Description Module
The Description Module contains narrative descriptions of the clinical trial, including a brief summary and detailed description. These descriptions provide important information about the study's purpose, methodology, and key details in language accessible to both researchers and the general public.
Description Module path is as follows:
Study -> Protocol Section -> Description Module
Description Module
Ignite Creation Date:
2025-12-24 @ 2:16 PM
Ignite Modification Date:
2025-12-24 @ 2:16 PM
NCT ID:
NCT06247995
Brief Summary:
In the phase I part, to determine the recommended doses (RD) and dosing regimens of \[177Lu\]Lu-NeoB in combination with capecitabine in adult patients with gastrin releasing peptide receptor positive, estrogen receptor-positive, human epidermal growth factor receptor-2 negative metastatic breast cancer after progression on previous endocrine therapy in combination with a CDK4/6 inhibitor. In the phase II part, to evaluate the preliminary anti-tumor activity of two different doses/regimens of \[177Lu\]Lu-NeoB in combination with capecitabine (dose optimization).
Detailed Description:
Despite remarkable clinical results with the use of CDK4/6i, breast cancer patients will experience progression of disease requiring alternative treatment options. The optimal sequence of therapy after progression on CDK4/6i has not been established and it depends on multiple factors, including previous regimens, mutational profile, comorbidities, patient preference or disease burden (NCCN v4, 2023). Thus, new targeted treatment modalities are needed for treatment of patients with endocrine-resistant mBC.
The purpose of this Phase I/II study conducted in participants with ER+/HER2-, gastrin releasing peptide receptor positive (GRPR+) mBC after progression on CDK4/6i-based therapy is:
In the Phase I (dose escalation part) to determine the recommended doses and regimens of \[177Lu\]Lu-NeoB in combination with capecitabine in post-menopausal women and men not requiring gonadotropin releasing hormone agonist.
In the Phase II (dose optimization part) to evaluate preliminary efficacy across 2 different dose levels and regimens of \[177Lu\]Lu-NeoB in combination with capecitabine in adults including pre/peri-menopausal and post-menopausal women, and men, regardless of their need of a gonadotropin releasing hormone agonist (GnRha).
During screening, study participants will receive the radioligand imaging agent \[68Ga\]Ga-NeoB for a positron emission tomography (PET)/computed tomography (CT) or PET/magnetic resonance imaging (MRI). An additional \[68Ga\]Ga-NeoB for PET/CT or PET/MRI will be performed after their last administration of \[177Lu\]Lu-NeoB for phase II participants only.
During the treatment period participants will be required to attend a site visit approximately every 3 weeks for the first 9 months and every 6 weeks thereafter, on the first day of every cycle (defined as a period of 3 weeks) or every other cycle, respectively, to undergo study treatment administration or dispensing, dosimetry and safety assessments. Tumor assessments are performed every 9 weeks (+/- 7 days) until M18, then every 12 weeks until M36, and thereafter as clinically indicated until documented disease progression, death, withdrawal of consent, loss to follow-up, participant/guardian decision. After study treatment discontinuation, participants will be followed up for safety for 8 weeks after their last study treatment administration. Beyond the initial 8 weeks of safety follow-up, all participants will be followed up as per the Schedule of Assessments, for a total of 5 years from their last \[177Lu\]Lu-NeoB administration, or until death, lost to follow-up, participant/guardian's or investigator's decision or withdrawal of consent (WoC).
The end of study is defined as the date of the last visit, scheduled procedure or follow up (or date of death, participant/guardian's or investigator's decision, WoC or lost to follow up, whichever occurs first) of the last participant in the study globally, or at 5 years from the last \[177Lu\]Lu-NeoB administration to the last study participant, whichever occurs last.
This study includes \[177Lu\]Lu-NeoB and capecitabine as study treatment and \[68Ga\]Ga-NeoB as an imaging agent. Participants will receive \[177Lu\]Lu-NeoB in combination with capecitabine (and a GnRHa, where applicable, as per local clinical practice, for pre-/peri-menopausal women and men in the Phase II part only).
\[68Ga\]Ga-NeoB is a PET imaging agent being investigated in studies with \[177Lu\]Lu-NeoB treatment in patients with tumors overexpressing GRPR, including mBC patients. \[68Ga\]Ga-NeoB has shown favorable technical and diagnostic performance to identify GRPR-expressing malignancies, both in preclinical and in clinical studies, with good image quality that allows interpretation.
