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Study of Tozuleristide and the Canvas Imaging System in Pediatric Subjects With CNS Tumors Undergoing Surgery

Primary Purpose

Pediatric Central Nervous System Tumor

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
tozuleristide
Canvas System
Sponsored by
Blaze Bioscience Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Pediatric Central Nervous System Tumor focused on measuring Tumor Paint, tozuleristide, Canvas imaging system, BLZ-100, CNS tumor, brain cancer, pediatrics, fluorescence guided surgery

Eligibility Criteria

1 Month - 30 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Subjects must be >1 month and ≤30 years of age at the time of study enrollment
  2. Subjects must have MRI obtained within 30 days of study enrollment documenting a measurable lesion consistent with a pediatric primary CNS tumor for which maximal safe resection is indicated
  3. Adequate renal function
  4. Adequate liver function
  5. Prior therapy: Subjects with prior therapy are eligible provided they have recovered from any acute toxic effects of prior therapy and have sufficient time interval prior to enrollment:

    1. Radiation therapy: subjects may not have had radiation therapy to the area of tumor planned to be resected within 28 days of study enrollment
    2. Chemotherapy: at least 14 days from any myelosuppressive chemotherapy (28 days if prior nitrosourea) and if prior chemotherapy, must have an absolute neutrophil count recovery of ≥ 1000/mm3 following count nadir
    3. Biologic: at least 7 days from any anti-neoplastic biologic agent (at least 3 half-lives since last administration of monoclonal antibodies)
    4. Immunotherapy: at least 42 days after completion of any cellular immunotherapy, such as CAR-T cell therapy
    5. Prior surgery for CNS tumors is allowed
    6. Prior tozuleristide: at least 1 week after prior dose of tozuleristide if previously treated
  6. Written informed consent must be obtained from the subject or parent or legal guardian prior to the conduct of study activities. Routine clinical tests, e.g., MRI, clinical laboratory studies, may be used for screening requirements. Assent, when appropriate, will be obtained according to institutional guidelines.
  7. The risks of treatment with tozuleristide during pregnancy have not been evaluated. Female subjects of child-bearing potential must agree not to attempt to become pregnant or undergo in vitro fertilization and, if participating in sexual activity that could lead to pregnancy, must use 2 reliable methods of contraception simultaneously for 30 days after surgery. Male subjects must agree not to attempt to father a child and, if participating in sexual activity that could lead to pregnancy, must use 2 reliable methods of contraception simultaneously for 30 days after surgery if their partner is of child-bearing potential.

Exclusion Criteria:

  1. Pregnancy and contraception: Subjects who are pregnant or breast-feeding or planning to conceive a child within 30 days are not eligible. Males and females of childbearing potential must agree to use 2 effective forms of contraception from the time of enrollment until 30 days post-surgery
  2. Subjects with on-going serious medical conditions (poorly controlled asthma, diabetes, heart disease) such that participation in the study could put the subject at increased risk of worsening their condition
  3. Subjects planned to undergo only a diagnostic biopsy procedure, without intent to resect tissue for therapeutic purposes (e.g., stereotactic pontine biopsy)
  4. Subjects who in the opinion of the investigator are not willing or able to comply with randomization procedures or other study-required study procedures and observations. Subjects previously enrolled and randomized to Arm 1 (control) are not eligible for re-enrollment unless a second surgery is required by standard of care.

Sites / Locations

  • Chlidren's Hospital Los Angeles
  • University of California, San Francisco
  • University of Florida Shands Hospital
  • Johns Hopkins University
  • Children's Hospital of Michigan
  • Children's Minnesota
  • Washington University St. Louis Children's Hospital
  • St. Jude Children's Research Hospital
  • Seattle Children's Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Arm 1 (no tozuleristide)

Arm 2 (tozuleristide treated)

Arm Description

Subjects randomized to Arm 1 (~9% of subjects) will not receive tozuleristide but will undergo standard of care neurosurgery and will have imaging performed with the Canvas System.

