Panitumumab-IRDye800 for Brain Cancer

Overseen by Gordon Li

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 1 & 2

Recruiting

Sponsor: Eben Rosenthal

Must not be taking: Antiarrhythmics

Disqualifiers: Pregnancy, Heart disease, Liver disease, others

No Placebo Group

Approved in 1 Jurisdiction

Trial Summary

What is the purpose of this trial?

This trial studies how well Panitumumab-IRDye800 works in making cancer cells glow during surgery for patients with malignant glioma. The glowing effect helps surgeons see and remove the tumor more accurately. Panitumumab-IRDye800 has been evaluated for its potential as a targeting agent for fluorescence detection of glioblastoma multiforme and high-grade gliomas.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you cannot participate if you are taking certain heart rhythm medications (like quinidine, procainamide, dofetilide, amiodarone, or sotalol).

What data supports the effectiveness of the treatment Panitumumab-IRDye800 for brain cancer?

Research shows that Panitumumab-IRDye800 can help surgeons see brain tumors more clearly during surgery, which may lead to better removal of the tumor. In studies, it was able to detect small tumor fragments and provided high contrast between tumor and normal brain tissue, making it a promising tool for improving surgical outcomes in brain cancer. ^{1 2 3 4 5}

What makes the treatment Panitumumab-IRDye800 unique for brain cancer?

Panitumumab-IRDye800 is unique because it combines a targeted therapy with a fluorescent dye, potentially allowing surgeons to better visualize and remove brain tumors during surgery. This approach is different from standard treatments that do not provide real-time imaging to guide surgical removal of cancerous tissue. ^{6 7 8 9 10}

Research Team

Gordon Li

Principal Investigator

Stanford University

Eligibility Criteria

This trial is for individuals who are scheduled for brain tumor surgery and have a malignant glioma. They must be deemed eligible for resection by their surgeon, may have had previous treatments like chemotherapy or radiation, and need to have an adequate platelet count. People with recent heart issues, history of bad reactions to monoclonal antibodies, pregnant or breastfeeding women, certain abnormal lab values, lung conditions like interstitial pneumonitis or pulmonary fibrosis can't participate.

Inclusion Criteria

I've had chemotherapy, radiation, or a biopsy and am considered a candidate for surgery.

My surgeon has approved me for surgery.

Platelet count ≥ 75,000/mm^3

Exclusion Criteria

My tumor cannot be surgically removed due to its location or other factors.

I have had interstitial pneumonitis or pulmonary fibrosis.

I am taking medication for heart rhythm problems.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive panitumumab-IRDye800 at varying doses 1 to 5 days before surgery, followed by NIR imaging during surgery

1-5 days

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, including adverse events and tumor-to-background ratio assessments

30 days

Long-term Follow-up

Further analysis of tissue samples and outcomes related to tumor-to-background ratio over an extended period

1 year

Treatment Details

Interventions

• Panitumumab-IRDye800 (Monoclonal Antibodies)

Trial Overview The study is testing the safety and optimal dose of Panitumumab-IRDye800 during surgery in patients with malignant glioma. This substance binds to tumor cells making them glow under a special camera so surgeons can see the cancer more clearly compared to normal brain tissue.

Participant Groups

Group I: Cohort 4 Experimental Treatment 4 Interventions

Cohort 4 will enroll 24 participants with vestibular schwannomas at the optimal dose of 100mg, as determined by the research team based on data analysis from the first two cohorts.

Group II: Cohort 3 -100mg panitumumab-IRDye800 Experimental Treatment 4 Interventions

Cohort 3 dose will be determined based on Cohort 1 and Cohort 2, with or without a 100 mg loading dose of unlabeled panitumumab will be injected 1 to 5 days before the planed standard of care surgery

Group III: Cohort 2 -100mg panitumumab-IRDye800 Experimental Treatment 4 Interventions

A panitumumab-IRDye800 dose of 100mg (Cohort 2) with or without a 100 mg loading dose of unlabeled panitumumab will be injected 1 to 5 days before the planed standard of care surgery. Participants then undergo NIR imaging during standard of care surgery 1-5 days after receiving panitumumab-IRDye800.

