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Surgical Evaluation for Upper Extremity Lymphedema (BioBridge)

Primary Purpose

Lymphedema, Edema

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
BioBridge® Collagen Matrix
Vascularized Lymph Node Transfer (VLNT)
Sponsored by
Fibralign Corporation
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Lymphedema focused on measuring Lymphedema, Edema

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: The subject must be a breast cancer survivor, at least 3 years beyond completion of cancer therapy, free of clinical disease, and eligible for surgical intervention. Participants who are not able to safely undergo general anesthesia and/or perioperative care for VLNT are excluded. Ages 18 to 75 years (inclusive) Eastern Cooperative Oncology Group (ECOG) Performance Status 0 to 2 Life expectancy > 2 years Acquired (secondary) upper limb lymphedema secondary to breast cancer treatment The participant must be eligible for surgical intervention Swelling of 1 limb that is not completely reversed by elevation or compression Stage I-II lymphedema at screening, based on the International Society of Lymphology (ISL) staging system Participants must have no evidence of disease (NED), have completed breast cancer therapy 3 years prior to enrollment; use of endocrine therapy is allowed. Completion of a full course of complete decongestive therapy (CDT), according to ISL guidelines at least 12 weeks prior to screening, including use of compression garments for at least 12 weeks without change in regimen Willingness to comply with recommended regimen of self care, with consistent use of compression garments from screening through the entire study duration (through the safety follow up visit), excluding the first 3 weeks postoperatively where patients are required to not wear compression. Self bandaging, use of nighttime compression garments, and intermittent pneumatic compression devices are allowed, but the procedures and regimens are expected to remain consistent from screening though the entire study duration. Consistent use of an appropriately sized compression garment for daytime use. Limb volume (LV) in the affected limb and unaffected limb must be at least 10% of each other. Evidence of abnormal bioimpedance ratio, if feasible, based upon unilateral disease: L Dex > 10 units. Willingness and ability to comply with all study procedures, including measurement of skin biopsy, and preoperative and postoperative imaging studies. Willingness and ability to understand, and to sign a written informed consent form document Exclusion Criteria: Edema arising from increased capillary filtration will be excluded (venous incompetence). Inability to safely undergo general anesthesia and/or perioperative care related to vascularized lymph node transfer Concurrent participation in a clinical trial of any other investigational drug or therapy, regardless of indication, within 1 month before screening or 5 times the drug's half life, whichever is longer Recent initiation (≤ 12 weeks) of CDPT for lymphedema Other medical condition that could lead to acute limb edema, such as (but not limited to) acute venous thrombosis or heart failure Other medical condition that could result in symptoms overlapping those of lymphedema in the affected limb (eg, pain, swelling, decreased range of motion) History of clotting disorder (hypercoagulable state) Chronic (persistent) infection in the affected limb Infection of the lymphedema limb within 1 month prior to screening Currently receiving chemotherapy or radiation therapy Current evidence, or a history of malignancy within the past 3 years (except for non melanoma skin cancer or cervical cancer in situ treated with curative intent). If the participant has undergone cancer treatment, this must have been completed > 3 years prior to enrollment. Significant or chronic renal insufficiency (defined as serum creatinine > 2.5 mg/dL or an estimated glomerular filtration rate [eGFR] < 30 mL/min at screening) or requires dialytic support Hepatic dysfunction, defined as alanine transaminase (ALT) or aspartate transaminase (AST) levels > 3 × upper limit of the normal range (ULN) and/or bilirubin level > 2 × ULN at screening Absolute neutrophil count < 1500 mm3 at screening Hemoglobin concentration < 9 g/dL at screening Body Mass Index (BMI) >35 Known sensitivity to porcine products Anaphylaxis to iodine Pregnancy or nursing Substance abuse (such as alcohol or drug abuse) within 6 months prior to screening Any reason (in addition to those listed above) that, in the opinion of the investigator, precludes full participation in the study.

