This Phase 3 open-label single-arm study is designed to investigate the safety, diagnostic performance, and clinical usefulness of Gleolan for the real time detection and visualization of meningiomas during tumor resection surgery. The study is planned to run for 15 months with individual study participation lasting for approximately 2 months.
This Phase 3 open-label single-arm study is designed to investigate the safety, diagnostic performance, and clinical usefulness of the imaging agent Gleolan™ (Aminolevulinic Acid Hydrochloride, ALA HCl, ALA, 5-ALA), an orally administered imaging agent for the real time detection and visualization of meningiomas during tumor resection surgery. ALA is a prodrug that is metabolized intracellularly to form the fluorescent molecule Protoporphyrin IX (PpIX). The exogenous application of ALA leads to a highly selective accumulation of PpIX in tumor cells. Following excitation with blue light (BL) (λ = 375 - 440 nm), the PpIX, which has accumulated selectively in tumor tissue, emits a red-violet light. This phenomenon allows for the real-time visualization of tumor tissue during resection surgery. Patients about to undergo resection for suspected meningioma \[World Health Organization (WHO) Grade I, II, III\] will be screened and informed consent will be obtained prior to surgery and prior to study participation. Eligible study participants will receive an oral solution of Gleolan (20 mg/kg body weight) 3 hours, (target range 2-4 hours) prior to anesthesia, and then undergo surgery for meningioma resection. During the surgery, the surgeon will use a microscope equipped with WL and BL for visualization of Gleolan-induced PpIX fluorescence for the selection of protocol-driven tissue locations and to assess fluorescence status. Study participants will be evaluated within 48 hours post procedure, 2 weeks post procedure, and 6 weeks post procedure for study safety assessment.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
108
One time oral dose on day of surgery (20 mg/kg bodyweight)
Mayo Clinic
Phoenix, Arizona, United States
University of California San Diego
La Jolla, California, United States
The Percentage of Participants Who Had at Least 1 Indeterminate Tissue or Unexpected Fluorescent End of Surgery (EOS) Tissue Where Gleolan-induced PpIX Fluorescence Status is Consistent With Histology (i.e., True Positive or True Negative for Meningioma).
Responders are defined as the percentage of participants among all participants receiving Gleolan (the Intent to Image Population) who had at least one indeterminate tissue or unexpected fluorescent end of surgery (EOS) tissue where Gleolan-induced PpIX fluorescence status was consistent with central laboratory histology. For a participant to be considered a success, only biopsies considered 'non-obvious' for tumor status by an external panel of neurosurgeons who reviewed videos and images were eligible to be assessed in the numerator. A two-sided 95% confidence interval was calculated using the Wilson (score) method. The lower bound of the confidence interval was tested against a null hypothesis value of 30%. A modified worst-case imputation was used for missing data.
Time frame: Surgery (Day 1)
Positive Predicted Value (PPV) of Gleolan-induced PpIX Fluorescence Status of Biopsied Tissue Locations at the Margin of the Tumor [Indeterminate Tissues and Unexpected Fluorescent EOS Tissues (Combined)].
PPV calculation considers both indeterminate and unexpected fluorescent end-of-surgery tissues. Generalized Estimating Equation (GEE) models that take into account the correlation (clustering) of the biopsies within a participant were used to calculate the estimates and two-sided 95% confidence intervals. The models used a binomial distribution function with an exchangeable working correlation matrix and utilized a robust variance estimator. PPV = TP/(TP+FP) TP = True Positive; FP = False Positive; The truth standard was determined via central histopathology.
Time frame: Surgery (Day 1)
Negative Predicted Value (NPV) of Gleolan-induced PpIX Fluorescence Status of Biopsied Tissue Locations at the Margin of the Tumor [Indeterminate Tissues].
NPV calculation considered indeterminate tissues only since unexpected fluorescent end-of-surgery tissues were, by definition, fluorescence positive. Generalized Estimating Equation (GEE) models that take into account the correlation (clustering) of the biopsies within a participant were used to calculate the estimates and two-sided 95% confidence intervals. The models used a binomial distribution function with an exchangeable working correlation matrix and utilized a robust variance estimator. NPV = TN/(TN+FN) TN = True Negative; FN = False Negative; The truth standard was determined via central histopathology.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Keck Hospital of USC
Los Angeles, California, United States
Providence St. Joseph Hospital
Orange, California, United States
Swedish Medical Center
Englewood, Colorado, United States
University of Miami
Coral Gables, Florida, United States
Baptist Health South Florida
Miami, Florida, United States
Southern Illinois University
Springfield, Illinois, United States
Massachusetts General Hospital
Boston, Massachusetts, United States
Henry Ford Health System
Detroit, Michigan, United States
...and 7 more locations
Time frame: Surgery (Day 1)
Positive Predictive Value of Single Bulk Tumor Sample Obtained From Each Participant.
PPV (PPV=TP/(TP+FP)) of Gleolan-induced PpIX fluorescence status of biopsied tissue locations of bulk/core meningioma tumor
Time frame: Surgery (Day 1)