Sequential 225Ac-LNC1011 treatment for metastatic castration-resistant prostate cancer

Prospective Sequential Study of Dose-Escalating 225Ac-LNC1011 in the Treatment of Metastatic Castration-Resistant Prostate Cancer

We'll test whether different doses of a PSMA-targeted alpha therapy called 225Ac-LNC1011 are safe and can shrink tumors in men whose prostate cancer has spread and no longer responds to hormone therapy.

Quick facts

• Phase: Phase1; Phase2
• Study type: Interventional
• Enrollment: 9 (estimated)
• Ages: 18 Years to 90 Years
• Sex: Male
• Sponsor: First Affiliated Hospital of Fujian Medical University (Academic / other)
• Drugs / interventions: chemotherapy, immunotherapy, radiation
• Locations: 1 site (Fuzhou, Fujian)
• Trial ID: NCT07363486 on ClinicalTrials.gov

What this trial studies

This open-label dose-escalation and expansion program gives a PSMA-targeted radioligand (225Ac-LNC1011) that includes an albumin-binding motif to prolong blood circulation and boost tumor uptake. The therapy uses the alpha emitter actinium-225, which delivers very high-energy, short-range radiation intended to kill cancer cells while sparing nearby normal tissue. A standard 3+3 dose-escalation design will start at 3.70 MBq (100 μCi) to identify the maximum tolerated or recommended phase II dose, followed by additional cohorts to explore efficacy. Eligible participants will be men with PSMA-positive metastatic castration-resistant prostate cancer who have limited or no standard therapy options.

Who should consider this trial

Good fit: Ideal candidates are men with PSMA-positive metastatic castration-resistant prostate cancer with castrate-level testosterone who have progressed on or lack standard treatment options and meet organ function/safety criteria.

Not a fit: Patients whose tumors are PSMA-negative or who have poor bone marrow, renal, or other organ function that precludes radionuclide therapy are unlikely to benefit from this approach.

Why it matters

Potential benefit: If successful, this approach could deliver highly focused radiation to PSMA-positive tumors, potentially shrinking metastases and delaying disease progression with limited damage to normal tissues.

How similar studies have performed: PSMA-targeted radioligand therapies such as 177Lu-PSMA have shown clinical benefit and early reports of Ac-225 agents suggest strong responses, but LNC1011's specific albumin-binding design is novel and less tested in humans.

Eligibility criteria

Inclusion Criteria:

1. Metastatic Castration-Resistant Prostate Cancer (mCRPC) mCRPC refers to prostate cancer that progresses despite serum testosterone at castrate levels (\< 50 ng/dL or 1.7 nmol/L), meeting at least one of the following criteria:

   * PSA \>1 ng/mL with two consecutive rises at least 1 week apart, each increase ≥50% above the nadir.
   * Radiographic progression: Either two or more new bone lesions on bone scan, or soft tissue lesion progression as per RECIST 1.1 criteria. Progression based on symptoms alone is insufficient for mCRPC diagnosis and requires further evaluation.
2. Failure of, Refusal of, Absence of, or Refractoriness to Standard Therapy, or Disease Progression, or No Available Standard Therapy per Current Guidelines:

   * Patients who have not received, refused, or progressed after receiving at least 1 but no more than 2 prior taxane-based therapies. The taxane regimen must have included exposure for at least 2 cycles. Patients who received only one taxane may be included if the investigator deems them unsuitable for a second taxane (e.g., due to frailty assessed by geriatric/comorbidity evaluation or intolerance).
   * Patients who have progressed after receiving at least one novel androgen axis drug \[NAAD\] (e.g., abiraterone, enzalutamide).
3. Ability to understand and voluntarily sign a written informed consent form (ICF), and willingness and ability to comply with trial procedures including examinations and follow-up.
4. Age 18-90 years (inclusive).
5. Expected survival \> 6 months.
6. ECOG performance status ≤ 2.
7. Presence of high-uptake lesions confirmed by 68Ga-PSMA-11 PET/CT imaging (positive defined as lesion uptake \>1.5 times the liver background).
8. At least one measurable lesion per RECIST 1.1 criteria OR at least one bone metastasis per PCWG3 criteria.
9. Adequate organ function (No blood products, growth factors, or albumin administered within 14 days prior to baseline lab tests):

