Study of Lutetium (177Lu) Vipivotide Tetraxetan in mCRPC Participants With Moderately and Severely Impaired and With Normal Renal Function

Clinicaltrials.gov ID: NCT06004661
db-list-check Status RECRUITING
b-loader Phase PHASE2
b-people Age 18 - 100 Years
b-bullseye-arrow Enrollments 20

Conditions

Metastatic Castration-Resistant Prostate Cancer (mCRPC)

Drugs

AAA617, 68Ga-PSMA-11

Summary

This study will address health authorities' requests to determine whether moderate and severe renal impairment have an impact on the biodistribution, dosimetry and safety of lutetium (177Lu) vipivotide tetraxetan (AAA617) administered to participants with progressive PSMA-positive metastatic castration-resistant prostate cancer. The study will also characterize the risk of QT prolongation of AAA617 in this participant population.

Detailed Description

This open-label, non-randomized, multicenter, single arm phase II study in mCRPC participants aims to better characterize the safety and tolerability of AAA617 in participants with moderate and severe renal impairment compared with normal renal function. Since both severe and moderate renal impairment have very low incidence within mCRPC participant population compared to participants with normal renal function, the enrollment will occur in parallel for the 3 cohorts; participants will be stratified in one of the three cohorts (A:normal, B: moderate or C: severe) based on their eGFR at screening.

All participants will undergo a 68Ga-PSMA-11 PET/CT scan at screening to confirm PSMA positivity.

Participants will receive a dose of 7.4 GBq (±10%) of AAA617 once every 6 weeks for a planned 6 cycles for cohorts A and B and for 3 cycles (and 3 additional cycles) for cohort C.

After treatment period, participants will be asked to join a long term follow up (LTFU) study to monitor their safety up to 10 years after the 1st dose of AAA617. In case of the LTFU study is not available at the time of end of treatment period (safety follow-up visit), participants will continue in Long Term Follow-up period in this study for up to one year until they can roll over into the separate LTFU study.

The primary outcome will be to determine the effect of radiation absorption in kidney and other organs at risk as well as the concentration in blood and radioactivity in urine in PSMA- positive mCRPC participants with moderate and severe renal impairment. In addition, the study will assess the relationship between drug concentrations and QTcF.

20 participants with 6 countries are expected to be included with at least 6 evaluable participantts per cohort.

Locations

1 location Found with status Recruiting

Status

  • RECRUITING

Contact Person

Study Director

  • Novartis Pharmaceuticals

Eligibility Criteria

Key Inclusion Criteria:

1. An Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2
2. 68Ga-PSMA-11 Positron emission tomography (PET)/CT scan positive, and eligible as determined by the sponsor's central reader.
3. A castrate level of serum/plasma testosterone (< 50 ng/dL or < 1.7 nmol/L).
4. Documented progressive mCRPC will be based on at least 1 of the following criteria:

* Serum/plasma Prostate-Specific Antigen (PSA) progression defined as 2 consecutive increases in PSA over a previous reference value measured at least 1 week prior. The minimal start value is 2.0 ng/mL
* Soft-tissue progression defined as an increase >= 20% in the sum of the diameter (SOD) (short axis for nodal lesions and long axis for non-nodal lesions) of all target lesions based on the smallest SOD since treatment started or the appearance of one or more new lesions.
* Progression of bone disease: evaluable disease or new bone lesions(s) by bone scan (2+2 PCWG3 criteria)
5. Documented stable renal disease without evidence of renal progressive disease (stable renal disease is defined as no significant change, such as a stable eGFR, within 4 weeks prior to study entry)
6. Kidney function based on eGFR by Modification of Diet in Renal Disease (MDRD) equation:

* Normal renal function: participants with eGFR >= 90 mL/min
* Moderate renal impairment: participants with eGFR >= 30 to =< 59 mL/min
* Severe renal impairment: participants with eGFR >= 15 to =< 29 mL/min

Key Exclusion Criteria:

1. Previous treatment with PSMA-targeted radioligand therapy.
2. Previous treatment with any of the following within 6 months of enrollment confirmation: Strontium-89, Samarium-153, Rhenium-186, Rhenium-188, Radium-223 or hemi-body irradiation.
3. Use of agents known to prolong the QT interval from start of screening to end of Cycle 1, unless they can be permanently discontinued for the duration of study.
4. Current severe urinary incontinence, hydronephrosis, severe voiding dysfunction, any level of urinary obstruction requiring indwelling/condom catheters. Participants with postrenal impairment, like obstructions, retroperitoneal fibrosis (eg after prostectomy) must be excluded or first resolved to ≤ Grade 1.
5. History or current diagnosis of ECG abnormalities indicating significant risk of safety for participants participating in the study such as:

* Concomitant clinically significant cardiac arrhythmias, e.g. sustained ventricular tachycardia, and clinically significant second- or third-degree AV block without a pacemaker.
* History of familial long QT syndrome or known family history of Torsades de Pointe.
* Resting heart rate (physical exam or 12 lead ECG) <60 bpm

Other protocol-defined inclusion/exclusion criteria may apply.

Study Plan

AAA617

EXPERIMENTAL

Participants will receive a dose of 7.4 GBq (200 mCi) +/- 10% of AAA617 which will be administered once every 6 weeks (1 cycle) for 3 to 6 cycles according to eGFR calculation at screening and radiation absorbed dose results from Cycle1 Day1.

