Pilot and Feasibility Study of the Imaging Potential of EC17: Intraoperative Folate-fluorescein Conjugate (EC17) Lung Cancer (CA)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01778920
Recruitment Status : Completed
First Posted : January 29, 2013
Last Update Posted : May 17, 2016
VA Office of Research and Development
Information provided by (Responsible Party):
University of Pennsylvania

January 18, 2013
January 29, 2013
May 17, 2016
April 2012
April 2016   (Final data collection date for primary outcome measure)
Number of FRA tumors identified by EC17 during surgery. [ Time Frame: Within two to four hours of injection of the EC17 ]
Measure the number of patients who have a positive margin during lung cancer surgery 2 - 4 hours after receiving administration of EC17.
The ability of the imaging system to detect the expression of EC17 in the nodule/mass (i.e. tumor) and discern the uptake of the dye by the tumor [ Time Frame: Within two hours of injection of the EC17 ]
Complete list of historical versions of study NCT01778920 on Archive Site
The number of participants that will have an adverse reaction to the EC17 [ Time Frame: Day 1 - Day 30 ]
Same as current
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Pilot and Feasibility Study of the Imaging Potential of EC17: Intraoperative Folate-fluorescein Conjugate (EC17) Lung Cancer (CA)
Intraoperative Imaging of Pulmonary Adenocarcinoma

The goal of this study is to perform imaging of patient's tumors while the chest is open and the tumor is being removed.

According to the World Health Organization, lung cancer is the most common cause of cancer-related death in men and women, and is responsible for 1.3 million deaths worldwide annually as of 2004. Surgery remains the best option for patients presenting with operable Stage I or II cancers, however the five year survival rate for these candidates remains at a dismal 53% for Stage I and 32% for Stage II. The high rates of recurrence suggest that surgeons are unable to completely detect and remove primary tumor nodules in a satisfactory manner as well as lingering metastases in sentinel lymph nodes. By ensuring a negative margin through imaging during surgery it would be possible for us to improve the rates of recurrence free patients and thus overall survival.

Thoracic malignancies are the ideal disease to investigate intra-operative imaging. Over 85% of lung and pleural malignancies express folate receptor alpha (FRA). It is important to note that FRA is expressed only in the proximal tubules of the kidneys, activated macrophages, and in the choroidal plexus. Thus, the false positive detection rate is expected to be extremely low. A group well known to us in the Netherlands has completed a pilot study utilizing a folate-fluorescein isothiocyanate (folate-FITC) conjugate in 12 patients with ovarian cancer. Another group of investigators in Mayo have subsequently performed this study on 20 more patients without any serious adverse events (personal communication). They report excellent sensitivity and specificity with this technique with only grade 1 side effects (allergic reaction). All side effects reversed when the injection was halted. Patients with a history of allergic reactions to insect bites should not participate (fluorescein is derived from the firefly insect, folate is an essential vitamin).

This will identify the margins and the lymph nodes that may have cancer cells during cancer surgery
Phase 1
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
  • Lung and Pleural Malignancies
  • Neoplasms
  • Nodules
  • Adenocarcinoma
Drug: EC17 imaging contrast agent
This is an imaging agent to locate lung adenocarcinoma cancer cells during surgery
Experimental: IV Injection of EC17
The group will receive a single dose of EC17, infused over 10 minutes, prior to surgery. Then, during surgery, the EC-17 will be imaged with a camera that the investigators have developed.
Intervention: Drug: EC17 imaging contrast agent
Okusanya OT, DeJesus EM, Jiang JX, Judy RP, Venegas OG, Deshpande CG, Heitjan DF, Nie S, Low PS, Singhal S. Intraoperative molecular imaging can identify lung adenocarcinomas during pulmonary resection. J Thorac Cardiovasc Surg. 2015 Jul;150(1):28-35.e1. doi: 10.1016/j.jtcvs.2015.05.014. Epub 2015 May 7.

*   Includes publications given by the data provider as well as publications identified by Identifier (NCT Number) in Medline.
May 2016
April 2016   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  • Adult patients over 18 years of age
  • Patients presenting with a lung or pleural nodule or mass presumed to be resectable on pre-operative assessment
  • Good operative candidate
  • Subject capable of giving informed consent and participating in the process of consent

Exclusion Criteria:

  • Pregnant women as determined by urinary or serum beta human chorionic gonadotropin (hCG) within 72 hours of surgery
  • Patients with a history of anaphylactic reactions to Folate-FITC or insects
  • At-risk patient populations:

    • Homeless patients
    • Patients with drug or alcohol dependence
    • Children and neonates
    • Patients unable to participate in the consent process
Sexes Eligible for Study: All
18 Years and older   (Adult, Senior)
Contact information is only displayed when the study is recruiting subjects
United States
EC17 Lung Cancer ( Other Identifier: University of Pennsylvania )
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University of Pennsylvania
University of Pennsylvania
VA Office of Research and Development
Principal Investigator: Sunil Singhal, MD Philadelphia VA Medical Center, Philadelphia, PA
University of Pennsylvania
December 2015

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP