpain
-
Amr Mohamed MDNovatek PharmaceuticalsRecruitingNeuroendocrine Carcinoma | Gastroenteropancreatic Neuroendocrine Tumor | Gastroenteropancreatic Neuroendocrine Neoplasm | Mixed Neuroendocrine-Non Neuroendocrine NeoplasmUnited States
-
Francesco De CobelliCompleted
-
Australasian Gastro-Intestinal Trials GroupCompletedMidgut Neuroendocrine Tumours | Pancreatic Neuroendocrine TumoursAustralia
-
TaiRx, Inc.Active, not recruitingNeuroendocrine Tumors | Gastro-enteropancreatic Neuroendocrine Tumor | Neuroendocrine Carcinoma | Pancreatic Neuroendocrine Tumor | Lung Neuroendocrine NeoplasmTaiwan
-
Memorial Sloan Kettering Cancer CenterRecruitingNeuroendocrine Tumors | Liver-Dominant Metastatic Pancreatic Neuroendocrine TumorsUnited States
-
University Hospital, Basel, SwitzerlandSwiss National Science Foundation; Paul Scherrer Institute (PSI)RecruitingNeuroendocrine Neoplasia's (NENs) | Gastroenteropancreatic Neuroendocrine Tumour (GEP-NET)Switzerland
Clinical Trials on 68Gallium DOTATATE
-
Korea UniversitySHIN JIN MEDICSCompletedAtherosclerosis | Carotid Atherosclerosis | Noninvasive Imaging of AtherosclerosisKorea, Republic of
-
University of EdinburghActive, not recruiting
-
University of Warmia and MazuryStowarzyszenie Pacjentów i Osób Wspierających Chorych na Guzy NeuroendokrynneUnknown
-
Jonsson Comprehensive Cancer CenterCompletedNeuroendocrine CarcinomaUnited States
-
Peking Union Medical College HospitalUnknown
-
Jonsson Comprehensive Cancer CenterNo longer availableNeuroendocrine Tumors | Medullary Thyroid Cancer | Carcinoid Cancer | Cancers Expressing Somatostatin ReceptorsUnited States
-
National Cancer Institute (NCI)RecruitingNeuroendocrine Tumors | Von Hippel-Lindau Disease | VHL Pancreatic Neuroendocrine TumorsUnited States
-
University of Alabama at BirminghamWithdrawnCarcinoid | Neuroendocrine Carcinoma of PancreasUnited States
-
Istituto Scientifico Romagnolo per lo Studio e...Active, not recruiting
-
National Institute of Diabetes and Digestive and...RecruitingThyroid Cancer | Papillary Thyroid Cancer | Hurthle Cell Thyroid Cancer | Tall Cell Variant Thyroid Cancer | Follicular Thyroid CancerUnited States