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Monoclonal Antibodies
Pembrolizumab + Liver-Directed/PRRT for Liver Cancer
Phase 2
Waitlist Available
Research Sponsored by Nicholas Fidelman, MD
Eligibility Criteria Checklist
Specific guidelines that determine who can or cannot participate in a clinical trial Must have
Be >= 18 years of age on day of signing informed consent
Have a histologically proven well-differentiated neuroendocrine tumor (WHO grade 1, grade 2, or morphologically and/or clinically well-differentiated grade 3) of any primary site, including unknown primary site
Must not have
Has known active untreated Hepatitis B
Has had prior peptide receptor radionuclide therapy (group 1 only)
Timeline
Screening 3 weeks
Treatment Varies
Follow Up up to 3 years
Awards & highlights
No Placebo-Only Group
Summary
This trial tests a combination of pembrolizumab and liver-targeted treatments or PRRT for patients with specific liver-spread neuroendocrine tumors. The treatments aim to boost the immune system and directly attack tumors. It focuses on patients whose tumors are difficult to treat with standard methods. Everolimus has demonstrated effectiveness in neuroendocrine neoplasms and has shown a synergistic effect with radiation therapy.
Who is the study for?
This trial is for adults with well-differentiated neuroendocrine tumors that have spread to the liver. Participants must show tumor progression, have a life expectancy over 3 months, and adequate organ function. They should not be pregnant or breastfeeding and agree to use contraception. Exclusions include severe liver involvement by the tumor, active infections, certain medical treatments within specific timeframes before the trial starts, and known allergies to pembrolizumab.
What is being tested?
The effectiveness of combining pembrolizumab (an immunotherapy drug) with either liver-directed therapies (like arterial embolization or radioembolization using Yttrium-90) or peptide receptor radionuclide therapy using 177Lu-DOTA0-Tyr3-Octreotate is being tested in patients with neuroendocrine tumors and liver metastases. The goal is to see if this combination works better than pembrolizumab alone.
What are the potential side effects?
Potential side effects may include immune-related reactions affecting organs, infusion-related symptoms like fever or chills, fatigue, changes in blood counts leading to increased infection risk or bleeding problems. Liver-directed therapies can cause abdominal pain or changes in liver function tests.
Eligibility Criteria
Inclusion Criteria
You may be eligible if you check “Yes” for the criteria belowSelect...
I am 18 years old or older.
Select...
I have a well-differentiated neuroendocrine tumor.
Select...
My tumor is grade 2 or 3, has a Ki-67 index over 10%, and shows somatostatin receptor expression.
Select...
My cancer has grown or spread in the last year.
Select...
I am fully active or restricted in physically strenuous activity but can do light work.
Select...
My blood counts and organ functions are within the required ranges.
Exclusion Criteria
You may be eligible for the trial if you check “No” for criteria below:Select...
I have active, untreated Hepatitis B.
Select...
I have had peptide receptor radionuclide therapy before.
Select...
I've had a procedure on my bile duct that affected the Ampulla of Vater or required a connection between my bile duct and intestines.
Select...
More than 75% of my liver is affected by cancer.
Select...
I have an immune system disorder or have been on steroids or other immune-weakening medicines in the last week.
Select...
I have an active Tuberculosis infection.
Select...
I am currently being treated for an infection.
Select...
I haven't had any cancer treatment with monoclonal antibodies in the last 4 weeks or have recovered from their side effects.
Select...
I have cancer that has spread to my brain or spinal cord.
Select...
I have liver fibrosis confirmed by tests or scans.
Select...
I have been treated with drugs targeting PD-1, PD-L1, or PD-L2.
Select...
I have been diagnosed with HIV.
Select...
I have been treated for an autoimmune disease in the last 2 years.