Sites / Locations

  • Stanford UniversityRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

BioBridge treatment group

Control group

Arm Description

Vascularized Lymph Node Transplant surgery (VLNT) supplemented by BioBridge Collagen Matrix implantation

Vascularized Lymph Node Transplant surgery (VLNT) only

Outcomes

Primary Outcome Measures

Excess limb volume change
Change in % of (excess) limb volume in the intervention group relative to control group

Secondary Outcome Measures

LLIS survey
Lymphedema-specific instrument to measure impairments, activity limitations, and participation restrictions in those living with any extremity lymphedema
L-Dex bioimpedance spectroscopy.
Change in the Lymphedema Index (L-Dex) in the intervention group relative to control group. The L-Dex score has the requisite sensitivity and specificity to detect the differences in retained interstitial fluid that might discriminate the therapeutic responses of the treated patients. It has been established that the normal range of the L-Dex score is in the interval from -10 to +10 units; the higher score the more difference is in the retained interstitial fluid between the affected and unaffected limbs.
Histology
Change in cutaneous histological architecture. The impact of treatment on the cutaneous histopathology will be evaluated through the use of an empirically derived scoring system and will be performed by a dermatopathologist.
ICG fluorescence imaging
Change in lymphatic function assessed by ICG fluorescence imaging

Full Information

First Posted
January 13, 2023
Last Updated
January 13, 2023
Sponsor
Fibralign Corporation
Collaborators
Stanford University
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1. Study Identification

Unique Protocol Identification Number
NCT05695924
Brief Title
Surgical Evaluation for Upper Extremity Lymphedema (BioBridge)
Official Title
Prospective Evaluation of Nanofibrillar Collagen Scaffold (BioBridge®) as an Adjunct to Lymph Node Transplant for Upper Extremity Lymphedema
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Recruiting
Study Start Date
March 1, 2023 (Anticipated)
Primary Completion Date
May 1, 2024 (Anticipated)
Study Completion Date
June 1, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Fibralign Corporation
Collaborators
Stanford University

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
To investigate whether the addition of Fibralign's BioBridge® Collagen Matrix (BioBridge) devices to the standard surgery for vascularized lymph node transfer will improve the outcome of surgical treatment in lymphedema of the upper arm.
Detailed Description
The proposed study utilizes Fibralign's BioBridge® Collagen Matrix (BioBridge), a sterile implantable biocompatible and biodegradable surgical mesh ribbon comprised of highly purified porcine collagen. The Class II device was cleared by CDRH Division of Surgical Devices on 8 January 2016 under 510(k) K151083. The study will investigate whether addition of the BioBridge Collagen Matrix to the standard surgery for vascularized lymph node transfer will improve the outcome of surgical treatment in lymphedema of the upper extremity. This clinical study will also be used in support of IDE G200200 review conducted by the FDA. Primary endpoint is the post surgical % change in excess limb volume, measured at 12 months following the surgical procedure. Secondary endpoints are change in quality of life scores measured by LLIS and change in lymphatic function as measured by indocyanine green (ICG) fluorescence imaging.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lymphedema, Edema
Keywords
Lymphedema, Edema

