Cancer of Unknown Primary
Conditions
Keywords
[18F]F-FAPI, PET-CT, Cancer of Unknown Primary, Diagnostics
Brief summary
The investigators will determine the proportion of CUP patients in whom the primary tumor can be identified by \[18F\]F-FAPI PET-CT.
Detailed description
Carcinoma of unknown primary origin (CUP) is a diverse group of cancers defined by the presence of metastatic disease with no identified primary tumor after exhaustive diagnostic work-up. Absence of a known targetable primary tumor precludes patients from receiving tumor-specific evidence-based therapies which significantly impacts the life expectancy of CUP patients. In this investigator-initiated and patient association-driven, multi-center, prospective clinical study we aim to detect the primary tumor by PET-CT using the novel radiotracer \[18F\]F-fluoro fibroblast activation protein inhibitor (F-FAPI). We will include 50 patients (aged \>18 year) who have been diagnosed with CUP after standard diagnostic work-up including FDG PET-CT. Participation in the study entails a one-time \[18F\]F-FAPI PET-CT examination in one of the six study centers (UMC Groningen, UMC Utrecht, Antoni van Leeuwenhoek, Radboudumc, Maastricht UMC, Erasmus MC). For the interpretation of images, central reading will be performed and results will be made available to the treating physician with an accompanying recommendation for additional diagnostics and/or treatment. After 6 months, the results of the \[18F\]F-FAPI PET-CT will be compared with patient follow up, including clinical, radiological and pathological outcome parameters. These findings will holistically be discussed in a multidisciplinary Truth Panel meeting to determine a uniform verdict with regard to the clinical value of \[18F\]F-FAPI for CUP. We hypothesize that \[18F\]F-FAPI PET-CT will detect the primary tumor in at least 15% of our CUP patients.¬
Interventions
DIAGNOSTIC_TEST[18F]F-FAPI PET-CT
Each patient will receive a FAPI PET-CT.
Sponsors
Dutch Cancer Society
Academisch Ziekenhuis Maastricht
Missie Tumor Onbekend
Noordwest Ziekenhuisgroep
Cyclotron Noordwest BV
Erasmus Medical Center
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 99 Years
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years old * Histologically-confirmed metastatic disease without identification of a primary tumor after standard diagnostic work-up, according to the national care pathway for CUP (in Dutch: Regionaal Zorgpad Primaire Tumor Onbekend), which includes at least an \[18F\]FDG PET-CT.
Exclusion criteria
* Patients with metastasis from a known primary tumor. * Sarcomas, melanomas, germ cell tumors, neuroendocrine tumors and haematological malignancies whose exact site of origin is not established. * History of malignancy within 5 years prior to \[18F\]F-FAPI PET-CT scan, with the exception of the cancer under investigation in this study and malignancies with a negligible risk of metastasis or death (e.g., 5-year OS rate \> 90%), such as adequately treated carcinoma in-situ of the cervix, nonmelanoma skin carcinoma, localized prostate cancer, ductal carcinoma in-situ, or Stage I uterine cancer. * Prior systemic therapy for the treatment of CUP. * Radiotherapy prior to \[18F\]F-FAPI PET-CT. Off note: radiotherapy with palliative intent for symptomatic skeleton lesions is allowed. * Impaired renal function, defined as eGFR (MDRD) \<25 ml/min/1,73 m2. An exception can be made in consultation with the treating physician. * WHO performance status \>2 (Vademecum). * Pregnancy/breastfeeding. For the latter, temporary discontinuation may be considered. * Known allergic reaction to therapeutic radiopharmaceuticals * Inability to lie still on the back for the duration of PET-CT * Any (other) condition, disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding that may affect the interpretation of the results, or which might contribute substantially to the patient's experience of study burden (such as non-suppressible claustrophobia)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Detection of the primary tumor by [18F]F-FAPI PET-CT | 2 years | The proportion of CUP patients in whom the primary tumor can be identified by \[18F\]F-FAPI PET-CT |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Sensitivity, specificity, positive- and negative predictive value of [18F]F-FAPI PET-CT | 2 years | These numbers will be calculated based on correlation between the outcome of the FAPI reading and the clinical outcome for the patient, i.e., correct or incorrect identification of a primary tumor (or not) by additional diagnostics or follow-up determined as such by a dedicated Truth Panel established for this study. |
Countries
Netherlands
Contacts
Primary ContactSophie Veldhuijzen van Zanten, MD, PhD
Backup ContactEsther Droogers
Outcome results
None listed