There are two cases:
1. Someone want to give you something,and others may say“这个东西不能要”,that's mean you cannot take it whether you want it or not,maybe because “这个东西”is very expensive or not so good.
2. If you say“这个东西不能要了”,that usually means it is broken or rotten,and it is useless so you don't need to keep it any more.