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Prospective, randomized, control arm
Masking
Outcomes Assessor
Masking Description
Partially Blinded: Patients will be informed which group they are randomized into and given the option to opt out of the study. Investigators (other than surgeons conducting surgery) and study personnel involved in patient measurements will be unaware of the patient treatment option.
Allocation
Randomized
Enrollment
60 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
BioBridge treatment group
Arm Type
Experimental
Arm Description
Vascularized Lymph Node Transplant surgery (VLNT) supplemented by BioBridge Collagen Matrix implantation
Arm Title
Control group
Arm Type
Active Comparator
Arm Description
Vascularized Lymph Node Transplant surgery (VLNT) only
Intervention Type
Device
Intervention Name(s)
BioBridge® Collagen Matrix
Intervention Description
BioBridge Collagen Matrix (BioBridge) is a sterile implantable bio-compatible and biodegradable surgical mesh ribbon comprised of highly purified porcine collagen. The Class II device was cleared by CDRH Division of Surgical Devices on 8 January 2016 under 510(k) K151083. The device will be used for soft tissue surgical support at the time of vascularized lymph node transplant surgery (VLNT); the device will be used, specifically, for surgical support of the lymphatic component of the soft tissue.
Intervention Type
Procedure
Intervention Name(s)
Vascularized Lymph Node Transfer (VLNT)
Intervention Description
Micro-surgical procedure for vascularized lymph node transfer (VLNT)
Primary Outcome Measure Information:
Title
Excess limb volume change
Description
Change in % of (excess) limb volume in the intervention group relative to control group
Time Frame
Baseline and 12 months after treatment
Secondary Outcome Measure Information:
Title
LLIS survey
Description
Lymphedema-specific instrument to measure impairments, activity limitations, and participation restrictions in those living with any extremity lymphedema
Time Frame
Baseline and 12 months after treatment
Title
L-Dex bioimpedance spectroscopy.
Description
Change in the Lymphedema Index (L-Dex) in the intervention group relative to control group. The L-Dex score has the requisite sensitivity and specificity to detect the differences in retained interstitial fluid that might discriminate the therapeutic responses of the treated patients. It has been established that the normal range of the L-Dex score is in the interval from -10 to +10 units; the higher score the more difference is in the retained interstitial fluid between the affected and unaffected limbs.
Time Frame
Baseline and 12 months after treatment
Title
Histology
Description
Change in cutaneous histological architecture. The impact of treatment on the cutaneous histopathology will be evaluated through the use of an empirically derived scoring system and will be performed by a dermatopathologist.
Time Frame
Baseline and 12 months after treatment
Title
ICG fluorescence imaging
Description
Change in lymphatic function assessed by ICG fluorescence imaging
Time Frame
Baseline and 12 months after treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: The subject must be a breast cancer survivor, at least 3 years beyond completion of cancer therapy, free of clinical disease, and eligible for surgical intervention. Participants who are not able to safely undergo general anesthesia and/or perioperative care for VLNT are excluded. Ages 18 to 75 years (inclusive) Eastern Cooperative Oncology Group (ECOG) Performance Status 0 to 2 Life expectancy > 2 years Acquired (secondary) upper limb lymphedema secondary to breast cancer treatment The participant must be eligible for surgical intervention Swelling of 1 limb that is not completely reversed by elevation or compression Stage I-II lymphedema at screening, based on the International Society of Lymphology (ISL) staging system Participants must have no evidence of disease (NED), have completed breast cancer therapy 3 years prior to enrollment; use of endocrine therapy is allowed. Completion of a full course of complete decongestive therapy (CDT), according to ISL guidelines at least 12 weeks prior to screening, including use of compression garments for at least 12 weeks without change in regimen Willingness to comply with recommended regimen of self care, with consistent use of compression garments from screening through the entire study duration (through the safety follow up visit), excluding the first 3 weeks postoperatively where patients are required to not wear compression. Self bandaging, use of nighttime compression garments, and intermittent pneumatic compression devices are allowed, but the procedures and regimens are expected to remain consistent from screening though the entire study duration. Consistent use of an appropriately sized compression garment for daytime use. Limb volume (LV) in the affected limb and unaffected limb must be at least 10% of each other. Evidence of abnormal bioimpedance ratio, if feasible, based upon unilateral disease: L Dex > 10 units. Willingness and ability to comply with all study procedures, including measurement of skin biopsy, and preoperative and postoperative imaging studies. Willingness and ability to understand, and to sign a written informed consent form document Exclusion Criteria: Edema arising from increased capillary filtration will be excluded (venous incompetence). Inability to safely undergo general anesthesia and/or perioperative care related to vascularized lymph node transfer Concurrent participation in a clinical trial of any other investigational drug or therapy, regardless of indication, within 1 month before screening or 5 times the drug's half life, whichever is longer Recent initiation (≤ 12 weeks) of CDPT for lymphedema Other medical condition that could lead to acute limb edema, such as (but not limited to) acute venous thrombosis or heart failure Other medical condition that could result in symptoms overlapping those of lymphedema in the affected limb (eg, pain, swelling, decreased range of motion) History of clotting disorder (hypercoagulable state) Chronic (persistent) infection in the affected limb Infection of the lymphedema limb within 1 month prior to screening Currently receiving chemotherapy or radiation therapy Current evidence, or a history of malignancy within the past 3 years (except for non melanoma skin cancer or cervical cancer in situ treated with curative intent). If the participant has undergone cancer treatment, this must have been completed > 3 years prior to enrollment. Significant or chronic renal insufficiency (defined as serum creatinine > 2.5 mg/dL or an estimated glomerular filtration rate [eGFR] < 30 mL/min at screening) or requires dialytic support Hepatic dysfunction, defined as alanine transaminase (ALT) or aspartate transaminase (AST) levels > 3 × upper limit of the normal range (ULN) and/or bilirubin level > 2 × ULN at screening Absolute neutrophil count < 1500 mm3 at screening Hemoglobin concentration < 9 g/dL at screening Body Mass Index (BMI) >35 Known sensitivity to porcine products Anaphylaxis to iodine Pregnancy or nursing Substance abuse (such as alcohol or drug abuse) within 6 months prior to screening Any reason (in addition to those listed above) that, in the opinion of the investigator, precludes full participation in the study.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Shannon Meyer
Phone
650-721-1807
Email
smeyer27@stanford.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Dung H Nguyen, MD, PharmD
Organizational Affiliation
Stanford University
Official's Role
Study Director
Facility Information:
Facility Name
Stanford University
City
Stanford
State/Province
California
ZIP/Postal Code
94305
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dung H Nguyen, MD, PharmD

