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NCT03042312: RESIST-PC

Lutetium-177 (Lu177) Prostate-Specific Antigen (PSMA)-Directed EndoRadiotherapy

Terminated Phase 2 Results posted Last updated 24 March 2021
What this trial tests

Phase 2 trial testing 177Lu-PSMA-617 in Metastatic Castration Resistant Prostate Cancer in 71 participants. Terminated before completion.

Timeline
12 July 2017
Primary endpoint
15 January 2020
15 January 2020

Quick facts

Lead sponsorEndocyte
PhasePhase 2
StatusTerminated
Study typeINTERVENTIONAL
Allocationnon randomized
Designsingle group
Maskingnone
Primary purposetreatment
Enrollment71
Start date12 July 2017
Primary completion15 January 2020
Estimated completion15 January 2020
Sites2 locations across United States

Drugs / interventions tested

Conditions studied

Sponsor

Endocyte — full company profile →

Who can join

18 and older, male only, with Metastatic Castration Resistant Prostate Cancer. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Number of Participants With Treatment Emergent Adverse Events Primary · From first dosing (Day 0) up to last follow-up visit or until the event has resolved to baseline grade or better or the event was assessed stable by the investigator or the patient was lost to follow-up or withdrew consent, up to 24 months

Treatment-emergent adverse events (TEAEs) were collected from first dosing up to last follow-up visit or until the event has resolved to baseline grade or better or the event was assessed stable by the investigator or the patient was lost to follow-up or withdrew consent. The distribution of adverse events was done via the analysis of frequencies for treatment emergent Adverse Event (TEAEs), Serious Adverse Event (TESAEs) and Deaths due to AEs, through the monitoring of relevant clinical and laboratory safety parameters. Only descriptive analysis performed.

Treatment-Emergent Adverse Events (TEAEs)
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)22
177Lu-PSMA-617 (7.4 GBq)39
Serious TEAEs
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)4
177Lu-PSMA-617 (7.4 GBq)8
Drug-related TEAEs
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)20
177Lu-PSMA-617 (7.4 GBq)37
Serious drug-related TEAEs
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)1
177Lu-PSMA-617 (7.4 GBq)4
TEAEs leading to reduction of Lu-PSMA-617
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)2
TEAEs leading to discontinuation of Lu-PSMA-617
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)1
TEAEs leading to death
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)2
177Lu-PSMA-617 (7.4 GBq)1
Number of Participants Achieving PSA Response at Week 12 Primary · Week 12

PSA response was defined as the proportion of patients who had a \>= 50% decrease in PSA from Baseline at Week 12.

GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)5
177Lu-PSMA-617 (7.4 GBq)8
177Lu-PSMA-617 (6.0 GBq)6
177Lu-PSMA-617 (7.4 GBq)6
177Lu-PSMA-617 (6.0 GBq)3
177Lu-PSMA-617 (7.4 GBq)11
Percent Change in PSA From Baseline to Week 12 Secondary · Week 12

Percent change in PSA from Baseline to Week 12 was reported for participants who had a baseline and a week 12 valid assessments.

GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)-22.54± 75.513
177Lu-PSMA-617 (7.4 GBq)92.15± 301.932
Maximum Percent Change in PSA Response Secondary · Every 6 weeks during the treatment and every 3 (+/- 1) months after last treatment until reaching endpoint or 24 months after the first treatment

Maximal baseline to follow-up PSA decline, at any time during or after therapy was evaluated in both treatment groups.

GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)-3.63± 95.394
177Lu-PSMA-617 (7.4 GBq)8.75± 132.954
PSA Progression and Death Events Secondary · Date of randomization to the date of first documented PSA progression or death, whichever occurs first, reported between day of first patient randomized up to 24 months after the first treatment

PSA progression was defined as: 1. For patients with PSA decline: PSA progression was defined as the date that a \>= 25% increase in PSA and an absolute increase of 2 ng/mL or more from the nadir was documented and confirmed by a second consecutive value obtained 3 or more weeks later. Rises in PSA within the first 12 weeks were ignored (PCWG3 Guidance), 2. For patients without PSA decline: PSA progression was defined as a \>= 25% increase from the baseline value along with an increase in absolute value of 2 ng/mL or more after 12 weeks of treatment.

Deaths without PSA progression
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)2
177Lu-PSMA-617 (7.4 GBq)2
Participants with PSA progression, but who did not die
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)11
177Lu-PSMA-617 (7.4 GBq)17
RECIST 1.1 Overall Response by Follow-up Assessment Visit Secondary · Before 3rd radioligand therapy (RLT) cycle, and then every 3 (+/- 1) months after last treatment dose until disease progression or 24 months after the first treatment dose.