Group IV: Cohort 1 -50mg panitumumab-IRDye800 Experimental Treatment 4 Interventions

A panitumumab-IRDye800 dose of 50mg (Cohort 1) with or without a 100 mg loading dose of unlabeled panitumumab will be injected 1 to 5 days before the planed standard of care surgery. Participants then undergo NIR imaging during standard of care surgery 1-5 days after receiving panitumumab-IRDye800.

Who Is Running the Clinical Trial?

Eben Rosenthal

Lead Sponsor

Trials

9

Recruited

200+

National Institutes of Health (NIH)

Collaborator

Trials

2,896

Recruited

8,053,000+

Findings from Research

The anti-EGFR antibody panitumumab-IRDye800 was found to be safe and effective for imaging high-grade gliomas (HGGs) in 11 patients, with no adverse events reported at both low (50 mg) and high (100 mg) doses.

This imaging agent demonstrated high sensitivity (95%) and specificity (96%) for detecting tumor tissue, allowing for improved intraoperative visualization of tumors, which could enhance surgical outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

EGFR-targeted intraoperative fluorescence imaging detects high-grade glioma with panitumumab-IRDye800 in a phase 1 clinical trial. Zhou, Q., van den Berg, NS., Rosenthal, EL., et al.[2021]

In a study involving 16 nude mice with patient-derived glioblastoma (GBM), panitumumab-IRDye800CW demonstrated a 30% higher tumor-to-background ratio compared to the standard agent 5-ALA, indicating better visualization of tumor margins during surgery.

Panitumumab-IRDye800CW also showed improved specificity for identifying tumor core and margins, suggesting it could enhance surgical resection outcomes and potentially improve survival rates for patients with GBM compared to 5-ALA.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of Panitumumab-IRDye800CW and 5-Aminolevulinic Acid to Provide Optical Contrast in a Model of Glioblastoma Multiforme. Napier, TS., Udayakumar, N., Jani, AH., et al.[2021]

Panitumumab-IRDye800 has been developed as an effective intraoperative optical imaging agent for detecting EGFR-expressing tumors, showing high specificity and sensitivity in various mouse models with different levels of EGFR expression.

The study demonstrated a strong correlation between the level of EGFR expression in tumors and the uptake of the panitumumab-IRDye800, indicating its potential for precise tumor visualization during surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Synthesis and biological evaluation of panitumumab-IRDye800 conjugate as a fluorescence imaging probe for EGFR-expressing cancers. Bhattacharyya, S., Patel, N., Wei, L., et al.[2020]

Rindopepimut, an immunotherapy targeting the EGFRvIII mutation, is the first of its kind to enter Phase III clinical trials for treating recurrent glioblastoma, a highly aggressive brain tumor.

The ReACT Phase II trial evaluated the combination of rindopepimut and bevacizumab in patients with EGFRvIII-positive recurrent glioblastoma, highlighting the potential of this approach to activate the immune response against tumor cells.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

ReACT Phase II trial: a critical evaluation of the use of rindopepimut plus bevacizumab to treat EGFRvIII-positive recurrent glioblastoma. Gatson, NT., Weathers, SP., de Groot, JF.[2018]

A prototype glioma cancer vaccine using a mix of antigens from both patient and donor tumor tissues showed promise in stopping tumor growth in a rat model of malignant glioma.

The vaccine was particularly effective when combined with immunostimulants like Bacille Calmette Guerin (BCG) and interleukin-2, or the TLR 7/8 activator resiquimod, indicating that these combinations enhance the immune response against the tumor.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exploring the Therapeutic Efficacy of Glioma Vaccines Based on Allo- and Syngeneic Antigens and Distinct Immunological Costimulation Activators. Stathopoulos, A., Pretto, C., Devillers, L., et al.[2021]

Tumor-associated B-cells in glioblastoma express high levels of checkpoint molecules that inhibit their immune functions, suggesting a barrier to effective immunotherapy in brain tumors.

