Using advanced MRI to detect primary CNS lymphoma

Pilot Study of Feasibility of Acquiring Hyperpolarized Imaging in Patients With Primary CNS Lymphoma

This study is testing a new type of MRI to see if it can help doctors better detect and monitor primary central nervous system lymphoma in patients.

Quick facts

• Phase: Phase 1
• Study type: Interventional
• Enrollment: 25 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: University of California, San Francisco (Academic / other)
• Drugs / interventions: rituximab, methotrexate
• Locations: 1 site (San Francisco, California)
• Trial ID: NCT04656431 on ClinicalTrials.gov

What this trial studies

This phase I trial evaluates the feasibility and safety of hyperpolarized carbon-13 pyruvate magnetic resonance imaging (MRI) for diagnosing primary central nervous system lymphoma (PCNSL). The study aims to determine the effectiveness of this imaging technique in assessing tumor burden and monitoring treatment response. It includes two cohorts: one to establish imaging parameters and another to evaluate changes in imaging after standard therapy. The trial also explores the correlation between genetic markers and imaging results.

Who should consider this trial

Good fit: Ideal candidates include adults over 18 with histologically confirmed primary CNS lymphoma and measurable disease based on MRI.

Not a fit: Patients without histologically confirmed CNS lymphoma or those with non-measurable disease may not benefit from this study.

Why it matters

Potential benefit: If successful, this study could provide a new, non-invasive imaging tool for early detection and monitoring of treatment response in patients with primary CNS lymphoma.

How similar studies have performed: While the use of hyperpolarized imaging is a novel approach, similar imaging techniques have shown promise in other cancer types, suggesting potential for success in this context.

Eligibility criteria

Inclusion Criteria:

* For Patients in Cohort 1: Histologically proven PCNSL who have evidence of evaluable disease based on a prior MR scan: measurable disease based on MRI is defined as gadolinium enhancement of a central nervous system (CNS) lymphoma lesion (at least one centimeter (cm) diameter).
* For Patients in Cohort 2: Histologically proven newly diagnosed PCNSL who will receive standard treatment with high-dose methotrexate, temozolomide plus rituximab (MT-R). These criteria will ensure validity of this study in terms of safety, evaluation of clinically and radiographically relevant disease.

To be included in the study all subjects must also meet the following criteria:

1. Patients must be \> 18 years old and with a life expectancy \> 12 weeks.
2. Patients are eligible provided the participant had histologic confirmation of CNS non-Hodgkin lymphoma (NHL), DLBCL-type.
3. Measurable disease based on MRI that shows gadolinium enhancement of CNS lymphoma lesion, (at least one cm diameter) within two weeks of enrollment, is mandatory. Recent MRI must be eligible for review.
4. Concomitant involvement of cerebrospinal fluid/leptomeninges and intraocular compartments is allowed.
5. Patients must have adequate renal function (creatinine \>50 ml/min) before starting therapy. These tests must be performed within 21 days prior to Hyperpolarized Imaging scan.
6. Patients must not have any significant medical illnesses that in the investigator's opinion cannot be adequately controlled with appropriate therapy, would compromise the patient's ability to participate in this study or any disease that will obscure toxicity or dangerously impact response to the imaging agent.
7. Patients must not have New York Heart Association (NYHA) Grade II or greater congestive heart failure
8. Patients must be eligible for treatment with high-dose methotrexate (dose between 1 gm/m\^2 - 8 gm/m\^2).
9. Each participant must sign an institutional review board-approved informed consent document in accordance with federal and institutional guidelines. Patients must sign an authorization for release of their protected health information.
10. This study was designed to include women and minorities but was not designed to measure differences of intervention effects. Males and females will be recruited with no preference to gender. Minorities will actively be recruited to participate. No exclusion to this study will be based on race.
11. Patients must not have a history of any other cancer (except non-melanoma skin cancer or carcinoma in-situ of the cervix), unless in complete remission and off of all therapy for that disease for \>3 yrs.
12. Patients must not be pregnant or breast feeding. Women of childbearing potential are required to obtain a negative pregnancy test within 14 days of Hyperpolarized Imaging scan. Effective contraception (men and women) must be used in subjects of childbearing potential.

Exclusion Criteria:

1. Subjects must be excluded from participating in this study if are not able to comply with study and/or follow-up procedures.

Where this trial is running

San Francisco, California

• University of California, San Francisco — San Francisco, California, United States (Recruiting)

Study contacts

• Principal investigator: James Rubenstein, MD, PhD — University of California, San Francisco
• Study coordinator: Wendy Ma

Conditions Primary CNS Lymphoma; CNS Lymphoma; Hyperpolarized pyruvate