FAP-targeted PET/NIR in Lung Malignant Tumors

Official title

Visualization Study on Tumor Progression Mechanisms and Key Molecular Functions in Neoadjuvant Immunotherapy for Lung Cancer: Preoperative Efficacy Prediction and Intraoperative Fluorescence Navigation

Overview

Single center, prospective, diagnostic study. Patients with stage II-IIIB resectable NSCLC diagnosed by pathology were included. After receiving standard neoadjuvant therapy (chemotherapy/immunotherapy/combination therapy), FAPI-PET/CT and fluorescence imaging were performed one week before surgery. During the surgery, a near-infrared fluorescence navigation system was used to locate the tumor lesion. After surgery, the tumor bed range was determined by pathological gold standards (HE staining+immunohistochemistry), and the predictive efficacy and localization accuracy of FAPI-PET/fluorescence were compared and analyzed.

Detailed description

This is a prospective, exploratory clinical study designed to evaluate the role of FAP-targeted imaging in efficacy prediction and tumor bed delineation in patients with NSCLC undergoing surgical resection after neoadjuvant therapy. Following neoadjuvant treatment, enrolled patients will undergo preoperative FAP-targeted PET imaging to assess treatment response and identify metabolically active tumor-associated stromal regions. Surgical resection will be performed according to standard clinical practice. Immediately after tumor resection, ex vivo fluorescence imaging of the surgical specimen will be conducted using a EB-FAPI fluorescence probe. Based on fluorescence signal distribution, systematic multipoint sampling will be performed across tumor center, tumor margin, and adjacent normal tissues. Routine pathological sampling will be conducted in parallel according to standard protocols. Additional fluorescence-guided sampling will be performed in regions with persistent fluorescence signals. Histopathological analysis will be used as the reference standard to evaluate tumor bed distribution, residual tumor presence, and pathological response. The concordance between fluorescence imaging, PET imaging, and pathological findings will be analyzed. The study will also evaluate whether fluorescence-guided sampling can improve detection of residual tumor and reduce false-negative pathological assessments. This study aims to establish a multimodal imaging approach integrating preoperative molecular imaging and intraoperative fluorescence guidance to enhance tumor bed visualization and improve the accuracy of pathological response assessment after neoadjuvant therapy in NSCLC.

Interventions

• Diagnostic test PET/CT scans
  PET Dynamic Data: The tracer is administered based on the patient's body weight at approximately 0.06-0.12 mCi/kg. PET scanning is initiated simultaneously with tracer injection, followed by a flush with 10 ml of normal saline. The image acquisition matrix is 192 × 192. Reconstruction is performed using the OSEM algorithm with 4 iterations and 20 subsets, incorporating time-of-flight attenuation correction, scatter correction, and random correction. The total duration of PET dynamic data acquisi

Primary outcome measures

• Accuracy of EB-FAPI fluorescence imaging for tumor bed delineation after neoadjuvant therapy [Time frame: From surgery to completion of postoperative pathological evaluation (within 2 weeks after surgery)]
• Diagnostic performance of preoperative FAPI PET for treatment response assessment [Time frame: From preoperative imaging to postoperative pathological assessment (within 4 weeks)]

Secondary outcome measures (2)

• Correlation between fluorescence signal intensity and pathological features [Time frame: Postoperative specimen analysis (within 2-3 weeks after surgery)]
• Tumor-to-background ratio (TBR) of fluorescence imaging in surgical specimens [Time frame: Postoperative specimen analysis (within 2-3 weeks after surgery)]

Eligibility criteria

Inclusion criteria

• Age between 18 and 70 years old;
• Have complete clinical and imaging data;
• Prior to neoadjuvant therapy, the biopsy pathology showed lung cancer;
• Able to retain sufficient tumor tissue for testing and research;
• Sign informed consent.

Exclusion criteria

• Previously combined with other malignant tumors or received other anti-tumor treatments;
• Failure to collect sufficient tumor tissue for testing and research;
• The duration of neoadjuvant therapy is less than 3 cycles;
• The dynamic scanning image quality of multimodal probe PET cannot meet the analysis standards or is missing;
• Lack of clinical and imaging data;
• There are situations where other researchers consider it inappropriate to participate in this study

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Observational model

Cohort

Study locations

China · 1 center

• Peking University People's Hospital — Beijing

Publications

• Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249. doi: 10.3322/caac.21660. Epub 2021 Feb 4. PMID 33538338
• Chen K, Yang F, Shen H, Wang C, Li X, Chervova O, Wu S, Qiu F, Peng D, Zhu X, Chuai S, Beck S, Kanu N, Carbone D, Zhang Z, Wang J. Individualized tumor-informed circulating tumor DNA analysis for postoperative monitoring of non-small cell lung cancer. Cancer Cell. 2023 Oct 9;41(10):1749-1762.e6. doi: 10.1016/j.ccell.2023.08.010. Epub 2023 Sep 7. PMID 37683638
• Gangadharan S, Sarkaria IN, Rice D, Murthy S, Braun J, Kucharczuk J, Predina J, Singhal S. Multiinstitutional Phase 2 Clinical Trial of Intraoperative Molecular Imaging of Lung Cancer. Ann Thorac Surg. 2021 Oct;112(4):1150-1159. doi: 10.1016/j.athoracsur.2020.09.037. Epub 2020 Nov 19. PMID 33221195
• Kennedy GT, Azari FS, Bernstein E, Marfatia I, Din A, Kucharczuk JC, Low PS, Singhal S. Targeted Intraoperative Molecular Imaging for Localizing Nonpalpable Tumors and Quantifying Resection Margin Distances. JAMA Surg. 2021 Nov 1;156(11):1043-1050. doi: 10.1001/jamasurg.2021.3757. PMID 34431971
• Sarkaria IS, Martin LW, Rice DC, Blackmon SH, Slade HB, Singhal S; ELUCIDATE Study Group. Pafolacianine for intraoperative molecular imaging of cancer in the lung: The ELUCIDATE trial. J Thorac Cardiovasc Surg. 2023 Dec;166(6):e468-e478. doi: 10.1016/j.jtcvs.2023.02.025. Epub 2023 Mar 3. PMID 37019717

Identifiers

NCT: NCT07498933 · 2101000672

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