For each follow-up imaging assessment by the investigator per Response Evaluation Criteria in Solid Tumors (RECIST v1.1) for target, non-target, and new lesions assessed by CT or MRI: the number of participants with an overall response of Complete Response (CR), Partial Response (PR), Stable Disease (SD), or Progressive Disease (PD). The timing of follow-up imaging assessments varied depending on how many RLT cycles a participant received. Therefore, regardless of when the imaging assessments occurred, each participant's first follow-up imaging was combined as Follow-up 1, each participant's

Follow-up 1
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)1
177Lu-PSMA-617 (7.4 GBq)1
177Lu-PSMA-617 (6.0 GBq)3
177Lu-PSMA-617 (7.4 GBq)4
177Lu-PSMA-617 (6.0 GBq)1
177Lu-PSMA-617 (7.4 GBq)7
177Lu-PSMA-617 (6.0 GBq)6
177Lu-PSMA-617 (7.4 GBq)9
Follow-up 2
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)3
177Lu-PSMA-617 (7.4 GBq)1
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)3
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)0
177Lu-PSMA-617 (6.0 GBq)1
177Lu-PSMA-617 (7.4 GBq)1
Follow-up 3
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)1
177Lu-PSMA-617 (7.4 GBq)0
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)0
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)1
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)0
Follow-up 4
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)0
177Lu-PSMA-617 (6.0 GBq)1
177Lu-PSMA-617 (7.4 GBq)0
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)0
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)0
RECIST 1.1 Disease Control Rate by Follow-up Assessment Visit Secondary · Before 3rd radioligand therapy (RLT) cycle, and then every 3 (+/- 1) months after last treatment dose until disease progression or 24 months after the first treatment dose.

The proportion of participants with an overall response of Complete Response (CR), Partial Response (PR) and Stable Disease (SD) was reported using investigator assessments per Response Evaluation Criteria in Solid Tumors (RECIST v1.1) for target, non-target, and new lesions assessed by CT or MRI. The timing of follow-up imaging assessments varied depending on how many RLT cycles a participant received. Therefore, regardless of when the imaging assessments occurred, each participant's first follow-up imaging was combined as Follow-up 1, each participant's second follow-up imaging was combined

Follow-up 1
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)17.9
177Lu-PSMA-617 (7.4 GBq)27.9
Follow-up 2
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)10.7
177Lu-PSMA-617 (7.4 GBq)9.3
Follow-up 3
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)3.6
177Lu-PSMA-617 (7.4 GBq)2.3
Follow-up 4
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)3.6
Prostate Cancer Working Group 3 (PCWG3) Bone Scan Clinical Impression by Visit Secondary · Screening, Week 8, Week 10, Week 16, Week 18, Week 22, Week 24, Follow-up Week 4, Follow-up Week 6, Follow-up Week 8

Investigator's assessed bone metastases using the Prostate Cancer Working Group 3 (PCWG3) criteria; new lesions had to be confirmed on a second scan (2+2 rule). The investigator documented their clinical impression of each PCWG3 assessment as Improved, Stable or Progression. The number of participants with a clinical impression of Improved, Stable or Progression according to PCWG3 using investigators assessments was reported by visit.

Screening
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)0
177Lu-PSMA-617 (6.0 GBq)1
177Lu-PSMA-617 (7.4 GBq)0
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)0
Week 8
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)1
177Lu-PSMA-617 (7.4 GBq)3
177Lu-PSMA-617 (6.0 GBq)1
177Lu-PSMA-617 (7.4 GBq)2
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)1
Week 10
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)3
177Lu-PSMA-617 (6.0 GBq)2
177Lu-PSMA-617 (7.4 GBq)1
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)0
Week 16
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)2
177Lu-PSMA-617 (6.0 GBq)2
177Lu-PSMA-617 (7.4 GBq)0
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)0
Week 18
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)0
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)3
177Lu-PSMA-617 (6.0 GBq)1
177Lu-PSMA-617 (7.4 GBq)0
Week 22
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)0
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)1
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)0
Week 24
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)0
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)1
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)0
Follow-up Week 4
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)0
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)0
177Lu-PSMA-617 (6.0 GBq)0
177Lu-PSMA-617 (7.4 GBq)1
Change From Baseline in Expanded Prostate Cancer Index Composite Short Form (EPIC-26) Secondary · Baseline, Month 3, Month 6, Follow-up Month 3

The Expanded Prostate Cancer Index-Composite (EPIC) is a well-established patient-reported outcome (PRO) questionnaire developed to monitor health-related quality of life outcomes among prostate cancer. The 26-item version of EPIC, also known as EPIC Short Form or EPIC-26, contains 26 items and 5 domains: Urinary Incontinence (Items 1-4), Urinary Irritative/Obstructive (Items 5-8), Bowel (Items 10-15), Sexual (Items 16-21), and Hormonal (Items 22-26). Response options for each EPIC item form a Likert scale, and multi-item scale scores are transformed linearly to a 0 to 100 scale for each domai

