This Phase 1, open-label study will evaluate two investigational radiopharmaceuticals in adults with selected advanced or metastatic solid tumors. SKL35502 is an imaging agent used with SPECT scans to identify tumors with neurotensin receptor 1 (NTSR1), a protein found on some cancer cells, and to assess where the agent travels in the body and the radiation dose delivered to tissues. Participants with sufficient SKL35502 tumor uptake may receive SKL35501, a treatment designed to deliver targeted alpha radiation to NTSR1-expressing tumor cells. Part A will evaluate the safety and imaging performance of SKL35502 and the safety, tolerability, pharmacokinetics, biodistribution, dosimetry, and biologically active dose range of SKL35501, as well as preliminary antitumor activity. Part B will further evaluate selected SKL35501 dose levels, including randomized low- and high-dose groups in participants with colorectal cancer, and will expand evaluation in selected tumor types. The study will also examine relationships among SKL35502 imaging, NTSR1 expression, SKL35501 tumor uptake, and treatment outcomes.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
100
Therapeutic agent that consists of an NTSR1-targeting small molecule linked to alpha emitter 225Ac to induce killing of NTSR1-expressing tumor cells
Imaging agent that consists of an NTSR1-targeting small molecule linked to 111In to detect NTSR1-expressing tumors via SPECT imaging
United Theranostics
Glen Burnie, Maryland, United States
RECRUITINGUPMC Hillman Cancer Center
Pittsburgh, Pennsylvania, United States
NOT_YET_RECRUITINGSeoul National University Hospital
Seoul, South Korea
NOT_YET_RECRUITINGAsan Medical Center
Seoul, South Korea
NOT_YET_RECRUITINGThe Catholic University of Korea, Seoul St. Mary's Hospital
Seoul, South Korea
NOT_YET_RECRUITINGNumber of Participants With Treatment-Emergent Adverse Events Following SKL35502 Administration
The number of participants with at least one treatment-emergent adverse event following administration of SKL35502 will be reported. A treatment-emergent adverse event is an adverse event that begins or worsens after the first administration of SKL35502. Adverse-event severity will be assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 6.0. Each participant will be counted once for this outcome regardless of the number of events experienced.
Time frame: From the first administration of SKL35502 until initiation of SKL35501, 15 days after the last administration of SKL35502, or initiation of a new antitumor therapy, whichever occurs first.
Absorbed Radiation Dose to Prespecified Normal Organs Following SKL35502 Administration
Absorbed radiation dose will be estimated for each prespecified normal organ following SKL35502 administration using serial imaging, organ time-activity data, and protocol-defined dosimetry methods. Organ-specific absorbed-dose values will be reported separately using the same protocol-defined absorbed-dose unit.
Time frame: From SKL35502 administration through 7 days after administration.
Absorbed Radiation Dose to Evaluable Tumor Lesions Following SKL35502 Administration
Absorbed radiation dose will be estimated for each evaluable tumor lesion following SKL35502 administration using serial imaging, lesion time-activity data, and protocol-defined dosimetry methods. Lesion-specific absorbed-dose values will be reported separately using the same protocol-defined absorbed-dose unit.
Time frame: From SKL35502 administration through 7 days after administration.
Whole-Body Radiation Dose Following SKL35502 Administration
The whole-body radiation dose following SKL35502 administration will be estimated using serial imaging and protocol-defined dosimetry methods. One whole-body radiation-dose value will be reported for each evaluable participant using the protocol-defined unit.
Time frame: From SKL35502 administration through 7 days after administration.
Number of Participants With Dose-Limiting Toxicities During Cycle 1 Following the First Dose of SKL35501
The number of participants who experience at least one SKL35501-related dose-limiting toxicity during the protocol-defined dose-limiting toxicity assessment period will be reported. Dose-limiting toxicities are protocol-defined hematologic or non-hematologic adverse events occurring during the first treatment cycle. Each participant will be counted once regardless of the number of dose-limiting toxicities experienced.
Time frame: From the first administration of SKL35501 through the end of Cycle 1, a period of 6 weeks.
