Diagnostic Accuracy of Gallium-68-DOTATATE PET/CT Compared to Indium-111-pentetreotide Scintigraphy (SPECT/CT) for Gastroenteropancreatic Neuroendocrine Tumors (GaIN)

September 5, 2016 updated by: University Hospital Inselspital, Berne
The investigators hypothesize that the new imaging method Gallium-68-DOTATATE has a higher diagnostic value in the detection of neuroendocrine tumors than the established imaging method Indium-111-Octreoscan. Therefore, the investigators will perform both imaging procedures in patients with suspected or confirmed neuroendocrine tumors. Subsequently, the investigators will compare the diagnostic performance of both methods.

Study Overview

Status

Terminated

Conditions

Intervention / Treatment

Detailed Description

Background

Neuroendocrine tumors Neuroendocrine tumors (NET) are heterogeneous slow-growing neoplasms, occurring in 1-4/100,000 people per year. They origin from endocrine cells that derive from entodermal stem cells and are characterized by an endocrine metabolism and a typical pathologic pattern.

Slow metabolic rates of NET, small lesion size and variable anatomical localization have represented the major limits for lesions diagnosis. The diagnostic workup for NET has relied on conventional morphological imaging procedures including computed tomography (CT), ultrasound (US) and magnetic resonance imaging (MRI) combined with gamma camera functional imaging, namely whole-body somatostatin receptor scintigraphy (SRS). SRS show a higher diagnostic accuracy than CT for NET diagnosis at both the primary and metastatic site, but there is still room for improvement. Novel PET tracers specifically developed for NET may increase diagnostic accuracy considerably as outlined below.

Somatostatin receptor scintigraphy (SRS) As NET have high affinity somatostatin receptors, scintigraphic methods have been developed in the early nineties to allow in vivo imaging. SRS using Indium-111-DTPA-octreotide (Indium-111-pentetreotide scintigraphy), is the most widely used diagnostic test. Although rather sensitive and helpful for whole body staging compared to traditional imaging methods, this technique has pitfalls, one of them being the poor spatial resolution, leading to the development of PET-based imaging.

Gallium-68-DOTA-peptide PET In the past decade, several positron emitting tracers have been developed for NET imaging. 68Ga-DOTA-peptides are a group of PET tracers that specifically bind to somatostatin receptors (SSTR) over-expressed on NET cells. Gallium-68-DOTA-peptides structure can be summarized in (1) the active part binding to SSTR (TOC, NOC, TATE), (2) the chelant (DOTA) and (3) the isotope (68Ga). Indications to perform 68Ga -DOTA-peptides studies in NET patients include: staging, re-staging after therapy, identification of the site of the unknown primary tumor in patients with proven NET secondary lesions and selection of cases eligible for therapy with somatostatin analogues.

68Ga-DOTA-TOC was the first tracer to be employed in NET imaging and was reported to present a high tumor to non-tumor contrast and a higher sensitivity compared to SRS . The study with the largest patients population (84 pts with NET), reported sensitivity (97%) for DOTA-TOC PET to be superior to CT (61%) and SRS (52%) for the detection of NET lesions, especially in case of small tumors at nodal or bone level. In a comparison study of 51 patients with well differentiated NET, PET with Gallium-DOTA-TOC performed better than CT and SRS for the early detection of bone NET secondary lesions (sensitivity of 97%, specificity of 92%). 68Ga-DOTA-TATE is characterized by a very high affinity for SSTR2 with a considerably higher affinity than 111In-DTPA octreotide. In a recent study, 51 patients with established NET (35 negative and 16 equivocal for uptake on SRS) were examined by 68Ga-DOTA-TATE PET. 68Ga-DOTA-TATE PET identified significantly more lesions than SRS and changed management in 36 patients (70.6%), who were subsequently deemed suitable for peptide receptor-targeted therapy.

Rationale of the study 111In-pentetreotide scintigraphy is the current standard for the detection of NET, even though its diagnostic accuracy is less than optimal. In the past decade, several 68Ga-DOTA-peptides have been developed for NET imaging, which showed a better detection for NET than 111In-pentetreotide scintigraphy in a small number of studies. These studies had several limitations, most importantly the inclusion of rather small and heterogeneous patient populations.

The aim of this study is to prospectively compare the diagnostic accuracy of 68Ga-DOTA-TATE PET/CT with 111In-pentetreotide scintigraphy in a well-defined population of consecutive patients with established GEP-NET or patients with suspicion of NET with indication for a scintigraphy.

