[18F]-Fludarabine PET/MRI in Primary Central Nervous System Lymphoma

Study Purpose

Primary central nervous system (CNS) lymphomas represent 5% of primary brain tumors. More than 90% of them are diffuse large B-cell lymphomas. [18F]-Fluorodeoxyglucose positron emission tomography (PET-[18F]-FDG) is the gold standard for imaging systemic lymphomas, but its application in primary CNS lymphoma is compromised by the limited specificity of brain fixations and the high uptake of [18F]-FDG in healthy brain tissue. [18F]-Fludarabine is a new radiopharmaceutical developed for PET imaging of lymphomas. Preclinical studies indicate a restricted binding specificity to lymphoid tissue compared to [18F]-FDG and an ability to detect residual lymphoma disease after treatment. A pilot study in humans shows good agreement of its binding with tumor sites in systemic lymphoma and superior tumor contrast to [18F]-FDG. Finally, a recent preclinical study shows a binding ratio in brain lymphoma 3 times higher than that of healthy brain tissue in mouse models of primary CNS lymphoma, whereas in mouse models of high-grade glial tumors, the binding level is very low, comparable to that of healthy tissue (background). Investigators hypothesize that [18F]-Fludarabine could be the radiopharmaceutical of choice for the diagnosis and monitoring of primary CNS lymphomas in PET. The main objective of the study is to characterize the cerebral distribution and [18F]-Fludarabine uptake in newly-diagnosed primary CNS lymphomas before surgery, chemotherapy or radiotherapy, using PET-MR imaging.

Recruitment Criteria

Accepts Healthy Volunteers

Healthy volunteers are participants who do not have a disease or condition, or related conditions or symptoms

No
Study Type

An interventional clinical study is where participants are assigned to receive one or more interventions (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes.


An observational clinical study is where participants identified as belonging to study groups are assessed for biomedical or health outcomes.


Searching Both is inclusive of interventional and observational studies.

Interventional
Eligible Ages 18 Years and Over
Gender All
More Inclusion & Exclusion Criteria

Inclusion Criteria:

  • - Patients aged ≥ 18 years.
  • - Diagnosis of newly diagnosed high-grade CNS lymphoma (with histological and/or cytological confirmation) - Patient naive to chemotherapy, or radiotherapy treatment for CNS lymphoma.
  • - Contrast-enhanced intracranial mass greater than or equal to 1 cm longest axis.
  • - Karnofsky index ≥ 40.
  • - No systemic lymphoma on [18F]-FDG PET/CT.
  • - Creatinine clearance ≥ 30 mL/min.
  • - Social security affiliation (excluding AME) - Signature of the informed consent by the patient or by a legal representative or the close relative if the patient is not able to do so.

Exclusion Criteria:

  • - Hypersensitivity to the active substance, to any of the excipients or to any of the components of [18F]-Fludarabine.
  • - Previous treatment for primary central nervous system lymphoma.
  • - Isolated primary vitro-retinal lymphoma.
  • - Isolated CNS relapse of a systemic lymphoma.
  • - Other active cancer except basal cell carcinoma of the skin and/or cervical cancer in situ.
  • - Immunosuppression (organ transplant in particular) - Positive HIV serology.
  • - Presence of another progressive pathology that is life-threatening in the short term.
  • - Treatment with dipyridamole.
  • - History of allergy to gadolinium chelates (DOTAREM®) - Absolute contraindication to MRI (pacemaker, cochlear implant .
..), to the administration of gadolinium.
  • - Patient of childbearing potential without effective contraception, breastfeeding or pregnant.
  • - Severe cognitive impairment incompatible with good cooperation in the PET-MRI examination.
  • - Patient with pain or restlessness unable to remain motionless in supine position for 60 minutes.
  • - Weight > 100 Kg.
  • - Patient deprived of liberty or under legal protection (guardianship or curatorship) - Ongoing participation in another interventional research protocol.
Participation in research of a non-interventional type is authorized.

Trial Details

Trial ID:

This trial id was obtained from ClinicalTrials.gov, a service of the U.S. National Institutes of Health, providing information on publicly and privately supported clinical studies of human participants with locations in all 50 States and in 196 countries.

NCT05390814
Phase

Phase 1: Studies that emphasize safety and how the drug is metabolized and excreted in humans.

Phase 2: Studies that gather preliminary data on effectiveness (whether the drug works in people who have a certain disease or condition) and additional safety data.

Phase 3: Studies that gather more information about safety and effectiveness by studying different populations and different dosages and by using the drug in combination with other drugs.

Phase 4: Studies occurring after FDA has approved a drug for marketing, efficacy, or optimal use.

Phase 1
Lead Sponsor

The sponsor is the organization or person who oversees the clinical study and is responsible for analyzing the study data.

Assistance Publique - Hôpitaux de Paris
Principal Investigator

The person who is responsible for the scientific and technical direction of the entire clinical study.

Aurélie KAS, Pr
Principal Investigator Affiliation Assistance Publique - Hôpitaux de Paris
Agency Class

Category of organization(s) involved as sponsor (and collaborator) supporting the trial.

Other
Overall Status Recruiting
Countries France
Conditions

The disease, disorder, syndrome, illness, or injury that is being studied.

Primary Central Nervous System Lymphoma
Additional Details

Monocenter, open, uncontrolled and non-randomized pilot study designed to evaluate the uptake of [18F]-Fludarabine in 8 patients with newly diagnosed CNS lymphoma at initial diagnosis, before treatment using hybrid PET/MR system. Main objective: to characterize the brain distribution and tumoral uptake in CNS lymphoma before treatment. The secondary objectives are to compare PET-[18F]-Fludarabine results with those of morphological MRI with and without gadolinium injection, diffusion and perfusion MRI, proton-spectroscopy, histological or cytological diagnosis, and brain [18F]-FDG PET imaging. Patient screening includes a clinical and neurological examination, diagnostic MRI, biological examination, [18F]-FDG PET examination to exclude systemic lymphoma, histological/cytological diagnosis of brain lymphoma. Once informed consent is obtained, one brain PET with [18F]-Fludarabine (4 MBq/kg) combined with simultaneous multiparametric MR sequences is scheduled.

Arms & Interventions

Arms

Experimental: PET-RMI

Interventions

Drug: - PET-MRI

[18F]-Fludarabine imaging in the diagnostic workup of primary central nervous system lymphomas: a PET-MRI pilot study

Contact a Trial Team

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International Sites

Hôpital Pitié Salpêtrière, Paris, France

Status

Recruiting

Address

Hôpital Pitié Salpêtrière

Paris, , 75013

Site Contact

Aurélie KAS, Pr

aurelie.kas@aphp.fr

01 42 17 62 81

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