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Hyperpolarized 13C Pyruvate MRI Scan in Predicting Tumor Aggressiveness in Patients With Localized Renal Tumor

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ClinicalTrials.gov Identifier: NCT04258462
Recruitment Status : Recruiting
First Posted : February 6, 2020
Last Update Posted : November 25, 2020
Sponsor:
Collaborator:
American Cancer Society, Inc.
Information provided by (Responsible Party):
Zhen Wang, MD, University of California, San Francisco

Brief Summary:
This feasibility study will evaluate how well hyperpolarized 13C pyruvate magnetic resonance imaging (MRI) scan works in predicting tumor aggressiveness in patients with localized renal tumor. Hyperpolarized 13C pyruvate is a non-radioactive substance with potential usage in the diagnostic imaging of tumors. Hyperpolarized 13C pyruvate MRI may help doctors determine non-invasively whether a kidney tumor is a benign tumor or cancer, and if cancer, how aggressive it is. This may help doctors and patients with renal tumors in the future to make better treatment decisions.

Condition or disease Intervention/treatment Phase
Benign Kidney Neoplasm Kidney Neoplasm Renal Cell Cancer Drug: Hyperpolarized Carbon C 13 Pyruvate Procedure: Magnetic Resonance Imaging Phase 2

Detailed Description:

PRIMARY OBJECTIVES:

  1. To investigate the correlation between hyperpolarized (HP) 13C pyruvate-to-lactate conversion, as measured by lactate/pyruvate ratio, and renal tumor histology (benign renal tumors versus renal cell carcinomas (RCCs)) and grade (low versus high grade in cases of RCCs).
  2. To investigate the correlation between HP 13C pyruvate-to-lactate conversion, as measured by the apparent rate constant kPL, and renal tumor histology (benign renal tumors versus renal cell carcinomas (RCCs)) and grade (low versus high grade in cases of RCCs).

SECONDARY OBJECTIVES:

  1. To determine the reproducibility of HP 13C pyruvate MRI in patients who undergo an optional second HP 13C pyruvate MRI.
  2. To investigate the association between HP markers (peak lactate/pyruvate, lactate /pyruvate AUC, kPL, ADClac) and tissue-based markers including LDHA expression and LDH activity, and Monocarboxylate transporter 4 (MCT4) expression on tumor tissues from surgical specimen or from biopsy.
  3. To determine the safety of HP 13C pyruvate in renal tumor patients

OUTLINE:

Patients receive HP 13C pyruvate intravenously (IV) and then undergo 13C MRI scan 1-2 minutes post HP 13C pyruvate injection. Patients may receive an optional second HP 13C pyruvate injection and undergo 13C pyruvate MRI scan 15 to 60 minutes following completion of the first scan.

After completion of study treatment, patients are followed up 30 minutes.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 100 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
Official Title: Hyperpolarized 13C Pyruvate Metabolic MRI to Predict Renal Tumor Aggressiveness
Actual Study Start Date : January 1, 2019
Estimated Primary Completion Date : December 31, 2026
Estimated Study Completion Date : December 31, 2026

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Diagnostic (HP 13C pyruvate MRI)
Patients receive HP 13C pyruvate IV and then undergo 13C MRI scan 1-2 minutes post HP 13C pyruvate injection. Patients may receive an optional second HP 13C pyruvate injection and undergo 13C pyruvate MRI scan 15 to 60 minutes following completion of the first scan.
Drug: Hyperpolarized Carbon C 13 Pyruvate
Given IV
Other Names:
  • Hyperpolarized 13C-Pyruvate
  • Hyperpolarized Pyruvate (13C)

Procedure: Magnetic Resonance Imaging
Undergo MRI
Other Names:
  • Magnetic Resonance Imaging Scan
  • Medical Imaging, Magnetic Resonance / Nuclear Magnetic Resonance
  • MRI
  • MRI Scan
  • Nuclear Magnetic Resonance Imaging




Primary Outcome Measures :
  1. Comparison between HP 13C pyruvate-to-lactate conversion, as measured by peak lactate/pyruvate ratio with tumor histology and grade. [ Time Frame: Up to 12 months ]
    Descriptive statistics (mean, median, standard deviation, distribution, etc) of the metabolism measures will be calculated. We will use a tree-based cross-validated Classification & Regression Trees (CART) model for predicting benign renal tumors vs. low grade renal cell carcinoma (RCC) vs. high grade RCCs based on the HP 13C pyruvate metabolic data

