Glioma, MalignantNCT05263466
Establishing Radiolabelled PSMA as a Target for Glioma Treatment
A study testing PET-MRI and Brain tumour biopsy in people with Glioma, Malignant, run by King's College Hospital NHS Trust at 1 site in United Kingdom.
Trial summary
A study is being performed to observe whether a novel type of brain imaging using a technique called PET-MRI may provide useful information in the 'mapping' of adult primary brain tumours. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Glioma, Malignant
- What is being tested?
- PET-MRI and Brain tumour biopsy
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 30 participants
- Where
- 1 siteUnited Kingdom
- Study dates
- 1 Aug 2022to 1 May 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Individuals of 18 years or older
- Referred for surgery (resection or biopsy) of presumed high grade primary brain tumour (based on imaging features of aggression e.g. perfusion imaging, diffusion restriction etc.). As standard, all patients will have had a full body CT and other investigations to rule out metastatic disease (this has a very high negative predictive value).
- Written informed consent
Who cannot join
- Patient already enrolled in a drug trial
- Contra-indication for MRI contrast
- Contra-indication for radiotracer
- Inability to give consent
- Patient is pregnant or planning to become pregnant
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
United Kingdom1 site
King's College London
London
Professor Reza Razavi, PhD, 0)207 8483224, reza.razavi@kcl.ac.uk
About this study
Official title: Dosimetry and Immunohistochemistry Study to Establish Radiolabelled PSMA as a Potential Target in Glioma Treatment
A study is being performed to observe whether a novel type of brain imaging using a technique called PET-MRI may provide useful information in the 'mapping' of adult primary brain tumours. It employs a radiolabelled molecule targeting a particular molecule called PSMA which is hypothesised to be a marker of aggression in primary brain tumours. 'Mapping' of the concentration and distribution of this molecule within brain tumours via PET-MRI may provide vital clinical information regarding the extent and timing of treatment.
Read the detailed description
One potential avenue of high grade glioma treatment involves a 'theranostic' radiotherapeutic approach. This consists of two stages: firstly, a particular protein expressed specifically by the tumour is radiolabelled with a targeted radioligand emitting gamma radiation, enabling confirmation of the presence, concentration and distribution of this target protein (diagnostic stage). Following this, a similar ligand is this time attached to an alpha or beta-emitter, enabling targeted tumour destruction (therapeutic stage).
There is growing, but limited, evidence that prostate specific membrane antigen (PSMA) is strongly and specifically expressed in high grade glioma and may be a potential theranostic target [Wernicke 2011, Unterrainer 2017]. It has already been used extensively as a theranostic target in metastatic prostate cancer, demonstrating safety and efficacy in this condition [Abou et al 2020].
The clinical outcomes shown in prostate cancer, along with evidence of PSMA expression in high grade glioma, led the study team to convene an Incubator Day with a group of experts to explore the possibility of developing a PSMA-targeting theranostic agent in high grade glioma. Expertise included PSMA theranostics (Prof Lewington), neuro-oncology (Dr Brazil, Guy's and St Thomas' Hospital (GSTT)), neurosurgery (Prof Ashkan, King's College Hospital (KCH)), neuropathology (Prof Al-Sarraj, KCH), neuroradiology (Dr Booth, KCH) PSMA PET imaging (Prof Gary Cook and Prof Alexander Hammers GSTT/KCL), nuclear physics (Prof Paul Marsden GSTT/KCL), and PSMA radiopharmaceutical chemistry (Prof Blowers, KCL).
It was concluded that a PSMA-targeting theranostic agent has the potential to be a safe and effective treatment for high grade glioma. The regulatory pathway should be eased enormously by the precedent of use in prostate cancer, which would obviate the need for pre-clinical studies.
This approach was conditional upon two objectives:
- Perform a series of five [68Ga]PSMA PET scans for dosimetry analysis and assessment of the retention of the tracer in the tumour (Using GSTT/KCL PET/MRI) prior to biopsy, at the same time as the patient's routine brain tumour imaging series. At time of recurrence a further [68 Ga]PSMA PET-MRI scan may be performed in each patient (depending on whether or not recurrence occurs during the study period) to assess for change in the standardised uptake value (SUV).
- Performing immunohistochemical analysis on high grade glioma specimens (prospectively in patients enrolled in this study with additional retrospective samples), in order to replicate published evidence on the expression of PSMA in such tumours, and also to demonstrate in the prospective cohort, a correlation between imaging detection of [68 Ga]PSMA and histopathological detection in stereotactic brain tumour biopsy samples (Using KCH neuropathology facilities).
