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Cetuximab-IRDye 800CW and Intraoperative Imaging in Finding Pancreatic Cancer in Patients Undergoing Surgery

Intraoperative Pancreatic Cancer Detection Using Multimodality Molecular Imaging

Status
Terminated
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02736578
Enrollment
8
Registered
2016-04-13
Start date
2016-07-31
Completion date
2017-05-22
Last updated
2019-06-25

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Pancreatic Adenocarcinoma

Brief summary

This phase 1-2 trial studies the side effects and best dose of cetuximab-IRDye 800CW when used with intraoperative imaging, to determine the utility of cetuximab-IRDye 800CW to identify and assess pancreatic cancer in patients undergoing surgery to remove the tumor. Cetuximab-IRDye 800CW may help doctors better identify cancer in the operating room by making the cancer visible when viewed through a fluorescent imaging system.

Detailed description

This is a dose-escalation study of 50 mg or 100 mg cetuximab-IRDye800. Clearance of the tumor margin during surgical resection of pancreatic cancer is clinical importance, as margin-positive resections are suspected to be associated with rapid emergence of distant metastases shortly after surgery. However, pancreatic cancer is known to be difficult to visualize intraoperatively. Nonetheless, better detection of tumor tissue might improve the rate of complete tumor clearance, thereby improving outcomes. However, in order to be actionable, the data from such enhanced tumor detection must be available during the resection procedure. This study evaluates the use of a dye, Cetuximab-IRDye 800CW, that is administered pre-surgery, and is detectable during the surgical procedure. Florescent Imaging Cetuximab is a chimeric (mouse/human) monoclonal antibody that targets the epidermal growth factor (EGF) receptor (EGFR). EGFR is highly-expressed in pancreatic ductal adenocarcinoma (PDAC) and is a good target for antibody-mediated imaging, due to its transmembrane position. Cetuximab-IRDye 800CW is cetuximab labeled with IRDye800, an N-hydroxysuccinimide (NHS) ester infrared dye. IRDye800 has very similar properties compared to indocyanine green, and indocyanine green is readily detectable with a number of imaging systems. This study evaluates the Cetuximab-IRDye 800CW as a intraoperative labeling agent. Patients receive Cetuximab-IRDye 800CW intravenously (IV) at 50 mg or 100 mg over 30 minutes to 1 hour on day 0. Within 2 to 5 days, patients undergo surgery with intraoperative imaging. Cetuximab-IRDye 800CW is used as part of a tumor-targeted molecular imaging procedure operating on the principles of differential accumulation of the antibody-dye conjugate in pancreatic tumor tissue vs normal pancreatic tissue vs pancreatitis tissue. Excised tissues are prepared as formalin-fixed paraffin-embedded (FFPE) blocks for assessment of fluorescent intensity. Photoacoustic imaging (PAI) For purposes of non-quantitative comparison, photoacoustic imaging (PAI) of the tumor lesions is also conducted. PAI refers to a non-invasive evaluation by ultrasound of the area of the resected tumor and surrounding tissue. PAI may have special utility for detecting tumors within 5 to 7 mm of depth, with a high degree of spatial resolution, which might be useful to enhance generation of tumor-free surgical margins. PAI does not utilize ionizing radiation, and should complement and conform to the findings from the fluorescent imaging. PRIMARY OBJECTIVE: Determine the efficacy of cetuximab-IRDye800 in intraoperatively identifying pancreatic cancer compared to surrounding normal pancreatic and extrapancreatic tissue, as measured by tumor-to-background ratio. SECONDARY OBJECTIVE: Determine the tolerability of the cetuximab IRDye800 as an imaging agent in patients undergoing resection of pancreatic cancer.