  2. Comparison between HP 13C pyruvate-to-lactate conversion, as measured by the lactate /pyruvate area under curve (AUC) with tumor histology and grade. [ Time Frame: Up to 12 months ]
    Descriptive statistics (mean, median, standard deviation, distribution, etc) of the metabolism measures will be calculated. We will use a tree-based cross-validated Classification & Regression Trees (CART) model for predicting benign renal tumors vs. low grade RCCs vs. high grade RCCs based on the HP 13C pyruvate metabolic data;

  3. Comparison between HP 13C pyruvate-to-lactate conversion, as measured by the apparent rate of constant metabolic flux of HP 13C-pyruvate to lactate (kPL), with tumor histology and grade. [ Time Frame: Up to 12 months ]
    Descriptive statistics (mean, median, standard deviation, distribution, etc) of the metabolism measures will be calculated. We will use a tree-based cross-validated Classification & Regression Trees (CART) model for predicting benign renal tumors vs. low grade RCCs vs. high grade RCCs based on the HP 13C pyruvate metabolic data;


Secondary Outcome Measures :
  1. Estimate of intra-subject agreement for those with optional second scan [ Time Frame: Up to 12 months ]
    For patients who obtained an optional second HP 13 C pyruvate magnetic resonance imaging (MRI), intraclass correlation coefficient (ICC) will be used to estimate the intra-subject agreement. ICCs will be obtained from a one-way analysis of variance model based on 2 serial measurements per subject. The ICC ranges from 0 to 1. An ICC close to 1 indicates high similarity between values from the same group. An ICC close to zero means that values from the same group are not similar. The results will be presented with a 95% confidence interval.

  2. Comparison of the HP magnetic resonance (MR) peak lactate/pyruvate with Lactate dehydrogenase-A (LDHA) expression [ Time Frame: Up to 12 months ]
    When both the HP biomarker and molecular biomarker are continuous variables, Spearman's rank correlation coefficient will be used to investigate a possible correlation between them. If the outcome is categorical (e.g. immunohistochemistry score 0-1+ vs 2-3+), the HP biomarker distributions will be compared for the two categories using the Mann-Whitney test.

  3. Comparison of the HP MR peak lactate/pyruvate with Lactate dehydrogenase (LDH) activity [ Time Frame: Up to 12 months ]
    When both the HP biomarker and molecular biomarker are continuous variables, Spearman's rank correlation coefficient will be used to investigate a possible correlation between them. If the outcome is categorical (e.g. immunohistochemistry score 0-1+ vs 2-3+), the HP biomarker distributions will be compared for the two categories using the Mann-Whitney test.

  4. Comparison of the HP MR peak lactate/pyruvate with MCT4 expression [ Time Frame: Up to 12 months ]
    When both the HP biomarker and molecular biomarker are continuous variables, Spearman's rank correlation coefficient will be used to investigate a possible correlation between them. If the outcome is categorical (e.g. immunohistochemistry score 0-1+ vs 2-3+), the HP biomarker distributions will be compared for the two categories using the Mann-Whitney test.

  5. Comparison of the HP MR lactate /pyruvate area under the curve (AUC) with LDHA expression [ Time Frame: Up to 12 months ]
    When both the HP biomarker and molecular biomarker are continuous variables, Spearman's rank correlation coefficient will be used to investigate a possible correlation between them. If the outcome is categorical (e.g. immunohistochemistry score 0-1+ vs 2-3+), the HP biomarker distributions will be compared for the two categories using the Mann-Whitney test.

  6. Comparison of the HP MR lactate /pyruvate AUC with LDH activity [ Time Frame: Up to 12 months ]
    When both the HP biomarker and molecular biomarker are continuous variables, Spearman's rank correlation coefficient will be used to investigate a possible correlation between them. If the outcome is categorical (e.g. immunohistochemistry score 0-1+ vs 2-3+), the HP biomarker distributions will be compared for the two categories using the Mann-Whitney test.

  7. Comparison of the HP MR lactate /pyruvate AUC with MCT4 expression [ Time Frame: Up to 12 months ]
    When both the HP biomarker and molecular biomarker are continuous variables, Spearman's rank correlation coefficient will be used to investigate a possible correlation between them. If the outcome is categorical (e.g. immunohistochemistry score 0-1+ vs 2-3+), the HP biomarker distributions will be compared for the two categories using the Mann-Whitney test.

  8. Comparison of the HP MR kPL with LDHA expression [ Time Frame: Up to 12 months ]
    When both the HP biomarker and molecular biomarker are continuous variables, Spearman's rank correlation coefficient will be used to investigate a possible correlation between them. If the outcome is categorical (e.g. immunohistochemistry score 0-1+ vs 2-3+), the HP biomarker distributions will be compared for the two categories using the Mann-Whitney test.

