A Phase II Trial Evaluating 18F-Fluciclovine PET/CT in Multiple Myeloma
试验速览
- 阶段
- 2 期
- 状态
- 招募中
- 入组人数
- 60
- 试验地点
- 1
- 主要终点
- To determine the concordance between 18F-fluciclovine PET/CT and 18F-FDG PET/CT in participants with multiple myeloma.
研究概览
简要总结
Background:
Multiple myeloma (MM) is an incurable cancer of certain blood cells. MM often returns after treatment, and most people survive only 5 to 8 years after diagnosis. To improve survival, researchers need to find ways to identify returning disease earlier.
Objective:
To find out if the radiotracer 18F-fluciclovine (a substance injected into the blood during imaging scans) is better at detecting MM than the one (18F-FDG) currently used for this purpose.
Eligibility:
Adults aged 18 years or older with MM. The MM may be newly diagnosed (NDMM); or it may have returned or failed to respond after at least 1 prior line of treatment (RRMM).
Design:
Participants will be screened. They will have blood tests. They will have a positron emission tomography (PET) or computed tomography (CT) scan using 18F-FDG. The radiotracer will be injected into a vein. Then participants will lie on a table while the PET/CT scan takes images of their body.
All participants will have 3 study visits. During each visit they will have:
Two PET/CT scans. One with 18F-FDG, one with 18F-fluciclovine.
An optional magnetic resonance imaging scan.
A bone marrow biopsy. An area on the hip will be numbed; a needle will be inserted to draw out a sample of the soft tissue from inside the bone.
These tests may be spread over 30 days for each visit.
NDMM participants will have their second study visit 2 to 4 weeks after they complete their usual treatment for the disease. RRMM participants will have their second visit 6 months after their first.
All participants will have a third study visit after 5 years or when their disease progresses....
详细描述
Background:
- Multiple myeloma (MM) is an incurable malignancy of plasma cells that leads to destructive bone lesions, renal damage, anemia, and hypercalcemia. MM is the second most common hematologic malignancy. The American Cancer Society estimates that annually over 34,000 new cases of MM will occur in the U.S. and over 12,000 deaths due to MM in 2022.
- Overall survival (OS) has improved significantly over the past 20 years with the development of proteasome inhibitors (PIs), immunomodulatory agents (IMiDs) and anti-CD38 monoclonal antibodies. However, despite these advances, patients ultimately relapse requiring multiple subsequent lines of therapy. As MM evolves, it generally becomes more refractory, and patients ultimately succumb to their disease.
- With multiple lines of efficacious therapies, the correct early identification of relapsed disease is important to trigger initiation of a new line of therapy.
- Limitations in conventional imaging highlight a need for molecular imaging agents with better sensitivity for detecting and measuring tumor burden to improve staging and treatment selection for patients with MM and plasma cell dyscrasias.
- 18F-fluciclovine is a radionuclide approved by the FDA for evaluating suspected prostate cancer recurrence but has shown additional ability in detecting MM lesions.
Objective:
To determine the concordance between 18F-fluciclovine PET/CT and 18F-FDG PET/CT in participants with multiple myeloma
Eligibility:
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 120 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •INCLUSION CRITERIA:
- •Participants must have a documented diagnosis of MM defined by the IMWG Criteria. Participants at diagnosis must have had a serum M-protein >= 3 g/dL and/or bone marrow plasma cells >= 10% and at least one of the following:
- •Anemia: Hemoglobin <=10 g/dL, or
- •Renal Failure: serum creatinine >= 2.0 mg/dL, or
- •Hypercalcemia: Ca >= 10.5 mg/dL, or
- •Lytic bone lesions on X-ray, CT, or PET/CT, or
- •>= 2 focal lesions on spinal MRI, or
- •>= 60% bone marrow plasma cells, or
- •Involved/un-involved serum free light chain ration >= 100
- •Participants must have measurable disease defined by any one of the following:
- •Monoclonal bone marrow plasma cells > 5%
- •Serum monoclonal protein >= 0.2 g/dl
- •Urine monoclonal protein > 200 mg/24 hr
- •Serum immunoglobulin free light chain > 10 mg/dL AND abnormal kappa/lambda ratio
- •A measurable lesion on PET/CT or MRI
- •Participants fit criteria for one of the following categories:
- •Newly diagnosed multiple myeloma (NDMM)
- •Relapsed and/or refractory multiple myeloma (RRMM) with at least 1 prior line of therapy
- •Age >=18 years.
- •ECOG performance status <= 2
- •Negative serum or urine pregnancy test at screening for WOCBP.
- •Women of child-bearing potential and men must agree to use effective contraception (hormonal or barrier method of birth control; abstinence) 24 hours prior to and for the 24 hours after each 18F-fluciclovine administration.
- •Ability of subject to understand and the willingness to sign a written informed consent document.
排除标准
- •History of allergic reactions attributed to compounds of similar chemical or biologic composition to 18F-FDG
- •History of allergic reactions attributed to compounds of similar chemical or biologic composition to 18F-fluciclovine or other similar agents.
- •Subjects with severe claustrophobia unresponsive to oral anxiolytics or unwilling to take them.
- •Uncontrolled intercurrent illness including, psychiatric illness/social situations that would limit compliance with study requirements.
- •Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with 18F-fluciclovine, breastfeeding should be discontinued if the mother is treated with 18F-fluciclovine until 3 days after 18F-fluciclovine.
研究组 & 干预措施
18F-fluciclovine PET/CT in Multiple Myeloma
Evaluate 18F-fluciclovine PET/CT in participants with multiple myeloma at Timepoint #1, Timepoint #2 ( after induction treatment (NDMM) or six months (RRMM)) and at Timepoint #3 (the time of progression or 5 years).
干预措施: 18F-FDG PET/CT (Procedure)
18F-fluciclovine PET/CT in Multiple Myeloma
Evaluate 18F-fluciclovine PET/CT in participants with multiple myeloma at Timepoint #1, Timepoint #2 ( after induction treatment (NDMM) or six months (RRMM)) and at Timepoint #3 (the time of progression or 5 years).
干预措施: 18F-fluciclovine injection (Drug)
结局指标
主要结局
To determine the concordance between 18F-fluciclovine PET/CT and 18F-FDG PET/CT in participants with multiple myeloma.
时间窗: After 50 evaluable participants have completed baseline scans.
The performance of 18F-fluciclovine PET/CT is assessed by concordance with the 18F-FDG PET/CT imaging in scan positivity. A positive lesion is defined as focal uptake greater than background associated with abnormal CT findings (i.e., lytic bone lesions or extramedullary tissue.) The point estimates and 95% confidence intervals of the concordance rate in scan positivity between 18F-fluciclovine and 18F-FDG PET/CT will be reported.
次要结局
- Evaluate the ability for 18F-fluciclovine to evaluate response after treatment as compared to the IMWG response criteria.(Between Timepoint #1 and Timepoint #3)
- Evaluate the efficacy of 18F-fluciclovine in measuring disease volume as compared to other indicators of disease volume such as serum M protein, serum free-light chains, urine M protein, B2 microglobulin, and bone marrow plasma cell percentage.(Between Timepoint #1 and Timepoint #3)
- Evaluate the safety of 18F-fluciclovine as a radiotracer in patients with multiple myeloma.(From the time at each 18F-fluciclovine dose through 3 days after each dose.)
- Evaluate the ability of 18F-fluciclovine to identify minimal residual disease (MRD) as compared to MRD status determined by bone marrow flow cytometry or next generation sequencing (NGS).(Between Timepoint #1 and Timepoint #3)