[18F]FET PET for Differentiating Tumor Progression vs Treatment-Related Changes in Brain Metastases (TLX101-Px)
A Phase 3, Open-label, Single-arm Study to Investigate the Utility of ([18F]FET) PET in Participants With Brain Metastases and Equivocal MRI Findings Following Therapy to Differentiate Between Intracranial Tumor and Treatment-related Changes
This Phase 3 study will evaluate whether [18F]Floretyrosine ([18F]FET) PET imaging can help distinguish active brain tumor growth from treatment-related changes in patients with brain metastases who have unclear MRI findings after treatment. The study has two parts. Part 1 will identify the lowest effective dose of [18F]FET PET that provides reliable imaging results. Part 2 will evaluate the accuracy of [18F]FET PET, using the optimized dose, for distinguishing tumor progression from treatment-related changes. Study results will be compared with information from follow-up imaging, clinical assessments, and, when available, tissue samples obtained during routine clinical care. The goal is to determine whether [18F]FET PET can improve diagnostic accuracy and support clinical decision-making for patients with brain metastases.
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Phase 3
Contacts and Locations
Study Contact
Study Contact
- Name: Sahar Khan, Clinical Project Manager, MBA, MS
- Phone Number: 2484692985
- Email: sahar.khan@telixpharma.com
Study Contact Backup
- Name: Sapna Shah, Senior Director, Clinical Operations, MD
- Email: sapna.shah@telixpharma.com
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Adults ≥18 years of age at the time of informed consent.
- Prior diagnosis of brain metastases from a histologically confirmed solid tumor.
- At least one measurable intracranial lesion (≥10 mm longest diameter and/or ≥5 mm short axis) identified on MRI and assessed according to RANO-BM criteria.
- Target lesion considered equivocal for tumor progression versus treatment-related changes on MRI within 1 month prior to Day 1.
- Prior receipt of CNS-directed therapy for brain metastases within 12 months before Day 1.
- Planned standard-of-care management including biopsy/neurosurgical intervention and/or clinical follow-up MRI within 2 to 3 months after Day 1.
- ECOG Performance Status 0-2.
- Life expectancy of at least 3 months.
- Willing and able to provide written informed consent and comply with study procedures.
Exclusion Criteria:
- Serious non-malignant disease that may interfere with study objectives, safety, or compliance.
- Known hypersensitivity to [18F]FET or tyrosine derivatives.
- Ongoing Grade 3 toxicity from previous therapies.
- Exposure to a diagnostic or therapeutic radiopharmaceutical within protocol-specified washout periods.
- Whole brain radiotherapy or stereotactic radiosurgery within 2 months prior to Day 1.
- Exposure to another investigational agent within 30 days prior to Day 1 or participation in a conflicting clinical study.
- Absence of at least one measurable intracranial lesion.
- Contraindication to PET, CT, or MRI procedures.
- Inability to undergo required imaging procedures or comply with study requirements.
- Pregnant or breastfeeding women.
- Any condition that, in the investigator's opinion, would make the participant unsuitable for the study.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Arm Group Label: [18F]FET PET Imaging
|
Floretyrosine F 18 ([18F]FET) is an investigational amino acid positron emission tomography (PET) radiopharmaceutical administered as a single intravenous injection for diagnostic imaging. Participants in Part 1 receive 740 MBq (±10%) of [18F]FET to evaluate dose optimization through comparison of reconstructed reduced-dose and full-dose PET images. Participants in Part 2 receive [18F]FET at the optimized dose identified in Part 1 to evaluate its diagnostic performance for differentiating tumor progression from treatment-related changes in brain metastases with equivocal MRI findings following therapy |
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Patient-Level Mean Dice Similarity Coefficient for Lesion Spatial Agreement Between Reduced-Dose and Full-Dose [18F]FET PET Images
Time Frame: From Day 1 through Day 2 (±1 day) follow-up
|
The patient-level mean Dice Similarity Coefficient (DSC), derived from all evaluable lesions, will be used to assess lesion spatial agreement between each reduced-dose [18F]FET PET dataset and the full-dose reference scan. The DSC results will be used to identify the lowest [18F]FET dose demonstrating non-inferior lesion spatial agreement. |
From Day 1 through Day 2 (±1 day) follow-up
|
|
Sensitivity of [18F]FET PET for Distinguishing Tumor Progression From Treatment-Related Changes Compared With CSOT
Time Frame: From baseline Day 1 through CSOT determination (approximately 2-3 months).
|
Sensitivity will be assessed for [18F]FET PET at the optimized dose for distinguishing tumor progression from treatment-related changes, using the Composite Standard of Truth (CSOT) as the reference standard. |
From baseline Day 1 through CSOT determination (approximately 2-3 months).