Interventions

Administered intravenously (IV) at 50 or 100 mg

DRUGCetuximab

Administered as a 100 mg IV loading dose

Sponsors

National Cancer Institute (NCI)
CollaboratorNIH
Eben Rosenthal
Lead SponsorOTHER

Study design

Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
19 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Clinically suspected or biopsy confirmed diagnosis of pancreatic adenocarcinoma * Planned standard of care surgery with curative intent for pancreatic adenocarcinoma * ≥ 19 years of age * Life expectancy of more than 12 weeks * EITHER * Karnofsky performance status of at least 70%, OR * Eastern Cooperative Oncology Group (ECOG)/Zubrod level 1 * Hemoglobin ≥ 9 gm/dL * Platelet count ≥ 100,000/mm\^3 * Magnesium \> the lower limit of normal (LLN) per institution normal lab values * Potassium \> LLN * Calcium \> LLN * Thyroid-stimulating hormone (TSH) \< 13 micro International units/mL

Exclusion criteria

* Received an investigational drug within 30 days prior to first dose of cetuximab IRDye800 * Myocardial infarction (MI); cerebrovascular accident (CVA); uncontrolled congestive heart failure (CHF); or unstable angina within 6 months prior to enrollment * History of infusion reactions to cetuximab or other monoclonal antibody therapies * Pregnant or breastfeeding * Evidence of QT prolongation on pretreatment electrocardiography (ECG) (greater than 440 ms in males or greater than 450 ms in females) * Lab values that in the opinion of the primary surgeon would prevent surgical resection * Patients receiving class IA (quinidine, procainamide) or class III (dofetilide, amiodarone, sotalol) antiarrhythmic agents

Design outcomes

Primary

MeasureTime frameDescription
Peri-operative Cetuximab-IRDye800 Fluorescent Imaging, Both Dosesup to 5 daysCetuximab-IRDye800 (50 mg or 100 mg) was administered pre-operatively, and the uptake of the dye was assessed by observed fluorescence intra-operatively (ie, in vivo) and post-operatively (ex vivo, or back table), in tumorous (tumor or tumor-bearing lymph nodes) or normal (non-tumorous) tissues. Collectively, intra-operative and immediately post-operative are considered peri-operative. The outcome tumor-to-background ratio (TBR) is measured as the mean of the ratios observed between tumor and normal tissue for the participants, and the outcome is expressed as the mean with standard deviation.

