Pediatric Central Nervous System Tumor
Conditions
Keywords
Tumor Paint, tozuleristide, Canvas imaging system, BLZ-100, CNS tumor, brain cancer, pediatrics, fluorescence guided surgery
Brief summary
Many types of cancer are primarily treated with surgery and patient survival is directly related to the extent to which the tumor is able to be removed. It is often difficult for surgeons to distinguish tumor tissue from normal tissue or to detect tumor cells that have spread from the original tumor site, resulting in incomplete removal of the tumor and reduced patient survival. In some sites, such as the brain, it is critical to avoid damage to normal tissue around the tumor to prevent adverse effects of surgery on function. Tozuleristide is a drug that is thought to attach to tumor tissue and then fluoresces (glows) when a special light from the Canvas is shined on it. It is hypothesized that tozuleristide, when imaged with the Canvas, will improve surgical outcomes by allowing surgeons to visualize the edges of the tumor or other ambiguous tissue in real-time as they operate. The purpose of this study is to evaluate how well tozuleristide imaged with Canvas work at helping to distinguish between tumor and normal tissue during surgery in pediatric primary central nervous system tumors.
Detailed description
Subjects who provide voluntary written informed consent, or have it provided by their legally acceptable representative, will be screened for eligibility. Subjects meeting all of the inclusion and none of the exclusion criteria will be eligible to participate. Surgical excision will occur at least 1 hour and no more than 36 hours after tozuleristide administration. Surgery will be performed by a neurosurgeon and the Canvas will be operated by a designated Imaging Operator. Fluorescence of tumor and ambiguous tissue during surgery will be assessed and scored. Biopsy samples of these tumor and ambiguous tissues will be collected for pathology analysis. All subjects will be monitored for safety during their participation in the study.
Interventions
DRUGtozuleristide
Tozuleristide will be administered at least 1 hour and no more than 36 hours prior to planned surgical excision of their tumor.
DEVICECanvas System
All subjects enrolled in the study will have their tissue imaged with the Canvas System.
Sponsors
Pacific Pediatric Neuro-Oncology Consortium
Blaze Bioscience Inc.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Outcomes Assessor)
Masking description
Central Pathology assessment and Central Radiology post-operative MRI assessment will be blinded to study arm and fluorescence data. Central Fluorescence assessment will be blinded to study arm.
Intervention model description
Subjects will be randomized 1:10 to 1 of 2 study arms. Subjects in arm 1 (\ 9% of subjects) will not receive tozuleristide but will undergo neurosurgery and imaging will be performed with the Canvas. Subjects in arm 2 (\ 91% of subjects) will receive tozuleristide and will undergo neurosurgery and imaging will be performed with the Canvas.
Eligibility
Sex/Gender
ALL
Age
1 Months to 30 Years
Healthy volunteers
No
Inclusion criteria
1. Subjects must be \>1 month and ≤30 years of age at the time of study enrollment 2. Subjects must have MRI obtained within 30 days of study enrollment documenting a measurable lesion consistent with a pediatric primary CNS tumor for which maximal safe resection is indicated 3. Adequate renal function 4. Adequate liver function 5. Prior therapy: Subjects with prior therapy are eligible provided they have recovered from any acute toxic effects of prior therapy and have sufficient time interval prior to enrollment: 1. Radiation therapy: subjects may not have had radiation therapy to the area of tumor planned to be resected within 28 days of study enrollment 2. Chemotherapy: at least 14 days from any myelosuppressive chemotherapy (28 days if prior nitrosourea) and if prior chemotherapy, must have an absolute neutrophil count recovery of ≥ 1000/mm3 following count nadir 3. Biologic: at least 7 days from any anti-neoplastic biologic agent (at least 3 half-lives since last administration of monoclonal antibodies) 4. Immunotherapy: at least 42 days after completion of any cellular immunotherapy, such as CAR-T cell therapy 5. Prior surgery for CNS tumors is allowed 6. Prior tozuleristide: at least 1 week after prior dose of tozuleristide if previously treated 6. Written informed consent must be obtained from the subject or parent or legal guardian prior to the conduct of study activities. Routine clinical tests, e.g., MRI, clinical laboratory studies, may be used for screening requirements. Assent, when appropriate, will be obtained according to institutional guidelines. 7. The risks of treatment with tozuleristide during pregnancy have not been evaluated. Female subjects of child-bearing potential must agree not to attempt to become pregnant or undergo in vitro fertilization and, if participating in sexual activity that could lead to pregnancy, must use 2 reliable methods of contraception simultaneously for 30 days after surgery. Male subjects must agree not to attempt to father a child and, if participating in sexual activity that could lead to pregnancy, must use 2 reliable methods of contraception simultaneously for 30 days after surgery if their partner is of child-bearing potential.
