A Study of 177Lu-PSMA-617 in People With Gliomas

Inclusion criteria

• Confirmed histologic diagnosis of a WHO grade 2-4 glioma that is IDH1 R132H-wildtype, including the following:

• Diffuse astrocytoma, IDH-wildtype (grade 2-4)
• Glioblastoma, IDH-wildtype
• Diffuse midline glioma, H3 K27-altered
• Diffuse hemispheric glioma, H3 G34-mutant
• Diffuse pediatric-type high-grade glioma, H3-wildtype and IDH-wildtype PSMA positive pathological stain (by immunohistochemistry) of baseline (pre-radiotherapy) resection or biopsy sample
• Completion of standard of care therapy including surgery (for resectable tumors) and adjuvant EBRT for glioma
• Patients must be on a dose of 4 mg or less of dexamethasone (or dexamethasone equivalent steroid) for 5 days prior to first planned dose of radiopharmaceutical
• Age ≥ 18
• ECOG ≤ 2
• Serum creatinine level < 1.5 x ULN or EGFR > 60 mL/min
• Liver laboratory values: ALT and AST ≤ 2.5 x ULN; Albumin > 2 g/ dL; Bilirubin < 3 X ULN
• Normal organ and marrow function as defined as the following

• Total white blood count > 3.0 K/mcL
• ANC ≥ 1.5 K/mcL
• Platelets ≥ 100 K/mcL
• Hemoglobin ≥ 9 g/dL
• Adequate contraception prior to registration (see section 9.0)
• Ability to understand, and willingness to sign the informed consent.

Exclusion criteria

• Patient known to harbor any other non-canonical IDH mutations (i.e., non-R132H)
• Target lesion within 5 mm of either the brainstem, optic chiasm or optic nerves Receipt of bevacizumab as part of the initial treatment for glioma
• Life expectancy less than 12 weeks
• Nonhealing wound, ulcer or bone fracture
• History of severe brain injury
• Patient not eligible for sequential MRI evaluations
• Patients with prior RT to > 25% of the skeleton or prior exposure to prior Radium223, Strontium89 or Samarium153 containing compounds
• Patients with a prior or concurrent malignancy whose natural history or treatment has the potential to interfere with the safety or efficacy assessment of the investigational regimen
• Unable to tolerate the PSMA PET/MR or PSMA PET/CT
• History of viral hepatitis or chronic liver disease with active symptoms
• History of pituitary or adrenal dysfunction
• Previously diagnosed active infection (e.g., human immunodeficiency virus [HIV] or viral hepatitis)
• Any condition that in the opinion of the investigator, would preclude participation in this study
• Receipt of any other investigational agents or participation in a concurrent treatment protocol
• Known allergies, hypersensitivities, or intolerance to 68Ga-PSMA-11/177Lu-PSMA-617 or its inactive compounding components
• Current or planned pregnancy
• Refusal to comply with detailed contraception requirements