Secondary

MeasureTime frameDescription
Effect of Cetuximab-IRDye800 Dose on Fluorescence Intensityup to 14 daysCetuximab-IRDye800 (50 mg or 100 mg) florescence intensity was assessed in normal pancreatic tissue; pancreatitis tissue; and pancreatic tumor tissue prepared as formalin-fixed paraffin-embedded (FFPE) blocks. Fluorescent intensity was measured in the image for each tissue, and expressed as counts per pixel. The outcome is expressed for each tissue as the dose-independent mean fluorescent intensity (MFI) for the cohort. The outcome is expressed as a mean with standard deviation, by dose.
Sensitivity and Specificity of Ex Vivo Fluorescent Imagingup to 14 daysSensitivity is the ability of a test to correctly identify patients with the condition, ie, how well Cetuximab-IRDye800 fluorescent imaging detects true-positive patients. Sensitivity is defined as \[TP/(TP+FN)\], where TP=true-positive, and FN=false-negative. The outcome is a % without dispersion. A higher % means a greater probability that an imaging target identified as cancerous is confirmed by histology to be cancerous, and a lower % means reduced confidence in that result. Specificity is the ability of a test to correctly identify patients who do not have the condition, ie, how well Cetuximab-IRDye800 fluorescent imaging detects true-negative patients. Specificity is defined as \[TN/(TN+FP)\], where TN=true-negative, and FP=false-positive. The outcome is a % without dispersion. A higher % means a greater probability that an imaging target identified as non-cancerous is confirmed by histology to be non-cancerous, and a lower % means reduced confidence in that result.
Cetuximab-IRDye800 Tumor Detection in Lymph Nodesup to 14 daysCetuximab-IRDye800 (50 mg or 100 mg) florescence intensity was assessed in excised lymph nodes (ie, ex vivo) that were histologically-determined to be normal or tumor-bearing. Fluorescent intensity was measured in the image for each lymph using close-field fluorescence imaging and expressed as counts per pixel. The outcome is expressed for each tissue as the dose-independent mean fluorescent intensity (MFI) for the cohort. The outcome is expressed as the mean MFI with standard deviation.
Cetuximab-IRDye800 Labeling Intensity in Tumor and Non-Tumor Tissues (Ex Vivo)up to 14 daysCetuximab-IRDye800 (50 mg or 100 mg) florescence intensity was assessed in normal pancreatic tissue; pancreatitis tissue; and pancreatic tumor tissue prepared as formalin-fixed paraffin-embedded (FFPE) blocks. Fluorescent intensity was measured in the image for each tissue, and expressed as counts per pixel. The outcome is expressed for each tissue as the dose-independent mean counts/pixel for the cohort. The outcome is expressed as the mean counts/pixel with standard deviation.
Signal-to-Noise Ratio (SNR) by In Vivo Photoacoustic Imaging (PAI)up to 5 daysPhotoacoustic imaging (PAI) was to be used to evaluate tumor and normal margin tissues (waste tissue) immediately peri-operatively (in vivo) and prior to pathological evaluation. The signal-to-noise ratio (SNR) as measured in dB of the tumor was to be calculated in the tumor specimens for comparison to surrounding normal tissue. The outcome would be expressed as the mean of the ratios, with standard deviation, and data used to qualitatively confirm the findings with Cetuximab-IRDye 800CW fluorescent imaging.
Toxicity (≥ Grade 2)Up to 30 daysToxicity was assessed as the number of grade 2 or greater adverse events \[Common Terminology Criteria for Adverse Events (CTCAE) version 4.03\] determined to be clinically-significant and definitely-, probably-, or possibly-related to cetuximab-IRDye 800CW. The outcome is reported as the number of treatment-related adverse events ≥ grade 2 without dispersion, by dose level.
Signal-to-Noise Ratio (SNR) by Ex Vivo Photoacoustic Imaging (PAI)up to 5 daysPhotoacoustics were assessed as the signal-to-noise ratio (SNR), a unit-less number, as observed for tumor vs surrounding tissue using an ultrasound device. The value observed for tumor tissue is considered signal, and the value for normal tissue is considered noise. The more the ratio is greater than 1 reflects the more that the tumor tissue reflects an ultrasound signal compared to normal tissue. The outcome is expressed as the ratio of mean SNR signal for tumor tissue to normal tissue, without dispersion.

Countries

United States

Participant flow

Participants by arm

ArmCount
Cetuximab IRDye800, 50 mg
On day 0, participants receive a 100 mg cetuximab loading dose by intravenous infusion (IV), followed 1 hour later by cetuximab-IRDye 800CW IV at 50 mg, followed by surgery with intraoperative imaging within 2 to 5 days. Cetuximab-IRDye800: Administered intravenously (IV) at 50 or 100 mg Cetuximab: Administered as a 100 mg IV loading dose
6
Cetuximab IRDye800, 100 mg
On day 0, participants receive a 100 mg cetuximab loading dose by intravenous infusion (IV), followed 1 hour later by cetuximab-IRDye 800CW IV at 100 mg, followed by surgery with intraoperative imaging within 2 to 5 days. Cetuximab-IRDye800: Administered intravenously (IV) at 50 or 100 mg Cetuximab: Administered as a 100 mg IV loading dose
2
Total8

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event10

Baseline characteristics

CharacteristicCetuximab IRDye800, 50 mgCetuximab IRDye800, 100 mgTotal
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
2 Participants2 Participants4 Participants
Age, Categorical
Between 18 and 65 years
4 Participants0 Participants4 Participants
Age, Continuous63.5 years
STANDARD_DEVIATION 7.9
70.4 years
STANDARD_DEVIATION 7.1
65.2 years
STANDARD_DEVIATION 7.9
Ethnicity (NIH/OMB)
Hispanic or Latino
1 Participants0 Participants1 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
5 Participants2 Participants7 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
1 Participants0 Participants1 Participants
Race (NIH/OMB)
Black or African American
0 Participants0 Participants0 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
1 Participants0 Participants1 Participants
Race (NIH/OMB)
White
4 Participants2 Participants6 Participants
Region of Enrollment
United States
6 participants2 participants8 participants
Sex: Female, Male
Female
2 Participants0 Participants2 Participants
Sex: Female, Male
Male
4 Participants2 Participants6 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
0 / 60 / 2
other
Total, other adverse events
6 / 62 / 2
serious
Total, serious adverse events
1 / 60 / 2

