- ICH GCP
- 미국 임상 시험 레지스트리
- 임상시험 NCT05533242
표준 치료 후 교모세포종 환자에서 Lu-177 표지된 6A10 Fab-단편을 사용한 방사면역요법 (RIT in GBM)
표준 치료 후 교모세포종 환자에서 Lu-177 표지 6A10 Fab-단편을 사용한 분할 강내 방사선 면역 요법의 최대 허용 용량 및 환자별 선량 측정을 결정하기 위한 1상 시험
Locoregional, intracavitary radioimmunotherapy (iRIT) with a newly developed radioimmunoconjugate (Lu-177 labeled 6A10-Fab-fragments) will be used to prevent or postpone tumour recurrence in patients with GBM following standard therapy .
Following study objectives will be analyzed:
- Determining the Maximum Tolerated Dose (MTD)
- Determining safety by assessing all new neurological, hematological and other AEs CTC grade 2 or higher
- Determining absorbed dose to the 2 cm shell of the resection cavity (based on a series of SPECT/CTs of the head 2h,24h,48h, 72h p.i. and on day 5-7)
- Determining absorbed dose values for the kidneys, the liver, the active marrow (based on a series of SPECT/CTs of the abdomen 2h,24h,48h, 72h p.i. and on day 5-7)
- Determining 24 weeks Progression-Free-Survival (PFS), defined from the day of inclusion
연구 개요
상세 설명
In glioblastoma (GBM), tumour recurrence occurs adjacent to the initial tumor resection cavity in about 85% of cases (Albert et al., 1994; Bashir et al., 1988; Nestler et al., 2015). Therefore, local treatment concepts seem crucial for effective recurrence treatment strategies. We consider locoregional, intracavitary radioimmunotherapy (iRIT) to be a new therapeutic approach to delay or prevent the development of local tumour regrowth in GBM patients. By applying a radioimmunoconjugate (RIC) into the surgically created resection cavity (RC) the blood-brain barrier can effectively be by-passed, allowing the a deposit of high radiation doses locally while sparing sensitive organs like the bone marrow and the kidneys. LuCaFab (Lu-177 labeled 6A10- Fab-fragment) is a carbonic anhydrase XII-specific antibody Fab fragment developed by Helmholtz Munich, labeled with ITM's highly pure medical radioisotope, lutetium-177. (ITM IsotopeTechnologies Munich SE). Patients with GBM after standard therapy (surgery by radio-chemotherapy concomitant and adjuvant chemotherapy) Are eligible for the study. Patients will receive the calculated total doses of Lu-177-labeled 6A10-Fabs in three fractions with an interval of 4 weeks between injections, administered into the tumour cavity via an implanted reservoir. A patient specific dosing strategy will be applied and will depend on the individual RC volume. This investigator-initiated trial is sponsored by the University Hospital Münster, conducted in hospitals in Münster, Essen, Cologne, and Wuerzburg, and supported by ITM and Helmholtz Munich.
연구 유형
등록 (실제)
단계
- 1단계
연락처 및 위치
연구 장소
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Cologne, 독일, 50937
- Klinik für Allgemeine Neurochirurgie des Universitätsklinikums Köln
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Cologne, 독일, 50937
- Klinik für Nuklearmedizin des Universitätsklinikums Köln
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Essen, 독일, 45147
- Klinik für Neurochirurgie des Universitätsklinikums Essen
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Essen, 독일, 45147
- Klinik für Nuklearmedizin, Strahlenklinik des Universitätsklinikums Essen
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Münster, 독일, 48149
- Klinik für Nuklearmedizin der Universität Münster
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Würzburg, 독일, 97080
- Universitätsklinikum Würzburg - Neurochirurgie
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Würzburg, 독일, 97080
- Universitätsklinikum Würzburg - Nuklearmedizin
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참여기준
자격 기준
공부할 수 있는 나이
건강한 자원 봉사자를 받아들입니다
연구 대상 성별
설명
Inclusion Criteria:
- Written patient consent after comprehensive information
- Age between 18 and 80 years
- Primary supratentorial high grade glioma after standard therapy (fluorescence-guided surgery, radio-chemotherapy, concomitant + adjuvant chemotherapy), with no or stable small tumor residue (residual contrast enhancement of up to 5cm3) at earliest 6 weeks after completion of radiotherapy
- Histological verification of glioblastoma and CA 12-expression of tumor cells confirmed
- Karnofsky-score ≥ 60
- Volume of resection cavity 2,5-25 cm3
- Male and female patients with reproductive potential must use an approved contraceptive method
- Pre-menopausal female patients with childbearing potential: a negative serum pregnancy test must be obtained prior to treatment start
- Adequate bone marrow reserve: white blood cell (WBC) count ≥3000/μl, granulocyte count >1500/μl, platelets ≥100000/μl, hemoglobin ≥ 10 g/dl
- Adequate liver function: bilirubin < 1.5 times above upper limit of normal range (ULN), alanine transaminase (ALT/SGPT) and aspartate transaminase (AST/SGOT) < 3 times ULN. In the case of documented or suspected Gilbert's disease bilirubin < 3 times ULN.
