Clinical Trial Details
— Status: Completed
Administrative data
NCT number |
NCT04823065 |
Other study ID # |
CIMS-2019-01 |
Secondary ID |
|
Status |
Completed |
Phase |
Phase 1/Phase 2
|
First received |
|
Last updated |
|
Start date |
September 1, 2018 |
Est. completion date |
April 30, 2024 |
Study information
Verified date |
May 2024 |
Source |
Centre de recherche du Centre hospitalier universitaire de Sherbrooke |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
This project is about exploring a novel method to detect ovarian and uterine cancers earlier
and better. More precisely, a high-performance radioactive estrogen analog will be used to
visualize hormone-sensitive uterine and ovarian tumors using PET imaging. Not only this
imaging methodology could improve the whole-body assessment of those diseases, but will also
hint clinicians about the optimal course of therapy to undertake.
The lead investigator's team designed in the past years an innovative radioactive estrogen
derivative tracer (4FMFES) for the medical imaging modality termed Positron Emission
Tomography (PET). The compound was first shown to be safe for human use. Recently, a clinical
trial demonstrated that 4FMFES-PET is superior to any existing comparable tracer for
detection of hormone-sensitive breast cancer patients. 4FMFES is particularly useful to
pinpoint unsuspected metastases early, which allowed better breast cancer patient management
and staging. 4FMFES and standard FDG PET imaging were shown to be complementary in breast
cancer, the use of both techniques together providing a detection rate nearing 100%. Since
ovarian and uterine cancers are about as likely to be targeted by 4FMFES as breast cancer,
the use of this novel precision imaging method will be adapted to those other indications.
In general, the sooner a cancer is diagnosed and treated, the better the outcome of a patient
will be. Gynecological cancers lack precise screening and detection tools. In particular,
while a majority of uterine cancers are relatively well managed, patients burdened with
metastatic burden have a much worse prognosis, and precise and early detection of those
lesions will greatly help clinicians to better treat those complicated cases. As for ovarian
cancers, they are usually devoid of clinical symptoms until late onset, which partly explain
the high mortality rate of this disease. Hence, for both diseases, a precision, whole-body
imaging technique will allow earlier assessment, followed by earlier intervention, resulting
in improved survival rate and better quality of life for patients.
Description:
Knowledge of estrogen receptor (ER) status is of paramount importance for breast cancer
management. Mounting evidence supports an equally important role of ER status for uterine and
ovarian cancers. Indeed, this prognostic factor was shown to stratify survival and
progression-free rates, and to predict efficacy of ER-targeting adjuvant hormone therapy in
those cancers. Between 70 and 80% of gynecological cancers expresses ER, akin to what is
found in breast cancer. However, ER status is assessed by biopsy and hence is limited to
primary lesions and to known, accessible metastases.
Commonly used diagnostic tools for gynecological cancers includes anatomical imaging
modalities, such as echography, computed tomography (CT) and magnetic resonance imaging
(MRI), with an increased role for metabolic [18F]-fluorodeoxyglucose positron emission
tomography (FDG-PET) imaging, all yielding suboptimal tumor detection rate and poor
specificity. Studies explored combination of FDG-PET/CT with [18F]-16α-fluoroestradiol (FES)
PET/CT imaging to obtain whole-body assessment of ER status of both uterine and ovarian
cancers, with FDG/FES uptake ratio correlating with grade and stage of disease. However, FES
has many shortcomings, including rapid hepatic metabolism and binding to plasma globulins,
resulting in a strong blood pool and in high nonspecific uptake, both detrimental to tumor
detection.
The investigator's research center have designed a novel ER-targeting PET tracer,
4-fluoro-11β-methoxy-16α-[18F] fluoroestradiol (4FMFES) that addresses those flaws; 4FMFES is
2.5-fold more resistant to metabolism and does not bind to globulins. A phase II study
comparing FES with 4FMFES-PET in breast cancer patients showed significantly reduced
background with 4FMFES, resulting in improved tumor contrast and in an increased tumor
detection rate. Preliminary results showed that addition of 4FMFES-PET to the standard
FDG-PET allowed upstaging of ~20% of the breast cancer patients studied so far. Those breast
cancer derived data forebode the potential of combined FDG- and 4FMFES-PET for whole-body
diagnosis and ER status assessment for uterine and ovarian cancers.
Aim: Launch a phase I/II clinical trial evaluating the use of FDG and 4FMFES PET in ER+
uterine and ovarian cancer patients to enhance diagnostic confidence and accuracy, and to
assess whole-body ER status non-invasively.
Specific aims:
1. Optimize imaging protocol for abdomen 4FMFES imaging: 4FMFES is eliminated by
hepatobiliary excretion and as such generates strong signals in the intestinal tract,
which could induce strong background and even false positives. Appropriate timing
between 4FMFES injection and scan would allow optimal tumor uptake and minimal unwanted
signal in the peritoneal area. Separately, pre-treatment with cholecystokinine (to
pre-empty the gallbladder) or with opioids (to prevent intestinal peristalsis) will be
explored as alternate ways of optimizing the protocol. A cohort of patients will be
constituted in order to explore the best strategy to undertake for the rest of the
study.
2. Evaluate the use of combined FDG and 4FMFES-PET for diagnosis and staging of ER+ uterine
and ovarian cancers: Two cohorts of both uterine and ovarian cancer patients will be
monitored by FDG and 4FMFES-PET/CT in sequence. Tumor uptake for each tracer will be
compared. Number of detected lesion per patient using this protocol will be compared to
whatever findings CT, or FDG alone would have found, and % of upstaged patients will be
reported.
3. Correlate FDG and 4FMFES-PET tumor uptake with biopsy-derived grade and status: Every
known, accessible lesion will be biopsied, and tumor grade and receptor status will be
assessed. Correlation between pathological characteristics, and FDG and 4FMFES
PET-derived tumor uptake will be drawn.
The lack of sensitive and accurate imaging tools for uterine and ovarian cancer means that
diagnosis is too often achieved at late onset of those diseases. Not only the validation of
4FMFES-PET combined with standard FDG-PET should yield more precise, whole-body diagnostic
and staging, but also could predict prognosis and targeted therapy efficacy.