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
27556764
Citation
Chang DW, Masia J, Garza R 3rd, Skoracki R, Neligan PC. Lymphedema: Surgical and Medical Therapy. Plast Reconstr Surg. 2016 Sep;138(3 Suppl):209S-218S. doi: 10.1097/PRS.0000000000002683.
Results Reference
background
PubMed Identifier
26846735
Citation
Silva AK, Chang DW. Vascularized lymph node transfer and lymphovenous bypass: Novel treatment strategies for symptomatic lymphedema. J Surg Oncol. 2016 Jun;113(8):932-9. doi: 10.1002/jso.24171. Epub 2016 Feb 5.
Results Reference
background
PubMed Identifier
31209884
Citation
Rochlin DH, Inchauste S, Zelones J, Nguyen DH. The role of adjunct nanofibrillar collagen scaffold implantation in the surgical management of secondary lymphedema: Review of the literature and summary of initial pilot studies. J Surg Oncol. 2020 Jan;121(1):121-128. doi: 10.1002/jso.25576. Epub 2019 Jun 18.
Results Reference
background
PubMed Identifier
31228351
Citation
Inchauste S, Zelones J, Rochlin D, Nguyen DH. Successful treatment of lymphedema in a vasculopath and neuropathic patient. J Surg Oncol. 2020 Jan;121(1):182-186. doi: 10.1002/jso.25590. Epub 2019 Jun 22.
Results Reference
background
PubMed Identifier
30562150
Citation
Garza RM, Ooi ASH, Falk J, Chang DW. The Relationship Between Clinical and Indocyanine Green Staging in Lymphedema. Lymphat Res Biol. 2019 Jun;17(3):329-333. doi: 10.1089/lrb.2018.0014. Epub 2018 Dec 18.
Results Reference
background
PubMed Identifier
34705812
Citation
Nguyen DH, Zhou A, Posternak V, Rochlin DH. Nanofibrillar Collagen Scaffold Enhances Edema Reduction and Formation of New Lymphatic Collectors after Lymphedema Surgery. Plast Reconstr Surg. 2021 Dec 1;148(6):1382-1393. doi: 10.1097/PRS.0000000000008590.
Results Reference
background
PubMed Identifier
35160049
Citation
Deptula P, Zhou A, Posternak V, He H, Nguyen D. Multimodality Approach to Lymphedema Surgery Achieves and Maintains Normal Limb Volumes: A Treatment Algorithm to Optimize Outcomes. J Clin Med. 2022 Jan 25;11(3):598. doi: 10.3390/jcm11030598.
Results Reference
background
PubMed Identifier
34549427
Citation
Nguyen D, Zaitseva TS, Zhou A, Rochlin D, Sue G, Deptula P, Tabada P, Wan D, Loening A, Paukshto M, Dionyssiou D. Lymphatic regeneration after implantation of aligned nanofibrillar collagen scaffolds: Preliminary preclinical and clinical results. J Surg Oncol. 2022 Feb;125(2):113-122. doi: 10.1002/jso.26679. Epub 2021 Sep 21.
Results Reference
background

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Surgical Evaluation for Upper Extremity Lymphedema (BioBridge)

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