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Neuroendocrine TumorsPhase 2HEPAR_PlusNCT02067988

Holmium-166-radioembolization in NET After Lutetium-177-dotatate; an Efficacy Study

A Phase 2 study testing Holmium-166 microspheres hepatic radioembolization. in people with Neuroendocrine Tumors, run by UMC Utrecht at 1 site in Netherlands.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Patients with gastroenteropancreatic neuroendocrine tumours (NET) often die from intrahepatic disease or are excluded from liver-directed treatment because of extrahepatic disease. Adjuvant liver-directed treatment is warranted to control both intra- and extrahepatic disease. Read more about this study

Who is it for?
Any age
Conditions the study is for
Neuroendocrine Tumors
What is being tested?
Holmium-166 microspheres hepatic radioembolization.
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
34 participants
Where
1 siteNetherlands
Study dates
Feb 2014to 1 Sep 2019
Phase
Phase 2
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Any age
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Patients must have given written informed consent.
  • Female or male aged 18 years and over.
  • Confirmed histological diagnosis NET, including bronchial carcinoids, and metastatic malignancy with liver metastases without standard therapeutic options for treatment including chemotherapy or surgery.
  • Patients must have been treated with 4 cycles of 200 mCi 177Lu-dotatate, the last cycle within 8-12 weeks of 166Ho-RE.
  • Life expectancy of 12 weeks or longer.
  • World Health Organisation (WHO) Performance status 0-2.
  • Liver disease with three or more measurable liver lesions according to the RECIST 1.1 criteria.
  • Negative pregnancy test for women of childbearing potential.

Who cannot join

  • Brain metastases or spinal cord compression, unless irradiated at least 4 weeks prior to the date of the experimental treatment and stable without steroid treatment for at least 1 week.
  • Radiation therapy within the last 4 weeks before the start of study therapy.
  • The last dose of prior chemotherapy has been received less than 4 weeks prior the start of study therapy.
  • Major surgery within 4 weeks or incompletely healed surgical incision before starting study therapy.
  • Any unresolved toxicity greater than National Cancer Institute (NCI), Common Terminology Criteria for Adverse Events grade 2 from previous anti-cancer therapy.
  • Serum bilirubin > 1.5 x Upper Limit of Normal (ULN).
Show all 21Show fewer
  • Glomerular filtration rate <35 ml/min, determined according to the Modification of Diet in Renal Disease formula.
  • Alanine aminotransferase (ALT), aspartate aminotransferase (AST), or alkaline phosphatase (ALP) > 5 x ULN.
  • Leukocytes < 3.0 x 109/l and/or platelet count < 100 x 109/l.
  • Significant cardiac event (e.g. myocardial infarction, superior vena cava (SVC) syndrome, New York Heart Association (NYHA) classification of heart disease ≥2 within 3 months before entry, or presence of cardiac disease that in the opinion of the Investigator increases the risk of ventricular arrhythmia.
  • Pregnancy or nursing (women of child-bearing potential).
  • Patients suffering from diseases with an increased chance of liver toxicity.
  • Patients suffering from psychic disorders that make a comprehensive judgement impossible, such as psychosis, hallucinations and/or depression.
  • Patients who are declared incompetent.
  • Previous enrolment in the present study or previous treatment with RE.
  • Female patients who are not using an acceptable method of contraception (oral contraceptives, barrier methods, approved contraceptive implant, long-term injectable contraception, intrauterine device or tubal ligation) OR are less than 1 year postmenopausal or surgically sterile during their participation in this study (from the time they sign the consent form) to prevent pregnancy.
  • Male patients who are not surgically sterile or do not use an acceptable method of contraception during their participation in this study (from the time they sign the consent form) to prevent pregnancy in a partner.
  • Patients with abnormalities of the bile ducts (such as stents) with an increased chance of infections of the bile ducts (papillotomy and cholecystectomy are allowed). Or evidence of extensive portal hypertension, splenomegaly, ascites or active hepatitis (B and/or C).
  • Body weight over 150 kg.
  • Severe allergy for i.v. contrast (Visipaque®), used for CT evaluation, pre-treatment angiography and treatment angiography.
  • Liver tumour involvement ≥70% as quantified on CT.

Trial locations and contacts

1 site in 1 country.

