Clinical nodal staging for rectal cancer tumours in early stages, is today shown to be unreliable and no precise or accurate methods exist. Thus, there is an unmet need for better clinical staging of rectal cancer in early stages. If new imaging techniques for clinical staging of early rectal cancer are developed an opportunity for increased treatment by local excision and decreased unnecessary radical surgery would be possible. NanoEcho Particle-1 (NEP-1, Ferumoxtran Lyophilisate 20 mg Fe/mL) will be used, in combination with NanoEcho Imaging Device, to enhance the signal in the detection and identification of possible spread of rectal cancer to nearby rectal regional lymph nodes by magnetomotive ultrasound (MMUS) technology. NEP-1 is an ultrasmall superparamagnetic iron oxide (USPIO)-based contrast agent. It belongs to the specific contrast agents-group, which are specific to reticuloendothelial system (liver, spleen, lymph nodes, bone marrow), mainly represented by iron oxide nanoparticles coated with macromolecules such as dextran in the presence of adjuvants (mineral salts, polyhydric alcohols, etc.). It belongs to the USPIO sub-group (with a mean particle diameter of 30 nm. The NanoEcho Imaging Device is based on the MMUS technology. It aims to identify possible spread of rectal cancer to nearby rectal regional lymph nodes by visualisation of the movement, generated by the nanoparticles (nTrace). The iron oxide-based nanoparticles, NEP-1, are administered submucosally at four separate administration sites locally in rectum, close to the suspected tumour area. After some time allowing the particles to spread, the MMUS probe, dressed in a probe cover with ultrasound gel inside, is inserted into the rectum. The nanoparticles are set in motion by a magnetic field, introduced by a rotating magnet located inside the probe. The motion of the tissue, the so-called tissue displacement, is detected with ultrasound and called NanoEcho visualisation of the movement generated by the nanoparticles (nTrace) and is visualised on the screen of the NanoEcho Imaging Device. The higher the concentration of the nanoparticles, the stronger the nTrace signal. Based on the distribution pattern of the particles, the system aims to support the user in distinguishing between healthy and metastatic lymph nodes located nearby the tumour within the rectal region. Part A In Part A (healthy volunteers) of the trial, NEP-1 will be administered on a single occasion, followed by four MMUS-assessments, in four ascending dose groups of three participants each. Part B In Part B (rectal cancer patients) of the trial, NEP-1 will be administered on a single occasion, followed by a MMUS assessment in a maximum of ten patients with rectal cancer. The dose level of NanoEcho Particle-1 (Ferumoxtran) to be used and the timepoint for the MMUS assessment will be decided based on Part A.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
12
Submucosal injection of nanoparticles in rectum, 28 mg Fe (7 mg Fe/mL)
MMUS examination of lymphnodes in rectum
Submucosal injection in rectum 56 mg Fe (3,5 mg Fe/mL)
Submucosal injection in rectum : 56 mg Fe (14 mg Fe/mL)
Submucosal injection in rectum 112 mg Fe (14 mg Fe/mL)
Clinical Trial Consultants
Uppsala, Sweden
RECRUITINGPart A: Normalised average nTrace value for all lymph nodes at all timepoints
Dose-response curve and Time-response curve for normalised average nTrace value. nTrace value is NanoEcho visualisation of the movement generated by the nanoparticles
Time frame: From dosing and up to 72 hours.
Part B, Normalised average nTrace value for all lymph nodes
Time frame: From dosing to end of MMUS examination up to 72 hours
Part A. Size of lymph nodes with and without detectable nTrace in Healthy Volunteers
At what size of lymph nodes is (i) lymph nodes detectable (B mode) but no nTrace detectable in lymph nodes? (ii) nTrace detectable in lymph nodes? (iii) nTrace showing an even distribution in lymph nodes?
Time frame: From dosing and up to 72 hours after dosing
Part A, Frequency, seriousness, and intensity of adverse events (AEs) for the IMP and the medical device.
Time frame: From dosing until end of study Day 8 after dosing
Part A. User experience
Result of user experience questionnaire
Time frame: From dosing up to 72 hours
Part B. Number of lymph nodes detected by NanoEcho diagnostic method compared to historic MRI data per section and overall
Time frame: After the MMUS examination up to 72 hours after dosing
Part B, True positive fraction (N+) (sensitivity) and true negative fraction (N0) (specificity) of identified lymph node per section of rectum.
Time frame: At end of MMUS examination up to 72 hours after dosing
Part A. Distance from injection to lymphnodes with and without detectable nTrace
At what distance from the injection is (i) lymph nodes detectable (B mode) but no nTrace detectable in lymph nodes? (ii) is nTrace detectable in lymph nodes? (iii) is nTrace showing an even distribution in lymph nodes?
Time frame: From dosing and up to 72 hours after dosing
Part B. Size of lymph nodes with and without detectable nTrace in Rectal Cancer patients
At what size of lymph nodes is (i) lymph nodes detectable (B mode) but no nTrace detectable in lymph nodes? (ii) is nTrace detectable in lymph nodes? (iii) is nTrace showing an even distribution in lymph nodes?
Time frame: From dosing and up to 72 hours after dosing
Part B, Frequency, seriousness, and intensity of adverse events (AEs) for the IMP and the medical device.
Time frame: From dosing until end of study Day 8 after dosing
Part B. User experience
Result of user experience questionnaire
Time frame: From dosing up to 72 hours
Part B. Distance from injection to lymph nodes with and without detectable nTrace in Rectal Cancer Patients
At what distance from the injection is (i) lymph nodes detectable (B mode) but no nTrace detectable in lymph nodes? (ii) is nTrace detectable in lymph nodes? (iii) is nTrace showing an even distribution in lymph nodes?
Time frame: From dosing and up to 72 hours after dosing
Part B, Size of detectable metastases
Time frame: End of MMUS examination up to 72 hours after dosing
Part B, distance form tumour to detectable tumour infiltration
Time frame: End of MMUS examination up to 72 hours after dosing
Part A, Frequency and nature of device deficiencies (DDs).
Time frame: From dosing until end of last examination after 72 hours
Part A, Safety and Tolerability of NEP 1 and NanoEcho Imaging Device examination in healthy volunteers.
Clinically significant changes in vital signs, ECG, safety laboratory measurements (haematology, clinical chemistry, coagulation) and physical examination findings.
Time frame: From dosing until end of study Day 8 after dosing
Part B, Frequency and nature of device deficiencies (DDs).
Time frame: From dosing until end of last MMUS examination after 72 hours after dosing
Part B, Safety and Tolerability of NEP 1 and NanoEcho Imaging Device examination in Rectal Cancer Patients
Clinically significant changes in vital signs, ECG, safety laboratory measurements (haematology, clinical chemistry, coagulation) and physical examination findings.
Time frame: From dosing until end of study Day 8 after dosing
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