Outcome results

Primary

Peri-operative Cetuximab-IRDye800 Fluorescent Imaging, Both Doses

Cetuximab-IRDye800 (50 mg or 100 mg) was administered pre-operatively, and the uptake of the dye was assessed by observed fluorescence intra-operatively (ie, in vivo) and post-operatively (ex vivo, or back table), in tumorous (tumor or tumor-bearing lymph nodes) or normal (non-tumorous) tissues. Collectively, intra-operative and immediately post-operative are considered peri-operative. The outcome tumor-to-background ratio (TBR) is measured as the mean of the ratios observed between tumor and normal tissue for the participants, and the outcome is expressed as the mean with standard deviation.

Time frame: up to 5 days

Population: Due to small numbers and the expression of the outcome value as a mean of ratios, the analysis was conducted on all evaluable participants as a single cohort in order to reduce variance/dispersion.

ArmMeasureGroupValue (MEAN)Dispersion
Cetuximab IRDye800, 50 mgPeri-operative Cetuximab-IRDye800 Fluorescent Imaging, Both DosesIn vivo (tumor at resection)2.3 ratioStandard Deviation 0.72
Cetuximab IRDye800, 50 mgPeri-operative Cetuximab-IRDye800 Fluorescent Imaging, Both DosesIn vivo (lymph node at resection)6.3 ratioStandard Deviation 0.82
Cetuximab IRDye800, 50 mgPeri-operative Cetuximab-IRDye800 Fluorescent Imaging, Both DosesEx vivo (post-operative, back-table)3.4 ratioStandard Deviation 0.4
Secondary

Cetuximab-IRDye800 Labeling Intensity in Tumor and Non-Tumor Tissues (Ex Vivo)

Cetuximab-IRDye800 (50 mg or 100 mg) florescence intensity was assessed in normal pancreatic tissue; pancreatitis tissue; and pancreatic tumor tissue prepared as formalin-fixed paraffin-embedded (FFPE) blocks. Fluorescent intensity was measured in the image for each tissue, and expressed as counts per pixel. The outcome is expressed for each tissue as the dose-independent mean counts/pixel for the cohort. The outcome is expressed as the mean counts/pixel with standard deviation.

Time frame: up to 14 days

Population: Due to small numbers and the expression of the outcome value as a mean of ratios, the analysis was conducted on all evaluable participants as a single cohort in order to reduce variance/dispersion.

ArmMeasureGroupValue (MEAN)Dispersion
Cetuximab IRDye800, 50 mgCetuximab-IRDye800 Labeling Intensity in Tumor and Non-Tumor Tissues (Ex Vivo)Normal pancreatic tissue0.02 counts per pixelStandard Deviation 0.01
Cetuximab IRDye800, 50 mgCetuximab-IRDye800 Labeling Intensity in Tumor and Non-Tumor Tissues (Ex Vivo)Pancreatitis tissue0.04 counts per pixelStandard Deviation 0.02
Cetuximab IRDye800, 50 mgCetuximab-IRDye800 Labeling Intensity in Tumor and Non-Tumor Tissues (Ex Vivo)Pancreatic tumor tissue0.09 counts per pixelStandard Deviation 0.06
Secondary

Cetuximab-IRDye800 Tumor Detection in Lymph Nodes

Cetuximab-IRDye800 (50 mg or 100 mg) florescence intensity was assessed in excised lymph nodes (ie, ex vivo) that were histologically-determined to be normal or tumor-bearing. Fluorescent intensity was measured in the image for each lymph using close-field fluorescence imaging and expressed as counts per pixel. The outcome is expressed for each tissue as the dose-independent mean fluorescent intensity (MFI) for the cohort. The outcome is expressed as the mean MFI with standard deviation.