Urinary Incontinence (Baseline)
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)78.3± 26.87
177Lu-PSMA-617 (7.4 GBq)77.4± 24.64
Urinary Incontinence (Change from BL@Month 3)
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)4.9± 12.57
177Lu-PSMA-617 (7.4 GBq)9.7± 20.88
Urinary Incontinence (Change from BL@Month 6)
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)11.1± 19.20
177Lu-PSMA-617 (7.4 GBq)-6.3± 14.66
Urinary Incontinence (Change from BL@Follow-up Month 3)
GroupValue95% CI
177Lu-PSMA-617 (7.4 GBq)-2.1± 9.55
Urinary Irritative/Obstructive (Baseline)
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)83.2± 20.73
177Lu-PSMA-617 (7.4 GBq)84.8± 19.13
Urinary Irritative/Obstructive (Change from BL@Month 3)
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)17.9± 25.37
177Lu-PSMA-617 (7.4 GBq)-1.4± 4.17
Urinary Irritative/Obstructive (Change from BL@Month 6)
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)2.1± 9.55
177Lu-PSMA-617 (7.4 GBq)6.3± 8.84
Urinary Irritative/Obstructive (Change from BL@Follow-up Month 3)
GroupValue95% CI
177Lu-PSMA-617 (7.4 GBq)8.3± 9.55
Change From Baseline in Eastern Cooperative Oncology Group (ECOG) Performance Status Secondary · Baseline, Treatment Visit 1, Treatment Visit 2, Treatment Visit 3, Treatment Visit 4, Follow-up Month 3, Follow-up Month 12, Follow-up Month 15

The Eastern Cooperative Oncology Group Performance Status (ECOG PS) score classifies participants according to their functional impairment, with scores ranging from 0 (fully active) to 5 (dead). ECOG PS: 0 = fully active, able to carry on all pre-disease performance without restriction; 1 = restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light housework, office work; 2 = ambulatory and capable of all self-care but unable to carry out any work activities, up and about more than 50% of waking hours; 3 = capable of only l

Baseline
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)0.9± 0.81
177Lu-PSMA-617 (7.4 GBq)0.9± 0.61
Change from BL@Treatment Visit 1
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)-0.2± 0.60
177Lu-PSMA-617 (7.4 GBq)0.0± 0.54
Change from BL@Treatment Visit 2
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)-0.3± 0.60
177Lu-PSMA-617 (7.4 GBq)-0.1± 0.63
Change from BL@Treatment Visit 3
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)-0.2± 0.73
177Lu-PSMA-617 (7.4 GBq)-0.2± 0.50
Change from BL@Treatment Visit 4
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)-0.1± 0.93
177Lu-PSMA-617 (7.4 GBq)-0.3± 0.48
Change from BL@Follow-up Month 3
GroupValue95% CI
177Lu-PSMA-617 (6.0 GBq)0.0± NA
Change from BL@Follow-up Month 12
GroupValue95% CI
177Lu-PSMA-617 (7.4 GBq)-1.0± NA
Change from BL@Follow-up Month 15
GroupValue95% CI
177Lu-PSMA-617 (7.4 GBq)0.0± NA

Adverse events — posted to ClinicalTrials.gov

Time frame: Adverse events (AEs) were collected from informed consent signature through to 24 months after first 177Lu-PSMA-617 treatment therapy.. Reporting threshold: 1%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

177Lu-PSMA-617 (6.0 GBq)
Serious: 4/23 (17%)
Deaths: 3/23
177Lu-PSMA-617 (7.4 GBq)
Serious: 8/41 (20%)
Deaths: 3/41

Serious adverse events (13 terms)

ReactionSystem177Lu-PSMA-617 (6.0 GBq)177Lu-PSMA-617 (7.4 GBq)
Metastases to central nervous systemNeoplasms benign, malignant and unspecified (incl cysts and polyps)
AnaemiaBlood and lymphatic system disorders
ThrombocytopeniaBlood and lymphatic system disorders
Abdominal painGastrointestinal disorders
Gastrointestinal haemorrhageGastrointestinal disorders
DeathGeneral disorders
PneumoniaInfections and infestations
Subdural haematomaInjury, poisoning and procedural complications
OsteoporosisMusculoskeletal and connective tissue disorders
Adenocarcinoma of colonNeoplasms benign, malignant and unspecified (incl cysts and polyps)
Metastases to meningesNeoplasms benign, malignant and unspecified (incl cysts and polyps)
Acute kidney injuryRenal and urinary disorders
Pleural effusionRespiratory, thoracic and mediastinal disorders
Other adverse events (57 terms — click to expand)

