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NCT Number: NCT05387603

Systemic Targeted Adaptive RadioTherapy of NeuroEndocrine Tumors.

There are several ways of personalizing PRRT (peptide receptor radionuclide treatment) in NEN (neuroendocrine neoplasia). Nevertheless, the current treatment regimen is not personalized. This trial aims to compare personalized PRRT to non-personalized PRRT in terms of safety, efficacy and resource demands in order to optimize treatment outcomes in an evidence-based manner in future.

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Key information

Conditions

Neuroendocrine Tumors Neoplasms Neoplasms by Histologic Type Neoplasms, Germ Cell and Embryonal Neoplasms, Nerve Tissue Neuroectodermal Tumors

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 3

Primary location

Sahlgrenska University Hospital, Dept. of Oncology, Gothenburg, Sweden

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Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Age ≥18 years
  • Written informed consent
  • Eastern Cooperative Oncology Group (ECOG) 0-1
  • Presence of histologically confirmed, advanced, well-differentiated, inoperable neuroendocrine tumors (NET) of any primary tumor origin and any grade, except for pheochromocytoma and paraganglioma.
  • Somatostatine receptor (SSTR)-expression in tumor lesions > basal liver uptake on 68Ga-DOTA-PET
  • Radiologically progressive disease within the last 1-24 months according to common clinical criteria and confirmed by the institutional multidisciplinary conference for the treatment of NETs. The CT/MRI that shows tumor progression compared to screening/baseline must have been performed 1-24 months earlier.
  • All previous anti-tumor treatment except SSA must be terminated at least 4 weeks before start of treatment within the trial.
  • Measurable disease according to RECIST v 1.1
  • Given the available, approved anti-tumor treatments and the specific characteristics of the patient and the tumor, the investigator judges peptide receptor radionuclide therapy (PRRT) to be the treatment of choice
  • GFR > 50 ml/min/1.73 m2 as determined by iohexol- or 51Cr-EDTA clearance, calculated according to a combination of LMR18 and CAPA formulas, or equally accurate method
  • Hemoglobin > 90 g/L, platelets >100 x109/L, leukocytes > 3.0x109/L, neutrophils > 1.5 x109/L, aspartate transaminase (ASAT)/alanine aminotransferase (ALAT) < 3 x ULN, bilirubin < 2 x upper limit of normal (ULN), albumin > 25 g/L
  • For women of child-bearing potential, highly effective contraception should be used from the time of inclusion up to at least six months after the end of treatment (EOT) visit.

Exclusion criteria

  • Pregnancy or lactation
  • Previous treatment with PRRT
  • Concomitant systemic anti-tumor therapy other than somatostatin analogue (SSA)
  • Contraindications for treatment with capecitabine according to the approved label.
  • Discordance between CT/MRI/18F-FDG-PET and 68Ga-DOTA-PET, with evidence of tumor lesions without uptake on 68Ga-DOTATOC.
  • Any other serious, uncontrolled medical or psychiatric condition that, in the opinion of the investigator, precludes the patient from participation in the trial
  • Unwillingness, or inability, to participate in any part of the trial procedures or treatments.

Treatment and study plan

177Lu-DOTATOC

Drug

The investigational medicinal product (IMP) is 177Lu-DOTATOC which is registered as an orphan drug by the EMA ( European Medicines Agency) for the treatment of GEP-NEN (gastro-entero-pancreatic neuroendocrine tumor).

The IMP will be administered to participants both in the control arm and the experimental arms, but with different intervals, but the same activity; 7.5 Gbq per dosing.

Capecitabine

Drug

Will be given orally with a dose of 825/m2 twice daily, starting on day 1 of each of the 4 first treatment cycles, cycle length 3 weeks.

Primary outcomes

  1. Median progression free survival (PFS) defined as time from randomization to radiological progression.

    Time frame: Before start of treatment (within 4 weeks), then every 10 +/- 2 weeks weeks, at follow up (every 3-6 month (investigators choice) until progression.

    Time to progression is evaluated by CT (computed tomography) or MRI (magnetic resonance imaging) after every 16-22 weeks.

