A Phase 2/3 interventional study of Al18F-NOTA-octreotide and PET/CT in Neuroendocrine Tumors, sponsored by Universitaire Ziekenhuizen KU Leuven. Completed at 1 site in Belgium. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2022-02-17.
Sponsored by Universitaire Ziekenhuizen KU Leuven · Phase 2/3, Interventional, and Diagnostic
The aim of this study is to evaluate the diagnostic performance of Al18F-NOTA-octreotide PET imaging in comparison with the current golden standard, 68Ga-DOTA-somatostatin analog PET, in neuroendocrine tumor patients.
Part A (main part of the trial):
Seventy-five neuroendocrine tumor (NET) patients (M/F, aged 18 years and older) with a routine clinical 68Ga-DOTA-somatostin analog (SSA) PET/CT performed in the last three months or scheduled within three months, will undergo a whole-body Al18F-NOTA-octreotide PET/CT.
Part B:
At least 10, possibly up to 20 NET patients (M/F, aged 18 years and older) with a routine clinical 68Ga-DOTA-SSA PET/CT performed in the last three months or scheduled within three months, will undergo a whole-body Al18F-NOTA-octreotide PET/MR.
676 studies on the registry are indexed under Neuroendocrine Tumors; 169 are open to participants now.
This study's enrollment of 85 is above the median of 42 across 464 interventional studies indexed under Neuroendocrine Tumors.
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Exclusion Criteria:
Part A and B:
Only for part B:
In the main part of the trial (part A) 75 patients with cytologically and/or histologically confirmed neuroendocrine tumors of all grades of gastroenteropancreatic, pulmonary, neural crest or unknown primary origin will receive a single intravenous injection of Al18F-NOTA-octreotide. At two hours after tracer injection they will undergo a whole-body PET/CT scan. In part B of the trial 10 up to 20 patients with with cytologically and/or histologically confirmed neuroendocrine tumors of all grades of gastroenteropancreatic, pulmonary, neural crest or unknown primary origin will receive a single intravenous injection of Al18F-NOTA-octreotide. At two hours after tracer injection they will undergo a whole-body PET/MR scan.
Drug: Al18F-NOTA-octreotide · Device: PET/CT · Device: PET/MR
One intravenous injection of 4 MBq/kg
Also known as: 18F-AlF-NOTA-octreotide, 18F-IMP-466
Patients in part A of the trial will undergo a whole-body PET/CT scan 120 minutes (acceptable range: 105 - 240 minutes) after injection of the tracer. The CT-scan is a low-dose CT that will be acquired for both PET attenuation correction and anatomical information.
Patients in part B of the trial will undergo a whole-body PET/MR scan 120 minutes (acceptable range: 105 - 240 minutes) after injection of the tracer. The MR scan is a fully diagnostic MR requiring intravenous contrast (Dotarem®) injection and Buscopan® administration to minimize bowel movement.
Differential detection ratio (DDR)
The fraction of lesions detected by one tracer is the detection ratio. In case of non-inferiority, the difference in detection ratio on Al18F-NOTA-octerotide PET and the detection ratio on 68Ga-DOTA-SSA PET, i.e. the differential detection ratio (DDR), equals zero. The primary objective will be met if the lower margin of the 95% confidence interval for the DDR is higher than -15%. Readers will be blinded for the radiopharmaceutical that is used. (only for part A of the trial)
Time frame: 2 years
Lesion detection rate on the organ level
A sub analysis will be performed, involving a lesion count per organ to determine the sensitivity of Al18F-NOTA-octreotide PET and 68Ga-DOTA-SSA PET on the organ level.
Time frame: 2 years
Lesion uptake
Standardized uptake value (SUV) measurements will be performed: SUVmax for lesions and SUVmean for several background areas will be determined. Lesion uptake, in terms of SUVmax and tumor-to-background ratio (TBR), will be compared for both tracers.
Time frame: 2 years
Clinical impact on TNM staging or patient management
We will evaluate whether different findings with both tracers have a clinical impact, e.g. leading to different TNM staging or differences in patient management. (only part A of the trial as this will be blinded)
Time frame: 2.5 years
Lesion detection rate according to the specific 68Ga-DOTA-SSA used for the routine PET scan
Due to the multicenter nature of this study, two or three different standard PET tracers will be used for the routine clinical care 68Ga-DOTA-SSA PET: 68Ga-DOTATATE (current standard in UZ Leuven), 68Ga-DOTANOC (current standard in UZ Antwerp), and potentially 68Ga-DOTATOC (depending where patients from UZ Ghent are scanned). Therefore, the diagnostic performance of Al18F-NOTA-octreotide PET will also be compared with the two or three 68Ga-DOTA-SSAs tracers separately.
Time frame: 2 years
Lesion detection rate according to tumor grade
A sub analysis will be performed, comparing the diagnostic performance and lesion uptake with Al18F-NOTA-octreotide and 68Ga-DOTA-SSA between low-grade and high-grade NETs.
Time frame: 2 years
Overall diagnostic image quality according to a five-point Likert-scale
As part of an inter-observer agreement analysis, readers will score overall diagnostic image quality using a five-point Likert-scale: (1) non diagnostic, (2) poor, (3) sufficient, (4) good and (5) excellent.
Time frame: 3 years
Lesion conspicuity according to a five-point Likert-scale
As part of an inter-observer agreement analysis, readers will score lesion conspicuity relative to the surrounding background using a five-point Likert-scale: (1) no increased uptake (equal or lower than background uptake), (2) barely perceived (slightly higher than background uptake), (3) moderately detectable (higher than background uptake, but less than twice, or less than 5 standardized uptake value (SUV) units above, the background uptake), (4) definitely detected (at least twice the background uptake and at least 5 SUV units higher than background uptake) and (5) strikingly evident/easily spotted (evident on maximum intensity projection images and typically higher than uptake in all normal organs, including the spleen).
Time frame: 3 years
Diagnostic confidence according to a five-point Likert-scale
As part of an inter-observer agreement analysis, for each focus of increased non-physiologic uptake readers will score diagnostic confidence using a five-point Likert-scale: (1) definitely no lesion, (2) probably no lesion, (3) indeterminate, (4) probably a lesion, (5) definitely a lesion.
Time frame: 3 years
Whole-body MRI correlate of the lesions detected by the PET scans
For the union of lesions identified on both PET scans, MRI images will be checked for corresponding MRI lesions. If a correlating lesion is detected and deemed to be of malignant nature by an experienced whole-body MRI radiologist, the PET lesions will be considered true positives. (only part B of the trial)
Time frame: 2.5 years
Effect of Al18F-NOTA-octreotide injection on blood pressure
The impact of Al18F-NOTA-octreotide administration on blood pressure (in mmHg) will be assessed. This parameter and changes from baseline values will be scored according to the Common Terminology Criteria for Adverse Events (CTCAE) version 4.03
Time frame: 2 years
Effect of Al18F-NOTA-octreotide injection on heart rate
The impact of Al18F-NOTA-octreotide administration on heart rate (in beats per minute) will be assessed. This parameter and changes from baseline values will be scored according to the Common Terminology Criteria for Adverse Events (CTCAE) version 4.03
Time frame: 2 years
Plan to share: No
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Universitaire Ziekenhuizen KU Leuven