Randomized Phase II Trial of Everolimus 5 mg vs 10 mg/Daily for Patients With Advanced Neuroendocrine Tumors
Everolimus is approved in many countries to treat patients with advanced/metastatic well-differentiated neuroendocrine tumors (NET), providing median progression-free survival times of approximately 12 months across different types of NET. However, it is can cause severe adverse effects. Phase I trial demonstrated that a dose of 5mg/day/week was sufficient to inhibit cell proliferation by blocking the mTOR pathway. This is a randomized, open-label, phase II near-equivalence clinical trial of oral everolimus 5 mg vs 10 mg oral/daily and continuously in patients with Grade 1 or Grade 2 metastatic NET, with tumor progression or intolerance to at least one line of treatment and with radiological disease progression within 6 months.
• Histological confirmation of well-differentiated Grade 1/Grade 2 NET from gastrointestinal, pancreatic, pulmonary or unknown primary sites.
• Metastatic or locally advanced and unresectable disease, measurable by images
• Disease progression by RECIST 1.1 in the last 6 months assessed by local investigators
• At least one previous line of systemic treatment (suspended for more than 3 weeks).
• Eastern Cooperative Oncology Group (ECOG) 0-2 o Good organ function:
‣ Hemoglobin \> 8 g/dL
⁃ Neutrophils ≥ 1,500/mm³
⁃ Platelets \> 90,000/mm³
⁃ Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT) ≤ 2.5 x ULN \[upper limit of normal\] or ≤ 5 x ULN for patients with liver metastases
⁃ Bilirubin ≤ 1.5 x ULN, creatinine \< 1.5 mg/dL