Objective

The objective of this study is to compare the diagnostic accuracy of Gallium-68-DOTATATE PET/CT with Indium-111-pentetreotide scintigraphy (SPECT/CT) for the diagnosis of gastroenteropancreatic neuroendocrine tumors (GEP-NET) in consecutive patients with established GEP-NET or patients with suspicion of NET with indication for a scintigraphy. The working hypothesis is that Gallium-68-DOTATATE PET/CT is superior to Indium-111-pentetreotide scintigraphy (SPECT/CT) in terms of sensitivity and specificity.

Methods

The present study is a multi-center assessor-blind diagnostic case-control study of Gallium-68-DOTATATE PET/CT compared to Indium-111-pentetreotide scintigraphy (SPECT/CT) in consecutive patients with established GEP-NET or patients with suspicion of NET with indication for a scintigraphy.

The study is conducted at the University Hospital Basel, Bern University Hospital, and CHUV Lausanne. The University Clinics of Nuclear Medicine of Basel, Bern and Lausanne, as well as Endocrinology, Diabetes and Clinical Nutrition of Bern will accrue consecutive patients with established GEP-NET or patients with suspicion of GEP-NET that meet eligibility criteria. All patients will undergo Gallium-68-DOTATATE PET/CT as index test and Indium-111-pentetreotide scintigraphy as standard test. Both results will be compared with histology and the follow-up results as diagnostic gold standards.

Study Type

Interventional

Enrollment (Actual)

54

Phase

  • Phase 2
  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Switzerland
      • Bern, Switzerland, 3010
        • Nuclear Medicine, Bern University Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

16 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Age ≥ 18 years
  • Signed written informed consent with full understanding of the study procedures and the investigational nature of the study
  • Patient referred to Indium-111-pentetreotide scintigraphy., which was performed as part of clinical routine care
  • Inclusion criteria specific for cases only
  • Histologically established GEP-NET (new or recurrent)
  • Tumor mass remaining after initial biopsy or surgery
  • Inclusion criteria specific for controls only
  • 5.6. Suspicion of any NET (new or recurrent) but no established diagnosis or established diagnosis of any NET (new or recurrent) but no remaining tumor mass after surgery

Exclusion Criteria

  • Previous inclusion in the same study with the following exception: a patient may be included as case if she/he was previously included as control
  • Gastric type 2 ECL cell neuroendocrine tumors
  • Pregnant or nursing women
  • Known intolerance to any protocol required diagnostic intervention
  • Patient's lack of accountability, inability to appreciate the nature, meaning and consequences of the study and to formulate his/her own wishes correspondingly
  • Exclusion criteria specific for controls only
  • Patients for whom it remains unclear whether the tumor was completely removed

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

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
Other: All patients
Subsequent performance of index test and standard test
Drug: Gallium-68-DOTATATE PET/CT (index test)
Somatostatin-based imaging tracer
Drug: Indium-111-Octreoscan (standard test)
Somatostatin-based imaging tracer

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Number of patients correctly identified as having GEP-NET by using Gallium-68-DOTATATE PET/CT and Indium-111-pentetreotide scintigraphy (SPECT/CT)
Time Frame: 6 months
6 months
Number of patients correctly identified as not having GEP-NET by using Gallium-68-DOTATATE PET/CT and Indium-111-pentetreotide scintigraphy (SPECT/CT)
Time Frame: 6 months
6 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Patient satisfaction
Time Frame: 6 months
Measured by patient satisfaction questionnaire relating to Indium-111-pentetreotide scintigraphy
6 months
Number of patients with adverse events
Time Frame: 6 months
6 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University Hospital Inselspital, Berne

Collaborators

University Hospital, Basel, Switzerland
University of Lausanne Hospitals
University of Bern
SWAN Isotopen AG, Bern

Investigators

  • Principal Investigator: Thomas Krause, Prof. Dr. med., Institute of Nuclear Medicine, University Hospital Berne
  • Principal Investigator: Christoph Stettler, Prof. Dr. med., Division of Endocrinology, University Hospital Bern

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

March 1, 2014

Primary Completion (Actual)

August 1, 2016

Study Completion (Actual)

August 1, 2016

Study Registration Dates

First Submitted

February 26, 2014

First Submitted That Met QC Criteria

March 3, 2014

First Posted (Estimate)

March 5, 2014

Study Record Updates

Last Update Posted (Estimate)

September 7, 2016

Last Update Submitted That Met QC Criteria

September 5, 2016

Last Verified

September 1, 2016

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 092/11

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.

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