Netherlands1 site
  • University Medical Center Utrecht

    Utrecht, 3584 CX

Other trials in Netherlands

About this study

Official title: Adjuvant Hepatic Holmium-166-radioembolization in Patients With Unresectable Liver Metastases of Neuroendocrine Origin, Who Have Been Treated With Lutetium-177-dotatate

Patients with gastroenteropancreatic neuroendocrine tumours (NET) often die from intrahepatic disease or are excluded from liver-directed treatment because of extrahepatic disease. Adjuvant liver-directed treatment is warranted to control both intra- and extrahepatic disease. Patients with liver metastases of NET will be included in this study (n = 30-48).The efficacy and toxicity of adjuvant 166Ho-radioembolization (166Ho-RE) after systemic 177Lu-dotatate will be studied in a non-comparative phase II study. The study is an interventional, treatment, non-randomized, open label, non-comparative, phase II study. 166Ho-RE will be performed via a catheter during angiography.

Read the detailed description

Acronym :

Holmium Embolization Particles for Arterial Radiotherapy Plus 177Lu-dotatate in Salvage NET patients- HEPAR PLUS-trial.

Rationale:

Patients with gastroenteropancreatic neuroendocrine tumours (NET) often die from intrahepatic disease or are excluded from liver-directed treatment because of extrahepatic disease. Adjuvant liver-directed treatment is warranted to control both intra- and extrahepatic disease.

Objective:

Primary objectives:

  • To evaluate efficacy of adjuvant 166Ho-radioembolization (166Ho-RE) after systemic 177Lu-dotatate in a non-comparative phase II study.
  • To establish the safety and toxicity profile of adjuvant 166Ho-RE after systemic treatment with 177Lu-dotatate.

Secondary objectives:

  • To evaluate Quality of Life (QoL).
  • To evaluate biodistribution / dosimetry.

Study design:

Interventional, treatment, non-randomized, open label, non-comparative, phase II study.

Study population:

Patients with liver metastases of NET will be included in this study (n = 30-48). These male and female patients must be aged ≥18 years. All NET histologies are acceptable, provided no standard therapeutic options are available, such as chemotherapy and surgery.

Intervention:

166Ho-RE will be performed via a catheter during angiography.

Study endpoints:

Primary endpoints:

  • Tumour response at 3 months.
  • Safety and toxicity profile of 166Ho-RE as adjuvant treatment after 177Lu-dotatate.

Secondary endpoints:

  • Changes in tumour markers.
  • Quality of Life (QoL).
  • Biodistribution / Dosimetry.

Duration of treatment:

The study consists of a screening phase of approximately 2 weeks followed by a treatment phase of approximately 2-3 weeks. Patients will be followed until liver specific tumour progression or death has occurred, to a maximum of 12 months.

Methodology:

A first cohort of 30 patients will be treated with 166Ho-RE. After the first cohort, up to 3 additional cohorts of 6 patients will be treated with 166Ho-RE. The total number of patients treated in the HEPAR PLUS trial will therefore be at least 30 and at most 48 patients, depending on the observed number of responses. Early termination at a response interim analysis (after 30, 36 or 42 patients) is determined by pre-defined boundaries on the number of observed responses. The boundary in favour of treatment effect may be crossed before 30 patients are reached, but then the study will continue to at least 30 patients to allow estimation of the key secondary endpoints.

Number of study centers:

Single center (UMC Utrecht).

Adverse events:

All adverse events will be recorded throughout the study.

Inclusion period:

January 2014 - January 2017

Being tested
Holmium-166 microspheres hepatic radioembolization.
Keywords
Radioembolization, Somatostatin receptor treatment, Neuroendocrine tumors, Liver metastases
Medical subject headings
Neuroendocrine Tumors

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Holmium-166 microspheres hepatic radioembolization.Device

    Holmium-166 microspheres hepatic radioembolization.

Study groups in NCT02067988
Study groupRoleWhat they receive
Treatment armExperimentalHolmium-166 microspheres hepatic radioembolization, adjuvant to systemic 177Lu-dotatate.
Receives: Device: Holmium-166 microspheres hepatic radioembolization.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Response (RECIST 1.1 Partial plus complete)

    To evaluate efficacy of adjuvant 166Ho-radioembolization (166Ho-RE) after systemic 177Lu-dotatate in a non-comparative phase II study

    Measured: 3 months

Secondary outcomes (4)
  1. Quality of Life (QoL)

    To evaluate QoL using EORTC questionnaire. The impact of treatment on QoL will be compared to tumour response, and other parameters. A questionnaire in the patient's native language will be provided.