- Conditions
- Glioma, Malignant
- Being tested
- PET-MRI, Brain tumour biopsy
- Medical subject headings
- Glioma
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
PET-MRIDiagnostic test
For the diagnostic imaging aspect included in this pilot study, [68Ga]PSMA-11 will be used. This is a peptidomimetic agent with a covalently bound chelator (HBED-CC) that is FDA-approved in prostate cancer imaging. We will use PET-MRI to visualise a) the concentration and b) the distribution of this tracer to establish a functional map of primary brain tumour activity
Brain tumour biopsyProcedure or surgery
All patients included in our study will undergo stereotactic surgery for biopsy/resection of the tumour as part of the standard of care at KCH. During this study we will not vary from the surgical standard of care for primary brain tumours and will only extend the surgery time due to additional stereotactic biopsies (an additional 3 biopsies increasing the time of the operation by ~30 minutes). Professor Ashkan (KCH) has defined the additional surgical risk of performing these biopsies to be ~0%, since targeted biopsies will only be taken within the tumour just before resection. The stereotactic biopsy may be targeted to areas of high [68Ga]PSMA SUV within the tumour as defined by the PET MRI scan.
| Study group | Role | What they receive |
|---|---|---|
| Brain tumour patients | Experimental | Patients will be those undergoing routine care of primary brain tumours. Study group patients will undergo additional PET-MRI examination and biopsies in addition to the standard of care. Receives: Diagnostic Test: PET-MRI; Procedure: Brain tumour biopsy |
What is being measured
The primary outcome is the main question the study is designed to answer.
Correlation of the PET-MRI PSMA signal intensity (arbitrary units) and glioma protein concentration (g/L) in a 1 x 1 x 1 cm region of interest (R value)
PET-MRI signal will be recorded from different regions of interest within a glioma where stereotactic surgical biopsies taken and protein concentration determined.
Measured: 5 years
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted2 Mar 2022
- Study start1 Aug 2022 (estimated)
- Primary completion1 May 2027 (estimated)
- Study completion1 May 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (4)Papers the sponsor has linked to this study.
- Other trials for Glioma, MalignantStudies of the same condition, open and under way.
- More trials run by King's College Hospital NHS TrustThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Diagnosis
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Enrolment
- 30 participants (estimated)
Sponsor and investigators
- Lead sponsor
- King's College Hospital NHS Trust
- Sponsor type
- University, hospital or other
- Collaborators
- King's College London
- Responsible party
- Sponsor
- Investigators
- Thomas C Booth, PhD, Principal investigator, King's College London
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05263466
- Sponsor's protocol ID
- 306945
- Status last verified
- Jun 2022
- First submitted
- 21 Feb 2022
- Last updated
- 10 Jun 2022
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Louis DN, Wesseling P, Aldape K, Brat DJ, Capper D, Cree IA, Eberhart C, Figarella-Branger D, Fouladi M, Fuller GN, Giannini C, Haberler C, Hawkins C, Komori T, Kros JM, Ng HK, Orr BA, Park SH, Paulus W, Perry A, Pietsch T, Reifenberger G, Rosenblum M, Rous B, Sahm F, Sarkar C, Solomon DA, Tabori U, van den Bent MJ, von Deimling A, Weller M, White VA, Ellison DW. cIMPACT-NOW update 6: new entity and diagnostic principle recommendations of the cIMPACT-Utrecht meeting on future CNS tumor classification and grading. Brain Pathol. 2020 Jul;30(4):844-856. doi: 10.1111/bpa.12832. Epub 2020 Apr 19.
PubMed 32307792Wernicke AG, Edgar MA, Lavi E, Liu H, Salerno P, Bander NH, Gutin PH. Prostate-specific membrane antigen as a potential novel vascular target for treatment of glioblastoma multiforme. Arch Pathol Lab Med. 2011 Nov;135(11):1486-9. doi: 10.5858/arpa.2010-0740-OA.
PubMed 22032578Unterrainer M, Niyazi M, Ruf V, Bartenstein P, Albert NL. The endothelial prostate-specific membrane antigen is highly expressed in gliosarcoma and visualized by [68Ga]-PSMA-11 PET: a theranostic outlook for brain tumor patients? Neuro Oncol. 2017 Nov 29;19(12):1698-1699. doi: 10.1093/neuonc/nox172. No abstract available.