\[177Lu\]Lu-NeoB has shown high affinity to the GRPR and its ability to target the GRPR expressing tumor has been confirmed in in vivo imaging and biodistribution studies in tumor models. \[177Lu\]Lu-NeoB is rapidly cleared from the blood, quickly eliminated through the renal system, with no retention in kidneys. \[177Lu\]Lu-NeoB is currently being evaluated as a single agent in an ongoing Phase I/IIa, open-label, multi-center study (NeoRay) which evaluates the safety, tolerability, whole-body distribution, radiation dosimetry and anti-tumor activity of \[177Lu\]Lu-NeoB administered in patients with advanced solid tumors known to overexpress GRPR who have no available therapeutic options. Data show that \[177Lu\]Lu-NeoB has shown a good tolerability and safety profile and a favorable biodistribution with low uptake in organs considered to be at risk due to GRPR-expression, such as the pancreas, or due to radioligand therapy (RLT), such as the red marrow, and the route of excretion, such as the kidneys.
Capecitabine is an oral fluoropyrimidine carbamate that is converted to 5-fluorouracil (5-FU) preferentially in tumor tissue through exploitation of high intratumoral concentrations of thymidine phosphorylase. It is one of the most frequent chemotherapy treatment choices for HR+/HER2- mBC patients post-CDK4/6i failure from 2nd line and beyond as reflected in real word data. It is also considered to be a potent radiosensitizer. The synergistic combination of chemotherapy and radionuclides has the potential to enhance efficacy.
This study will enroll a total of between 36 and 58 participants, depending on the applicable scenario. In the Phase I part, about 18 participants will be either enrolled or assigned to treatment/randomized (as applicable). In the Phase II part, between 28 and 40 participants will be randomized, depending on the applicable scenario. A standalone Japanese cohort will run in parallel to the Phase II of the Study.
* The screening period of 42 days is followed by the treatment period until disease progression, discontinuation of study treatment due to any other reason such as unacceptable toxicity, symptomatic deterioration, WoC, lost to follow up, investigator decision or death, whichever occurs first. The post treatment follow up period comprises the safety follow up for 8 weeks after treatment discontinuation and the long term safety and survival follow up for up to 5 years from the date of the participant's last dose of \[177Lu\]Lu-NeoB
* During screening, each participant will receive \[68Ga\]Ga-NeoB for PET/CT or PET/MRI imaging to confirm eligibility. Additionally, within 4-8 weeks from the last administration of \[177Lu\]Lu-NeoB, another administration of \[68Ga\]Ga-NeoB for PET/CT or PET/MRI will be performed, in the phase II part only.
* In the phase I part, participants will receive \[177Lu\]Lu-NeoB at a starting dose of 150mCi +/- 10% (iv infusion) Q6W in combination with capecitabine (tablet, 1000 mg/m2 twice daily for 14 consecutive days followed by 7 days off treatment). If dose escalation is supported, then two higher dose levels of \[177Lu\]Lu-NeoB in combination with capecitabine are planned to be explored, in a randomized way: 200mCi Q6W and 100mCi Q3W. These correspond to the same total dose given in a 6 weeks timeframe but exploring a different dose fractionation.
* If dose escalation from the starting dose is not supported, then lower dose levels will be explored (100mCi Q6W and if shown safe, 100mCi Q3W). If none of these are shown safe then the study will be terminated
* In the phase II part, there are four potential scenarios that may apply, depending on the outcome of the phase I part:
* Scenario 1 (if both higher dose levels in phase I were shown safe) participants will be randomized to either \[177Lu\]Lu-NeoB 200mCi Q6W or 100mCi Q3W, in combination with capecitabine
* Scenario 2 (if only one of the two higher dose levels in phase I were shown safe) participants will be randomized to either \[177Lu\]Lu-NeoB 200mCi Q6W / 100mCi Q3W (whichever was shown safe in phase I) or 150 mCi Q6W, in combination with capecitabine
* Scenario 3 (if none of the higher doses in phase I are shown safe): participants will be randomized to either \[177Lu\]Lu-NeoB 150mCi Q6W or 100mCi Q6W, in combination with capecitabine
* Scenario 4 (if dose escalation from the starting dose was no supported in phase I and lower investigational dose levels and regimens are shown safe in phase I part): participants will be randomized to either \[177Lu\]Lu-NeoB 100 mCi Q6W or 100 mCi Q3W, in combination with capecitabine.
* Treatment duration with \[177Lu\]Lu-NeoB is 6 administrations for Q6W regimens and 12 administrations for Q3W regimens. Additional \[177Lu\]Lu-NeoB administrations may be considered based on an individual benefit-risk assessment performed by the Investigator, participant and Sponsor
Study:
NCT06247995
Study Brief:
Protocol Section:
NCT06247995