    Measured: 3 months

  2. Biodistribution

    To evaluate biodistribution using CT and quantitative SPECT.

    Measured: 3 months

  3. Dosimetry

    To evaluate dosimetry using CT and quantitative SPECT. The imaging protocol after injection of 166Ho-PLLA-MS will consist of a dual isotope fusion SPECT/CT protocol.

    Measured: 3 months

  4. AD Adverse events

    To establish the safety and toxicity profile of treatment with 166Ho-microspheres as an adjuvant treatment after 177Lu-dotatate. This profile will be established using CTCAE (incl. SAE) methodology (CTCAE version 4.03).

    Measured: 1 year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Feb 2014 (estimated)
  2. Study startFeb 2014
  3. Primary completion1 Sep 2019
  4. Study completion1 Sep 2019

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
34 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02067988
Sponsor's protocol ID
NL45329.041.13
Acronym
HEPAR_Plus
Status last verified
Jun 2020
First submitted
13 Feb 2014
Last updated
17 Jun 2020
Results posted
No
Data monitoring committee
Yes
Individual data sharing
Undecided: Undecided

Publications

  • Stella M, van Rooij R, Lam MGEH, de Jong HWAM, Braat AJAT. Automatic healthy liver segmentation for holmium-166 radioembolization dosimetry. EJNMMI Res. 2023 Jul 15;13(1):68. doi: 10.1186/s13550-023-00996-1.

    PubMed 37453996
  • Stella M, Braat AJAT, Lam MGEH, de Jong HWAM, van Rooij R. 166Holmium-99mTechnetium dual-isotope imaging: scatter compensation and automatic healthy-liver segmentation for 166Holmium radioembolization dosimetry. EJNMMI Phys. 2022 Apr 21;9(1):30. doi: 10.1186/s40658-022-00459-x.

    PubMed 35445948
  • Ebbers SC, Brabander T, Tesselaar MET, Hofland J, Braat MNGJA, Wessels FJ, Barentsz MW, Lam MGEH, Braat AJAT. Inflammatory markers and long term hematotoxicity of holmium-166-radioembolization in liver-dominant metastatic neuroendocrine tumors after initial peptide receptor radionuclide therapy. EJNMMI Res. 2022 Feb 2;12(1):7. doi: 10.1186/s13550-022-00880-4.

    PubMed 35107642
  • Stella M, Braat A, Lam M, de Jong H, van Rooij R. Quantitative 166Ho-microspheres SPECT derived from a dual-isotope acquisition with 99mTc-colloid is clinically feasible. EJNMMI Phys. 2020 Jul 14;7(1):48. doi: 10.1186/s40658-020-00317-8.

    PubMed 32666401
  • Braat AJAT, Bruijnen RCG, van Rooij R, Braat MNGJA, Wessels FJ, van Leeuwaarde RS, van Treijen MJC, de Herder WW, Hofland J, Tesselaar MET, de Jong HWAM, Lam MGEH. Additional holmium-166 radioembolisation after lutetium-177-dotatate in patients with neuroendocrine tumour liver metastases (HEPAR PLuS): a single-centre, single-arm, open-label, phase 2 study. Lancet Oncol. 2020 Apr;21(4):561-570. doi: 10.1016/S1470-2045(20)30027-9. Epub 2020 Feb 26.

    PubMed 32112737
  • Braat AJAT, Kwekkeboom DJ, Kam BLR, Teunissen JJM, de Herder WW, Dreijerink KMA, van Rooij R, Krijger GC, de Jong HWAM, van den Bosch MAAJ, Lam MGEH. Additional hepatic 166Ho-radioembolization in patients with neuroendocrine tumours treated with 177Lu-DOTATATE; a single center, interventional, non-randomized, non-comparative, open label, phase II study (HEPAR PLUS trial). BMC Gastroenterol. 2018 Jun 15;18(1):84. doi: 10.1186/s12876-018-0817-8.

    PubMed 29902988

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Holmium-166 microspheres hepatic radioembolization. in people with Neuroendocrine Tumors, run by UMC Utrecht at 1 site in Netherlands.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 21 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 17 Jun 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Response (RECIST 1.1 Partial plus complete) (time frame: 3 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02067988, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 Jun 2020.

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