The purpose of the study is to qualify, independently, tumor cell proliferation by 3'-Deoxy-3'-\[18F\]Fluorothymidine (FLT) -Positron Emission Tomography , and cell death by Diffusion Weighted Imaging (DWI) -Magnetic Resonance Imaging (MRI) compared to pathological quantification (% of viable tumor cells) of the primary tumor after pre-operative chemotherapy in patients with operable Non Small Cell Lung Cancer (NSCLC).
This is a prospective, multicenter, single-arm imaging trial. Patients with NSCLC will undergo 18F-FLT-PET/CT and DWI-MRI scans on three separate occasions: at baseline, at 14 days (maximum +/- 1 days deviation is acceptable) after first administration of chemotherapy and finally after up to 4 cycles of chemotherapy, and then followed by surgery. The quantification of 18F-FLT SUV and ADC will be measured to assess tumor characteristics and response to therapy. Patients will be first registered into the EORTC system after signing the informed consent form. The site will have to complete all the study related procedures within 6 weeks prior to treatment and all eligibility criteria should be met before the patient can be enrolled into the study. Both 18F-FLT-PET/CT and DWI-MRI will be assessed independently in this trial. Therefore the overall type I error of 0.1 will be split by two in order to test independently each imaging biomarker with a one-sided type I error of 0.05. In order to demonstrate with 95% confidence interval (one sided) that the correlation between the imaging biomarker change and the pathological response is \> 0.5 (H0: rho ≤ 0.5) with 90% power if the true correlation is 0.8 (H1: rho \> 0.5), 31 lesions are needed. As, in this population, patients only have the primary tumor, 31 eligible and evaluable patients will be needed for each primary endpoint. If all included patients have both 18F-FLT-PET/CT and DWI-MRI then 31 eligible and evaluable patients will be enough. If some patients have only one type of scans (18F-FLT-PET/CT or DWI-MRI), the sample size would need to be adapted to have 31 patients with each type of scans. In addition, the total number of patients to be registered may be increased to 40 patients for each primary endpoint to take into account some screening failure. For the primary analysis of correlation between relative change in imaging biomarkers (18F-FLT-SUV or ADC) and pathological quantification, the correlation coefficient will be reported using a one-sided 95% confidence interval, and tested as a one-sided comparison to the null hypothesis (H0: ρ ≤ 0.5). All secondary objectives to correlate preoperative imaging biomarkers and IHC biological markers or tumor volume will use the same analysis as cited above with 99% confidence intervals. All measures will be analyzed in a random effect ANOVA model allowing for within center-variability. Quality assurance is planned for the control of data consistency, on-site monitoring, audits, and quality assurance in pathological response assessment and in imaging.
Patients with NSCLC will undergo 18F-FLT-PET/CT and DWI-MRI scans on three separate occasions. Dedicated in-house developed software will be used to quantify 18F-FLT SUV and ADC to assess tumor characteristics and response to therapy.
Istituto Clinico Humanitas
Milan, Italy
RECRUITINGRoyal Marsden Hospital - Sutton, Surrey
Sutton, United Kingdom
RECRUITINGPercentage of Apparent Diffusion Coefficient (ADC) change
Percentage of Apparent Diffusion Coefficient (ADC) change at day 14 relative to baseline
Time frame: day 14 relative to baseline
Percentage of FLT uptake change
Percentage of FLT uptake change at day 14 relative to baseline
Time frame: day 14 relative to baseline
Pathological quantification (% viable residual tumor cells)
participants will receive chemotherapy for up to 12 weeks (4 cycles) and followed by surgery (with an expected surgical preparation of 2-4 weeks)
Time frame: in average at week 16 from baseline
Pre-operative (post-treatment) ADC measurement
participants will receive chemotherapy for up to 12 weeks (4 cycles) and performed the DWI-MRI scan within one week prior to the surgery
Time frame: in average at week 15 from baseline
Pre-operative (post-treatment) FLT uptake measurement
participants will receive chemotherapy for up to 12 weeks (4 cycles) and performed the FLT-PET scan within one week prior to the surgery
Time frame: in average at week 15 from baseline
Tumor volume (baseline, day 14 and post-treatment)
Time frame: baseline, day 14 and post-treatment
Immunohistochemistry (IHC) cell proliferation marker Ki-67
Immunohistochemistry (IHC) cell proliferation marker Ki-67-index in diagnostic biopsy samples (if available) and surgical specimens.
Time frame: 1y
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Study Type
INTERVENTIONAL
Allocation
NA
Purpose
BASIC_SCIENCE
Masking
NONE
Enrollment
31
Metabolic change from FDG-PET (if available)
standard imaging per routine practice
Time frame: in average at week 9 from baseline