Fluorescence imaging to improve breast cancer surgery outcomes

A Prospective Multi-center Clinical Study Evaluating the Use of PD G 506 A and the Eagle V1.2 Imaging System for the Visualization of Carcinoma During Breast Conserving Surgery

This study is testing a special imaging tool to see if it can help surgeons remove all cancer during breast surgery while keeping healthy tissue safe.

Quick facts

• Phase: Phase 3
• Study type: Interventional
• Enrollment: 370 (estimated)
• Ages: 18 Years and up
• Sex: Female
• Sponsor: SBI ALApharma Canada, Inc. (Industry-sponsored)
• Drugs / interventions: chemotherapy, Radiation
• Locations: 3 sites (Orlando, Florida and 2 other locations)
• Trial ID: NCT04815083 on ClinicalTrials.gov

What this trial studies

This Phase 3 clinical trial evaluates the safety and efficacy of the fluorescent imaging agent PD G 506 A during breast conserving surgery (BCS) for breast cancer. The study aims to provide real-time visualization of cancerous tissues, helping surgeons ensure complete removal of malignancies while preserving healthy tissue. Patients will receive PD G 506 A prior to surgery, followed by the use of the Eagle V1.2 Imaging System to detect fluorescence from cancer cells. The trial consists of a training phase and a pivotal randomized, single-blind phase to assess the effectiveness of this approach.

Who should consider this trial

Good fit: Ideal candidates are females aged 18 and older with confirmed primary breast cancer scheduled for lumpectomy.

Not a fit: Patients with non-cancerous breast conditions or those not scheduled for breast conserving surgery may not benefit from this study.

Why it matters

Potential benefit: If successful, this method could significantly reduce the need for repeat surgeries and improve surgical outcomes for breast cancer patients.

How similar studies have performed: Other studies utilizing fluorescence imaging in surgical oncology have shown promising results, indicating potential for success in this novel application.

Eligibility criteria

Inclusion Criteria:

1. Female, 18 years or older
2. Histologically or cytologically confirmed primary breast cancer (includes invasive lobular carcinoma, invasive ductal carcinoma, inflammatory breast cancer, papillary breast cancer, adenoid cystic carcinoma of the breast, mucinous breast cancer, metaplastic breast cancer, cribriform carcinoma and ductal carcinoma in situ, alone or in combination with invasive disease)
3. Scheduled for a lumpectomy (including bilateral lumpectomy) of a breast malignancy (eligibility for breast conserving surgery/partial mastectomy based on clinical staging using TNM staging system (AJCC Cancer Staging Manual: Breast Cancer, 8th Edition70).
4. Patient must have normal organ and bone marrow function and be appropriate surgical candidate per site standard of care
5. Women of child-bearing potential must agree to use adequate contraception (hormonal or barrier method of birth control, abstinence) starting the day entering the study, and for the duration of the study period (until the Week 2 visit)

Exclusion Criteria:

1. Currently on (neo)adjuvant therapy to treat another cancer
2. Receiving or intended to receive neoadjuvant therapy to treat the primary breast cancer (including chemotherapy, endocrine therapy and radiotherapy)
3. Stage 4 cancer, inclusive of metastatic disease
4. Non-invasive diseases of the breast (includes lobular carcinoma in situ, phyllodes and Paget's disease of the breast)
5. Patients who have had the following procedures performed on the involved breast:

   1. Surgery for a benign lesion(s) within 1 year of the BCS date
   2. Breast implants inserted within 1 year of the BCS date
   3. Breast reduction, surgery for malignant disease or mastectomy (at any time prior to the BCS date)
   4. Surgery for a benign lesion(s) or insertion of implants \>1 year prior to the BCS date and who have signs of ongoing inflammation, active tissue healing and/or extensive scarring
   5. Radiation at any time prior to the BCS date and who have signs of ongoing inflammation, active tissue healing and/or extensive scarring
6. Patients for whom intraoperative frozen section analysis is planned
7. Patients who have not recovered from adverse events due an investigational pharmaceutical or diagnostic agents administered more than 30 days prior to their scheduled surgical procedure
8. History of hypersensitivity to ALA HCl or porphyrins
9. Known or documented personal or family history of porphyria
10. Patient has a recording of any parameter as defined below:

    1. Bilirubin: Above upper limit of normal
    2. Aspartate aminotransferase (SGOT): \> 2.5 X institutional upper limit of normal
    3. Alanine aminotransferase ( (SGPT): \> 2.5 X institutional upper limit of normal
11. Patient has serum creatinine \>1.5 times institutional upper limit of normal, OR calculated creatinine clearance \> 60 mL/min/1.73 m² for patients with creatinine levels above institutional normal.
12. Uncontrolled concurrent illness, that in the opinion of the Investigator would prevent the patient from participation in the study, including but not limited to:

    1. Ongoing or active infection;
    2. Cardiovascular disease (e.g. symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia).
13. Patients who have the following collagen vascular diseases:

    1. Lupus
    2. Scleroderma
14. Use of an investigational drug within 30 days of their scheduled surgical procedure
15. Simultaneous use of other potentially phototoxic substances (such as St. John's wort, griseofulvin, thiazide diuretics, sulfonylureas, phenothiazines, sulphonamides, quinolones and tetracyclines), and topical preparations containing ALA for 24 hours during the perioperative period.
16. Social or medical situations including uncontrolled psychiatric illnesses that would in the opinion of the Investigator limit compliance with study requirements (e.g. ability to travel for follow-up)
17. Patients who are pregnant or become pregnant (it is unknown if ALA HCl is teratogenic or has abortifacient effects)
18. Patients who are breast feeding (there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with ALA HCl, breastfeeding should be discontinued if the mother is treated with ALA HCl)
19. Inability to consent

Where this trial is running

Orlando, Florida and 2 other locations

• Orlando Health, Inc. — Orlando, Florida, United States (Recruiting)
• Montefiore Medical Center — Bronx, New York, United States (Recruiting)
• Aurora St. Luke's Medical Centre — Milwaukee, Wisconsin, United States (Recruiting)

Study contacts

• Study coordinator: Maeve Richmond

Conditions Breast Neoplasm Female; Breast Cancer; Breast conserving surgery; Fluorescence Imaging; Intraoperative margin assessment