Subjects randomized to Arm 2 (~ 91% of subjects) will be administered tozuleristide at a dose of 15 mg/m^2 at least 1 hour and no more than 36 hours prior to surgery. They will undergo standard of care neurosurgery and will have imaging performed with the Canvas System.

Outcomes

Primary Outcome Measures

Sensitivity and specificity of tozuleristide fluorescence to detect tumor in equivocal (ambiguous) tissue during surgery when imaged with the Canvas system
Sensitivity and specificity of tozuleristide imaged with the Canvas system to fluorescently identify tumor in equivocal tissue will be evaluated based on assessments made by the surgeon and imaging operator. These measures will be compared to the sensitivity and specificity of surgical designation of equivocal tissue without fluorescence.

Secondary Outcome Measures

Safety - number of patients with adverse events
Safety will be assessed by physical examination and measurement of vital signs and laboratory safety parameters.
Extent of resection
Extent of resection will be evaluated by the surgeon and by central review of post-operative magnetic resonance images (MRI). Extent of resection will be designated in the following categories: gross total resection (GTR; all tumor removed), near total resection (NTR; bulk of tumor removed), sub-total resection (STR; residual tumor present).
Concentration of tozuleristide in the blood (pharmacokinetics)
Tozuleristide concentration in the blood will be analyzed by chemical means and these data will be used to calculate pharmacokinetic parameters.
Performance of the Canvas system
The surgeon and imaging operator will complete a survey to evaluate the usability of the Canvas during surgery

Full Information

First Posted
June 15, 2018
Last Updated
November 9, 2022
Sponsor
Blaze Bioscience Inc.
Collaborators
Pacific Pediatric Neuro-Oncology Consortium
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1. Study Identification

Unique Protocol Identification Number
NCT03579602
Brief Title
Study of Tozuleristide and the Canvas Imaging System in Pediatric Subjects With CNS Tumors Undergoing Surgery
Official Title
A Randomized, Blinded Study of Fluorescence Detection of Pediatric Primary Central Nervous System Tumors in Subjects Receiving Tozuleristide and Imaged With the Canvas System
Study Type
Interventional

2. Study Status

Record Verification Date
November 2022
Overall Recruitment Status
Completed
Study Start Date
November 26, 2018 (Actual)
Primary Completion Date
April 1, 2022 (Actual)
Study Completion Date
June 13, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Blaze Bioscience Inc.
Collaborators
Pacific Pediatric Neuro-Oncology Consortium

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
Yes
Device Product Not Approved or Cleared by U.S. FDA
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Many types of cancer are primarily treated with surgery and patient survival is directly related to the extent to which the tumor is able to be removed. It is often difficult for surgeons to distinguish tumor tissue from normal tissue or to detect tumor cells that have spread from the original tumor site, resulting in incomplete removal of the tumor and reduced patient survival. In some sites, such as the brain, it is critical to avoid damage to normal tissue around the tumor to prevent adverse effects of surgery on function. Tozuleristide is a drug that is thought to attach to tumor tissue and then fluoresces (glows) when a special light from the Canvas is shined on it. It is hypothesized that tozuleristide, when imaged with the Canvas, will improve surgical outcomes by allowing surgeons to visualize the edges of the tumor or other ambiguous tissue in real-time as they operate. The purpose of this study is to evaluate how well tozuleristide imaged with Canvas work at helping to distinguish between tumor and normal tissue during surgery in pediatric primary central nervous system tumors.
Detailed Description
Subjects who provide voluntary written informed consent, or have it provided by their legally acceptable representative, will be screened for eligibility. Subjects meeting all of the inclusion and none of the exclusion criteria will be eligible to participate. Surgical excision will occur at least 1 hour and no more than 36 hours after tozuleristide administration. Surgery will be performed by a neurosurgeon and the Canvas will be operated by a designated Imaging Operator. Fluorescence of tumor and ambiguous tissue during surgery will be assessed and scored. Biopsy samples of these tumor and ambiguous tissues will be collected for pathology analysis. All subjects will be monitored for safety during their participation in the study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pediatric Central Nervous System Tumor
Keywords
Tumor Paint, tozuleristide, Canvas imaging system, BLZ-100, CNS tumor, brain cancer, pediatrics, fluorescence guided surgery

