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Fluorescence-guided Surgery in Laryngeal- and Hypopharyngeal Cancer: a Feasibility Trial (STELLAR)

Primary Purpose

Squamous Cell Carcinoma of the Larynx, Squamous Cell Carcinoma of the Hypopharynx

Status
Not yet recruiting
Phase
Phase 2
Locations
Netherlands
Study Type
Interventional
Intervention
CRGD-ZW800-1
Sponsored by
Erasmus Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional diagnostic trial for Squamous Cell Carcinoma of the Larynx focused on measuring Tumour specific fluorescence imaging

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Patients with biopsy-proven squamous cell Laryngeal and hypopharyngeal cancer, eligible for surgical resection of the tumor by TLE; ≥ 18 years of age; Written informed consent must be obtained; Sufficient knowledge of the Dutch language to understand the informed consent form; Exclusion Criteria: History of a clinically significant allergy or anaphylactic reactions to any of the components of the agent; Other synchronous biopsy proven malignancies currently active, except for adequately treated in situ carcinoma of cervix and basal, squamous cell skin carcinoma, or other head- and neck squamous cell cancer; Patients pregnant or breastfeeding; Patients with renal insufficiency (defined as eGFR < 60); Patients with previous kidney transplantation or a solitary functioning kidney; Patients using medications that may significantly impair renal function (i.e. NSAIDs, particularly COX-2 inhibitors), that cannot be paused during the course of the study; Patients with ASA classification of 4 or higher; Patients with measured QTc of 500 ms or higher at screening; Patients with laboratory abnormalities defined as: Aspartate AminoTransferase, Alanine AminoTransferase, Gamma Glutamyl Transferase) or Alkaline Phosphatase levels above 5 times the ULN or; Total bilirubin above 3 times the ULN or; Platelet count below 100 x 109/L or; Hemoglobin below 4 mmol/L (females) or below 5 mmol/l (males). Immuno-compromised patients who do not have the ability to respond normally to an infection due to an impaired or weakened immune system, caused by either a preexisting disease or concomitant medications;

Sites / Locations

  • Erasmus Medical Center

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Experimental

Experimental

Experimental

Arm Label

0.05 mg/kg cRGD-ZW800-1

0.025 mg/kg cRGD-ZW800-1

0.01 mg/kg cRGD-ZW800-1

Expansion Cohort

Arm Description

n=3. Injection of 0.05 mg/kg cRGD-ZW800-1, within 2 hours before imaging/surgery

n=3. Injection of 0.025 mg/kg cRGD-ZW800-1, within 2 hours before imaging/surgery

n=3. Injection of 0.01 mg/kg cRGD-ZW800-1, within 2 hours before imaging/surgery.

n=18: expansion cohort will be added to the group of patients that had received the selected dose in WP-I.

Outcomes

Primary Outcome Measures

WP-I: the optimal dose of cRGD-ZW800-1 for FLI of laryngeal and hypopharyngeal cancer
Based on the tumor-to-background ratio (TBR) on breadloaves. Higher TBRs indicate a better outcome
WP-II: the rate of clear tumor resection margins

Secondary Outcome Measures

Full Information

First Posted
February 21, 2023
Last Updated
March 30, 2023
Sponsor
Erasmus Medical Center
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1. Study Identification

Unique Protocol Identification Number
NCT05752149
Brief Title
Fluorescence-guided Surgery in Laryngeal- and Hypopharyngeal Cancer: a Feasibility Trial
Acronym
STELLAR
Official Title
The STELLAR Trial: Fluorescence-guided Surgery in Laryngeal- and Hypopharyngeal Cancer: a Feasibility Trial
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
May 2023 (Anticipated)
Primary Completion Date
November 2024 (Anticipated)
Study Completion Date
May 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Erasmus Medical Center

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is an open-label, single-dose, prospective clinical trial. The study comprises 2 work packages. The main objective of work package I (WP-1) is to assess feasibility of Fluorescence imaing (FLI) during total laryngectomy (TLE) and to assess the optimal dose of the cRGD-ZW800-1. Work package II (WP-II) is designed to assess whether FLI can detect and decrease tumor positive margins after a TLE.
Detailed Description
This is a two staged clinical trial to investigate intraoperative fluorescence imaging in patientsundergoing TLE. WP-I is a dose finding study in which 2 doses will be tested with a possibility of a third dosing group. Every dosing cohort comprises 3 patients. After WP-I, an interim analysis will be performed to decide the optimal dose. The optimal dose will be based on the TBR and the performance in detecting the most close margin (i.e. 'the sentinel margin'). A TBR of at least 1.5 is required for the optimal dose. If a positive margin is missed with fluorescence imaging, the concerned dose will be defined as suboptimal. WP-II is an extension cohort of the optimal dose cohort selected in WP-I. WP-II will comprise of 18 patients. The endpoints for WP-II are: the rate of tumor free resection margins based on the current golden standard; Sensitivity, specificity and positive predictive value of FLI; The intraoperative change in surgical management based on FLI; FLI of excised cervical lymph nodes; Influence of previous radiotherapy on the FLI performance; Adverse events and toxicity after intravenous injection with cRGD-ZW800-1;

