Natural History and Management of Von Hippel-Lindau (VHL) Associated Pancreatic Neuroendocrine Tumors

• ClinicalTrials.gov Identifier: NCT04074135
• Recruitment Status: Recruiting
• First Posted: August 29, 2019
• Last Update Posted: September 18, 2023
• Sponsor: National Cancer Institute (NCI)
• Information provided by (Responsible Party): National Institutes of Health Clinical Center (CC) ( National Cancer Institute (NCI) )

Study Description

Brief Summary:

Background:

People with von Hippel-Lindau (VHL) can have problems with a variety of organs, such as the pancreas. The disease can cause tumors of the pancreas. This can result in life-threatening complications. Researchers want to learn more about these pancreatic tumors and how to better detect them. This may help them design better future treatment and care for people with VHL disease.

Objective:

To better understand VHL disease that affects the pancreas and to test whether adding a certain type of scan (68-Gallium DOTATATE PET/CT) can further detect tumors.

Eligibility:

People ages 12 and older with VHL that causes tumors and cysts to grow in the pancreas

Design:

Participants will be screened with their medical records and imaging studies.

Participants will have an initial evaluation:

Participants will have their body examined by different doctors. This will depend on what types of symptoms they have.

Participants will have blood and urine tests

Participants will have images made of their body using one or more machines: They made have a CT or PET/CT scan in which they lie on a table that moves through a big ring. They may have an MRI in which they lie on a table that moves into a big tube. They may have an ultrasound that uses a small stick that produces sound waves to look at the body.

After the first visit, participants will be asked to return to the NIH. Some of the tests performed at the first visit will be repeated. Depending on their disease status, visits will be once a year or every 2 years for life.

Condition or disease	Intervention/treatment	Phase
VHL Pancreatic Neuroendocrine Tumors; Von Hippel-Lindau Disease; Neuroendocrine Tumors	Drug: 68-Gallium DOTATATE	Phase 2

Detailed Description:

Background:

• Patients with the von Hippel-Lindau (VHL) familial cancer syndrome demonstrate manifestations in a variety of organs, including the pancreas. Pancreatic manifestations can range from benign cysts and micro cystic adenomas to neuroendocrine tumors of the pancreas which are capable of regional and distant metastases. These neuroendocrine tumors can result in life-threatening complications.
• This protocol is designed to identify VHL patients with pancreatic manifestations and to follow these patients with serial imaging studies, germ line genetic analysis, discovery of serum biomarkers, and novel imaging modalities such as 68-Gallium DOTATATE PET/CT scan.

Objective:

- To comprehensively and longitudinally evaluate the natural history of patients with VHL pancreatic neuroendocrine tumors and cystic lesions, estimating and defining their clinical spectrum.

Eligibility:

- Patients greater than or equal to 12 years of age diagnosed with VHL.

Design:

• Demographic data will be collected from the medical record and patient interview for each patient participant. Data will be securely stored in a computerized database.
• Patients will be evaluated by the urology, neurosurgery, brain oncology and/or ophthalmology personnel as indicated to rule out or manage other manifestations of VHL such as hemangioblastoma, renal cell cancer, and pheochromocytoma.
• Anatomical and functional clinical imaging studies, research blood and urine sample collection will be performed at each scheduled visit. Research 68-Gallium DOTATATE PET/CT imaging studies in adult subjects will be performed, no more than once per year.
• Surgical resection of solid lesions of the pancreas will be recommended based on previously published criteria.
• Based on our analysis of likelihood of tumor growth or risk of metastasis, data will be analyzed every two years and appropriate revisions will be made to the surgical management guidelines, if indicated by data analysis.
• Projected accrual will be 40 patients per year for a total of 15 years. Considering some patients may have a screen failure, we anticipate accruing of 740 patients on this protocol.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 740 participants
• Allocation: Non-Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Diagnostic
• Official Title: Evaluation of the Natural History and Management of Von Hippel-Lindau (VHL) Associated Pancreatic Neuroendocrine Tumors
• Actual Study Start Date: June 2, 2020
• Estimated Primary Completion Date: January 30, 2036
• Estimated Study Completion Date: July 1, 2036

Arms and Interventions

Arm	Intervention/treatment
Experimental: 1/ Arm 1; Study natural history of VHL pancreatic neuroendocrine tumors with yearly 68-Gallium DOTATATE PET/CT research scans.	Drug: 68-Gallium DOTATATE; 68-Gallium DOTATATE, to be used in yearly PET/CT research scans
No Intervention: 2/ Arm 2; Study natural history of VHL pancreatic neuroendocrine tumors without research scans.