  2. Median progression free survival (PFS) defined as time from randomization to radiological progression.

    Time frame: Before start of treatment (within 4 weeks), then every 10 +/- week at follow up (every 3-6 month (investigators choice) until death.

    Time to progression is evaluated by CT (computed tomography) or MRI (magnetic resonance imaging) after every 10 +/- 2 weeks.

  3. Median progression free survival (PFS) defined as time from randomization to radiological progression,

    Time frame: Before start of treatment (within 4 weeks), then every 10 +/- 2 weeks, at follow up (every 3-6 month (investigators choice) or patients withdrawal of concent.. No end can be given.

    Time to progression is evaluated by CT (computed tomography) or MRI (magnetic resonance imaging) after every 16-22 weeks.

Secondary outcomes

  1. Rate of treatment-related adverse reactions

    Time frame: At every treatment cycle, cycle length is 10 +/-2 weeks, at treatment follow up every 3-6 month (investigators choice) until progression. No time point can be given.

    Treatment-related adverse reactions graded according to CTCAE v.5.0.

  2. Median overall survival (OS).

    Time frame: From date of randomization until the date of death. Timepoint unknown, as date of death can´t be predicted.

    Median OS defined as time from randomization to death of any cause.

  3. Progression free survival.

    Time frame: From time of randomization until the date of first documented progression. Is evaluated within 4 weeks before randomization, after each treatment, every 10 +/2 weeks. Timepoint unknown, as date of progression can´t be predicted.

    Median progression free survival (PFS).

  4. Percent change in sum of longest diameters (SLD) of tumor lesions.

    Time frame: At each radiological investigation with CT or MRI of thorax and abdomen. Is done every 10 +/- 2 weeks. In the follow up period, evaluations are done every 3-6 months until death.

    Percent change in SLD from baseline (within 4 weeks before treatment) to time of best response.

  5. Quality of Life as judged by the patient.

    Time frame: Patients complete the QoL forms before start of treatment, at cycle 2 (cycle length 10+/-2 weeks), at each treatment cycle (4-approximately 7), until progression.

    All patients complete the Eastern Cooperative Oncology Group (EORTC) QoL (quality of life)-questionnaires GI- neuroendocrine tumors (NET)21.

  6. Cumulative median absorbed dose (AD)

    Time frame: After each dosimetry measurements after each treatment cycle (cycle length 10 +/2 weeks), up to 18 +/-2 months.

    AD to target tumor lesions in subjects with complete remission (CR), partial remission (PR), stable disease (SD) and progressive disease (PD) as best response, according to RECIST evaluations.

  7. Correlation between cumulative median absorbed dose and time to progression.

    Time frame: Every 10 +/- 2 weeks up to 18 +/- 2 months.

    Correlation between cumulative median absorbed dose to target tumor lesions and time to progression, defined as time from randomization to radiological progression.

  8. Cumulative median absorbed dose (AD) and biological effective dose to kidneys.

    Time frame: Is evaluated with dosimetry after each treatment, 10 +/- 2 weeks, up to 18 +/- 2 months.

    Cumulative median AD and biological effective dose (BED) to kidneys vs rate of grade 3-4 renal toxicity (estimated and measured GFR ( glomerular filtration rate).

  9. Differences in resource utilization and treatment cost.

    Time frame: Through study completion, an average of 18 months, assessed every 10 +/- 2 weeks by questionnaires.

    Differences in resource utilization and treatment cost between the two treatment arms, in relation to the progressive free survival (PFS) and overall survival (OS).

Study contacts

Contact information is provided by the study sponsor or research team.

Pernilla Asp, MD, Senior consultant

CONTACT

[email protected]

+46 46 17 75 20

Sponsors and collaborators

Lead sponsor

Lund University Hospital

Other

Registry information

Official study title

Systemic Targeted Adaptive RadioTherapy of NeuroEndocrine Tumors. An Open-label, Multicenter, Randomized Phase III Trial Comparing Safety and Efficacy of Personalized Versus Non-personalized Radionuclide Therapy With 177Lu (Lutetium)-DOTATOC.

Acronym: START-NET

Important dates

Study start
2022
Primary completion
2026
Study completion
2026
First posted
May 24, 2022
Registry last updated
Sep 10, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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