7. Study Design

Primary Purpose
Other
Study Phase
Phase 2, Phase 3
Interventional Study Model
Parallel Assignment
Model Description
Subjects will be randomized 1:10 to 1 of 2 study arms. Subjects in arm 1 (~9% of subjects) will not receive tozuleristide but will undergo neurosurgery and imaging will be performed with the Canvas. Subjects in arm 2 (~91% of subjects) will receive tozuleristide and will undergo neurosurgery and imaging will be performed with the Canvas.
Masking
Outcomes Assessor
Masking Description
Central Pathology assessment and Central Radiology post-operative MRI assessment will be blinded to study arm and fluorescence data. Central Fluorescence assessment will be blinded to study arm.
Allocation
Randomized
Enrollment
118 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm 1 (no tozuleristide)
Arm Type
Active Comparator
Arm Description
Subjects randomized to Arm 1 (~9% of subjects) will not receive tozuleristide but will undergo standard of care neurosurgery and will have imaging performed with the Canvas System.
Arm Title
Arm 2 (tozuleristide treated)
Arm Type
Experimental
Arm Description
Subjects randomized to Arm 2 (~ 91% of subjects) will be administered tozuleristide at a dose of 15 mg/m^2 at least 1 hour and no more than 36 hours prior to surgery. They will undergo standard of care neurosurgery and will have imaging performed with the Canvas System.
Intervention Type
Drug
Intervention Name(s)
tozuleristide
Other Intervention Name(s)
BLZ-100, Tumor Paint
Intervention Description
Tozuleristide will be administered at least 1 hour and no more than 36 hours prior to planned surgical excision of their tumor.
Intervention Type
Device
Intervention Name(s)
Canvas System
Other Intervention Name(s)
mSIRIS
Intervention Description
All subjects enrolled in the study will have their tissue imaged with the Canvas System.
Primary Outcome Measure Information:
Title
Sensitivity and specificity of tozuleristide fluorescence to detect tumor in equivocal (ambiguous) tissue during surgery when imaged with the Canvas system
Description
Sensitivity and specificity of tozuleristide imaged with the Canvas system to fluorescently identify tumor in equivocal tissue will be evaluated based on assessments made by the surgeon and imaging operator. These measures will be compared to the sensitivity and specificity of surgical designation of equivocal tissue without fluorescence.
Time Frame
During surgery (which occurs at least 1 hour post tozuleristide administration)
Secondary Outcome Measure Information:
Title
Safety - number of patients with adverse events
Description
Safety will be assessed by physical examination and measurement of vital signs and laboratory safety parameters.
Time Frame
AEs will be collected from day of randomization until Day 8. Subjects will be contacted monthly for up to 3 months post-surgery for safety assessments.
Title
Extent of resection
Description
Extent of resection will be evaluated by the surgeon and by central review of post-operative magnetic resonance images (MRI). Extent of resection will be designated in the following categories: gross total resection (GTR; all tumor removed), near total resection (NTR; bulk of tumor removed), sub-total resection (STR; residual tumor present).
Time Frame
At completion of surgery and up to 72 hours post-surgery for MRI assessment. If additional MRIs are obtained within 3 months post-surgery, they will be submitted for central MRI review.
Title
Concentration of tozuleristide in the blood (pharmacokinetics)
Description
Tozuleristide concentration in the blood will be analyzed by chemical means and these data will be used to calculate pharmacokinetic parameters.
Time Frame
Subjects in Arm 2 only will have blood samples collected at 2 time points: One within 30 minutes after tozuleristide administration and one between 30 minutes and 180 minutes after tozuleristide administration.
Title
Performance of the Canvas system
Description
The surgeon and imaging operator will complete a survey to evaluate the usability of the Canvas during surgery
Time Frame
After completion of surgery