Outcome Measures

Primary Outcome Measures :

1. Characterization of the natural and clinical histories of VHL pancreatic neuroendocrine tumors and cystic lesions [ Time Frame: 15 years ]
   Characterization of the natural and clinical histories of VHL pancreatic neuroendocrine tumors and cystic lesions

Secondary Outcome Measures :

1. predictive value of 68-Gallium DOTATATE PET/CT imaging in patient population [ Time Frame: at each scheduled visit ]
   mean uptake between these two groups of adult patients in which per patient uptake is defined as the average uptake of multiple lesions detected in each patient
2. growth rate in solid pancreatic tumors [ Time Frame: at each scheduled visit ]
   graded tumor biopsy
3. distribution of time from initial presentation with pancreatic tumors to the time that surgery is recommended [ Time Frame: at each scheduled visit, until surgery is recommended ]
   median amount of time from initial presentation with pancreatic tumors to the time that surgery is recommended

Eligibility Criteria

• Ages Eligible for Study: 12 Years and older (Child, Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

• INCLUSION CRITIERIA:

  1. Subjects who have been diagnosed with VHL using the following criteria:

     -- Identification of a heterozygous germline pathogenic variant in VHL by molecular genetic testing.

     or

     -- Clinical criteria

  2. Subjects with at least 1 pancreatic manifestation of VHL as documented on any non-invasive imaging study. These manifestations may include:

     • Pancreatic cyst(s)
     • Solid lesions suspicious for microcystic adenoma(s)
     • Solid enhancing lesions suspicious for PNET(s)
     • Any other solid lesion(s) of the pancreas
  3. Age greater than or equal to 12 years.
  4. Ability of subject to understand and the willingness to sign a written informed consent document.

EXCLUSION CRITERIA:

1. Inability of subject to undergo serial non-invasive imaging.

Contacts and Locations

Contacts

Contact: Kristine J Villaruel; (240) 858-7033; villaruelkf@mail.nih.gov

Contact: Naris Nilubol, M.D.; (240) 760-6154; niluboln@mail.nih.gov

Locations

United States, Maryland

National Institutes of Health Clinical Center; Recruiting

Bethesda, Maryland, United States, 20892

Contact: For more information at the NIH Clinical Center contact National Cancer Institute Referral Office 888-624-1937

Sponsors and Collaborators

National Cancer Institute (NCI)

Investigators

• Principal Investigator: Naris Nilubol, M.D.; National Cancer Institute (NCI)

More Information

Additional Information:

NIH Clinical Center Detailed Web Page 

• Responsible Party: National Cancer Institute (NCI)
• ClinicalTrials.gov Identifier: NCT04074135
• Other Study ID Numbers: 190135; 19-C-0135
• First Posted: August 29, 2019
• Last Update Posted: September 18, 2023
• Last Verified: September 14, 2023

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Yes
• Plan Description: .All IPD recorded in the medical record will be shared with intramural investigators upon request. @@@@@@In addition, all large scale genomic sequencing data will be shared with subscribers to dbGaP.
• Supporting Materials: Study Protocol; Statistical Analysis Plan (SAP); Informed Consent Form (ICF)
• Time Frame: Clinical data available during the study and indefinitely.@@@@@@Genomic data are available once genomic data are uploaded per protocol GDS plan for as long as database is active.
• Access Criteria: Clinical data will be made available via subscription to BTRIS and with the permission of the study PI.@@@@@@Genomic data are made available via dbGaP through requests to the data custodians.

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by National Institutes of Health Clinical Center (CC) ( National Cancer Institute (NCI) ):

Pancreatic tumors; 68-Gallium DOTATATE; MEN1 syndrome; NETest; PNET

Additional relevant MeSH terms:

Neuroendocrine Tumors; Neoplasms; Adenoma, Islet Cell; Von Hippel-Lindau Disease; Neuroectodermal Tumors; Neoplasms, Germ Cell and Embryonal; Neoplasms by Histologic Type; Neoplasms, Nerve Tissue; Adenoma; Neoplasms, Glandular and Epithelial; Pancreatic Neoplasms; Digestive System Neoplasms; Neoplasms by Site; Endocrine Gland Neoplasms; Digestive System Diseases; Pancreatic Diseases; Endocrine System Diseases; Neurocutaneous Syndromes; Nervous System Diseases; Angiomatosis; Vascular Diseases; Cardiovascular Diseases; Ciliopathies; Abnormalities, Multiple; Congenital Abnormalities; Genetic Diseases, Inborn