   * Bone Marrow Function: Neutrophil count ≥ 1.5 × 10#/L, White blood cell count ≥ 3.0 × 10#/L, Platelet count ≥ 100 × 10#/L, Hemoglobin ≥ 10 g/dL (≥ 100 g/L).
   * Liver Function: Albumin ≥ 30 g/L, Total bilirubin ≤ 1.5 × ULN, ALT or AST ≤ 3.0 × ULN (without liver metastases) or ≤ 5.0 × ULN (with liver metastases).
   * Renal Function: Serum creatinine ≤ 1.5 × ULN.
   * Coagulation: INR ≤ 1.5; Activated partial thromboplastin time (APTT) ≤ 2 × ULN (for patients not on anticoagulation or on stable-dose anticoagulation).
10. Agreement to comply with prescribed radiation protection measures during the trial period.

Exclusion Criteria:

1. Inability to tolerate imaging procedures;
2. Patients who have received systemic anticancer therapy (e.g., chemotherapy, radiotherapy, immunotherapy; excluding endocrine therapy), investigational drugs, or device therapy within 4 weeks prior to dosing;
3. Patients who received radionuclide therapy (Strontium-89, Samarium-153, Rhenium-186, Rhenium-188, Radium-223, Lutetium-177) within 6 months, or any External Beam Radiation Therapy (EBRT) within 2 months prior to the first dose;
4. Patients with unresolved Grade 4 myelosuppression from prior anticancer therapy within 2 weeks, or Grade 3 myelosuppression requiring \>6 weeks for recovery;
5. Planned use of cytotoxic chemotherapy, antitumor immunotherapy, radioligand therapy, or similar agents during the study;
6. Use of blood products or albumin within 14 days before dosing to meet enrollment criteria;
7. Brain metastasis at screening, except:

   * Asymptomatic cases confined to supratentorial/cerebellar regions (no midbrain/pons/medulla/spinal cord involvement) without corticosteroid therapy and with lesions ≤1.5 cm;
   * Symptomatic cases with treated and radiologically stable lesions (\>4 weeks);
8. Other malignancies within 5 years (excluding cured localized cancers like basal/squamous cell skin carcinoma);
9. Superscan on bone scintigraphy;
10. Symptomatic or impending spinal cord compression;
11. Prior EBRT involving extensive bone marrow (\>25%);
12. Significant cardiac disease at screening, including:

    * QTcF \>470 ms or long QT syndrome history;
    * Myocardial infarction, angina, or CABG within 6 months deemed ineligible by investigators;
13. Any condition that, per investigator judgment, may compromise safety, data interpretation, or indicate high risk;
14. Uncontrolled bladder outlet obstruction, urinary incontinence, claustrophobia, or radiophobia at screening;
15. Positive for HCV-Ab, HIV, or syphilis antibodies at screening;
16. HBsAg-positive patients with active HBV replication (confirmed by HBVDNA per investigator assessment);
17. Known allergy to proteins/peptides, excipients, or structurally related compounds;
18. History of drug/alcohol abuse within 1 year or chronic substance abuse;
19. Failure to use effective contraception during the trial and for 6 months post-last dose;
20. Severe active infection prior to the first administration.

Where this trial is running

Fuzhou, Fujian

• Department of Nuclear Medicine, First Affiliated Hospital of Fujian Medical University — Fuzhou, Fujian, China (Recruiting)

Study contacts

• Study coordinator: Weibing Miao, MD

Conditions Prostate Cancer