Exclusion criteria
1. Pregnancy and contraception: Subjects who are pregnant or breast-feeding or planning to conceive a child within 30 days are not eligible. Males and females of childbearing potential must agree to use 2 effective forms of contraception from the time of enrollment until 30 days post-surgery 2. Subjects with on-going serious medical conditions (poorly controlled asthma, diabetes, heart disease) such that participation in the study could put the subject at increased risk of worsening their condition 3. Subjects planned to undergo only a diagnostic biopsy procedure, without intent to resect tissue for therapeutic purposes (e.g., stereotactic pontine biopsy) 4. Subjects who in the opinion of the investigator are not willing or able to comply with randomization procedures or other study-required study procedures and observations. Subjects previously enrolled and randomized to Arm 1 (control) are not eligible for re-enrollment unless a second surgery is required by standard of care.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Sensitivity and Specificity of Tozuleristide Fluorescence to Detect Tumor in Equivocal (Ambiguous) Tissue During Surgery When Imaged With the Canvas System | During surgery (which occurs at least 1 hour post tozuleristide administration) | Sensitivity and specificity of tozuleristide imaged with the Canvas system to fluorescently identify tumor in equivocal tissue will be evaluated based on central pathology consensus assessment of tumor and by imaging operator fluorescence assessment. These measures will be compared to the sensitivity and specificity of surgical designation of tumor (more likely tumor or less likely tumor) under white light. Sensitivity reflects the probability that tumor tissue evaluated is fluorescent. Specificity reflects the probability that normal tissue evaluated is not fluorescent. Equivocal tissues are those that the surgeon considers abnormal but ambiguous as tumor vs. not tumor under normal (white light) conditions. |
| Ratio of Tozuleristide Sensitivity Compared to Surgeon Sensitivity | During surgery (which occurs at least 1 hour post tozuleristide administration) | Tozuleristide sensitivity as assessed by imaging operator fluorescence assessment compared to sensitivity of surgeon designation of tumor under white light in equivocal tissue biopsies. Sensitivity reflects the probability that tumor tissue evaluated is fluorescent. Equivocal tissues are those that the surgeon considers abnormal but ambiguous as tumor vs. not tumor under normal (white light) conditions. |
| Ratio of Tozuleristide Specificity Compared to Surgeon Specificity | During surgery (which occurs at least 1 hour post tozuleristide administration) | Tozuleristide specificity as assessed by imaging operator fluorescence assessment compared to specificity of surgeon designation of tumor under white light in equivocal tissue biopsies. Specificity reflects the probability that normal tissue evaluated is not fluorescent. Equivocal tissues are those that the surgeon considers abnormal but ambiguous as tumor vs. not tumor under normal (white light) conditions. |
Countries
United States
Participant flow
Recruitment details
118 subjects were enrolled from 9 academic sites
Participants by arm
| Arm | Count |
|---|---|
| Arm 1 (no Tozuleristide) Subjects randomized to Arm 1 (\
9% of subjects) will not receive tozuleristide but will undergo standard of care neurosurgery and will have imaging performed with the Canvas System.
Canvas System: All subjects enrolled in the study will have their tissue imaged with the Canvas System. | 11 |
| Arm 2 (Tozuleristide Treated) Subjects randomized to Arm 2 (\
91% of subjects) will be administered tozuleristide at a dose of 15 mg/m\^2 at least 1 hour and no more than 36 hours prior to surgery. They will undergo standard of care neurosurgery and will have imaging performed with the Canvas System.
tozuleristide: Tozuleristide will be administered at least 1 hour and no more than 36 hours prior to planned surgical excision of their tumor.