Timeline
Screening ~ 3 weeks3 visits
Treatment ~ Varies
Follow Up ~ up to 3 years
Screening ~ 3 weeks
Treatment ~ Varies
Follow Up ~up to 3 years
Treatment Details
Study Objectives
Study objectives can provide a clearer picture of what you can expect from a treatment.Primary study objectives
Number of treatment-related adverse events (Group 1)
Proportion of participants with an overall response
Secondary study objectives
Duration of response (DOR)
Immune-related progression free survival (irPFS)
Median Progression free survival (PFS)
+1 moreSide effects data
From 2024 Phase 3 trial • 804 Patients • NCT0304099964%
Radiation skin injury
63%
Stomatitis
58%
Anaemia
56%
Nausea
48%
Dry mouth
45%
Constipation
45%
Weight decreased
44%
Dysphagia
42%
Neutrophil count decreased
33%
Dysgeusia
33%
Vomiting
32%
Fatigue
31%
White blood cell count decreased
28%
Hypomagnesaemia
26%
Decreased appetite
25%
Hypothyroidism
25%
Hypokalaemia
24%
Lymphocyte count decreased
24%
Platelet count decreased
23%
Oropharyngeal pain
23%
Blood creatinine increased
22%
Diarrhoea
22%
Odynophagia
20%
Hypoacusis
20%
Alanine aminotransferase increased
20%
Hyponatraemia
19%
Tinnitus
19%
Oral candidiasis
19%
Asthenia
16%
Pyrexia
16%
Cough
15%
Aspartate aminotransferase increased
15%
Rash
14%
Insomnia
13%
Acute kidney injury
13%
Pharyngeal inflammation
13%
Pruritus
12%
Dysphonia
12%
Gamma-glutamyltransferase increased
11%
Pneumonia
11%
Dehydration
10%
Hyperthyroidism
10%
Hypoalbuminaemia
10%
Hypocalcaemia
10%
Headache
10%
Productive cough
9%
Neck pain
9%
Peripheral sensory neuropathy
8%
Gastrooesophageal reflux disease
8%
Hiccups
8%
Hyperglycaemia
8%
Hyperuricaemia
8%
Dizziness
8%
Hypophosphataemia
7%
Urinary tract infection
7%
Ear pain
7%
Localised oedema
7%
Hyperkalaemia
7%
Erythema
7%
Oral pain
6%
Abdominal pain upper
6%
Arthralgia
6%
Anxiety
6%
Febrile neutropenia
6%
Dyspepsia
6%
Saliva altered
5%
Back pain
5%
Oedema peripheral
5%
Hypertension
5%
Dyspnoea
4%
Nasopharyngitis
4%
Alopecia
4%
Dry skin
3%
Sepsis
3%
Pneumonia aspiration
3%
Trismus
3%
Pneumonitis
3%
Laryngeal oedema
2%
Malnutrition
2%
Pharyngeal haemorrhage
2%
Cellulitis
1%
Septic shock
1%
Systemic infection
1%
Clostridium difficile colitis
1%
Cardiac arrest
1%
Death
1%
Bronchitis
1%
Hepatitis
1%
Immune-mediated hepatitis
1%
Oesophagitis
1%
General physical health deterioration
1%
Hypophagia
1%
Tumour haemorrhage
1%
Cerebrovascular accident
1%
Syncope
1%
Acute respiratory failure
1%
Aspiration
1%
Colitis
1%
Mouth haemorrhage
1%
Hypersensitivity
1%
Acute myocardial infarction
1%
Abscess neck
1%
Device related infection
1%
Stoma site infection
1%
Vascular device infection
1%
Wound infection
1%
Hypercalcaemia
1%
Pulmonary embolism
1%
Respiratory failure
100%
80%
60%
40%
20%
0%
Study treatment Arm
Pembrolizumab + CRT Followed by Pembrolizumab
Placebo + CRT Followed by Placebo
Awards & Highlights
No Placebo-Only Group
All patients enrolled in this study will receive some form of active treatment.
Trial Design
3Treatment groups
Experimental Treatment
Group I: Group III [pembrolizumab, yttrium-90 microsphere RE] (CLOSED)Experimental Treatment2 Interventions
Patients receive pembrolizumab as in Group I. Patients with any number of liver lesions, largest measuring more than 5 cm, who have \< 75% liver parenchyma replacement by tumors, undergo yttrium-90 microsphere Radio Embolization (RE) 3-15 days following the first dose of pembrolizumab.
Group II: Group II [pembrolizumab, TAE] (CLOSED)Experimental Treatment2 Interventions
Patients receive pembrolizumab as in Group I. Patients with any number of liver lesions, largest being no larger than 5 cm, who have \< 75% liver parenchyma replacement by tumors, undergo Arterial Embolization (TAE) over 2-3 hours, 3-7 days following the first dose of pembrolizumab.
