Clinical trial NCT05957250: [68Ga]Ga-FAPI-46 Positron Emission Tomography (PET) Scan to Improve the Imaging of Pancreatic and Bile Duct Cancer
Official title: [68Ga]Ga-FAPI-46 Positron Emission Tomography in Pancreaticobiliary Cancers: a Pharmacokinetics, Repeatability and Diagnostic Accuracy Study
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Pancreatic Cancer
Cholangiocarcinoma
Keywords: Positron Emission Tomography
PET/CT
FAPI
Fibroblast activation protein
Radiopharmaceuticals
Lead sponsor: Amsterdam UMC, location VUmc
Sponsor class: OTHER
Collaborators: name: Dutch Cancer Society
name: Leiden University Medical Center
First posted: 2023-07-24
Enrollment: 63
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: Monocenter, non-randomized, non-blinded, prospective observational study.
Primary purpose: DIAGNOSTIC

Brief summary: The goal of this clinical trial is to evaluate the clinical use of \[68Ga\]Ga-FAPI-46 PET (positron emission tomography)/CT (computed tomography) imaging in patients with pancreatic or bile duct cancer. The study consists of three parts and patients can only participate in one part of the study.

The main questions the study aims to answer are:

* In part A: What is the best timing and scanprotocol of a \[68Ga\]Ga-FAPI-46 PET/CT scan?
* In part B: Are the results of the simplified scan protocol repeatable?
* In part C: What is the accuracy of \[68Ga\]Ga-FAPI-46 PET/CT to detect pancreatic cancer and is it able to detect the effect of chemotherapy on pancreatic cancer lesions?

Participants in this study will be asked to undergo the following:

* In part A: participants will undergo 1 \[68Ga\]Ga-FAPI-46 PET/CT scan and will have 2 venous canullas and 1 arterial cannula placed.
* In part B: participants will undergo 2 \[68Ga\]Ga-FAPI-46 PET/CT scans and will have a venous cannula placed for each scan.
* In part C: participants will undergo 2 \[68Ga\]Ga-FAPI-46 PET/CT scans and will have a venous cannula placed for each scan.

Detailed description: Pancreaticobiliary cancer patients have a dismal prognosis. Therefore, patient stratification for the proper primary treatment is crucial to prevent unnecessary surgery and opens up the opportunity for novel (multimodal) treatment. Unfortunately, conventional imaging modalities are not sensitive enough to detect small tumor lesions or differentiate between benign and malignant tissue after neoadjuvant therapy. Tumor-specific imaging, using PET/CT imaging, can identify tumor tissue more accurately and therefore can improve lesion detection and patient stratification. Fibroblast activation protein (FAP) shows promise as a target to identify pancreaticobiliary cancers, lymph node metastases, and residual disease after neoadjuvant therapy. The FAP targeted inhibitor (FAPI) is developed to target FAP and has been labelled to the Gallium-68 (68Ga) radioisotope, resulting in the \[68Ga\]Ga-FAPI-46 tracer.

This study will be a three part monocenter study focusing on the clinical evaluation of \[68Ga\]Ga-FAPI-46.

* In part A, the pharmacokinetics of this tracer will be studied and the simplified method(s) to quantify tracer uptake will be validated.
* In part B, a test-retest study will be performed to assess the repeatability of these simplified quantitative methods.
* In part C, the sensitivity and feasibility of therapy response monitoring will be investigated.

Eligibility criteria: Inclusion Criteria:

* Patients aged 18 years or older.
* Before patient registration, written informed consent must be given according to ICH/GCP, and national/local regulations.
* Additional Part A: patients with pancreaticobiliary cancer (pancreatic, intra- or extrahepatic cholangiocarcinoma) and a tumor size of \>20mm on CT.
* Additional Part B: patients with primary pancreatic (or pancreaticobiliary) cancer (depending on the results of part A) and a tumor size of \>20mm on CT. No treatment may be given in between the two scans.
* Additional Part C: patients with pathologically proven pancreatic ductal adenocarcinoma, eligible for neoadjuvant therapy before surgical resection.

Exclusion Criteria:

* Women who are pregnant and/or lactating.
* Medical or psychiatric conditions that compromise the patient's ability to give informed consent. Presence of any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule.
* Impaired renal function (creatinine clearance \<60 mL/min according to the Cockcroft-Gault equation.
* Leucocytes (WBC) ≤3.0 x 10\^9/l
* Platelets ≤ 100 x 10\^9 /l
* Hemoglobin ≤ 6 mmol/l
* Known hypersensitivity to drugs comparative to \[68Ga\]Ga-FAPI-46, or any of the excipients of \[68Ga\]Ga-FAPI-46.
* Inability to undergo PET/CT scanning (e.g. claustrophobia, weight limits or inability to tolerate lying for the duration of a PET/CT scan (\~90 min)).

Additional Part A:

• Contra-indication for arterial cannula (e.g. inadequate circulation of extremity, positive Allen test, severe atherosclerosis, coagulant disorder (INR \>1.4 or APTT \>50)).

Additional Part C:

* Not eligible for surgery after neoadjuvant chemotherapy.
* If based on the first FAPI-46 PET/CT, there is a suspicion of metastatic disease the images will be discussed in the multidisciplinary meeting and one additional imaging modality (and a biopsy, if this would lead to a change of treatment strategy) can be used to confirm the suspicion. If metastatic disease is confirmed the patient will be excluded.

Primary outcomes:
measure: Semi quantitative measurements of [68Ga]Ga-FAPI-46 tracer
timeFrame: 3 months
measure: Blood activity measurements of [68Ga]Ga-FAPI-46 tracer
timeFrame: 3 months
measure: Plasma to blood ratio of [68Ga]Ga-FAPI-46 tracer
timeFrame: 3 months
measure: Repeatability
timeFrame: 3 months
measure: Diagnostic accuracy
timeFrame: 3 months
measure: Response monitoring
timeFrame: 3 months
Secondary outcomes:
measure: Agreement imaging and pathology
timeFrame: 3 months
measure: Agreement imaging modalities
timeFrame: 3 months
measure: Imaging and tumor regression
timeFrame: 3 months
measure: Change of therapy management
timeFrame: 3 months
measure: Response prediction first scan
timeFrame: 3 months
measure: Resectability (based on DPCG criteria)
timeFrame: 3 months
measure: Diagnostic accuracy of incidental findings
timeFrame: 3 months
Other outcomes:
Locations:
city: Amsterdam
country: Netherlands
facility: Amsterdam UMC, location VUmc
state: Noord-Holland
Study officials:
affiliation: Amsterdam UMC, location AMC
name: Rutger-Jan Swijnenburg, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References: