Biomarker Platform (Virtual Nodule Clinic) for the Management of Indeterminate Pulmonary Nodules

NCT ID: NCT06638398

Last Updated: 2025-11-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

400 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-10-31

Study Completion Date

2027-04-30

Brief Summary

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This clinical trial studies whether a biomarker platform, the Virtual Nodule Clinic, can be used for the management of lung (pulmonary) nodules that are not clearly non-cancerous (benign) or clearly cancerous (malignant) (indeterminate pulmonary nodules \[IPNs\]). The management of IPNs is based on estimating the likelihood that the observed nodule is malignant. Many things, such as age, smoking history, and current symptoms, are considered when making a prediction of the likelihood of malignancy. Radiographic imaging characteristics are also considered. Lung nodule management for IPNs can result in unnecessary invasive procedures for nodules that are ultimately determined to be benign, or potential delays in treatment when results of tests cannot be determined or are falsely negative. The Virtual Nodule Clinic is an artificial intelligence (AI) based imaging software within the electronic health record which makes certain that identified pulmonary nodules are screened by clinicians with expertise in nodule management. The Virtual Nodule Clinic also features an AI based radiomic prediction score which designates the likelihood that a pulmonary nodule is malignant. This may improve the ability to manage IPNs and lower unnecessary invasive procedures or treatment delays. Using the Virtual Nodule Clinic may work better for the management of IPNs.

Detailed Description

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PRIMARY OBJECTIVES:

I. To test the hypothesis that usual care plus a radiomic prediction score impacts patient management compared to usual care alone.

II. To conduct a multicenter pragmatic randomized controlled platform trial using a validated biomarker, the radiomic prediction score.

III. To conduct a biomarker study that will evaluate the first necessary (but not sufficient) step to show clinical utility.

IV. To assess the magnitude of change in patient management with use of the radiomic prediction score.

V. To develop a platform that can be used as framework for future larger biomarker studies.

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM I: Patients undergo standard of care (SOC) computed tomography (CT) evaluation and receive a Virtual Nodule Clinic radiomic prediction score on study. Patients then receive SOC lung nodule management on study.

ARM II: Patients undergo SOC CT evaluation on study. Patients then receive SOC lung nodule management on study.

Conditions

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Lung Neoplasm

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Arm I (Radiomic Prediction Score)

Patients undergo SOC CT evaluation and receive a Virtual Nodule Clinic radiomic prediction score on study. Patients then receive SOC lung nodule management on study.

Group Type EXPERIMENTAL

Best Practice

Intervention Type OTHER

Receive standard of care lung nodule management

Electronic Health Record Review

Intervention Type OTHER

Ancillary Studies

Computed Tomography

Intervention Type PROCEDURE

Undergo standard of care Computed Tomography

Diagnostic Procedure

Intervention Type DEVICE

Receive a Virtual Nodule Clinic radiomic prediction score obtained in Optellum software.

Arm II (Usual Care)

Patients undergo SOC CT evaluation on study. Patients then receive SOC lung nodule management on study.

Group Type ACTIVE_COMPARATOR

Best Practice

Intervention Type OTHER

Receive standard of care lung nodule management

Computed Tomography

Intervention Type PROCEDURE

Undergo standard of care Computed Tomography

Interventions

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Best Practice

Receive standard of care lung nodule management

Intervention Type OTHER

Electronic Health Record Review

Ancillary Studies

Intervention Type OTHER

Computed Tomography

Undergo standard of care Computed Tomography

Intervention Type PROCEDURE

Diagnostic Procedure

Receive a Virtual Nodule Clinic radiomic prediction score obtained in Optellum software.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Adults 35-year-old and older with undiagnosed IPN(s) 8-30mm referred for evaluation

* Referral includes direct in-basket messages in the electronic healthcare record (EHR) to study providers, telehealth visits or clinic visit
* For multiple nodules, we will obtain the score from the dominant or most suspicious nodule based on providers or radiologist impression
* Available CT scan with slice thickness of 3 mm or less with the nodule of interest present. Nodules identified during screening low dose computed tomography of the chest (LDCT) that have had a conventional, follow-up CT performed are eligible for inclusion

Exclusion Criteria

* Pure ground glass nodule
* Patients known to be a prisoners
* Patients known to be pregnant
* Known active malignancy within the last 5 years at time of enrollment (excluding non-melanoma skin cancers)
* More than 5 IPNs present on imaging
* Nodules referred after initial LDCT for screening with only one LDCT available. The Lung Cancer Prediction Convolutional Neural Network (LCP CNN) algorithm is not currently validated for screening studies
* Thoracic implants that impact the image appearance of the nodule
* Clinician determines that use of the LCP CNN model is required or contraindicated for the optimal care of the patient
Minimum Eligible Age

35 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

Vanderbilt-Ingram Cancer Center

OTHER

Sponsor Role lead

Responsible Party

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Fabien Maldonado

Professor of Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Fabien Maldonado, MD

Role: PRINCIPAL_INVESTIGATOR

Vanderbilt University/Ingram Cancer Center

Locations

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University of Colorado

Aurora, Colorado, United States

Site Status RECRUITING

Washington University in St. Louis

St Louis, Missouri, United States

Site Status RECRUITING

Vanderbilt University/Ingram Cancer Center

Nashville, Tennessee, United States

Site Status RECRUITING

Meharry Medical College

Nashville, Tennessee, United States

Site Status RECRUITING

VA Tennessee Valley Healthcare Center

Nashville, Tennessee, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Vanderbilt-Ingram Services for Timely Access

Role: CONTACT

800-811-8480

Facility Contacts

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Vanderbilt-Ingram Service for Timely Access

Role: primary

800-811-8480

Vanderbilt-Ingram Service for Timely Access

Role: primary

800-811-8480

Vanderbilt-Ingram Service for Timely Access

Role: primary

800-811-8480

Vanderbilt-Ingram Service for Timely Access

Role: primary

800-811-8480

Vanderbilt-Ingram Service for Timely Access

Role: primary

800-811-8480

Other Identifiers

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5R01CA252964-02

Identifier Type: NIH

Identifier Source: secondary_id

View Link

NCI-2024-08453

Identifier Type: REGISTRY

Identifier Source: secondary_id

VICC-IDTHO24059

Identifier Type: -

Identifier Source: org_study_id

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