  • DRUG:

    AAA617

    Description:

    Administered intravenously once every cycles (1 cycle = 6 weeks)
  • DRUG:

    68Ga-PSMA-11

    Description:

    Single intravenous dose of approximately 150 MBq

Outcome Measures

Primary Outcome Measures

Absorbed radiation dose in kidneys and selected organs

Time Frame: Up to 36 weeks

Concentrations of AAA617 in blood over time

Time Frame: Cycle (C) 1 Day (D) 1 (pre dose, end of infusion, 20 minutes (min), 60 min, 2 and 4 hours (h) post infusion), C1 D2 (24 h post infusion), C1 D3 (48 h post infusion), C1 D4 (72 h post infusion), C1 D6 (156-168 h post infusion). Cycle=6 weeks

Area under the serum concentration-time curve from time zero to the time of last quantifiable concentration (AUClast) of 177Lu-PSMA-617

Time Frame: Cycle (C) 1 Day (D) 1 (pre dose, end of infusion, 20 minutes (min), 60 min, 2 and 4 hours (h) post infusion), C1 D2 (24 h post infusion), C1 D3 (48 h post infusion), C1 D4 (72 h post infusion), C1 D6 (156-168 h post infusion). Cycle=6 weeks

Time of maximum observed drug concentration occurrence (Tmax) of 177Lu-PSMA-617

Time Frame: Cycle (C) 1 Day (D) 1 (2 and 4 hours (h) post infusion), C1 D2 (24 h post infusion), C1 D3 (48 h post infusion), C1 D4 (72 h post infusion), C1 D6 (156-168 h post infusion). Cycle = 6 weeks

Observed maximum plasma concentration (Cmax) of 177Lu-PSMA-617

Time Frame: Cycle (C) 1 Day (D) 1 (pre dose, end of infusion, 20 minutes (min), 60 min, 2 and 4 hours (h) post infusion), C1 D2 (24 h post infusion), C1 D3 (48 h post infusion), C1 D4 (72 h post infusion), C1 D6 (156-168 h post infusion). Cycle=6 weeks

Terminal elimination half-life (T^1/2) of 177Lu-PSMA-617

Time Frame: Cycle (C) 1 Day (D) 1 (pre dose, end of infusion, 20 minutes (min), 60 min, 2 and 4 hours (h) post infusion), C1 D2 (24 h post infusion), C1 D3 (48 h post infusion), C1 D4 (72 h post infusion), C1 D6 (156-168 h post infusion). Cycle=6 weeks

Area under the concentration-time curve from time zero (pre-dose) extrapolated to infinite time (AUCinf) of 177Lu-PSMA-617

Time Frame: Cycle (C) 1 Day (D) 1 (pre dose, end of infusion, 20 minutes (min), 60 min, 2 and 4 hours (h) post infusion), C1 D2 (24 h post infusion), C1 D3 (48 h post infusion), C1 D4 (72 h post infusion), C1 D6 (156-168 h post infusion). Cycle=6 weeks

Total systemic clearance for intravenous administration (CL) of 177Lu-PSMA-617

Time Frame: Cycle (C) 1 Day (D) 1 (pre dose, end of infusion, 20 minutes (min), 60 min, 2 and 4 hours (h) post infusion), C1 D2 (24 h post infusion), C1 D3 (48 h post infusion), C1 D4 (72 h post infusion), C1 D6 (156-168 h post infusion). Cycle=6 weeks

Volume of distribution during the terminal phase following intravenous elimination (Vz) of 177Lu-PSMA-617

Time Frame: Cycle (C) 1 Day (D) 1 (pre dose, end of infusion, 20 minutes (min), 60 min, 2 and 4 hours (h) post infusion), C1 D2 (24 h post infusion), C1 D3 (48 h post infusion), C1 D4 (72 h post infusion), C1 D6 (156-168 h post infusion). Cycle=6 weeks

Renal clearance of 177Lu-PSMA-617

Time Frame: Cycle 1 Day 1: end of infusion to 2 hours, 2 hours to 4 hours, 4 hours to 24 hours, 24 hours to 48 hours, 48 hours to 72 hours post infusion. Cycle = 6 weeks

Change from baseline in eGFR

Time Frame: at screening and at every visit, assessed up to 1 year after last treatment

Dose modifications for AAA617

Time Frame: Up to 36 weeks

Dose intensity for AAA617

Time Frame: Up to 36 weeks

Secondary Outcome Measures

Change from baseline in QTcF interval (u0394QTcF)

Time Frame: During Cycle 1 at predose, End of Injection (EoI), 20 minutes (min), 60 min, 2 hours (h), 4h and 24h post EoI. Cycle=6 weeks

Relationship between drug concentrations and QTcF

Time Frame: During Cycle 1 at predose, End of Injection (EoI), 20 minutes (min), 60 min, 2 hours (h), 4h and 24h post EoI. Cycle=6 weeks

Overall Response Rate (ORR)

Time Frame: From the date of 1st dose until the date of first documented progression or date of death from any cause, whichever comes first, assessed up to approximately 36 weeks

Disease Control Rate (DCR)

Time Frame: From the date of 1st dose until the date of first documented progression or date of death from any cause, whichever comes first, assessed up to approximately 36 weeks

PSA50 response

Time Frame: From screening up to 1 year

Timeline

  • Last Updated
    April 18, 2025
  • Start Date
    August 22, 2023
  • Today
    November 1, 2025
  • Completion Date ( Estimated )
    October 1, 2026

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