Breast conserving surgery (BCS) is performed on patients with breast cancer to resect and completely remove the cancer while conserving as much of the surrounding healthy tissue as possible. Current methods do not allow surgeons to determine the completeness of surgical resection in real-time. This often results in the need for a second surgical procedure, or in some cases more than two surgical procedures in order to have confidence that all cancer has been removed. This Phase 3 study will evaluate the safety and efficacy of the fluorescent imaging agent PD G 506 A for the real-time visualization of cancer during standard of care breast conserving surgery. PD G 506 A is an investigational drug which is converted in the body into a fluorescent molecule that accumulates in cancer cells. Patients receiving PD G 506 A will undergo standard of care breast conserving surgery followed by fluorescence imaging and removal of any potentially cancerous tissue left behind in the surgical cavity.
Re-operations due to positive margins following breast conserving surgery (BCS) increase poor cosmesis, complications, discomfort, stress, adjuvant delay, medical costs and risk of local recurrence. Reducing positive margin rates can be achieved through optimizing surgical procedures. This study evaluates a new method for surgeons to visualize carcinoma in real-time, both in the surgical cavity and on the margins of excised specimen(s) during the index BCS procedure. The active ingredient of PD G 506A is aminolevulinic acid hydrochloride (ALA HCl). ALA HCl is a prodrug that is metabolized intracellularly to form the fluorescent molecule protoporphyrin IX (PpIX). The exogenous application of ALA HCl leads to a highly selective accumulation of PpIX in malignant tissues. This Phase 3, 2-part, single-blind \[pathologist(s)-blinded\] randomized placebo-controlled trial study is designed to evaluate the efficacy and safety of PD G 506 A to aid in the visualization of carcinoma during BCS. The Eagle V1.2 Imaging System will be used in this trial to visualize PpIX fluorescence. Part A is an open-label training phase of the study to optimize workflow and Part B of the study is randomized and single-blind and will serve as the pivotal portion of the study.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
57
PD G 506 A for oral solution (aminolevulinic acid \[ALA\] hydrochloride \[HCl\] granules for oral solution) is administered as a single dose (20 mg/kg body weight) approximately 3 hours (min 2 hours, max 4 hours) prior to anesthesia.
Fluorescence imaging camera and associated accessories used to view and capture fluorescence and white light images and videos of the surgical cavity and excised tissue specimens during the surgical procedure.
Oral placebo is administered as a single dose approximately 3 hours (min 2 hours, max 4 hours) prior to anesthesia.
Stamford Hospital
Stamford, Connecticut, United States
BayCare Morton Plant Hospital
Clearwater, Florida, United States
University of Miami Sylvester Comprehensive Cancer Center
Miami, Florida, United States
Orlando Health, Inc.
Orlando, Florida, United States
BayCare St. Joseph's Hospital
Tampa, Florida, United States
Montefiore Medical Center
The Bronx, New York, United States
Aurora St. Luke's Medical Centre
Milwaukee, Wisconsin, United States
Positive Margin Conversion Rate
Percentage of patients with negative-margins following fluorescence-guided resection (FGR) among patients all patients imaged
Time frame: 2 weeks
Diagnostic Performance (Specificity)
Patient-level specificity to identify residual carcinoma
Time frame: 2 weeks
Diagnostic Performance (Sensitivity)
Patient-level sensitivity to identify residual carcinoma
Time frame: 2 weeks
Orientation-level Diagnostic Performance
Orientation-level diagnostic performance of PD G 506 A-induced fluorescence to determine the presence or absence of cancer in the surgical cavity as compared to margin histopathology.
Time frame: 2 weeks
Positive Margin Conversion Rate Among All Patients
Percentage of patients with at least one histopathology-positive margin following SoC who then have ALL histopathology-negative margins following FGR, among all patients imaged.
Time frame: 2 weeks
Patient-level Diagnostic Performance
Patient-level sensitivity, specificity, NPV, PPV of PD G 506 A-induced fluorescence to determine the presence or absence of residual cancer.
Time frame: 2 weeks
Patient-level Diagnostic Performance of PD G 506 A to Detect Residual Cancer at the End of FGR With Modified Patient-level Definitions
Patient-level sensitivity, specificity, PPV and NPV to determine the presence or absence of residual cancer in the surgical cavity at the end of FGR (using modified patient-level definitions).
Time frame: 2 weeks
Patient-level Diagnostic Performance of PD G 506 A to Detect Cancer After SoC BCS
Patient-level sensitivity, specificity, PPV and NPV to determine the presence or absence of cancer in the surgical cavity after SoC BCS.
Time frame: 2 weeks
Patient-level Diagnostic Performance of PD G 506 A to Detect Cancer After SoC With Modified Patient-level Definitions
Patient-level sensitivity, specificity, PPV and NPV to determine the presence or absence of cancer in the surgical cavity after SoC (using modified patient-level definitions).
Time frame: 2 weeks
Patient-level False Negative Rate of at the End of FGR
Percentage of patients assessed as residual tumor negative at the end of FGR who had positive final margins on histopathology.
Time frame: 2 weeks
Patient-level False Positive Rate
Percentage of patients in whom SOC final margins were carcinoma negative and all FL-driven shave specimens are carcinoma-negative.
Time frame: 2 weeks
Patients With Carcinoma-negative Margins After SoC Found to Have Residual Tumor Following SoC That Was Identified With FL Imaging
Percentage of patients with histopathology-negative margins at the end of SoC who have at least one orientation that was both FL-positive and histopathology-positive among (1) patients with histopathology negative final margins after SOC and (2) all patients imaged.
Time frame: 2 weeks
Patient-level True Negative Rate at the End of SoC
Percentage of patients with no fluorescence identified at the end of SoC in whom all final margins after SoC are histopathologically confirmed to be negative for carcinoma.
Time frame: 2 weeks
Patient-level Diagnostic Performance to Identify in Vivo Residual Carcinoma After FGR
Patient-level in vivo diagnostic performance of PD G 506 A-induced fluorescence to determine the presence or absence of residual cancer in the surgical cavity at the end of FGR as compared to the final margin histopathology.
Time frame: 2 weeks
Orientation Discordant Fluorescence Status
Percentage of orientations where in vivo and ex vivo fluorescence assessments are discordant.
Time frame: 2 weeks
Patient-level Re-operation Rate
Percentage of patients receiving a 2nd surgery on the ipsilateral breast within 1 year of index BCS to remove suspected residual disease.
Time frame: 1 year
Patient-level Early Re-operation Rate
Percentage of patients receiving an early 2nd surgery (planned or actual) on the ipsilateral breast related to positive final margins.
Time frame: 3 - 6 months
Amount of Tissue Removed With FGR Beyond SoC
Weight (mg) of all tissue removed based on SoC and/of FGR.
Time frame: 3 - 6 months
Patient Satisfaction With Breast
Patient satisfaction with the cosmetic outcome of breast conserving surgery performed based on SoC in combination with PD G 506 A and the Eagle V1.2 Imaging System.
Time frame: 2 weeks, 3-, 6- and 12-months
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