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Number of Participants With Adverse Events Following Administration of 740 MBq [18F]FET
Time Frame: From Day 1 through Day 2 (±1 day) follow-up
|
The incidence and severity of adverse events and other safety findings will be assessed following administration of 740 MBq (±10%) [18F]FET PET |
From Day 1 through Day 2 (±1 day) follow-up
|
|
Inter-Reader Agreement for [18F]FET PET Classification at the Optimized Dose
Time Frame: Baseline Day 1 through completion of image interpretation following CSOT determination (approximately 2-3 months
|
Inter-reader agreement will be assessed for interpretation of [18F]FET PET images obtained at the optimized dose. |
Baseline Day 1 through completion of image interpretation following CSOT determination (approximately 2-3 months
|
|
Lesion-Level Sensitivity of [18F]FET PET for Distinguishing Tumor Progression From Treatment-Related Changes
Time Frame: From baseline Day 1 through CSOT determination, approximately 2-3 months
|
Sensitivity will be assessed at the lesion level for distinguishing tumor progression from treatment-related changes |
From baseline Day 1 through CSOT determination, approximately 2-3 months
|
|
Sensitivity of [18F]FET PET Compared With Histopathologic Confirmation
Time Frame: From baseline Day 1 through histopathologic confirmation, approximately 2-3 months
|
Sensitivity of [18F]FET PET will be assessed using histopathologic confirmation as the reference in participants with available histopathology. |
From baseline Day 1 through histopathologic confirmation, approximately 2-3 months
|
|
Positive Predictive Value of [18F]FET PET for Tumor Progression Compared With CSOT
Time Frame: From baseline Day 1 through CSOT determination, approximately 2-3 months
|
Positive predictive value will be assessed for [18F]FET PET classification of tumor progression using the Composite Standard of Truth (CSOT) as the reference standard |
From baseline Day 1 through CSOT determination, approximately 2-3 months
|
|
Negative Predictive Value of [18F]FET PET for Tumor Progression Compared With CSOT
Time Frame: From baseline Day 1 through CSOT determination, approximately 2-3 months
|
Negative predictive value will be assessed for [18F]FET PET classification of tumor progression using the Composite Standard of Truth (CSOT) as the reference standard. |
From baseline Day 1 through CSOT determination, approximately 2-3 months
|
|
Maximum Standardized Uptake Value (SUVmax) of [18F]FET PET Lesions
Time Frame: Baseline Day 1 imaging assessment
|
SUVmax will be measured for evaluable lesions on [18F]FET PET. |
Baseline Day 1 imaging assessment
|
|
Mean Standardized Uptake Value (SUVmean) of [18F]FET PET Lesions
Time Frame: Baseline Day 1 imaging assessment
|
SUVmean will be measured for evaluable lesions on [18F]FET PET. |
Baseline Day 1 imaging assessment
|
|
Maximum Tumor-to-Brain Ratio (TBRmax) of [18F]FET PET Lesions
Time Frame: Baseline Day 1 imaging assessment
|
TBRmax will be measured for evaluable lesions on [18F]FET PET. |
Baseline Day 1 imaging assessment
|
|
Mean Tumor-to-Brain Ratio (TBRmean) of [18F]FET PET Lesions
Time Frame: Baseline Day 1 imaging assessment
|
TBRmean will be measured for evaluable lesions on [18F]FET PET. |
Baseline Day 1 imaging assessment
|
|
Number of Participants With Treatment-Emergent Adverse Events (TEAEs) at the Optimized Dose
Time Frame: From Day 1 administration through study completion, approximately 5-6 months
|
Safety and tolerability at the optimized dose will be assessed by the number of participants experiencing treatment-emergent adverse events (TEAEs), including serious adverse events (SAEs), adverse events leading to treatment discontinuation, and treatment-related adverse events, as applicable. Adverse events will be assessed and graded according to the protocol-specified safety assessment criteria. |
From Day 1 administration through study completion, approximately 5-6 months
|
Collaborators and Investigators
Sponsor
Sponsor
Study record dates
Study Major Dates
Study Start (Estimated)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
- PET Imaging
- Positron Emission Tomography
- Magnetic Resonance Imaging
- Brain Tumors
- Brain Metastases
- Diagnostic Imaging
- Pseudoprogression
- dose optimization
- Tumor Progression
- Clinical Utility
- Neuro-Oncology
- Diagnostic Performance
- Central Nervous System Metastases
- Radiation Necrosis
- RANO-BM
- Treatment-Related Changes
- Amino Acid PET
- Floretyrosine F 18
- [18F]FET PET
Additional Relevant MeSH Terms
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Pathologic Processes
- Neoplasms by Site
- Neoplasms
- Disease Attributes
- Nervous System Neoplasms
- Central Nervous System Neoplasms
- Pathological Conditions, Signs and Symptoms
- Disease Progression
- Brain Neoplasms
- (18F)fluoroethyltyrosine
Other Study ID Numbers
Other Study ID Numbers
- 18F-TLX101-Px-301
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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