Boronophenylalanine (BPA)-Based Boron Neutron Capture Therapy (BNCT) in the Treatment Head and Neck Tumors

NCT ID: NCT00114790

Last Updated: 2013-05-06

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE1/PHASE2
• Total Enrollment: 30 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2003-12-31
• Study Completion Date: 2012-01-31

Brief Summary

Boron Neutron Capture Therapy (BNCT) is an experimental radiation therapy technique which is based on the principle of irradiating boron atoms with neutrons. When neutrons have relatively low energy, boron atoms that have been targeted to cancerous tissue using a suitable boron carrier (an amino acid derivative called BPA, boronophenylalanine) will capture the neutrons. As a result from the neutron capture the boron atoms will split into two, producing helium and lithium ions. The helium and lithium ions, in turn, have only a short pathlength in tissue (about 5 micrometers) and will deposit their cell damaging effect mainly within the tumor provided that the boron carrier (BPA) has accumulated in the tumor. In practice, the study participants will receive BPA as an approximately 2-hour intravenous infusion, following which the tumor is irradiated with low energy (epithermal) neutrons obtained from a nuclear reactor at the BNCT facility. BNCT requires careful radiation dose planning, but neutron irradiation will last approximately only for one hour. In this study BNCT will be repeated, and the 2 treatments will be given 3 to 5 weeks apart. The study hypothesis is that head and neck cancers that have recurred following conventional radiotherapy might accumulate the boron carrier compound, and might respond to BNCT.

Detailed Description

This is a single BNCT-facility, non-randomized, non-comparative, open-label, phase I to II trial to determine the value of BNCT in the treatment of inoperable, irradiated, locally advanced cancers of the head and neck region. An attempt to perform 18F-labeled boronophenylalanine (18F-BPA) SPECT or PET imaging will be made before BNCT. Patients whose tumor uptake is >2.5 times that of the corresponding normal head and neck tissue will be enrolled, and treated with a single fraction BPA-based BNCT twice, 3 to 5 weeks apart. Another 18F-BPA SPECT or PET study may be performed 1 to 3 months after BNCT to determine the SPECT/PET response.

The neutron irradiation site is the FiR 1 reactor site, located at Otaniemi, Espoo, Finland, about 6 kilometers from the Helsinki University Central Hospital, Helsinki, where patient evaluation and post-irradiation care will take place.

Prior to BNCT, BPA is infused as a fructose complex (l-BPA-F) into a peripheral vein over 2 hours. Blood samples will be taken for monitoring whole blood boron concentration before starting the BPA infusion, and thereafter at 20 to 40 minute intervals during the infusion, following infusion, and after delivering neutron irradiation. The blood samples will be analyzed for blood boron concentration to estimate the average blood boron concentration during neutron irradiation.

All patients will be evaluated for response using CT or magnetic resonance imaging (MRI).

Conditions

Head and Neck Cancer

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

BNCT.

Boronophenylalanine-based BNCT.

Group Type: EXPERIMENTAL

boronophenylalanine-based BNCT

Intervention Type: RADIATION

Boronophenylalanine is infused into a peripheral vein prior to neutron irradiation.

Interventions

boronophenylalanine-based BNCT

Boronophenylalanine is infused into a peripheral vein prior to neutron irradiation.

Intervention Type: RADIATION

Eligibility Criteria

Inclusion Criteria

• Histologically confirmed, malignant head and neck cancer.
• Inoperable tumor, prior surgery may or may not have been done.
• Prior radiotherapy or chemoradiotherapy has been given.
• If prior SPECT or PET with 18F-BFA has been done, BPA needs to accumulate at least 2.5 times more in the tumor than in the corresponding contralateral normal tissue.
• WHO performance status <3.
• WBC >2,500/mm3, platelets >75,000/mm3, serum creatinine <180 umol/L.
• A written informed consent.