Time frame: up to 14 days

Population: The relationship of the number of participants to number of analyzed lymph nodes (tumor-bearing or not) is not 1:1, \& tissue sampling \& labeling are imprecise. Participants could contribute none or multiple normal and tumor-bearing lymph node for analysis. Data were not obtained for all participants.

ArmMeasureGroupValue (MEAN)Dispersion
Cetuximab IRDye800, 50 mgCetuximab-IRDye800 Tumor Detection in Lymph NodesTumor-bearing lymph nodes0.071 counts per pixelStandard Error 0.01
Cetuximab IRDye800, 50 mgCetuximab-IRDye800 Tumor Detection in Lymph NodesHistologically normal lymph nodes0.018 counts per pixelStandard Error 0.001
Cetuximab IRDye800, 100 mgCetuximab-IRDye800 Tumor Detection in Lymph NodesTumor-bearing lymph nodes0.046 counts per pixelStandard Error 0.007
Cetuximab IRDye800, 100 mgCetuximab-IRDye800 Tumor Detection in Lymph NodesHistologically normal lymph nodes0.035 counts per pixelStandard Error 0.004
Secondary

Effect of Cetuximab-IRDye800 Dose on Fluorescence Intensity

Cetuximab-IRDye800 (50 mg or 100 mg) florescence intensity was assessed in normal pancreatic tissue; pancreatitis tissue; and pancreatic tumor tissue prepared as formalin-fixed paraffin-embedded (FFPE) blocks. Fluorescent intensity was measured in the image for each tissue, and expressed as counts per pixel. The outcome is expressed for each tissue as the dose-independent mean fluorescent intensity (MFI) for the cohort. The outcome is expressed as a mean with standard deviation, by dose.

Time frame: up to 14 days

Population: Tissue sampling and labeling can be imprecise, and there may not have been residual tissue after standard-of-care pathological analysis. Data were not obtained for all participants.

ArmMeasureGroupValue (MEAN)Dispersion
Cetuximab IRDye800, 50 mgEffect of Cetuximab-IRDye800 Dose on Fluorescence IntensityNormal pancreatic tissue0.02 counts per pixelStandard Deviation 0.01
Cetuximab IRDye800, 50 mgEffect of Cetuximab-IRDye800 Dose on Fluorescence IntensityPancreatitis tissue0.03 counts per pixelStandard Deviation 0.02
Cetuximab IRDye800, 50 mgEffect of Cetuximab-IRDye800 Dose on Fluorescence IntensityPancreatic tumor tissue0.09 counts per pixelStandard Deviation 0.06
Cetuximab IRDye800, 100 mgEffect of Cetuximab-IRDye800 Dose on Fluorescence IntensityNormal pancreatic tissue0.03 counts per pixelStandard Deviation 0.02
Cetuximab IRDye800, 100 mgEffect of Cetuximab-IRDye800 Dose on Fluorescence IntensityPancreatitis tissue0.06 counts per pixelStandard Deviation 0.03
Cetuximab IRDye800, 100 mgEffect of Cetuximab-IRDye800 Dose on Fluorescence IntensityPancreatic tumor tissue0.10 counts per pixelStandard Deviation 0.05
Secondary

Sensitivity and Specificity of Ex Vivo Fluorescent Imaging

Sensitivity is the ability of a test to correctly identify patients with the condition, ie, how well Cetuximab-IRDye800 fluorescent imaging detects true-positive patients. Sensitivity is defined as \[TP/(TP+FN)\], where TP=true-positive, and FN=false-negative. The outcome is a % without dispersion. A higher % means a greater probability that an imaging target identified as cancerous is confirmed by histology to be cancerous, and a lower % means reduced confidence in that result. Specificity is the ability of a test to correctly identify patients who do not have the condition, ie, how well Cetuximab-IRDye800 fluorescent imaging detects true-negative patients. Specificity is defined as \[TN/(TN+FP)\], where TN=true-negative, and FP=false-positive. The outcome is a % without dispersion. A higher % means a greater probability that an imaging target identified as non-cancerous is confirmed by histology to be non-cancerous, and a lower % means reduced confidence in that result.