Canvas System: All subjects enrolled in the study will have their tissue imaged with the Canvas System. | 105 |
| Total | 116 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Subject did not complete all study visits as planned | 0 | 1 |
| Overall Study | Subject unable to receive study drug | 0 | 2 |
Baseline characteristics
| Characteristic | Arm 1 (no Tozuleristide) | Arm 2 (Tozuleristide Treated) | Total |
|---|---|---|---|
| Age, Continuous | 7.749 years | 9.445 years | 9.284 years |
| BSA | 0.9534 m sq | 1.1351 m sq | 1.1178 m sq |
| Ethnicity (NIH/OMB) Ethnicity Hispanic or Latino | 0 Participants | 10 Participants | 10 Participants |
| Ethnicity (NIH/OMB) Ethnicity Not Hispanic or Latino | 7 Participants | 72 Participants | 79 Participants |
| Ethnicity (NIH/OMB) Ethnicity Unknown or Not Reported | 4 Participants | 23 Participants | 27 Participants |
| Evidence of Metastatic Disease No | 11 Participants | 91 Participants | 102 Participants |
| Evidence of Metastatic Disease Unknown | 0 Participants | 4 Participants | 4 Participants |
| Evidence of Metastatic Disease Yes | 0 Participants | 10 Participants | 10 Participants |
| Height | 121.72 cm | 130.46 cm | 129.63 cm |
| Karnofsky Performance Status Score 100 | 0 Participants | 12 Participants | 12 Participants |
| Karnofsky Performance Status Score 40 | 0 Participants | 1 Participants | 1 Participants |
| Karnofsky Performance Status Score 50 | 0 Participants | 2 Participants | 2 Participants |
| Karnofsky Performance Status Score 70 | 0 Participants | 1 Participants | 1 Participants |
| Karnofsky Performance Status Score 80 | 0 Participants | 6 Participants | 6 Participants |
| Karnofsky Performance Status Score 90 | 2 Participants | 4 Participants | 6 Participants |
| Lansky Performance Status Score 100 | 5 Participants | 38 Participants | 43 Participants |
| Lansky Performance Status Score 30 | 0 Participants | 1 Participants | 1 Participants |
| Lansky Performance Status Score 70 | 1 Participants | 6 Participants | 7 Participants |
| Lansky Performance Status Score 80 | 2 Participants | 9 Participants | 11 Participants |
| Lansky Performance Status Score 90 | 1 Participants | 25 Participants | 26 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 3 Participants | 3 Participants |
| Race (NIH/OMB) Asian | 2 Participants | 7 Participants | 9 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants | 12 Participants | 13 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 2 Participants | 2 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 10 Participants | 10 Participants |
| Race (NIH/OMB) White | 8 Participants | 71 Participants | 79 Participants |
| Received Prior CNS Cancer Radiation Therapy No | 10 Participants | 91 Participants | 101 Participants |
| Received Prior CNS Cancer Radiation Therapy Yes | 1 Participants | 14 Participants | 15 Participants |
| Received Prior CNS Cancer Surgery No | 8 Participants | 67 Participants | 75 Participants |
| Received Prior CNS Cancer Surgery Yes | 3 Participants | 38 Participants | 41 Participants |
| Received Prior CNS Cancer Systemic Therapy, No | 10 Participants | 83 Participants | 93 Participants |
| Received Prior CNS Cancer Systemic Therapy, Yes | 1 Participants | 22 Participants | 23 Participants |
| Recurrent or Progressive Disease for Current Tumor No | 8 Participants | 72 Participants | 80 Participants |
| Recurrent or Progressive Disease for Current Tumor Yes | 3 Participants | 33 Participants | 36 Participants |
| Region of Enrollment United States | 11 participants | 105 participants | 116 participants |
| Sex: Female, Male Female | 5 Participants | 40 Participants | 45 Participants |
| Sex: Female, Male Male | 6 Participants | 65 Participants | 71 Participants |
| Weight | 27.09 kg | 37.14 kg | 36.19 kg |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 11 | 0 / 105 |
| other Total, other adverse events | 11 / 11 | 105 / 105 |
| serious Total, serious adverse events | 4 / 11 | 28 / 105 |
Outcome results
Primary
Ratio of Tozuleristide Sensitivity Compared to Surgeon Sensitivity
Tozuleristide sensitivity as assessed by imaging operator fluorescence assessment compared to sensitivity of surgeon designation of tumor under white light in equivocal tissue biopsies. Sensitivity reflects the probability that tumor tissue evaluated is fluorescent. Equivocal tissues are those that the surgeon considers abnormal but ambiguous as tumor vs. not tumor under normal (white light) conditions.
