[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

Not yet recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

381

Phase

  • Phase 3

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

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

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Diagnostic
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / 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

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

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

This is where you will find people and organizations involved with this study.

Sponsor

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

December 1, 2026

Primary Completion (Estimated)

April 1, 2028

Study Completion (Estimated)

July 1, 2028

Study Registration Dates

First Submitted

October 21, 2026

First Submitted That Met QC Criteria

November 5, 2026

First Posted (Actual)

November 12, 2026

Study Record Updates

Last Update Posted (Actual)

November 12, 2026

Last Update Submitted That Met QC Criteria

November 5, 2026

Last Verified

November 1, 2026

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

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