PubMed 29045711Abou D, Benabdallah N, Jiang W, Peng L, Zhang H, Villmer A, Longtine MS, Thorek DLJ. Prostate Cancer Theranostics - An Overview. Front Oncol. 2020 Jun 5;10:884. doi: 10.3389/fonc.2020.00884. eCollection 2020.
PubMed 32582550
Study at a glance
From the registry record, last updated by the sponsor on 10 Jun 2022. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Dosimetry and Immunohistochemistry Study to Establish Radiolabelled PSMA as a Potential Target in Glioma Treatment
- ClinicalTrials.gov ID
- NCT05263466
- Acronym / sponsor ID
- 306945
- Conditions
- Glioma, Malignant
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 30 participants (estimated)
- Lead sponsor
- King's College Hospital NHS TrustUniversity, hospital or other
- Collaborators
- King's College London
- Study start
- 1 Aug 2022 (estimated)
- Primary completion
- 1 May 2027 (estimated)
- Study completion
- 1 May 2027 (estimated)
- First posted
- 2 Mar 2022 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
A study is being performed to observe whether a novel type of brain imaging using a technique called PET-MRI may provide useful information in the 'mapping' of adult primary brain tumours. It employs a radiolabelled molecule targeting a particular molecule called PSMA which is hypothesised to be a marker of aggression in primary brain tumours. 'Mapping' of the concentration and distribution of this molecule within brain tumours via PET-MRI may provide vital clinical information regarding the extent and timing of treatment.
Detailed description
One potential avenue of high grade glioma treatment involves a 'theranostic' radiotherapeutic approach. This consists of two stages: firstly, a particular protein expressed specifically by the tumour is radiolabelled with a targeted radioligand emitting gamma radiation, enabling confirmation of the presence, concentration and distribution of this target protein (diagnostic stage). Following this, a similar ligand is this time attached to an alpha or beta-emitter, enabling targeted tumour destruction (therapeutic stage).
There is growing, but limited, evidence that prostate specific membrane antigen (PSMA) is strongly and specifically expressed in high grade glioma and may be a potential theranostic target [Wernicke 2011, Unterrainer 2017]. It has already been used extensively as a theranostic target in metastatic prostate cancer, demonstrating safety and efficacy in this condition [Abou et al 2020].
The clinical outcomes shown in prostate cancer, along with evidence of PSMA expression in high grade glioma, led the study team to convene an Incubator Day with a group of experts to explore the possibility of developing a PSMA-targeting theranostic agent in high grade glioma. Expertise included PSMA theranostics (Prof Lewington), neuro-oncology (Dr Brazil, Guy's and St Thomas' Hospital (GSTT)), neurosurgery (Prof Ashkan, King's College Hospital (KCH)), neuropathology (Prof Al-Sarraj, KCH), neuroradiology (Dr Booth, KCH) PSMA PET imaging (Prof Gary Cook and Prof Alexander Hammers GSTT/KCL), nuclear physics (Prof Paul Marsden GSTT/KCL), and PSMA radiopharmaceutical chemistry (Prof Blowers, KCL).
It was concluded that a PSMA-targeting theranostic agent has the potential to be a safe and effective treatment for high grade glioma. The regulatory pathway should be eased enormously by the precedent of use in prostate cancer, which would obviate the need for pre-clinical studies.
This approach was conditional upon two objectives:
- Perform a series of five [68Ga]PSMA PET scans for dosimetry analysis and assessment of the retention of the tracer in the tumour (Using GSTT/KCL PET/MRI) prior to biopsy, at the same time as the patient's routine brain tumour imaging series. At time of recurrence a further [68 Ga]PSMA PET-MRI scan may be performed in each patient (depending on whether or not recurrence occurs during the study period) to assess for change in the standardised uptake value (SUV).
- Performing immunohistochemical analysis on high grade glioma specimens (prospectively in patients enrolled in this study with additional retrospective samples), in order to replicate published evidence on the expression of PSMA in such tumours, and also to demonstrate in the prospective cohort, a correlation between imaging detection of [68 Ga]PSMA and histopathological detection in stereotactic brain tumour biopsy samples (Using KCH neuropathology facilities).
Study design
- Primary purpose
- Diagnosis
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Brain tumour patients | Experimental | Diagnostic Test: PET-MRI, Procedure: Brain tumour biopsyPatients will be those undergoing routine care of primary brain tumours. Study group patients will undergo additional PET-MRI examination and biopsies in addition to the standard of care. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- Individuals of 18 years or older
- Referred for surgery (resection or biopsy) of presumed high grade primary brain tumour (based on imaging features of aggression e.g. perfusion imaging, diffusion restriction etc.). As standard, all patients will have had a full body CT and other investigations to rule out metastatic disease (this has a very high negative predictive value).