Time frame: During surgery (which occurs at least 1 hour post tozuleristide administration)
Population: Subjects who receive tozuleristide, have at least one fluorescence-positive study tissue specimens of any type (primary, equivocal, and other) based on imaging operator fluorescence assessment, and the subject's central pathology consensus diagnosis is tumor, ambiguous, or not definitive.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Group 2 | Ratio of Tozuleristide Sensitivity Compared to Surgeon Sensitivity | 1.099 Ratio of sensitivity |
Primary
Ratio of Tozuleristide Specificity Compared to Surgeon Specificity
Tozuleristide specificity as assessed by imaging operator fluorescence assessment compared to specificity of surgeon designation of tumor under white light in equivocal tissue biopsies. Specificity reflects the probability that normal tissue evaluated is not fluorescent. Equivocal tissues are those that the surgeon considers abnormal but ambiguous as tumor vs. not tumor under normal (white light) conditions.
Time frame: During surgery (which occurs at least 1 hour post tozuleristide administration)
Population: Subjects who receive tozuleristide, have at least one fluorescence-positive study tissue specimens of any type (primary, equivocal, and other) based on imaging operator fluorescence assessment, and the subject's central pathology consensus diagnosis is tumor, ambiguous, or not definitive.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Group 2 | Ratio of Tozuleristide Specificity Compared to Surgeon Specificity | 0.614 Ratio of specificity |
Primary
Sensitivity and Specificity of Tozuleristide Fluorescence to Detect Tumor in Equivocal (Ambiguous) Tissue During Surgery When Imaged With the Canvas System
Sensitivity and specificity of tozuleristide imaged with the Canvas system to fluorescently identify tumor in equivocal tissue will be evaluated based on central pathology consensus assessment of tumor and by imaging operator fluorescence assessment. These measures will be compared to the sensitivity and specificity of surgical designation of tumor (more likely tumor or less likely tumor) under white light. Sensitivity reflects the probability that tumor tissue evaluated is fluorescent. Specificity reflects the probability that normal tissue evaluated is not fluorescent. Equivocal tissues are those that the surgeon considers abnormal but ambiguous as tumor vs. not tumor under normal (white light) conditions.
Time frame: During surgery (which occurs at least 1 hour post tozuleristide administration)
Population: (Group 2) Subjects who receive tozuleristide, have at least one fluorescence-positive study tissue specimens of any type (primary, equivocal, and other) based on imaging operator fluorescence assessment, and the subject's central pathology consensus diagnosis is tumor, ambiguous, or not definitive.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Group 2 | Sensitivity and Specificity of Tozuleristide Fluorescence to Detect Tumor in Equivocal (Ambiguous) Tissue During Surgery When Imaged With the Canvas System | Sensitivity of Tozuleristide Fluorescence for equivocal tissue biopsies in Group 2 | 79.8 % of equivocal tissue biopsies |
| Group 2 | Sensitivity and Specificity of Tozuleristide Fluorescence to Detect Tumor in Equivocal (Ambiguous) Tissue During Surgery When Imaged With the Canvas System | Specificity of Tozuleristide Fluorescence for equivocal tissue biopsies in Group 2 | 34.7 % of equivocal tissue biopsies |