Exclusion Criteria

• Lymphoma or other tumor type that is expected to respond to cancer chemotherapy or to a dose of conventional radiation therapy that can be safely given.
• A non-experimental, effective treatment option is available.
• Expected survival less than 3 months.
• Concomitant systemic chemotherapy (prior cancer chemotherapy is allowed).
• Other concurrent experimental therapy, or such therapy is being planned to be given.
• Less than 3 months since prior radiation therapy.
• Untreated or severe, treated congestive heart failure or renal failure.
• A cardiac pace-maker or an unremovable metal implant present in the head and neck region that will interfere with MRI-based dose-planning.
• Restlessness or inability to lie in a cast for 30 to 60 minutes.
• Clinical follow-up after therapy cannot be arranged or the patient is not willing to participate in follow-up.
• Pregnancy.
• Age less than 18.
• The patient is not able to understand the treatment options.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Boneca Corporation

INDUSTRY

Sponsor Role: lead

Responsible Party

Professor Heikki Joensuu

professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Heikki T Joensuu, M.D., prof.

Role: PRINCIPAL_INVESTIGATOR

Helsinki University Central Hospital

Locations

Department of Oncology, Helsinki University Central Hospital

Helsinki, , Finland

Countries

Finland

References

Kouri M, Kankaanranta L, Seppala T, Tervo L, Rasilainen M, Minn H, Eskola O, Vahatalo J, Paetau A, Savolainen S, Auterinen I, Jaaskelainen J, Joensuu H. Undifferentiated sinonasal carcinoma may respond to single-fraction boron neutron capture therapy. Radiother Oncol. 2004 Jul;72(1):83-5. doi: 10.1016/j.radonc.2004.03.016.

Reference Type: BACKGROUND

PMID: 15236879 (View on PubMed)

Joensuu H, Kankaanranta L, Seppala T, Auterinen I, Kallio M, Kulvik M, Laakso J, Vahatalo J, Kortesniemi M, Kotiluoto P, Seren T, Karila J, Brander A, Jarviluoma E, Ryynanen P, Paetau A, Ruokonen I, Minn H, Tenhunen M, Jaaskelainen J, Farkkila M, Savolainen S. Boron neutron capture therapy of brain tumors: clinical trials at the finnish facility using boronophenylalanine. J Neurooncol. 2003 Mar-Apr;62(1-2):123-34. doi: 10.1007/BF02699939.

Reference Type: BACKGROUND

PMID: 12749708 (View on PubMed)

Porra L, Wendland L, Seppala T, Koivunoro H, Revitzer H, Tervonen J, Kankaanranta L, Anttonen A, Tenhunen M, Joensuu H. From Nuclear Reactor-Based to Proton Accelerator-Based Therapy: The Finnish Boron Neutron Capture Therapy Experience. Cancer Biother Radiopharm. 2023 Apr;38(3):184-191. doi: 10.1089/cbr.2022.0059. Epub 2022 Oct 21.

Reference Type: DERIVED

PMID: 36269660 (View on PubMed)

Kankaanranta L, Seppala T, Koivunoro H, Saarilahti K, Atula T, Collan J, Salli E, Kortesniemi M, Uusi-Simola J, Valimaki P, Makitie A, Seppanen M, Minn H, Revitzer H, Kouri M, Kotiluoto P, Seren T, Auterinen I, Savolainen S, Joensuu H. Boron neutron capture therapy in the treatment of locally recurred head-and-neck cancer: final analysis of a phase I/II trial. Int J Radiat Oncol Biol Phys. 2012 Jan 1;82(1):e67-75. doi: 10.1016/j.ijrobp.2010.09.057. Epub 2011 Feb 6.

Reference Type: DERIVED

PMID: 21300462 (View on PubMed)

Related Links

http://www.boneca.fi

Boneca Corporation is a Finnish company that provides BNCT.

Other Identifiers

HN-BPA-01-2003

Identifier Type: -

Identifier Source: org_study_id