10. Eligibility

Sex
All
Minimum Age & Unit of Time
1 Month
Maximum Age & Unit of Time
30 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subjects must be >1 month and ≤30 years of age at the time of study enrollment Subjects must have MRI obtained within 30 days of study enrollment documenting a measurable lesion consistent with a pediatric primary CNS tumor for which maximal safe resection is indicated Adequate renal function Adequate liver function Prior therapy: Subjects with prior therapy are eligible provided they have recovered from any acute toxic effects of prior therapy and have sufficient time interval prior to enrollment: Radiation therapy: subjects may not have had radiation therapy to the area of tumor planned to be resected within 28 days of study enrollment Chemotherapy: at least 14 days from any myelosuppressive chemotherapy (28 days if prior nitrosourea) and if prior chemotherapy, must have an absolute neutrophil count recovery of ≥ 1000/mm3 following count nadir Biologic: at least 7 days from any anti-neoplastic biologic agent (at least 3 half-lives since last administration of monoclonal antibodies) Immunotherapy: at least 42 days after completion of any cellular immunotherapy, such as CAR-T cell therapy Prior surgery for CNS tumors is allowed Prior tozuleristide: at least 1 week after prior dose of tozuleristide if previously treated Written informed consent must be obtained from the subject or parent or legal guardian prior to the conduct of study activities. Routine clinical tests, e.g., MRI, clinical laboratory studies, may be used for screening requirements. Assent, when appropriate, will be obtained according to institutional guidelines. The risks of treatment with tozuleristide during pregnancy have not been evaluated. Female subjects of child-bearing potential must agree not to attempt to become pregnant or undergo in vitro fertilization and, if participating in sexual activity that could lead to pregnancy, must use 2 reliable methods of contraception simultaneously for 30 days after surgery. Male subjects must agree not to attempt to father a child and, if participating in sexual activity that could lead to pregnancy, must use 2 reliable methods of contraception simultaneously for 30 days after surgery if their partner is of child-bearing potential. Exclusion Criteria: Pregnancy and contraception: Subjects who are pregnant or breast-feeding or planning to conceive a child within 30 days are not eligible. Males and females of childbearing potential must agree to use 2 effective forms of contraception from the time of enrollment until 30 days post-surgery Subjects with on-going serious medical conditions (poorly controlled asthma, diabetes, heart disease) such that participation in the study could put the subject at increased risk of worsening their condition Subjects planned to undergo only a diagnostic biopsy procedure, without intent to resect tissue for therapeutic purposes (e.g., stereotactic pontine biopsy) Subjects who in the opinion of the investigator are not willing or able to comply with randomization procedures or other study-required study procedures and observations. Subjects previously enrolled and randomized to Arm 1 (control) are not eligible for re-enrollment unless a second surgery is required by standard of care.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sarah Leary, MD
Organizational Affiliation
Seattle Children's Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Chlidren's Hospital Los Angeles
City
Los Angeles
State/Province
California
ZIP/Postal Code
90027
Country
United States
Facility Name
University of California, San Francisco
City
San Francisco
State/Province
California
ZIP/Postal Code
94158
Country
United States
Facility Name
University of Florida Shands Hospital
City
Gainesville
State/Province
Florida
ZIP/Postal Code
32608
Country
United States
Facility Name
Johns Hopkins University
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21287
Country
United States
Facility Name
Children's Hospital of Michigan
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48201
Country
United States
Facility Name
Children's Minnesota
City
Saint Paul
State/Province
Minnesota
ZIP/Postal Code
55102
Country
United States
Facility Name
Washington University St. Louis Children's Hospital
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Facility Name
St. Jude Children's Research Hospital
City
Memphis
State/Province
Tennessee
ZIP/Postal Code
38105
Country
United States
Facility Name
Seattle Children's Hospital
City
Seattle
State/Province
Washington
ZIP/Postal Code
98105
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Study of Tozuleristide and the Canvas Imaging System in Pediatric Subjects With CNS Tumors Undergoing Surgery

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