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This clinical trial is a single-center, open-label, non-randomized, first-in-human (FIH), dose-escalation study evaluating the safety, tolerability, and preliminary efficacy of 177Lu-DOTA-SNA040 in patients with advanced Claudin18.2-positive solid tumors (e.g., gastric cancer, gastroesophageal junction adenocarcinoma, pancreatic cancer, cholangiocarcinoma, etc.) who have disease progression following first-line therapy.
Eligible subjects should first undergo 68Ga-NODAGA-SNA014 PET/CT imaging. Patients with negative 68Ga-NODAGA-SNA014 tumor uptake will be discharged from the study after one week of follow-up for adverse events. Patients with positive 68Ga-NODAGA-SNA014 tumor uptake (SUVmax ≥10) will proceed to the subsequent 177Lu-DOTA-SNA040 dose escalation study (with at least a 2-day interval between 68Ga-NODAGA-SNA014 imaging and 177Lu-DOTA-SNA040 treatment). After completing the first cycle of dosing for DLT observation, subsequent 2-6 cycles of 177Lu-DOTA-SNA040 treatment may be administered. For dose group 1, the subsequent 2-6 cycles of 177Lu-DOTA-SNA040 dosing activity will be determined by the investigator, with the dose per cycle adjustable. For dose groups 2-4, the 177Lu-DOTA-SNA040 dosing activity will follow the fixed original dose (e.g., the first cycle dose for dose group 2 is 100 mCi, with subsequent 2-6 cycles fixed at 100 mCi).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group 1 | Experimental | 30~70mCi |
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| Group 2 | Experimental | 100mCi |
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| Group 3 | Experimental | 150mCi |
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| Group 4 | Experimental | 200mCi |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| 177Lu-DOTA-SNA040 | Drug | 177Lu-DOTA-SNA040 administration |
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| Measure | Description | Time Frame |
|---|---|---|
| Dose-limiting toxicity(DLT) of the single dose | Occurance of DLT in the first cycle of each group | 4 to 6weeks |
| The safety and tolerance of 177Lu-DOTA-SNA040 | The occurance and stage of AE and SAE according to CTCAE | 4 to 6 weeks |
| The safety and tolerance of 177Lu-DOTA-SNA040 | The rates of abnormal laborotary tests after administration | 4 to 6 weeks |
| The safety and tolerance of 177Lu-DOTA-SNA040 | The rates of abnormal vital signs after administration | 4 to 6 weeks |
| The safety and tolerance of 177Lu-DOTA-SNA040 | The rates of abnormal physical examination after administration | 4 to 6 weeks |
| The safety and tolerance of 177Lu-DOTA-SNA040 | The rates of abnormal 12-lead ECG after administration | 4 to 6 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| The biodistribution of SNA040 | Absorbed dose in major organs throughout the body (red bone marrow, kidneys, liver, intestines, etc.) | 1 week |
| The tumor uptake of SNA040 | SUVmax and SUVmean of tumor |
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Inclusion Criteria:
7. At least one lesion must be immunohistochemistry positive for Claudin18.2 (≥ 20% of tumor cells have Claudin18.2 immunohistochemistry membrane staining intensity ≥ 2+); Before the first administration of 177Lu-DOTA-SNA040 treatment, the toxicity caused by previous treatments must be restored to ≤ level 2 (CTCAE V5.0) or a stable state evaluated by the researcher (excluding hair loss and pigmentation); 177Lu DOTA-SNA040 has sufficient organ function one week before treatment, defined as follows:
Bone marrow:
White blood cell count range from 3.0 to 10.0 × 10^9/L Absolute neutrophil count range from 1.5 to 7.0 × 10^9/L Platelets range from 75 to 300 × 10^9/L Hemoglobin ≥ 90g/L
Liver:
Total bilirubin ≤ 2.5 x upper limit of normal (ULN) Serum albumin>3.0 g/dL Alanine aminotransferase and aspartate aminotransferase ≤ 3 × ULN or liver metastasis patients ≤ 5 × ULN
Kidney:
Serum/plasma creatinine ≤ 1.5 × ULN or creatinine clearance rate ≥ 60 mL/min (calculated using the Cockcroft Gault formula)
Coagulation function The international standardized ratio of prothrombin is less than 1.5 × ULN Prothrombin time<2 × ULN During the treatment with 177Lu-DOTA-SNA040, the best support/standard of care agreed upon by the researcher is allowed; 11. Patients and/or partners with fertility must use adequate contraceptive measures during the study period and within 6 months after the last administration of the study drug.
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| shaoli song, doctor | Contact | 0512-67229125 | mengru.wu@smartnucl.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Fudan University Shanghai Cancer Center | Recruiting | Shanghai | Shanghai Municipality | 200000 | China |
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| 1 week |
| The tumor uptake of SNA040 | The retention time of tumor | 1 week |
| The tumor uptake of SNA040 | The ID% of tumor | 1 week |
| To evaluate the radiological characteristics 177Lu-DOTA-SNA040 | Rradiation doses in whole blood, serum, urine measured using a gamma counter | 1 week |
| The pharmacokinetic of the SNA040 protein | Peak plasma concentration (Cmax) of the SNA040 | 1 week |
| The pharmacokinetic of the SNA040 protein | Area under the concentration-time curve (AUC) of the SNA040 | 1 week |
| The pharmacokinetic of the SNA040 protein | Clearance (CL) of the SNA040 | 1 week |
| Assessment of the immunogenicity of SNA040 | Occurance of positive immunogenicity test | 1 week |
| Assessing tumour response according to RECIST1.1 | The DCR of tumors | 4 to 6 weeks |
| Assessing tumour response according to RECIST1.1 | The ORR of tumors | 4 to 6 weeks |
| Assessing tumour response according to RECIST1.1 | The DOR of tumors | 4 to 6 weeks |
| Explore the PFS of subjects | PFS according to the RECIST1.1 | 2 years |
| Explore the OS of subjects | Overall survival (OS) according to the RECIST1.1 | 2 years |
| the correlation between the clinical efficacy of SNA040 and Claudin18.2 expression | the correlation between overall response and Immunohistochemistry expression of Claudin18.2 | 2 years |