Time frame: up to 14 days

Population: Outcome results for sensitivity and specificity of fluorescent imaging were available by dose, and compiled across both doses. Tissue sampling and labeling can be imprecise, and there may not have been residual tissue after standard-of-care pathological analysis. Data were not obtained for all participants.

ArmMeasureGroupValue (NUMBER)
Cetuximab IRDye800, 50 mgSensitivity and Specificity of Ex Vivo Fluorescent ImagingSensitivity100.0 percentage of lymph nodes
Cetuximab IRDye800, 50 mgSensitivity and Specificity of Ex Vivo Fluorescent ImagingSpecificity78.0 percentage of lymph nodes
Cetuximab IRDye800, 100 mgSensitivity and Specificity of Ex Vivo Fluorescent ImagingSensitivity88.2 percentage of lymph nodes
Cetuximab IRDye800, 100 mgSensitivity and Specificity of Ex Vivo Fluorescent ImagingSpecificity32.1 percentage of lymph nodes
Cetuximab IRDye800, Both DosesSensitivity and Specificity of Ex Vivo Fluorescent ImagingSensitivity96.1 percentage of lymph nodes
Cetuximab IRDye800, Both DosesSensitivity and Specificity of Ex Vivo Fluorescent ImagingSpecificity67.0 percentage of lymph nodes
Secondary

Signal-to-Noise Ratio (SNR) by Ex Vivo Photoacoustic Imaging (PAI)

Photoacoustics were assessed as the signal-to-noise ratio (SNR), a unit-less number, as observed for tumor vs surrounding tissue using an ultrasound device. The value observed for tumor tissue is considered signal, and the value for normal tissue is considered noise. The more the ratio is greater than 1 reflects the more that the tumor tissue reflects an ultrasound signal compared to normal tissue. The outcome is expressed as the ratio of mean SNR signal for tumor tissue to normal tissue, without dispersion.

Time frame: up to 5 days

Population: Tissue sampling and labeling can be imprecise. Due to small numbers and the expression of the outcome value as a mean of ratios, the analysis was conducted on all evaluable participants as a single cohort. Data were not obtained for all participants. Dispersion was not and can not be determined for the outcome, a ratio (ratio of means).

ArmMeasureValue (NUMBER)
Cetuximab IRDye800, 50 mgSignal-to-Noise Ratio (SNR) by Ex Vivo Photoacoustic Imaging (PAI)3.7 ratio
Secondary

Signal-to-Noise Ratio (SNR) by In Vivo Photoacoustic Imaging (PAI)

Photoacoustic imaging (PAI) was to be used to evaluate tumor and normal margin tissues (waste tissue) immediately peri-operatively (in vivo) and prior to pathological evaluation. The signal-to-noise ratio (SNR) as measured in dB of the tumor was to be calculated in the tumor specimens for comparison to surrounding normal tissue. The outcome would be expressed as the mean of the ratios, with standard deviation, and data used to qualitatively confirm the findings with Cetuximab-IRDye 800CW fluorescent imaging.

Time frame: up to 5 days

Population: The in vivo photoacoustic imaging (PAI) component of this study was not IRB-approved, and this part of the study was not conducted.

Secondary

Toxicity (≥ Grade 2)

Toxicity was assessed as the number of grade 2 or greater adverse events \[Common Terminology Criteria for Adverse Events (CTCAE) version 4.03\] determined to be clinically-significant and definitely-, probably-, or possibly-related to cetuximab-IRDye 800CW. The outcome is reported as the number of treatment-related adverse events ≥ grade 2 without dispersion, by dose level.

Time frame: Up to 30 days

ArmMeasureValue (NUMBER)
Cetuximab IRDye800, 50 mgToxicity (≥ Grade 2)1 Adverse events
Cetuximab IRDye800, 100 mgToxicity (≥ Grade 2)0 Adverse events

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026