Group III: Group I [pembrolizumab, 177Lu DOTATATE]Experimental Treatment2 Interventions
Patients will be treated with pembrolizumab and intravenous peptide receptor radionuclide therapy (PRRT) using 177Lu-DOTA0-Tyr3-Octreotate (177Lu-DOTATATE, Lutathera®) for up to four (4) sessions. Patients with somatostatin receptor positive (SSTR+) tumors with Ki-67 index \> 20% (well-differentiated grade 3) and any number of liver and/or extrahepatic lesions with liver parenchyma replacement by tumor \< 75%. Patients who achieve progressive or stable disease response after cycle 4 may receive an additional 4 cycles of pembrolizumab and lutetium Lu-177 DOTATATE in the absence of disease progression or unacceptable toxicity and pembrolizumab for up to 35 cycles.
Treatment
First Studied
Drug Approval Stage
How many patients have taken this drug
Arterial Embolization
2016
Completed Phase 2
~10
Pembrolizumab
2017
Completed Phase 3
~3130
Research Highlights
Information in this section is not a recommendation. We encourage patients to speak with their healthcare team when evaluating any treatment decision.Mechanism Of Action
Side Effect Profile
Prior Approvals
Other Research
Neuroendocrine Tumors (NETs) are commonly treated with somatostatin analogs like lanreotide, which inhibit hormone secretion and tumor growth, and peptide receptor radionuclide therapy (PRRT), which delivers targeted radiation to tumor cells. Immunotherapy, such as pembrolizumab, uses monoclonal antibodies to enhance the body's immune response against cancer cells by blocking the PD-1/PD-L1 pathway, allowing T-cells to attack tumors more effectively.
This is particularly important for NET patients as it offers a targeted approach that can potentially improve outcomes in cases where traditional therapies are less effective.
Inclusion body myositis: update.
Inclusion body myositis: update.
Find a Location
Who is running the clinical trial?
BTG International Inc.OTHER
42 Previous Clinical Trials
3,025 Total Patients Enrolled
1 Trials studying Neuroendocrine Tumors
Nicholas Fidelman, MDLead Sponsor
1 Previous Clinical Trials
42 Total Patients Enrolled
1 Trials studying Neuroendocrine Tumors
42 Patients Enrolled for Neuroendocrine Tumors
Merck Sharp & Dohme LLCIndustry Sponsor
4,032 Previous Clinical Trials
5,189,684 Total Patients Enrolled
12 Trials studying Neuroendocrine Tumors
2,160 Patients Enrolled for Neuroendocrine Tumors
Media Library
Eligibility Criteria:
This trial includes the following eligibility criteria:- I have active, untreated Hepatitis B.I have not received a live vaccine within the last 30 days.I am using two birth control methods or am not having sex to join this study.I am 18 years old or older.I have a well-differentiated neuroendocrine tumor.My tumor is grade 2 or 3, has a Ki-67 index over 10%, and shows somatostatin receptor expression.My cancer has grown or spread in the last year.I am fully active or restricted in physically strenuous activity but can do light work.I have had peptide receptor radionuclide therapy before.I've had a procedure on my bile duct that affected the Ampulla of Vater or required a connection between my bile duct and intestines.More than 75% of my liver is affected by cancer.I have an immune system disorder or have been on steroids or other immune-weakening medicines in the last week.I have an active Tuberculosis infection.I am currently being treated for an infection.I haven't had any cancer treatment with monoclonal antibodies in the last 4 weeks or have recovered from their side effects.I haven't had cancer treatment in the last 2 weeks or I've recovered from its side effects.I have cancer that has spread to my brain or spinal cord.I have liver fibrosis confirmed by tests or scans.I have been treated with drugs targeting PD-1, PD-L1, or PD-L2.I have been diagnosed with HIV.My blood counts and organ functions are within the required ranges.I have been treated for an autoimmune disease in the last 2 years.I have undergone treatments like thermal ablation or radiation within the last 30 days.I agree to use or continue using contraception or practice abstinence for 120 days after my last treatment dose.
Research Study Groups:
This trial has the following groups:- Group 1: Group I [pembrolizumab, 177Lu DOTATATE]
- Group 2: Group II [pembrolizumab, TAE] (CLOSED)
- Group 3: Group III [pembrolizumab, yttrium-90 microsphere RE] (CLOSED)
Awards:
This trial has 1 awards, including:- No Placebo-Only Group - All patients enrolled in this study will receive some form of active treatment.
Timeline:
This trial has the following timeline:- Screening: It may take up to 3 Weeks to process to see if you qualify in this trial.
- Treatment: The duration you will receive the treatment varies.
- Follow Ups: You may be asked to continue sharing information regarding the trial for 6 Months after you stop receiving the treatment.