Abstract CT043: Feasibility study to evaluate performance of the LUM Imaging System for intraoperative detection of residual tumor in breast cancer patients receiving and not receiving neoadjuvant therapy
Authors: Ferrer Jorge M. , Wapnir Irene , Blumencranz Peter , Hunt Kelly , Hwang Shelley , Carr David , Smith Kate , Cruz Heidi Santa , Shanno Julia , Pogrebinsky Alexander , Chang Manna , Smith Barbara L. 
Published: April 2023

Background: Microscopically tumor-free lumpectomy margins are critical for safe breast conserving surgery (BCS). With current tools, 15%-25% of BCS have positive margins that require second surgical procedures and increase cost and patient discomfort. Better detection tools are needed to identify residual cancer during the initial BCS and reduce second operations. LUM015 is a protease-activated fluorescent imaging agent that accumulates in tumor cells and tumor associated macrophages after preoperative intravenous injection. The LUM Imaging System visualizes activated LUM015 in the lumpectomy cavity via a hand-held detector and tumor detection software. This system has been tested in multiple single-site studies and two prospective multi-site studies enrolling &gt;600 patients and demonstrated successful detection of residual BCS cavity tumor. Initial studies excluded the ~20% of patients receiving neoadjuvant therapy. Patchy tumor cell death with preoperative therapy can leave small, multifocal deposits of tumor invisible on pre-operative imaging and not palpable or visible during surgery. We now evaluate the LUM Imaging System in patients with and without neoadjuvant therapy.

Design: This prospective, multi-center study tests the LUM Imaging System in BCS after neoadjuvant therapy to evaluate potential impact of treatment-related tissue changes and tumor cell death on tumor detection algorithms. An initial cohort of 10 patients addressed the objective of algorithm development. A second cohort of 104 patients will further evaluate the feasibility of the LUM Imaging System after neoadjuvant therapy. A third cohort will enroll 208 patients who have not received neoadjuvant therapy. All cohorts are evaluated for safety and for reduction in residual tumor after LUM Imaging System guidance compared to standard BCS. After excision of the main lumpectomy specimen, patients are randomized 3:1. In the device arm, the cavity is imaged and margins with LUM015 signal are excised. Final comprehensive shaved margins are removed in both arms to evaluate extent of residual disease after the use of the LUM Imaging System or after standard lumpectomy. No LUM Imaging is performed in the control arm, however, all patients are injected with LUM015 to evaluate drug safety. Patient reported outcomes assessing re-excision concerns, breast appearance and preferences for treatment type are collected.

Eligibility: This study enrolls women with histologically confirmed primary invasive breast cancer (IBC), ductal carcinoma in situ (DCIS) or a combination of IBC/DCIS undergoing a BCS for their breast malignancy who have received any form of neoadjuvant treatment prior to surgery or who have not received any therapy prior to surgery. Patients allergic to polyethylene glycol or intravenous contrast agents are excluded. Use of blue node mapping dyes before imaging with the LUM015 is not allowed.

Progress: Cohort 1 has completed enrollment and interim analysis. No new risks specific to the neoadjuvant population were identified. LUM015 fluorescent signals measured in neoadjuvant patients were within the expected range, and no changes to the tumor detection algorithm were required. Cohorts 2 and 3 have enrolled a total of 84 patients. This trial is registered as NCT04440982.

Citation Format: Jorge M. Ferrer, Irene Wapnir, Peter Blumencranz, Kelly Hunt, Shelley Hwang, David Carr, Kate Smith, Heidi Santa Cruz, Julia Shanno, Alexander Pogrebinsky, Manna Chang, Barbara L. Smith. Feasibility study to evaluate performance of the LUM Imaging System for intraoperative detection of residual tumor in breast cancer patients receiving and not receiving neoadjuvant therapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr CT043.