Lower SKL35501 Administered Activity Selected for the Biologically Active Dose Range for Part B
The lower SKL35501 administered activity selected for the biologically active dose range will be determined by the Safety Review Committee based on integrated review of dose-limiting toxicities, safety and tolerability beyond the dose-limiting toxicity assessment period, pharmacokinetics, pharmacodynamics, imaging, dosimetry, and preliminary antitumor activity. One lower administered-activity value will be reported in megabecquerels.
Time frame: At completion of Part A dose escalation and backfill, after all Part A participants have completed at least one 6-week treatment cycle.
Upper SKL35501 Administered Activity Selected for the Biologically Active Dose Range for Part B
The upper SKL35501 administered activity selected for the biologically active dose range will be determined by the Safety Review Committee based on integrated review of dose-limiting toxicities, safety and tolerability beyond the dose-limiting toxicity assessment period, pharmacokinetics, pharmacodynamics, imaging, dosimetry, and preliminary antitumor activity. One upper administered-activity value will be reported in megabecquerels.
Time frame: At completion of Part A dose escalation and backfill, after all Part A participants have completed at least one 6-week treatment cycle.
Tumor-to-Background Ratio of SKL35502 Uptake in RECIST Version 1.1 Measurable Tumor Lesions
Tumor-to-background ratio will be calculated as SKL35502 uptake in an anatomically matched RECIST Version 1.1 measurable tumor lesion divided by uptake in the background reference region defined in the Imaging Charter or Imaging Manual. Tumor-to-background ratio values will be summarized separately at each protocol-specified imaging time point.
Time frame: From SKL35502 administration through 144 hours after administration.
Number of Participants With at Least One SKL35502-Positive RECIST Version 1.1 Measurable Tumor Lesion
The number of participants with at least one anatomically matched RECIST Version 1.1 measurable tumor lesion demonstrating focal SKL35502 uptake above the Imaging Charter-defined background region will be reported. Positivity will be assessed by a qualified nuclear medicine physician or radiologist using the protocol-defined visual and quantitative imaging criteria.
Time frame: From SKL35502 administration through 144 hours after administration.
SKL35502 Imaging Time Point Selected for Tumor Eligibility Assessment
The imaging time point selected for tumor eligibility assessment will be determined based on integrated review of tumor visualization, tumor-to-background ratio, normal-tissue uptake, image quality, biodistribution, and operational feasibility. One selected imaging time point will be reported as the number of hours after SKL35502 administration.
Time frame: At completion of the Part A SKL35502 imaging review following collection of imaging data through 144 hours after administration.
Percentage of Participants With Complete Response, Partial Response, or Stable Disease Lasting at Least 4 Months Following SKL35501 Treatment
The percentage of efficacy-evaluable participants whose best overall response is complete response or partial response, or whose stable disease lasts for at least 4 months, will be reported. Tumor response will be assessed by the Investigator according to RECIST Version 1.1 and, where applicable, RANO-BM for brain metastases.
Time frame: Tumor assessments will be performed every 8 weeks during the first 6 months and every 12 weeks thereafter, up to 12 months after the last participant's first SKL35501 dose.
Objective Response Rate Following SKL35501 Treatment
Objective response rate is the percentage of efficacy-evaluable participants whose best overall response is complete response or partial response, as assessed by the Investigator according to RECIST Version 1.1 and, where applicable, RANO-BM for brain metastases.
Time frame: Tumor assessments will be performed every 8 weeks during the first 6 months and every 12 weeks thereafter, up to 12 months after the last participant's first SKL35501 dose.
Clinical Benefit Rate Following SKL35501 Treatment
Clinical benefit rate is the percentage of efficacy-evaluable participants whose best overall response is complete response, partial response, or stable disease, as assessed by the Investigator according to RECIST Version 1.1 and, where applicable, RANO-BM for brain metastases.
Time frame: Tumor assessments will be performed every 8 weeks during the first 6 months and every 12 weeks thereafter, up to 12 months after the last participant's first SKL35501 dose.
Progression-Free Survival Following SKL35501 Treatment
Progression-free survival is defined as the time from the first administration of SKL35501 to the first documented disease progression, as determined by the Investigator according to RECIST Version 1.1 and, where applicable, RANO-BM for brain metastases, or death from any cause, whichever occurs first.
Time frame: From the first SKL35501 dose until documented disease progression, death, or completion of protocol-defined efficacy follow-up, up to 12 months after the last participant's first SKL35501 dose.
