Using a PET Imaging Agent, 18F-Clofarabine (CFA), to Measure Deoxycytidine Kinase Activity in Metastatic Cancer

Study Overview
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Brief Summary
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The purpose of this study is to evaluate whether a new type of imaging study, called 18F-Clofarabine (CFA) PET/CT, can be used to image cancer pyrimidine metabolism in participants. PET (positron emission tomography) imaging is a way of looking at cancers that can reveal cancer metabolism. Presently, however, there are no imaging agents in routine use to look at an aspect of cancer metabolism (pyrimidine metabolism) that dictates whether certain cancer drugs, e.g., gemcitabine, are likely to be taken into the cancer cells. This clinical trial will be testing whether 18F-Clofarabine (CFA) could be an imaging agent to measure this aspect of cancer metabolism.

Detailed Description
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The participants will receive a CFA injection into a vein in their arm. The imaging drug is attracted to and taken into certain cells in the body, including cancer cells. 18F-Clofarabine (CFA) is experimental because it is not approved by the Food and Drug Administration (FDA). The participants will be observed for side effects, and about 1 hour later, they will receive a PET/CT scan. Additionally, they will be contacted the next day to inquire again about any side effects. If the participant's routine care involves repeat imaging of cancer, then the CFA PET/CT scan will be repeated at that time, which could be a month to about 4 months after the first CFA PET/CT scan.

Official Title
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18F-Clofarabine (CFA) as a PET Imaging Agent to Measure Deoxycytidine Kinase (DCK) Activity in Metastatic Cancer, as a Candidate Predictive Biomarker for Response to DCK-dependent Drugs Such as Gemcitabine

Conditions
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Metastatic Cancer, Carcinoma, Adenocarcinoma

Intervention / Treatment
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* Drug: 18F-Clofarabine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Histologically or cytologically proven carcinoma or adenocarcinoma. Histologies other than carcinoma/adenocarcinoma will not be eligible. Subjects must have metastatic disease, confirmed by imaging, typically a CT scan of the chest/abdomen/pelvis. Subjects must have measurable disease per RECIST 1.1 Over 18 years of age ECOG performance status 0-1 Adequate organ function as defined by the following criteria: Serum aspartate transaminase (AST; serum glutamic oxaloacetic transaminase [SGOT]) and serum alanine transaminase (ALT; serum glutamic pyruvic transaminase [SGPT]) <= 2.5 x laboratory upper limit of normal (ULN) Total serum bilirubin <= 2.0 x ULN Absolute neutrophil count (ANC) >= 1500/uL Platelets >= 75,000/uL Hemoglobin >= 8.0 g/dL Serum calcium <= 12.0 mg/dL Serum creatinine <= 2.9 mg/dL Subjects must have the ability to understand and the willingness to sign a written informed consent document Patient is able to remain still for the duration of the imaging procedure (up to one hour). Exclusion Criteria: Within 6 months prior to enrollment on this study: myocardial infarction, severe/unstable angina, severe peripheral vascular disease (claudication) or procedure on peripheral vasculature, coronary/peripheral artery bypass graft, New York Heart Association grade II or greater congestive heart failure, cerebrovascular accident or transient ischemic attack, clinically significant bleeding or pulmonary embolism. Pregnancy or breastfeeding (pregnant or breastfeeding women are excluded from this study because study drugs have the potential for teratogenic or abortifacient effects. Other severe acute or chronic medical or psychiatric conditions or laboratory abnormalities that may increase the risk associated with study participation or study drug administration, or may interfere with the interpretation of study results, and in the judgment of the investigator would make the patient inappropriate for entry into this study.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 18F-Clofarabine<br>18F-Clofarabine as PET imaging agent for measuring the activity of deoxycytidine kinase (DCK) in various normal and abnormal tissues in cancer participants before and after therapy | Drug: 18F-Clofarabine<br>* The participants enrolled will receive a baseline CFA PET/CT evaluation. Then, the participants will undergo the routine follow up would normally occur for their cancer and its treatment. If this routine follow up and care involves repeat imaging of the cancer, then the CFA PET/CT scan will be repeated at that time (timed according to standard-of-care follow-up imaging), which is expected between a month to about 4 months after the first CFA PET/CT scan. The study period will end 24 hours after this repeat PET/CT scan.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evaluate CFA as a PET imaging agent | Establish the image-based biodistribution of CFA, a new tracer for imaging DCK enzyme activity. DCK converts the inactive prodrug clofarabine into its active form. Thus, the degree of DCK expression in normal and abnormal tissues may predict drug effects and effectiveness. The uptake of the radiotracer (SUVs) will be measured quantitatively from PET images taken at 60 min post-injection of [18F]CFA. | up to 60 minutes after CFA PET | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Correlate CFA uptake with conventional imaging | Correlate CFA uptake with conventional anatomic imaging using RECIST criteria to establish change over time and differences from participants' baseline scans. | up to 3 months after CFA PET | 
| Correlate CFA uptake with PFS | Correlate changes in CFA uptake (SUV) with disease progression as determined by standard of care surveillance imaging. | up to 12 months after CFA PET | 
| Correlate CFA uptake with OS | Correlate changes in CFA uptake with participant outcomes as measured by all cause mortality/overall survival (OS). | up to 12 months after CFA PET | 
| Adverse Events | Proportion of participants who develop any side effects/adverse events associated with radiotracer infusions. | within 48 hrs of radiotracer administration | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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18F-Clofarabine, Diagnostic Imaging, Cancer