- Blood clotting: INR (=PT) and PTT within acceptable limits according to the investigator
- Adequate renal function: creatinine < 3 times above ULN; eGFR > (or equal) 60 ml/min
Exclusion Criteria:
- Patient unable to undergo imaging by CT, PET or contrast-enhanced MRI for whatever reason (i.e., pacemaker)
- Resection cavity with intraventricular access
- Significant leakage of radioactivity into CSF spaces or ventricles
- Other actively treated invasive malignancy
- Breastfeeding women
- Past medical history of diseases with poor prognosis, e.g., severe coronary heart disease, heart failure (NYHA III/IV), severe and poorly controlled diabetes, immune deficiency, residual deficits after stroke, severe mental retardation, pre-existing neurological diseases except those related to glioblastoma or other serious concomitant systemic disorders incompatible with the study (at the discretion of the investigator)
- Any active infection (at the discretion of the investigator)
- Previous participation in a registered clinical trial with therapeutic intervention less than 6 weeks prior to enrolment (date of informed consent)
- Allergy against known constituents of study medication
공부 계획
연구는 어떻게 설계됩니까?
디자인 세부사항
- 주 목적: 치료
- 할당: 해당 없음
- 중재 모델: 순차적 할당
- 마스킹: 없음(오픈 라벨)
무기와 개입
참가자 그룹 / 팔 |
개입 / 치료 |
|---|---|
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실험적: Lu-177-labeled-6A10Fab-fragments
The patient will receive a predetermined dose of Lu-177-labeled- 6A10Fab-fragments via the intracavitary reservoir. Patients will receive 3 RIT-cycles with an interval of 4 weeks. The total activity, adjusted to the volume of the RC, will be injected in 3 fractions with 50%, 25% and 25% of the total activity to achieve the desired boost to the 2 cm margin. |
The antibody 6A10 is a specific CA12 Inhibitor, a highly specific glioma cell-associated enzyme; all tumor cells are CA12-positive, while its expression in normal brain is very low, and Lu-177 has a comparable β-emission, but a significantly low γ-Emission. |
연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
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Maximum Tolerated Dose (MTD)
기간: Through study completion, ca 1 ½ years
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Determine maximum tolerated dose (MTD) and safety of adjuvant radio-immunotherapy (RIT) with Lu-177 labeled 6A10-Fab-fragments |
Through study completion, ca 1 ½ years
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Safety of the adjuvant radio-immunotherapy
기간: Through study completion, ca 1 ½ years
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Determining safety by assessing all new neurological, hematological and other AEs CTC grade 2 or higher |
Through study completion, ca 1 ½ years
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2차 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
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Evaluation of pharmacokinetics of Lu-177 labeled 6A10 Fab fragments
기간: After first application: 2 ,24 ,48, 72 hours post injection and on day 5-7. After second and third application.