Targeting the TGFβ pathway and blocking specific integrins can enhance B-cell activity and improve the efficacy of immune-checkpoint blockade treatments, potentially leading to better outcomes for glioblastoma patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

B-cells Drive Response to PD-1 Blockade in Glioblastoma Upon Neutralization of TGFβ-mediated Immunosuppression. Hou, D., Castro, B., Dapash, M., et al.[2023]

In a phase 3 trial involving 745 patients with newly diagnosed glioblastoma, the addition of the vaccine rindopepimut to standard chemotherapy did not significantly improve overall survival compared to the control group, with median survival times of 20.1 months versus 20.0 months, respectively.

The study was terminated for futility after an interim analysis, indicating that rindopepimut alone may not be effective in enhancing survival outcomes, suggesting that combination therapies may be necessary for immunotherapy to be effective in treating glioblastoma.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rindopepimut with temozolomide for patients with newly diagnosed, EGFRvIII-expressing glioblastoma (ACT IV): a randomised, double-blind, international phase 3 trial. Weller, M., Butowski, N., Tran, DD., et al.[2023]

In a study involving 260 patients with recurrent EGFR-amplified glioblastoma, the antibody-drug conjugate depatuxizumab mafodotin (Depatux-M) did not improve health-related quality of life (HRQoL) or neurological deterioration-free survival (NDFS) compared to standard treatments like temozolomide or lomustine.

Patients receiving Depatux-M experienced significant visual disorders, which were clinically relevant and consistent with known side effects of the drug, highlighting a safety concern despite the lack of overall survival benefit.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of depatuxizumab mafodotin on health-related quality of life and neurological functioning in the phase II EORTC 1410/INTELLANCE 2 trial for EGFR-amplified recurrent glioblastoma. Clement, PMJ., Dirven, L., Eoli, M., et al.[2021]

References

1. United States pubmed.ncbi.nlm.nih.gov

Optimal Dosing Strategy for Fluorescence-Guided Surgery with Panitumumab-IRDye800CW in Head and Neck Cancer. [2021]

2. Australia pubmed.ncbi.nlm.nih.gov

EGFR-targeted intraoperative fluorescence imaging detects high-grade glioma with panitumumab-IRDye800 in a phase 1 clinical trial. [2021]

3. United States pubmed.ncbi.nlm.nih.gov

Comparison of Panitumumab-IRDye800CW and 5-Aminolevulinic Acid to Provide Optical Contrast in a Model of Glioblastoma Multiforme. [2021]

4. England pubmed.ncbi.nlm.nih.gov

Synthesis and biological evaluation of panitumumab-IRDye800 conjugate as a fluorescence imaging probe for EGFR-expressing cancers. [2020]

5. Australia pubmed.ncbi.nlm.nih.gov

Safety of panitumumab-IRDye800CW and cetuximab-IRDye800CW for fluorescence-guided surgical navigation in head and neck cancers. [2019]

6. England pubmed.ncbi.nlm.nih.gov

ReACT Phase II trial: a critical evaluation of the use of rindopepimut plus bevacizumab to treat EGFRvIII-positive recurrent glioblastoma. [2018]

7. United States pubmed.ncbi.nlm.nih.gov

Exploring the Therapeutic Efficacy of Glioma Vaccines Based on Allo- and Syngeneic Antigens and Distinct Immunological Costimulation Activators. [2021]

8. United States pubmed.ncbi.nlm.nih.gov

B-cells Drive Response to PD-1 Blockade in Glioblastoma Upon Neutralization of TGFβ-mediated Immunosuppression. [2023]

9. England pubmed.ncbi.nlm.nih.gov

Rindopepimut with temozolomide for patients with newly diagnosed, EGFRvIII-expressing glioblastoma (ACT IV): a randomised, double-blind, international phase 3 trial. [2023]

10. England pubmed.ncbi.nlm.nih.gov

Impact of depatuxizumab mafodotin on health-related quality of life and neurological functioning in the phase II EORTC 1410/INTELLANCE 2 trial for EGFR-amplified recurrent glioblastoma. [2021]