- Written informed consent
Key exclusion criteria (5 listed)
- Patient already enrolled in a drug trial
- Contra-indication for MRI contrast
- Contra-indication for radiotracer
- Inability to give consent
- Patient is pregnant or planning to become pregnant
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| PET-MRIFor the diagnostic imaging aspect included in this pilot study, [68Ga]PSMA-11 will be used. This is a peptidomimetic agent with a covalently bound chelator (HBED-CC) that is FDA-approved in prostate cancer imaging. We will use PET-MRI to visualise a) the concentration and b) the distribution of this tracer to establish a functional map of primary brain tumour activity | Diagnostic test | Brain tumour patients |
| Brain tumour biopsyAll patients included in our study will undergo stereotactic surgery for biopsy/resection of the tumour as part of the standard of care at KCH. During this study we will not vary from the surgical standard of care for primary brain tumours and will only extend the surgery time due to additional stereotactic biopsies (an additional 3 biopsies increasing the time of the operation by ~30 minutes). Professor Ashkan (KCH) has defined the additional surgical risk of performing these biopsies to be ~0%, since targeted biopsies will only be taken within the tumour just before resection. The stereotactic biopsy may be targeted to areas of high [68Ga]PSMA SUV within the tumour as defined by the PET MRI scan. | Procedure or surgery | Brain tumour patients |
Primary outcome
Correlation of the PET-MRI PSMA signal intensity (arbitrary units) and glioma protein concentration (g/L) in a 1 x 1 x 1 cm region of interest (R value)
Time frame: 5 years
PET-MRI signal will be recorded from different regions of interest within a glioma where stereotactic surgical biopsies taken and protein concentration determined.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 10 Jun 2022.
- Background: PubMed 32307792Louis DN, Wesseling P, Aldape K, Brat DJ, Capper D, Cree IA, Eberhart C, Figarella-Branger D, Fouladi M, Fuller GN, Giannini C, Haberler C, Hawkins C, Komori T, Kros JM, Ng HK, Orr BA, Park SH, Paulus W, Perry A, Pietsch T, Reifenberger G, Rosenblum M, Rous B, Sahm F, Sarkar C, Solomon DA, Tabori U, van den Bent MJ, von Deimling A, Weller M, White VA, Ellison DW. cIMPACT-NOW update 6: new entity and diagnostic principle recommendations of the cIMPACT-Utrecht meeting on future CNS tumor classification and grading. Brain Pathol. 2020 Jul;30(4):844-856. doi: 10.1111/bpa.12832. Epub 2020 Apr 19.
- Background: PubMed 22032578Wernicke AG, Edgar MA, Lavi E, Liu H, Salerno P, Bander NH, Gutin PH. Prostate-specific membrane antigen as a potential novel vascular target for treatment of glioblastoma multiforme. Arch Pathol Lab Med. 2011 Nov;135(11):1486-9. doi: 10.5858/arpa.2010-0740-OA.
- Background: PubMed 29045711Unterrainer M, Niyazi M, Ruf V, Bartenstein P, Albert NL. The endothelial prostate-specific membrane antigen is highly expressed in gliosarcoma and visualized by [68Ga]-PSMA-11 PET: a theranostic outlook for brain tumor patients? Neuro Oncol. 2017 Nov 29;19(12):1698-1699. doi: 10.1093/neuonc/nox172. No abstract available.
- Background: PubMed 32582550Abou D, Benabdallah N, Jiang W, Peng L, Zhang H, Villmer A, Longtine MS, Thorek DLJ. Prostate Cancer Theranostics - An Overview. Front Oncol. 2020 Jun 5;10:884. doi: 10.3389/fonc.2020.00884. eCollection 2020.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Thomas C Booth, PhD principal investigator
King's College London
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing PET-MRI and Brain tumour biopsy in people with Glioma, Malignant, run by King's College Hospital NHS Trust at 1 site in United Kingdom.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 10 Jun 2022. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Thomas C Booth, PhD (07977509937, thomasbooth@nhs.net), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Correlation of the PET-MRI PSMA signal intensity (arbitrary units) and glioma protein concentration (g/L) in a 1 x 1 x 1 cm region of interest (R value) (time frame: 5 years). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05263466, which also lists 4 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Jun 2022.