Panitumumab-IRDye800 and 89Zr-Panitumumab in Identifying Metastatic Lymph Nodes in Patients With Squamous Cell Head and Neck Cancer

Andrei Iagaru

Status and phase: Completed; Phase 1

Conditions: Squamous Cell Carcinoma of the Head and Neck; Carcinoma of the Head and Neck

Treatments: Drug: Panitumumab-IRDye800; Device: Leica fluorescence microscope; Device: Da Vinci Firefly Imaging System; Drug: 89-Zirconium (Zr-89) Panitumumab; Device: Vevo 3100 LAZR-X; Device: Explorer Air camera; Device: FIS-00 fluorescence imaging system (FIS); Device: IGP-ELVIS-v4 Macroscopic Specimen Imager; Device: Pearl Triology Imaging System; Device: PDE-NEO II camera; Device: SPY-PHI IR9000 fluorescence imaging system (FIS); Device: Odyssey CLx Imaging System; Device: Pinpoint IR IR9000 fluorescence imaging system (FIS)

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT03733210

P30CA124435 (U.S. NIH Grant/Contract)

R01CA190306 (U.S. NIH Grant/Contract)

ENT0066 (Other Identifier)

NCI-2018-02270 (Registry Identifier)

IRB-41878 (Other Identifier)

Details and patient eligibility

About

This study evaluates how well panitumumab-IRDye800 and 89Zr-panitumumab work in identifying cancer that has spread to the lymph nodes in patients with squamous cell head and neck cancer. Panitumumab-IRDye800 is a drug that contains a dye molecule that fluoresces during surgery to indicate cancerous tissue. 89Zr-panitumumab is a drug that contains a small amount of radiation, which makes it visible in positron emission tomography (PET) scans. PET scans make detailed, computerized pictures of areas inside the body where the drug is used. Giving panitumumab-IRDye800 and 89Zr-panitumumab to patients with head and neck cancer may help doctors find metastatic lymph nodes better than current methods [positron emission tomography (PET); computed tomography (CT); magnetic imaging resonance (MRI), or combinations].

Full description

For patients with head and neck cancer, detection of malignant cells within nearby lymph nodes (LNs) is an important measure of the extent and severity of the cancer. LNs are a key immunologic organ involved in overall immune surveillance. Historically, LN or LNs were harvested before the surgery of curative intent, evaluated pathologically, and then tumor status of the harvested LNs were utilized to inform the individual surgical plan. These LNs became known as "sentinel lymph nodes." In recent years, techniques have been developed to utilize peritumoral injection (around the tumor) of tumor labels that could identify tumor in the LNs without biopsy, ie, only LNs that were tumor-positive would be removed. However, in some patients, this technique could be limited by the location of the primary cancer. Effective and sensitive systemically-administered labels would be a significant advancement. The systemically-administered label 18F-fluorodeoxyglucose (18F-FDG), detected by positron emission tomography / computed tomography (PET/CT) and/or PET / magnetic imaging resonance (PET/MRI) radiologic scans and representing current regular medical care, has provided improvement in detection of cancer-positive LNs. However, further enhancements may be possible.

Participants with squamous cell carcinoma of the head and neck (SCCHN) and scheduled to undergo regular medical care surgery with curative intent, were assigned to 2 study groups on the basis of whether regular medical care scans using 18F-FDG PET/CT or PET/MRI had indicated that cancer was suspected in the lymph nodes (LN+ or cN+), or without suspected cancer in the lymph nodes (LN- or cN0). Following the 18F-FDG, and prior to surgery, 89Zr-panitumumab was systemically administered by intravenous infusion, and a PET-CT imaging scan was conducted. Research imaging will be performed intraoperatively using optical imaging devices and a high-energy gamma probe. Subsequently, the excised tissue will evaluated ex vivo (back table) using radioactive (89Zr-panitumumab) and fluorescence (panitumumab-IRDye800) imaging techniques. Regular medical care surgical excision of the tumor and adjacent LN was conducted on Day 2 to 5. After surgery, patients are followed up at 15 and 30 days.

