Natural History and Management of Von Hippel-Lindau (VHL) Associated Pancreatic Neuroendocrine Tumors
- - 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 (or Legally Authorized Representative (LAR)) to understand and the willingness to sign a written informed consent document. EXCLUSION CRITERIA: 1. Inability of subject to undergo serial non-invasive imaging. 2. Pregnant women are excluded from this study, as there is no direct benefit to study participation. Note: Pregnancy testing will be performed on all females of child bearing potential at screening, at each visit and prior to any imaging study using ionizing radiation or MRI with gadolinium. Those with positive pregnancy tests will be excluded.
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 620 patients on this protocol.
Trial Phase Phase II
Trial Type Diagnostic
National Cancer Institute
- Primary ID 190135
- Secondary IDs NCI-2019-06345, 19-C-0135
- Clinicaltrials.gov ID NCT04074135