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Early Prediction of Pathologic Complete Response (pathCR) With Fluoro-L-Thymidine (FLT) Positron Emission Tomography (PET)

2014-08-27 03:16:01 | BioPortfolio

Summary

The goal of this research study is to learn if a new type of PET scan (18F-FLT) can help to better detect changes of tumor growth rate (or how active) in esophagus cancer. Researchers will study at what time during treatment the 18F-FLT PET scan should be given to get the best results.

A Positron Emission Tomography (PET) scan is a type of scan that uses a radioactive solution to locate cancer cells inside the body. Using the PET scan, doctors can locate solid tumors and collect information about how "active" the cancer cells are.

For this study, a new type of solution, [F-18] fluoro-L-thymidine (FLT), will be used. FLT can detect actively growing tumor, and researchers hope that FLT may be able to help provide information about how well esophagus cancer treatment is working. This information could be used to help predict if the cancer will respond to treatment.

All enrolled subjects will receive 4D-PET/ CT imaging at pre-chemoradiotherapy (CRT) and post-CRT prior to the esophagectomy. At each time of the 4D-PET/ CT procedure, the subject will receive an injection of FLT which is an investigational pharmaceutical labeled with radioactive fluorine. Each scan process might take 45 to 60 minutes. The 4DPET/ CT imaging at pre-CRT and at post-CRT will be compared and evaluated with the pathological assessment of the surgical specimens.

Participation in this pilot study will not change the patients normal chemotherapy, radiation treatment, and surgery recommended the patients physician as parts of their standard of care.

Description

The goal of this study is to obtain preliminary data and initial estimates of the FLT ability(FluoroLThymidine)-PET (Positron Emission Tomography) to identify pathCR (pathologic complete response) patients who have esophageal carinoma and undergo Chemo-RT prior to surgery. Despite improvements in surgical management, long-term survival rates in patients with esophageal cancer have not changed dramatically. Achievement in pathCR after pre-operative CRT (chemoradiotherapy) is associated with improved patient outcomes; however, there is no effective method to predict pathological response before surgery. Thus, a patient with pathCR, for whom esophagectomy may be unnecessary, still undergoes surgery and faces the prohibitive side effects of this surgical procedure. Additionally, CRT is associated with considerable morbidities and tool to predict and avoid ineffective therapy are lacking. Because deregulated proliferation is one of the hallmarks of cancer and its proliferation rate is associated with aggressive biologic behavior and response to therapy, imaging the proliferative state of cancer cells by noninvasive functional imaging is of great interest. Recently 18F-FLT (3'deoxy33'-18F-fluorothymidine) has been reported as a promising PET radiopharmaceutical for imaging cancer proliferation and has been validated in several in vitro & in vivo models. However, only a few studies addressed its role in depicting changes in cancer proliferation and assessing response to CRT, and none of these studies have focused on esophageal cancer. We propose to conduct a pilot study to learn the optimal FLT PET imaging timepoint during the early course of CRT that has the highest predictive value for pathCR in patients with esophageal cancer.

Study Design

Control: Uncontrolled, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Diagnostic

Conditions

Esophageal Cancer

Intervention

Fluoro-L-Thymidine

Location

Columbia University Medical Center
New York
New York
United States
10032

Status

Recruiting

Source

Columbia University

Results (where available)

View Results

Links

Published on BioPortfolio: 2014-08-27T03:16:01-0400

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Medical and Biotech [MESH] Definitions

The enzyme catalyzing the transfer of 2-deoxy-D-ribose from thymidine to orthophosphate, thereby liberating thymidine. EC 2.4.2.4.

An enzyme that catalyzes the conversion of ATP and thymidine to ADP and thymidine 5'-phosphate. Deoxyuridine can also act as an acceptor and dGTP as a donor. (From Enzyme Nomenclature, 1992) EC 2.7.1.21.

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Circular innermost layer of the ESOPHAGUS wall that mediates esophageal PERISTALSIS which pushes ingested food bolus toward the stomach.

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