  9. Comparison of the HP MR kPL with LDH activity [ Time Frame: Up to 12 months ]
    When both the HP biomarker and molecular biomarker are continuous variables, Spearman's rank correlation coefficient will be used to investigate a possible correlation between them. If the outcome is categorical (e.g. immunohistochemistry score 0-1+ vs 2-3+), the HP biomarker distributions will be compared for the two categories using the Mann-Whitney test.

  10. Comparison of the HP MR kPL with MCT4 expression [ Time Frame: Up to 12 months ]
    When both the HP biomarker and molecular biomarker are continuous variables, Spearman's rank correlation coefficient will be used to investigate a possible correlation between them. If the outcome is categorical (e.g. immunohistochemistry score 0-1+ vs 2-3+), the HP biomarker distributions will be compared for the two categories using the Mann-Whitney test.

  11. Incidence of treatment-related adverse events [ Time Frame: 1 day, 30 minutes following hyperpolarized 13C pyruvate injection ]
    Assessment of the occurrence of clinically significant changes in safety variables from baseline. Safety endpoints include monitoring for the occurrence of treatment-emergent AEs. Toxicities will be graded using the National Cancer Institute (NCI) Common Terminology (Toxicity) Criteria for Adverse Events (CTCAE) version 4.0.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Localized renal tumor measuring 2 centimeters (cm) and greater in diameter. To minimize any potential partial volume effects in this pilot study, we have limited the lower size range of the tumor to 2cm. We will include all localized renal tumor measuring 2 cm and greater in diameter in this first study to facilitate obtaining tumors of a range of histology and grade
  2. The subject is either scheduled to undergo partial or radical nephrectomy at University of California, San Francisco (UCSF), or has a diagnostic renal tumor biopsy indicating benign histology. An increasing number of patients with small renal tumors at UCSF are referred for renal tumor biopsy and then active surveillance especially if biopsy indicates high likelihood of benign histology. We will recruit these patients into our study to ensure adequate number of benign renal tumors for this initial pilot study.
  3. The subject is able and willing to comply with study procedures and provide signed and dated informed consent.
  4. The subject is willing to undergo standard of care abdominal MRI in connection with the study exam.
  5. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1

Exclusion Criteria:

  1. Patients who because of age, general medical or psychiatric condition, or physiologic status cannot give valid informed consent.
  2. Patients unwilling or unable to undergo magnetic resonance (MR) imaging, including patients with contra-indications to MR imaging, such as cardiac pacemakers or non-compatible intracranial vascular clips.
  3. Any metallic implant or device that distorts local magnetic field and compromises the quality of MR imaging of the abdomen.
  4. Prior focal therapy (i.e. ablation) for the renal tumor. In patients with tumor biopsy, imaging study will occur at least 4 weeks following any biopsy to avoid artifact from hemorrhage.
  5. Poorly controlled hypertension, with blood pressure at study entry >160/100. The addition of anti-hypertensives to control blood pressure is allowed for eligibility determination.
  6. Congestive heart failure or New York Heart Association (NYHA) status >= 2.
  7. A history of clinically significant electrocardiogram (EKG) abnormalities, including QT prolongation, a family history of prolonged QT interval syndrome, or myocardial infarction (MI) within 6 months of study entry. Patients with rate-controlled atrial fibrillation/flutter will be allowed on study.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04258462


Contacts
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Contact: Zhen Jane Wang, MD 415-476-3767 Zhen.Wang@ucsf.edu
Contact: Namasvi Jariwala 415-514-6759 namasvi.jariwala@ucsf.edu

Locations
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United States, California
University of California, San Francisco Recruiting
San Francisco, California, United States, 94115
Contact: Zhen Jane Wang, MD    415-353-1821    zhen.wang@ucsf.edu   
Contact: Namasvi Jariwala    415-514-6759    namasvi.jariwala@ucsf.edu   
Principal Investigator: Zhen Jane Wang, MD         
Sub-Investigator: Peder Larson, PhD         
Sponsors and Collaborators
Zhen Wang, MD
American Cancer Society, Inc.
Investigators
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Principal Investigator: Zhen Jane Wang, MD University of California, San Francisco
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Responsible Party: Zhen Wang, MD, Professor of Radiology, University of California, San Francisco
ClinicalTrials.gov Identifier: NCT04258462    
Other Study ID Numbers: 18525
NCI-2018-03692 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
First Posted: February 6, 2020    Key Record Dates
Last Update Posted: November 25, 2020
Last Verified: November 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Additional relevant MeSH terms:
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Neoplasms
Carcinoma, Renal Cell
Kidney Neoplasms
Aggression
Adenocarcinoma
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Urologic Neoplasms
Urogenital Neoplasms
Neoplasms by Site
Kidney Diseases
Urologic Diseases
Behavioral Symptoms