Time to Disease Progression Following SKL35501 Treatment
Time to disease progression is defined as the time from the first administration of SKL35501 to the first documented disease progression, as determined by the Investigator according to RECIST Version 1.1 and, where applicable, RANO-BM for brain metastases.
Time frame: From the first SKL35501 dose until documented disease progression or completion of protocol-defined efficacy follow-up, up to 12 months after the last participant's first SKL35501 dose.
Overall Survival Following SKL35501 Treatment
Overall survival is defined as the time from the first administration of SKL35501 to death from any cause.
Time frame: From the first SKL35501 dose until death, loss to follow-up, withdrawal of consent, or completion of protocol-defined survival follow-up, up to 12 months after the last participant's first SKL35501 dose.
Number of Participants With Grade 3 or Higher Treatment-Emergent Adverse Events Following SKL35502 Administration
The number of participants with at least one Grade 3 or higher treatment-emergent adverse event following administration of SKL35502 will be reported. Severity will be assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 6.0. Each participant will be counted once regardless of the number of events experienced.
Time frame: From the first administration of SKL35502 until initiation of SKL35501, 15 days after the last administration of SKL35502, or initiation of a new antitumor therapy, whichever occurs first.
Number of Participants With Serious Adverse Events Following SKL35502 Administration
The number of participants with at least one serious adverse event following administration of SKL35502 will be reported. Each participant will be counted once regardless of the number of serious adverse events experienced.
Time frame: From the first administration of SKL35502 until initiation of SKL35501, 15 days after the last administration of SKL35502, or initiation of a new antitumor therapy, whichever occurs first.
Number of Participants With Adverse Events of Special Interest Following SKL35502 Administration
The number of participants with at least one protocol-defined adverse event of special interest following administration of SKL35502 will be reported. Each participant will be counted once regardless of the number of adverse events of special interest experienced.
Time frame: From the first administration of SKL35502 until initiation of SKL35501, 15 days after the last administration of SKL35502, or initiation of a new antitumor therapy, whichever occurs first.
Number of Participants With Clinically Significant 12-Lead Electrocardiogram Abnormalities Following SKL35502 Administration
The number of participants with at least one clinically significant abnormality or clinically significant change from baseline in heart rate, cardiac rhythm, PR interval, QRS duration, QT interval, or QT interval corrected using Fridericia's formula will be reported. Clinical significance will be determined by the Investigator. Each participant will be counted once for this outcome.
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Time frame: From baseline until initiation of SKL35501, 15 days after the last administration of SKL35502, or initiation of a new antitumor therapy, whichever occurs first.
Number of Participants With Clinically Significant Vital-Sign Abnormalities Following SKL35502 Administration
The number of participants with at least one protocol-defined clinically significant vital-sign abnormality or clinically significant change from baseline following SKL35502 administration will be reported. Each participant will be counted once regardless of the number of vital-sign abnormalities experienced.
Time frame: From baseline until initiation of SKL35501, 15 days after the last administration of SKL35502, or initiation of a new antitumor therapy, whichever occurs first.
Number of Participants With Clinically Significant Physical Examination Findings Following SKL35502 Administration
The number of participants with at least one clinically significant new or worsened physical examination finding following SKL35502 administration will be reported. Clinical significance will be determined by the Investigator. Each participant will be counted once for this outcome.
Time frame: From baseline until initiation of SKL35501, 15 days after the last administration of SKL35502, or initiation of a new antitumor therapy, whichever occurs first.
Number of Participants With Clinically Significant Safety Laboratory Abnormalities Following SKL35502 Administration
The number of participants with at least one clinically significant hematology or clinical chemistry laboratory abnormality or clinically significant change from baseline following SKL35502 administration will be reported. Laboratory abnormalities will be graded using the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 6.0, where applicable. Each participant will be counted once for this outcome.
Time frame: From baseline until initiation of SKL35501, 15 days after the last administration of SKL35502, or initiation of a new antitumor therapy, whichever occurs first.
Total Radioactivity Concentration in Whole Blood Following SKL35502 Administration
Total radioactivity concentration in whole blood will be measured and summarized separately at each protocol-specified collection time following SKL35502 administration.
Time frame: From predose through 144 hours after SKL35502 administration.