ReactionSystem177Lu-PSMA-617 (6.0 GBq)177Lu-PSMA-617 (7.4 GBq)
Dry mouthGastrointestinal disorders
FatigueGeneral disorders
NauseaGastrointestinal disorders
DiarrhoeaGastrointestinal disorders
ConstipationGastrointestinal disorders
VomitingGastrointestinal disorders
Taste disorderNervous system disorders
PainGeneral disorders
Decreased appetiteMetabolism and nutrition disorders
AnaemiaBlood and lymphatic system disorders
Dry eyeEye disorders
ArthralgiaMusculoskeletal and connective tissue disorders
DyspnoeaRespiratory, thoracic and mediastinal disorders
PyrexiaGeneral disorders
Back painMusculoskeletal and connective tissue disorders
Bone painMusculoskeletal and connective tissue disorders
Musculoskeletal chest painMusculoskeletal and connective tissue disorders
Pain in extremityMusculoskeletal and connective tissue disorders
DizzinessNervous system disorders
HeadacheNervous system disorders
HaematomaVascular disorders
LeukopeniaBlood and lymphatic system disorders
LymphadenopathyBlood and lymphatic system disorders
LymphopeniaBlood and lymphatic system disorders
DeafnessEar and labyrinth disorders
HypothyroidismEndocrine disorders
Lacrimation increasedEye disorders
Abdominal painGastrointestinal disorders
Frequent bowel movementsGastrointestinal disorders
Hyperaesthesia teethGastrointestinal disorders
Lip dryGastrointestinal disorders
Saliva alteredGastrointestinal disorders
AstheniaGeneral disorders
Chest painGeneral disorders
Feeling hotGeneral disorders
Oedema peripheralGeneral disorders
BronchitisInfections and infestations
Herpes zosterInfections and infestations
Urinary tract infectionInfections and infestations
Blood lactate dehydrogenase increasedInvestigations

Most-reported serious reactions: Metastases to central nervous system, Anaemia, Thrombocytopenia, Abdominal pain, Gastrointestinal haemorrhage, Death, Pneumonia, Subdural haematoma.

Data from ClinicalTrials.gov NCT03042312 adverse events section.

Sponsor's own description

This was an open-label, multicenter, prospective trial to assess safety and efficacy of 177Lu-PSMA-617 in patients with metastatic castration resistant prostate cancer.

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Nomograms to predict outcomes after <sup>177</sup>Lu-PSMA therapy in men with metastatic castration-resistant prostate cancer: an international, multicentre, retrospective study.
    Gafita A, Calais J, Grogan TR, Hadaschik B, et al · · 2021 · cited 189× · PMID 34246328 · DOI 10.1016/s1470-2045(21)00274-6
  2. Radiotheranostics: a roadmap for future development.
    Herrmann K, Schwaiger M, Lewis JS, Solomon SB, et al · · 2020 · cited 185× · PMID 32135118 · DOI 10.1016/s1470-2045(19)30821-6
  3. [<sup>177</sup>Lu]Lu-PSMA-617 (Pluvicto<sup>TM</sup>): The First FDA-Approved Radiotherapeutical for Treatment of Prostate Cancer.
    Hennrich U, Eder M. · · 2022 · cited 174× · PMID 36297404 · DOI 10.3390/ph15101292
  4. Novel Framework for Treatment Response Evaluation Using PSMA PET/CT in Patients with Metastatic Castration-Resistant Prostate Cancer (RECIP 1.0): An International Multicenter Study.
    Gafita A, Rauscher I, Weber M, Hadaschik B, et al · · 2022 · cited 131× · PMID 35422442 · DOI 10.2967/jnumed.121.263072
  5. Third-line treatment and &lt;sup&gt;177&lt;/sup&gt;Lu-PSMA radioligand therapy of metastatic castration-resistant prostate cancer: a systematic review.
    von Eyben FE, Roviello G, Kiljunen T, Uprimny C, et al · · 2018 · cited 113× · PMID 29247284 · DOI 10.1007/s00259-017-3895-x
  6. Status of PSMA-targeted radioligand therapy in prostate cancer: current data and future trials.
    Jang A, Kendi AT, Sartor O. · · 2023 · cited 63× · PMID 36895851 · DOI 10.1177/17588359231157632
  7. Lutetium Lu 177 Vipivotide Tetraxetan: First Approval.
    Keam SJ. · · 2022 · cited 62× · PMID 35553387 · DOI 10.1007/s40291-022-00594-2
  8. PSMA-Targeting Imaging and Theranostic Agents-Current Status and Future Perspective.
    Debnath S, Zhou N, McLaughlin M, Rice S, et al · · 2022 · cited 54× · PMID 35163083 · DOI 10.3390/ijms23031158

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