Hyperpolarized 13C MRI as a Biomarker in Advanced Solid Tumors

NCT ID: NCT05599048

Last Updated: 2025-03-24

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: PHASE1/PHASE2
• Total Enrollment: 65 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2022-12-15
• Study Completion Date: 2026-01-31

Brief Summary

This is a single center prospective imaging study investigating the utility of hyperpolarized 13C-pyruvate +/-13C,15N-Urea/ metabolic MR imaging. The current protocol will serve as a companion imaging biomarker study paired with standard of care (SOC) therapeutics, as well as investigational therapies that participants may be scheduled to receive outside of this protocol.

Detailed Description

PRIMARY OBJECTIVES:

Phase I/Part A

1. To optimize the signal-to-noise ratio in detecting intra-tumoral hyperpolarized 13C pyruvate/lactate signal and hyperpolarized urea area under the curve (AUC) using metabolic magnetic resonance (MR) imaging in patients with advanced solid tumors.

Phase II/Part B

1. To determine the mean percent change from baseline in peak intra-tumoral hyperpolarized lactate-to-pyruvate ratio,pyruvate-to-lactate kinetic constant (kPL) and urea AUC after initiation of usual care/standard of care (SOC) treatment

SECONDARY OBJECTIVES:

Phase I/Part A

1. To further characterize the safety profile of hyperpolarized 13C-pyruvate +/- 13C,15N-urea.

2. To determine the reproducibility of intra-tumoral HP lac/pyr ratio with same-day repeated dose studies.

Phase II/Part B

1. To study the association between clinical outcomes and the percent change from baseline in peak intra-tumoral hyperpolarized lactate-to pyruvate ratio and kPL (+/-correction for HP urea AUC) after initiation of SOC treatment.

2. To further characterize the safety profile of hyperpolarized 13C pyruvate +/- 13C,15N-urea.

3. To determine the reproducibility of intra-tumoral HP lac/pyr ratio and/or HP urea AUC with same-day repeated dose studies.

OUTLINE:

Participants will be enrolled in Part A which is the feasibility, run-in study which includes the iterative adjustment of coil design to optimize imaging parameters within the target tumor lesion(s). If the data from Part A supports further investigation, additional participants will be enrolled in Part B which is a biomarker cohort which includes participants who are planning on being treated with either standard-of-care (SOC) or investigational therapies and will be followed until discontinuation of the treatment regimen outside of this protocol.

Conditions

Advanced Solid Tumor

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: SEQUENTIAL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Part A / Phase 1: Feasibility Run-In

Participants will undergo MR imaging at a single time point. Imaging will take one day and no follow up is planned.

Group Type: EXPERIMENTAL

Hyperpolarized 13C-Pyruvate

Intervention Type: DRUG

Given IV

Magnetic Resonance Imaging (MRI)

Intervention Type: PROCEDURE

Imaging procedure

13C,15N-Urea

Intervention Type: DRUG

Given IV

Part B/ Phase II: Biomarker Cohort

Participants will undergo paired 13C-pyruvate +/- 13C,15N-urea/metabolic MR imaging at baseline and again after approximately 21 days of therapy. Duration of the intervention period is approximately 21 days, and participants will be followed until discontinuation of their current SOC treatment regimen, about 6 months.

Group Type: EXPERIMENTAL

Hyperpolarized 13C-Pyruvate

Intervention Type: DRUG

Given IV

Magnetic Resonance Imaging (MRI)

Intervention Type: PROCEDURE

Imaging procedure

13C,15N-Urea

Intervention Type: DRUG

Given IV

Interventions

Hyperpolarized 13C-Pyruvate

Given IV

Intervention Type: DRUG

Magnetic Resonance Imaging (MRI)

Imaging procedure

Intervention Type: PROCEDURE

13C,15N-Urea

Given IV

Intervention Type: DRUG

Other Intervention Names

Hyperpolarized (HP) carbon^13 (13C)-pyruvate; HP-13C; MRI

Eligibility Criteria

Inclusion Criteria

1. Presence of at least one target pelvic, abdominal, thoracic, neck or extremity lesion detected by standard staging scans that, in the judgment of study investigator, would be amenable to hyperpolarized C-13 pyruvate/metabolic MR imaging:

a. Target lesion must measure at least 1.0 cm in long axis diameter on Computerized tomography (CT) or magnetic resonance imaging (MRI).

2. The participant is able and willing to comply with study procedures and provide signed and dated informed consent.

3. Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 or 1.

4. Adequate renal function defined as creatinine < 1.5 x upper limit of normal (ULN) or estimated creatinine clearance >50 mL/min (by the Cockcroft Gault equation).

5. Participants age 18 and older.

Part B only:

6. Planned treatment for disease with either standard of care regimen or an investigational agent.

Exclusion Criteria

1. Patients who because of age, general medical or psychiatric condition, or physiologic status cannot give valid informed consent.

2. Patients with contra- indications to MRI, such as cardiac pacemakers or non-compatible intracranial vascular clips.

3. Patients with a metallic implant or device that distorts local magnetic field and compromises the quality of MR imaging.

4. Patients with poorly controlled hypertension, defined as systolic blood pressure at study entry greater than 160mm Hg or diastolic blood pressure greater than 100mm Hg.

Note: The addition of anti-hypertensives to control blood pressure is allowed.

5. Patients with congestive heart failure or New York Heart Association (NYHA) status >= 2.

6. Patients who are pregnant or lactating.

7. A history of clinically significant EKG abnormalities or myocardial infarction (MI) within 6 months of study entry.

Note: Patients with rate-controlled atrial fibrillation/flutter will be allowed on study.

8. Any condition that, in the opinion of the Principal Investigator,

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

Sponsors

National Institute for Biomedical Imaging and Bioengineering (NIBIB)

NIH

Sponsor Role: collaborator

National Cancer Institute (NCI)

NIH

Sponsor Role: collaborator

Sigma-Aldrich

UNKNOWN

Sponsor Role: collaborator

Robert Bok, MD, PhD

OTHER

Sponsor Role: lead

Responsible Party

Robert Bok, MD, PhD

Principal Investigator

Responsibility Role: SPONSOR_INVESTIGATOR

Principal Investigators

Robert Bok, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

University of California, San Francisco

Locations

University of California, San Francisco

San Francisco, California, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Louise Magat

Role: CONTACT

Louise.Magat@ucsf.edu

(415) 502-1822

Facility Contacts

Louise Magat

Role: primary

Louise.Magat@ucsf.edu

415-502-1822

Role: backup

cancertrials@ucsf.edu

877-827-3222

Other Identifiers

NCI-2022-09149

Identifier Type: REGISTRY

Identifier Source: secondary_id

P41EB013598-11

Identifier Type: NIH

Identifier Source: secondary_id

View Link

5U01EB026412-04

Identifier Type: NIH

Identifier Source: secondary_id

View Link

5R01CA256740-02

Identifier Type: NIH

Identifier Source: secondary_id

View Link

22924

Identifier Type: -

Identifier Source: org_study_id