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Squamous Cell Carcinoma of the Larynx, Squamous Cell Carcinoma of the Hypopharynx
Keywords
Tumour specific fluorescence imaging

7. Study Design

Primary Purpose
Diagnostic
Study Phase
Phase 2
Interventional Study Model
Sequential Assignment
Masking
Care Provider
Masking Description
The pathologist will be initially blinded during intraoperative assessment of the fresh surgical specimen.
Allocation
Non-Randomized
Enrollment
27 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
0.05 mg/kg cRGD-ZW800-1
Arm Type
Experimental
Arm Description
n=3. Injection of 0.05 mg/kg cRGD-ZW800-1, within 2 hours before imaging/surgery
Arm Title
0.025 mg/kg cRGD-ZW800-1
Arm Type
Experimental
Arm Description
n=3. Injection of 0.025 mg/kg cRGD-ZW800-1, within 2 hours before imaging/surgery
Arm Title
0.01 mg/kg cRGD-ZW800-1
Arm Type
Experimental
Arm Description
n=3. Injection of 0.01 mg/kg cRGD-ZW800-1, within 2 hours before imaging/surgery.
Arm Title
Expansion Cohort
Arm Type
Experimental
Arm Description
n=18: expansion cohort will be added to the group of patients that had received the selected dose in WP-I.
Intervention Type
Drug
Intervention Name(s)
CRGD-ZW800-1
Intervention Description
Intravenous administration of study drug at lesat 2h prior to surgery
Primary Outcome Measure Information:
Title
WP-I: the optimal dose of cRGD-ZW800-1 for FLI of laryngeal and hypopharyngeal cancer
Description
Based on the tumor-to-background ratio (TBR) on breadloaves. Higher TBRs indicate a better outcome
Time Frame
Up to 48 hours after administration (Depending on pathology grossing)
Title
WP-II: the rate of clear tumor resection margins
Time Frame
Through histopathology, up to max 4 weeks post-op

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients with biopsy-proven squamous cell Laryngeal and hypopharyngeal cancer, eligible for surgical resection of the tumor by TLE; ≥ 18 years of age; Written informed consent must be obtained; Sufficient knowledge of the Dutch language to understand the informed consent form; Exclusion Criteria: History of a clinically significant allergy or anaphylactic reactions to any of the components of the agent; Other synchronous biopsy proven malignancies currently active, except for adequately treated in situ carcinoma of cervix and basal, squamous cell skin carcinoma, or other head- and neck squamous cell cancer; Patients pregnant or breastfeeding; Patients with renal insufficiency (defined as eGFR < 60); Patients with previous kidney transplantation or a solitary functioning kidney; Patients using medications that may significantly impair renal function (i.e. NSAIDs, particularly COX-2 inhibitors), that cannot be paused during the course of the study; Patients with ASA classification of 4 or higher; Patients with measured QTc of 500 ms or higher at screening; Patients with laboratory abnormalities defined as: Aspartate AminoTransferase, Alanine AminoTransferase, Gamma Glutamyl Transferase) or Alkaline Phosphatase levels above 5 times the ULN or; Total bilirubin above 3 times the ULN or; Platelet count below 100 x 109/L or; Hemoglobin below 4 mmol/L (females) or below 5 mmol/l (males). Immuno-compromised patients who do not have the ability to respond normally to an infection due to an impaired or weakened immune system, caused by either a preexisting disease or concomitant medications;
Facility Information:
Facility Name
Erasmus Medical Center
City
Rotterdam
State/Province
Zuid-Holland
ZIP/Postal Code
3015GD
Country
Netherlands
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Stijn Keereweer, MD, PhD

12. IPD Sharing Statement

Plan to Share IPD
Undecided
IPD Sharing Plan Description
Uponr reasonable reasonable request
Links:
URL
https://clinicaltrials.gov/ct2/show/NCT04191460?term=guided+by+light&draw=2&rank=1
Description
Guided by Light trial

Learn more about this trial

Fluorescence-guided Surgery in Laryngeal- and Hypopharyngeal Cancer: a Feasibility Trial

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