PRIMARY OBJECTIVES:

I. Determine the sensitivity and specificity of zirconium(89Zr)-panitumumab (89Zr-panitumumab) for the detection of tumor-involved regional lymph nodes.

SECONDARY OBJECTIVES:

I. Determine the number (proportion) of lymph nodes determined to be tumor positive by histological and/or pathological evaluation that were NOT predicted tumor-positive by 89Zr-panitumumab labeling.

EXPLORATORY OBJECTIVES:

I. Determine the sensitivity and specificity of panitumumab-IRDye800 for the detection of tumor-involved regional lymph nodes.

II. Determine the number (proportion) of lymph nodes determined to be tumor positive by histological and/or pathological evaluation that were NOT predicted tumor-positive by panitumumab-IRDye800 labeling.

Enrollment: 14 patients

Sex: All

Ages: 19+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Biopsy confirmed diagnosis of squamous cell carcinoma of the head and neck.
• Subjects diagnosed with any T stage, any subsite within the head and neck that are scheduled to undergo surgical resection. Subjects with recurrent disease or a new primary will be allowed.
• Planned standard of care surgery with curative intent for squamous cell carcinoma.
• Hemoglobin ≥ 9 gm/dL.
• White blood cell count > 3000/mm³.
• Platelet count ≥ 100,000/mm³.
• Serum creatinine ≤ 1.5 times upper reference range.

Exclusion criteria

• Myocardial infarction (MI); cerebrovascular accident (CVA); uncontrolled congestive heart failure (CHF); significant liver disease; or unstable angina within 6 months prior to enrollment.
• Previous bilateral neck dissection.
• History of infusion reactions to monoclonal antibody therapies.
• Pregnant or breastfeeding.
• Magnesium or potassium lower than the normal institutional values.
• Subjects receiving class IA (quinidine, procainamide) or class III (dofetilide, amiodarone, sotalol) antiarrhythmic agents.
• Subjects with a history or evidence of interstitial pneumonitis or pulmonary fibrosis.
• Severe renal disease or anuria.
• Known hypersensitivity to deferoxamine or any of its components.

Trial design

Primary purpose: Diagnostic

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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14 participants in 2 patient groups

Tumor-negative Lymph Nodes (by 18F-FDG scan)

Experimental group

Description:

Participants whose lymph nodes are negative for cancer

Treatment:

Drug: Panitumumab-IRDye800

Device: Pearl Triology Imaging System

Device: IGP-ELVIS-v4 Macroscopic Specimen Imager

Device: Pinpoint IR IR9000 fluorescence imaging system (FIS)

Device: Vevo 3100 LAZR-X

Device: Da Vinci Firefly Imaging System

Device: Explorer Air camera

Device: SPY-PHI IR9000 fluorescence imaging system (FIS)

Device: Leica fluorescence microscope

Drug: 89-Zirconium (Zr-89) Panitumumab

Device: PDE-NEO II camera

Device: Odyssey CLx Imaging System

Device: FIS-00 fluorescence imaging system (FIS)

Tumor-positive Lymph Nodes (by 18F-FDG scan)

Experimental group

Description:

Participants whose lymph nodes are positive for cancer.

Treatment:

Drug: Panitumumab-IRDye800

Device: Pearl Triology Imaging System

Device: IGP-ELVIS-v4 Macroscopic Specimen Imager

Device: Pinpoint IR IR9000 fluorescence imaging system (FIS)

Device: Vevo 3100 LAZR-X

Device: Da Vinci Firefly Imaging System

Device: Explorer Air camera

Device: SPY-PHI IR9000 fluorescence imaging system (FIS)

Device: Leica fluorescence microscope

Drug: 89-Zirconium (Zr-89) Panitumumab

Device: PDE-NEO II camera

Device: Odyssey CLx Imaging System

Device: FIS-00 fluorescence imaging system (FIS)