Total Radioactivity Concentration in Plasma Following SKL35502 Administration
Total radioactivity concentration in plasma will be measured and summarized separately at each protocol-specified collection time following SKL35502 administration.
Time frame: From predose through 144 hours after SKL35502 administration.
Total Radioactivity Concentration in Urine Following SKL35502 Administration
Total radioactivity concentration in urine will be measured and summarized separately for each protocol-specified urine collection interval following SKL35502 administration.
Time frame: From predose through 72 hours after SKL35502 administration.
Correlation Coefficient Between SKL35502 Tumor-to-Background Ratio and Tumor NTSR1 Expression
SKL35502 tumor uptake will be represented by the tumor-to-background ratio for an evaluable tumor lesion. Tumor NTSR1 expression will be represented by the protocol-specified quantitative result obtained from corresponding tumor tissue when available. One protocol-specified correlation coefficient describing the association between tumor-to-background ratio and tumor NTSR1 expression will be reported.
Time frame: After completion of the corresponding tumor tissue assessment and SKL35502 imaging assessments, with imaging performed through 144 hours after SKL35502 administration.
Number of Participants With Treatment-Emergent Adverse Events Following SKL35501 Administration
The number of participants with at least one treatment-emergent adverse event following administration of SKL35501 will be reported. A treatment-emergent adverse event is an adverse event that begins or worsens after the first administration of SKL35501. Severity will be assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 6.0. Each participant will be counted once for this outcome. Results will be summarized by applicable Part A dose cohort and Part B dose group, including participants treated at the biologically active dose range.
Time frame: From the first administration of SKL35501 through 50 days after the last administration of SKL35501 or initiation of a new antitumor therapy, whichever occurs first.
Number of Participants With Grade 3 or Higher Treatment-Emergent Adverse Events Following SKL35501 Administration
The number of participants with at least one Grade 3 or higher treatment-emergent adverse event following administration of SKL35501 will be reported. Severity will be assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 6.0. Each participant will be counted once regardless of the number of events experienced.
Time frame: From the first administration of SKL35501 through 50 days after the last administration of SKL35501 or initiation of a new antitumor therapy, whichever occurs first.
Number of Participants With Serious Adverse Events Following SKL35501 Administration
The number of participants with at least one serious adverse event following administration of SKL35501 will be reported. Each participant will be counted once regardless of the number of serious adverse events experienced.
Time frame: From the first administration of SKL35501 through 50 days after the last administration of SKL35501 or initiation of a new antitumor therapy, whichever occurs first.
Number of Participants With Adverse Events of Special Interest Following SKL35501 Administration
The number of participants with at least one protocol-defined adverse event of special interest following administration of SKL35501 will be reported. Each participant will be counted once regardless of the number of adverse events of special interest experienced.
Time frame: From the first administration of SKL35501 through 50 days after the last administration of SKL35501 or initiation of a new antitumor therapy, whichever occurs first.
Number of Participants With Clinically Significant 12-Lead Electrocardiogram Abnormalities Following SKL35501 Administration
The number of participants with at least one clinically significant abnormality or clinically significant change from baseline in heart rate, cardiac rhythm, PR interval, QRS duration, QT interval, or QT interval corrected using Fridericia's formula will be reported. Clinical significance will be determined by the Investigator. Each participant will be counted once for this outcome.
Time frame: From baseline through 50 days after the last administration of SKL35501 or initiation of a new antitumor therapy, whichever occurs first.
Number of Participants With Clinically Significant Vital-Sign Abnormalities Following SKL35501 Administration
The number of participants with at least one protocol-defined clinically significant vital-sign abnormality or clinically significant change from baseline following SKL35501 administration will be reported. Each participant will be counted once regardless of the number of vital-sign abnormalities experienced.
Time frame: From baseline through 50 days after the last administration of SKL35501 or initiation of a new antitumor therapy, whichever occurs first.
Number of Participants With Clinically Significant Physical Examination Findings Following SKL35501 Administration
The number of participants with at least one clinically significant new or worsened physical examination finding following SKL35501 administration will be reported. Clinical significance will be determined by the Investigator. Each participant will be counted once for this outcome.
Time frame: From baseline through 50 days after the last administration of SKL35501 or initiation of a new antitumor therapy, whichever occurs first.
