Signed informed consent must be obtained prior to participation in the study.
Adult patients (age >= 18 years old) with any of the following advanced or metastatic solid tumors: breast cancer, lung cancer, prostate cancer, GIST, GBM.
At least one measurable lesion as per RECIST 1.1, RANO (applicable for GBM only) criteria detected on the low-dose CT/MRI (for GBM MRI only) acquired together with the [68Ga]-NeoB PET.
The same identified measurable lesion shows [68Ga]-NeoB uptake on PET/CT or PET/MRI. If the only matching lesion is located in the bone, the patient will still be eligible.
Patients for whom no standard therapy is available, tolerated or appropriate.
Patient Eastern Cooperative Oncology Group (ECOG) performance status =< 2.
Life expectancy more than 6 months.
Patients who have not had resolution, except where otherwise stated in the inclusion/ exclusion criteria, of all clinically significant toxic effects of prior systemic cancer therapy, surgery, or radiotherapy to Grade =<1 (except for alopecia)*.
Creatinine clearance (calculated using Cockcroft-Gault formula, or measured) < 60 mL/min or serum creatinine > 1.5 x ULN*
Platelet count of < 75 x 109/L*
Absolute neutrophil count (ANC) < 1.0 x 109/L*.
Hemoglobin < 9 g/dL*
Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 3 x upper limit of normal (ULN) if no demonstrable liver metastases or > 5 x ULN in the presence of liver metastases*
Total bilirubin > 1.5 x ULN, except for patients with documented Gilbert's syndrome who are eligible if total bilirubin =< 3 x ULN*
Serum amylase and/or lipase > 1.5 x ULN*
Known or expected hypersensitivity to [177Lu]-NeoB, [68Ga]-NeoB or any of their excipients.
Impaired cardiac function or clinically significant cardiac disease, including any of the following:
Clinically significant and/or uncontrolled heart disease such as congestive heart failure requiring treatment (NYHA grade >= 2), uncontrolled arterial hypertension or clinically significant arrhythmia
LVEF < 50% as determined by echocardiogram (ECHO)*
QTcF >470 msec for females and QTcF >450 msec for males on screening electrocardiogram (ECG) or congenital long QT syndrome
Acute myocardial infarction or unstable angina pectoris < 3 months prior to [177Lu]-NeoB (IMP1) administration.
Patients with diabetes mellitus not stable under current treatment as judged by the investigator or with hyperglycemia ≥ CTCAE Grade 2*
Patients with history of or ongoing acute or chronic pancreatitis.
Concurrent bladder outflow obstruction or unmanageable urinary incontinence.
Administration of a radiopharmaceutical with therapeutic intent within a period corresponding to 10 half-lives of the radionuclide used prior to injection of [68Ga]-NeoB (IMP2).
Prior External Beam Radiation Therapy (EBRT) to more than 25% of the bone marrow.
[223Ra]-therapy within the context of diffuse bone or bone-marrow involvement (i.e. "superscan" defined as bone scintigraphy in which there is excessive skeletal radioisotope uptake [>20 bone lesions] in relation to soft tissues along with absent or faint activity in the genitourinary tract due to diffuse bone/ bone marrow metastases).
Patients who have changed the dose of systemic steroid therapy within less than 2 weeks prior to [177Lu]-NeoB (IMP1) administration or patients for whom steroid dose increase is anticipated during the study.
Patients who have received prior systemic anti-cancer treatment within the following time frames:
Cyclical chemotherapy within a period that is shorter than the cycle length used for that treatment (e.g. 6 weeks for nitrosourea, mitomycin-C) prior to starting [177Lu]-NeoB treatment
Biologic therapy (e.g. antibodies), continuous or intermittent small molecule therapeutics, or any other investigational agents within a period which is =< 5 T1/2 or =< 4 weeks (whichever is shorter) prior to starting [177Lu]-NeoB treatment
History of somatic or psychiatric disease/condition that may interfere with the objectives and assessments of the study.
Malignant disease, other than that being treated in this study. Exceptions to this exclusion include the following: malignancies that were treated curatively and have not recurred within 2 years prior to [177Lu]-NeoB treatment; completely resected basal cell and squamous cell skin cancers; any malignancy considered to be indolent and that has never required therapy; and completely resected carcinoma in situ of any type.
Pregnant or breast-feeding women
Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, are not allowed to participate in this study UNLESS they are using highly effective methods of contraception throughout the study and for 6 months after study drug discontinuation. Highly effective contraception methods include:
True abstinence, when this is in line with the preferred and usual lifestyle of the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods), declaration of abstinence for the duration of exposure to IMPs, and withdrawal are not acceptable methods of contraception.
Male or female sterilization. Vasectomised partner is a highly effective birth control method if the partner is the sole sexual partner of the study participant and the vasectomised partner has received medical assessment of the surgical success.
Women tubal ligation is an acceptable highly effective contraception method, but surgical sterility is defined as bilateral salpingectomy (or bilateral oophorectomy or hysterectomy).
• Combination of any two of the following (a+b or a+c or b+c):
Use of oral, injected, or implanted hormonal methods of contraception. In case of use of oral contraception, women should be stable on the same pill for a minimum of 3 months before taking [177Lu]-NeoB treatment.
Placement of an intrauterine device (IUD) or intrauterine system (IUS)
Barrier methods of contraception: condom or occlusive cap (diaphragm or cervical/vault caps) with spermicidal foam/gel/film/cream/vaginal suppository Post-menopausal women are allowed to participate in this study. Women are considered post-menopausal and not of child bearing potential if they have had 12 months of natural (spontaneous) amenorrhea with an appropriate clinical profile (e.g. age appropriate, history of vasomotor symptoms) or six months of spontaneous amenorrhea with serum Follicle-Stimulating Hormone (FSH) levels > 40 mIU/mL [for US only: and estradiol < 20 pg/mL] or have had surgical bilateral oophorectomy or bilateral salpingectomy or hysterectomy or tubal ligation at least six weeks prior to screening. In the case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment is she considered not of child bearing potential.
Sexually active males must use a condom during intercourse while taking the drug and for 6 months after stopping treatment and should not father a child in this period. A condom is required to be used also by vasectomized men in order to prevent delivery of the drug via seminal fluid.
Participation in any other investigational trial at the time of informed consent signature.
To be considered as valid to determine the eligibility of a patient, exam results of exclusion criteria #2, #3, #4, #5, #6, #7, #8, #10 (except QTcF parameter) and #11 must not be older than 1 month prior to [68Ga]-NeoB administration and must be available in the source documents for monitoring.