|
Determining absorbed dose to the 2 cm shell of the resection cavity (based on a series of SPECT/CTs of the head 2 ,24 ,48, 72 hours post injection and on day 5-7). Determining absorbed dose values for the kidneys, the liver, the active marrow (based on a series of SPECT/CTs of the abdomen 2 ,24 ,48, 72 hours post injection and on day 5-7) |
After first application: 2 ,24 ,48, 72 hours post injection and on day 5-7. After second and third application.
|
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Progression-free survival (PFS)
기간: Through study completion, an average of 18 months
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Determining 24 weeks Progression-Free-Survival (PFS), defined from the day of inclusion |
Through study completion, an average of 18 months
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기타 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
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Overall survival (OS)
기간: 2 years from the day of inclusion
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OS is defined as the period of time from the start of a study or the treatment in a study until the death of the patient |
2 years from the day of inclusion
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공동 작업자 및 조사자
협력자
수사관
- 수석 연구원: Walter Stummer, Prof., University Hospital Muenster, Klinik und Poliklinik für Neurochirurgie
간행물 및 유용한 링크
일반 간행물
- Fiedler L, Kellner M, Gosewisch A, Oos R, Boning G, Lindner S, Albert N, Bartenstein P, Reulen HJ, Zeidler R, Gildehaus FJ. Evaluation of 177Lu[Lu]-CHX-A''-DTPA-6A10 Fab as a radioimmunotherapy agent targeting carbonic anhydrase XII. Nucl Med Biol. 2018 May;60:55-62. doi: 10.1016/j.nucmedbio.2018.02.004. Epub 2018 Mar 4.
- Alterio V, Kellner M, Esposito D, Liesche-Starnecker F, Bua S, Supuran CT, Monti SM, Zeidler R, De Simone G. Biochemical and Structural Insights into Carbonic Anhydrase XII/Fab6A10 Complex. J Mol Biol. 2019 Dec 6;431(24):4910-4921. doi: 10.1016/j.jmb.2019.10.022. Epub 2019 Nov 1.
- Battke C, Kremmer E, Mysliwietz J, Gondi G, Dumitru C, Brandau S, Lang S, Vullo D, Supuran C, Zeidler R. Generation and characterization of the first inhibitory antibody targeting tumour-associated carbonic anhydrase XII. Cancer Immunol Immunother. 2011 May;60(5):649-58. doi: 10.1007/s00262-011-0980-z. Epub 2011 Feb 5.
- Gondi G, Mysliwietz J, Hulikova A, Jen JP, Swietach P, Kremmer E, Zeidler R. Antitumor efficacy of a monoclonal antibody that inhibits the activity of cancer-associated carbonic anhydrase XII. Cancer Res. 2013 Nov 1;73(21):6494-503. doi: 10.1158/0008-5472.CAN-13-1110. Epub 2013 Sep 12.
- Proescholdt MA, Mayer C, Kubitza M, Schubert T, Liao SY, Stanbridge EJ, Ivanov S, Oldfield EH, Brawanski A, Merrill MJ. Expression of hypoxia-inducible carbonic anhydrases in brain tumors. Neuro Oncol. 2005 Oct;7(4):465-75. doi: 10.1215/S1152851705000025.
- Supuran CT. Carbonic anhydrase inhibitors as emerging agents for the treatment and imaging of hypoxic tumors. Expert Opin Investig Drugs. 2018 Dec;27(12):963-970. doi: 10.1080/13543784.2018.1548608. Epub 2018 Nov 22.
연구 기록 날짜
연구 주요 날짜
연구 시작 (실제)
기본 완료 (실제)
연구 완료 (실제)
연구 등록 날짜
최초 제출
QC 기준을 충족하는 최초 제출
처음 게시됨 (실제)
연구 기록 업데이트
마지막 업데이트 게시됨 (실제)
QC 기준을 충족하는 마지막 업데이트 제출
마지막으로 확인됨
추가 정보
이 연구와 관련된 용어
기타 연구 ID 번호
- UKM15_0027
개별 참가자 데이터(IPD) 계획
개별 참가자 데이터(IPD)를 공유할 계획입니까?
약물 및 장치 정보, 연구 문서
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