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Optimalisation of tumor identification during HIPEC surgery in patients with metastasis from colon cancer on their peritoneum

ABSTRACT: Primary objectives: - Evaluate tumour detection sensitivity and specificity with the following image enhancement modalities: - 1 ‘narrow-band imaging’, 2 ‘autofluorescent imaging’, 3 ‘near-infrared indocyanin green imaging’, 4 ‘5-aminolevulinic acid fluorescent imaging’, 5 ‘three-dimensional imaging’ and 6 ‘spray-dye chromoendoscopy’ compared to conventional white light laparoscopy in patients with peritoneal carcinomatosis in order to achieve best tumour detection. Primary endpoints: -Evaluate tumour detection sensitivity and specificity with the following image enhancement modalities: 1 ‘narrow-band imaging’, 2 ‘autofluorescent imaging’, 3 ‘near-infrared indocyanin green imaging’, 4 ‘5-aminolevulinic acid fluorescent imaging’, 5 ‘three-dimensional imaging’ and 6 ‘spray-dye chromoendoscopy’ compared to conventional white light laparoscopy in patients with peritoneal carcinomatosis in order to achieve best tumour detection.

DISEASE(S): Peritoneal Carcinomatosis From Colorectal Origin,Colorectal Cancer Metastatic

PROVIDER: 2533714 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:The Institute of Image-Guided Surgery (IHU) of Strasbourg is a translational research Institute aiming to develop hybrid surgery techniques. The IHU-SPECTRA research unit, entirely dedicated to the development of fluorescence-guided surgery, was set up to test several innovations as part of a large-scale project (ELIOS: Endoscopic Luminescent Imaging for Precision Oncology Surgery), funded by the ARC Foundation for Cancer Research. The proposed research protocol is part of the ELIOS project and targets in particular colon tumours. The Holy Grail in oncology surgery is the radical removal of cancer cells in order to reduce the rate of tumour recurrences and increase the tumour’s free survival. The administration of a tumour-specific antibody, which fluoresces in the Near-Infrared ranges and which could be univocally recognized at a tumour cellular level, could provide a rapid and accurate evaluation of radical tumour removal. The University Medical Center Groningen (UMCG) has developed a fluorescent tracer coupling Bevacizumab (which targets the Vascular Endothelial Growth Factor = VEGF) with a fluorescent dye, the IRDye800. The initial human results are very promising and no adverse events linked to the fluorescent molecule have been reported. In parallel, an alternative optical technique that does not require the use of a fluorophore, the Hyperspectral Imaging (HSI), is a relatively new method used in image-guided and precision surgery. The company Diaspective Vision GmbH (Pepelw, Germany) produces a HSI camera, the TIVITA system, enabling to obtain spectral information from the tissues. The main advantage of HSI over fluorescence imaging is in that it is a contrast-free imaging and intrinsically quantitative although it does not provide real-time videos. Another innovative optical imaging technology available at the IHU is FF-OCT (Light-CT Scanner, LLTechSAS, Paris, France) which allows non-destructive and high-resolution optical biopsy without tissue treatment. The working hypothesis is that molecular fluorescence enhanced-reality allows greater precision in the differentiation of tumour tissue and healthy tissue in patients with colorectal cancer compared to the immunohistochemistry conventionally used in anatomopathology. In parallel, this technique will be compared to hyperspectral imaging (HSI TIVITA system) and optical imaging (FF-OCT system), two potentially advantageous methods for the detection of tumour tissue.

Project description:Interventions: The Clinical Trial Application presents information related to the monoclonal antibody bevacizumab labeled with the fluorescent dye IRDye800CW as injection. The injection vial contains 5.0 mg bevacizumab-IRDye800CW in 0.9% NaCl. Patients will receive a single dose bevacizumab-IRDye800CW of 4.5 mg by intravenous administration, according to the IMPD. Bevacizumab (Avastin, Roche) is a recombinant, high affinity, humanized IgG1 monoclonal antibody with specific affinity for VEGF. The infrared dye IRDye800CW (LI-COR Biosciences, Lincoln, NE, USA) is a fluorescent dye applicable for clinical use, produced by REGIS technologies. Conjugation of the fluorescent dye to bevacizumab, purification and formulation will be performed at the department of hospital and clinical pharmacy of the UMC Groningen. The new tracer bevacizumab-IRDye 800CW has been evaluated preclinical in tumor bearing nude mice and an extended single microdose toxicity study has been performed by NOTOX, which did not show toxicity (more information can be found in the IMPD). Patients will receive a single dose of 4.5 mg microdosing of bevacizumab-IRDye800CW, compared to a therapeutic dose of 5-10 mg/kg every two weeks. Recently, 26 renal cancer patients underwent repeated 4.5 mg 89Zr-bevacizumab administrations and imaging at baseline, 4 weeks and 6 weeks at the UMCG (NCT00831857). One patient reported nausea, redness of the face and cold extremities for 24 hours after the third tracer injection but continued bevacizumab treatment (10 mg/kg) without adverse events. No toxicity was observed in the first five breast cancer (NL37479.042.11) using bevacizumab-IRDye800CW. Based on these we do not expect toxicity of the single micro-dose administration of bevacizumab-IRDye800CW. Off course, patients will be ext Primary outcome(s): Determining the feasibility of pre-operative detection of peritoneal carcinomatosis of colorectal origin by intraoperative fluorescence imaging using the VEGF-targeting optical agent bevacizumab-IRDye800CW as confirmed by ex vivo standard histopathological and immunohistochemical analyses for the presence of tumour cells and VEGF-A expression in excised tumor tissue en fluorescence microscopy for the bevacizumab-IRDye800CW tracer Study Design: N/A: single arm study, Open (masking not used), N/A , unknown, Other

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Optimalisation of tumor identification during HIPEC surgery in patients with metastasis from colon cancer on their peritoneum

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