Number of Participants With Clinically Significant Safety Laboratory Abnormalities Following SKL35501 Administration
The number of participants with at least one clinically significant hematology or clinical chemistry laboratory abnormality or clinically significant change from baseline following SKL35501 administration will be reported. Laboratory abnormalities will be graded using the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 6.0, where applicable. Each participant will be counted once for this outcome.
Time frame: From baseline through 50 days after the last administration of SKL35501 or initiation of a new antitumor therapy, whichever occurs first.
Total Radioactivity Concentration in Whole Blood Following SKL35501 Administration
Total radioactivity concentration in whole blood will be measured and summarized separately at each protocol-specified collection time following SKL35501 administration.
Time frame: From predose through 168 hours after SKL35501 administration in Cycles 1 and 3, with additional samples collected on Day 1 of Cycles 2 and 4. Each treatment cycle is 6 weeks.
Total Radioactivity Concentration in Plasma Following SKL35501 Administration
Total radioactivity concentration in plasma will be measured and summarized separately at each protocol-specified collection time following SKL35501 administration.
Time frame: From predose through 168 hours after SKL35501 administration in Cycles 1 and 3, with additional samples collected on Day 1 of Cycles 2 and 4. Each treatment cycle is 6 weeks.
Total Radioactivity Concentration in Urine Following SKL35501 Administration
Total radioactivity concentration in urine will be measured and summarized separately for each protocol-specified urine collection interval following the Cycle 1 administration of SKL35501.
Time frame: From predose through 72 hours after the Cycle 1 SKL35501 dose. Cycle 1 is 6 weeks.
Duration of Response Following SKL35501 Treatment
For participants whose best overall response is complete response or partial response, duration of response is defined as the time from the first documented complete response or partial response to the first documented disease progression, as determined by the Investigator according to RECIST Version 1.1 and, where applicable, RANO-BM for brain metastases, or death from any cause, whichever occurs first.
Time frame: From the first documented complete response or partial response until documented disease progression, death, or completion of protocol-defined efficacy follow-up, up to 12 months after the last participant's first SKL35501 dose.
Absorbed Radiation Dose to Prespecified Normal Organs Following SKL35501 Administration
Absorbed radiation dose will be estimated for each prespecified normal organ, including high-uptake and critical tissues such as the kidneys, liver, red marrow, and spleen, using serial imaging, organ time-activity data, and protocol-defined dosimetry methods. Organ-specific values will be reported separately using the same protocol-defined absorbed-dose unit.
Time frame: From the first SKL35501 dose through 168 hours after SKL35501 administration in Cycles 1 and 3. Each treatment cycle is 6 weeks.
Absorbed Radiation Dose to Evaluable Tumor Lesions Following SKL35501 Administration
Absorbed radiation dose will be estimated for each evaluable tumor lesion using serial imaging, lesion time-activity data, and protocol-defined dosimetry methods. Lesion-specific absorbed-dose values will be reported separately using the same protocol-defined absorbed-dose unit.
Time frame: From the first SKL35501 dose through 168 hours after SKL35501 administration in Cycles 1 and 3. Each treatment cycle is 6 weeks.
Cumulative Absorbed Radiation Dose to Prespecified Normal Organs Across SKL35501 Treatment Cycles
The cumulative absorbed radiation dose to each prespecified normal organ will be estimated across all SKL35501 treatment cycles received by the participant using protocol-defined dosimetry methods. Organ-specific cumulative absorbed-dose values will be reported separately using the same protocol-defined absorbed-dose unit.
Time frame: From the first SKL35501 dose through completion of up to 4 treatment cycles, up to approximately 24 weeks. Each treatment cycle is 6 weeks.
Maximum Absorbed Radiation Dose Among Prespecified Normal Organs Following SKL35501 Administration
For each evaluable participant, the highest absorbed radiation dose among the prespecified normal organs will be determined from the organ-specific dosimetry results. One maximum normal-organ absorbed-dose value will be reported for each participant using the protocol-defined absorbed-dose unit.
Time frame: From the first SKL35501 dose through completion of dosimetry assessments in Cycles 1 and 3, with serial imaging through 168 hours after each dose. Each treatment cycle is 6 weeks.