Trial of Lymphoseek in Intraoperative Localization of Lymph Nodes in Breast Cancer and Melanoma

June 6, 2013 updated by: Navidea Biopharmaceuticals

A Phase 3, Prospective, Open-Label, Multicenter Comparison Study of Lymphoseek® and Vital Blue Dye as Lymphoid Tissue Targeting Agents in Patients With Known Melanoma or Breast Cancer Who Are Undergoing Lymph Node Mapping

Data from this pivotal clinical trial will be used to support a marketing application (i.e., NDA) for Navidea's Lymphoseek for use in intraoperative localization of lymph tissue (nodes) in the lymphatic pathway draining the primary site of a tumor.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

In patients with primary melanoma and breast cancer, lymph node status is often a strong predictor of outcome and influences the course of treatment a patient may follow after surgery. In an effort to reduce the morbidity and costs of detection of lymph node metastases, surgical oncologists have developed a method by which the sentinel lymph node (the first node in a draining basin) is identified intraoperatively and removed. This technique, called sentinel node biopsy, has extremely high negative predictive values for melanoma metastases and breast cancer metastases. The two largest trials for melanoma, Morton, et al (2005) and Rossi, et al (2006), reported false negative rates of 6.3% and 14.7%, respectively. Morton, et al (2006), in perhaps the most mature trial reported to date, showed a false negative rate of 3.4% . There is growing evidence that sentinel node biopsy will have a significant impact on the management of melanoma. Sentinel node biopsy also has extremely high negative predictive values for breast cancer metastases; the false-negative rates range from 0% to 9%. There is growing evidence that sentinel node biopsy will have a significant impact on the management of breast cancer. Although the survival and local recurrence studies have yet to be completed, the technique has emerged into common practice.

Lymphatic mapping with a radiopharmaceutical is a nuclear medicine examination which identifies for the surgeon the first lymph node to receive lymphatic flow from the primary tumor site. This node is removed and analyzed for the presence of malignant cells. By locating the lymph node prior to surgery, a small incision can be used to remove the node and a smaller dissection can be employed. The high negative predictive value of the technique seems to provide an accurate staging procedure and may spare patients who are lymph node negative the morbidity of a complete lymph node dissection. Consequently, staging of melanoma by lymph node mapping and biopsy may be equivalent to regional node dissection without the attendant post surgical morbidity.

An ideal lymph node imaging agent would exhibit rapid clearance from the injection site, rapid uptake and high retention within the first draining lymph node, and low uptake by the remaining lymph nodes. The ideal agent would also have low radiation absorption; high biological safety; convenient, rapid, and stable technetium-99m labeling; and biochemical purity.

Lymphoseek (technetium-99m-labeled diethylenetriamine pentaacetic acid-mannosyl-dextran, [Tc-99m]DTPA-mannosyl-dextran) is a radiotracer that accumulates in lymphatic tissue by binding to a mannose-binding protein that resides on the surface of dendritic cells and macrophages. Lymphoseek is a macromolecule consisting of multiple units of DTPA and mannose, each synthetically attached to a 10 kilodalton dextran backbone. The mannose acts as a substrate for the receptor, and the DTPA serves as a chelating agent for labeling with Tc-99m.

Study Type

Interventional

Enrollment (Actual)

186

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 Locations

  • Israel
      • Tel Aviv, Israel, 64239
        • Schlomo Schneebaum, M.D.
  • United States
    • Alabama
      • Alexander City, Alabama, United States, 35010
        • Barbara Michna, M.D
      • Birmingham, Alabama, United States, 35294
        • Helen Krontiras, M.D.
    • California
      • La Jolla, California, United States, 92093
        • Anne Wallace, M.D.
      • Laguna Hills, California, United States, 92653
        • Ken Deck, M.D.
      • Sacramento, California, United States, 95817
        • Steve Martinez, M.D.
      • Santa Monica, California, United States, 90404
        • Mark Faries, M.D.
    • Florida
      • Miami, Florida, United States, 33101
        • Eli Avisar, M.D.
      • Tampa, Florida, United States, 33612
        • Charles Cox, M.D.
      • Tampa, Florida, United States, 33612
        • Vernon Sondak, M.D.
    • Ohio
      • Cleveland, Ohio, United States, 44106
        • Julian Kim, M.D.
      • Cleveland, Ohio, United States, 44109
        • Bruce Averbook, M.D
      • Columbus, Ohio, United States, 43210
        • Stephen Povoski, M.D.
    • Pennsylvania
      • Bryn Mawr, Pennsylvania, United States, 19010
        • Thomas Frazier, M.D.
      • Philadelphia, Pennsylvania, United States, 19096
        • Ned Carp, M.D.

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:

  • The patient has provided written informed consent with HIPAA authorization before participating in the study, as has his/her responsible caregiver, if applicable.
  • The patient is a candidate for surgical intervention, with lymph node mapping being a part of the surgical plan.
  • The patient is at least 18 years of age at the time of consent.
  • The patient has an ECOG performance status of Grade 0 - 2 [8].
  • The patient has a clinical negative node status at the time of study entry.
  • If of child bearing potential, the patient has a negative pregnancy test within 72 hours prior to administration of Lymphoseek, has been surgically sterilized, or has been postmenopausal for at least 1 year.
  • The patient is currently not participating in another investigational drug study.

Melanoma Patients

  • The patient has a diagnosis of primary melanoma.

Breast Cancer Patients

  • The patient has a diagnosis of primary breast cancer.
  • Patients with pure ductal carcinoma in situ (DCIS) or non-invasive carcinoma if lymph node biopsy is part of the surgical plan.

Exclusion Criteria:

  • The patient is pregnant or lactating;
  • The patient has clinical or radiological evidence of metastatic cancer including palpably abnormal or enlarged lymph nodes (i.e., all patients should be any T,N0,M0);
  • The patient has a known hypersensitivity to Lymphazurin or Patent Bleu V.

Melanoma Patients

  • The patient has a tumor with a Breslow depth less than 0.75mm.;
  • Patients that have had preoperative chemotherapy, immunotherapy or radiation therapy;
  • Patients diagnosed with a prior invasive melanoma that would occur on the same body region or potentially draining to the same nodal basin or patients with truncal or extremity primary melanoma who has had a prior breast cancer potentially draining to the same axillary nodal basin;
  • Patients who have undergone node basin surgery of any type or radiation to the nodal basin(s) potentially draining the primary melanoma;
  • Patients who have undergone a wide excision for their primary melanoma (>1 cm in dimension) or complex reconstruction (rotation, free flap or skin graft of any type).

Breast Cancer Patients

  • The patient has bilateral primary breast cancers or multiple tumors within their breast;
  • Patients that have had prior surgical procedures such as breast implants, reduction mammoplasty or axillary surgery;
  • Patients scheduled for bilateral mastectomy for any reason;
  • Patients that have had preoperative radiation therapy to the affected breast or axilla

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Lymphoseek, Lymphatic mapping, Injection
Drug: Lymphoseek
Breast Cancer: Intradermal admin of Lymphoseek: Inject 0.2-0.4 mL in multiple divided injections or a single injection overlying the intact primary tumor or excision biopsy site OR periareolar administration of Lymphoseek: Inject 0.2-.04 mL in multiple divided doses at the margin of the areola OR subareolar administration of Lymphoseek: Inject 0.2-0.4 in multiple divided injections or a single injection in subareolar area as a subcutaneous injection OR peritumor administration of Lymphoseek: Inject 2.0-4.0 mL in multiple divided injections, intraparenchemally surrounding the tumor or biopsy cavity. For melanoma pts intradermal administration of Lymphoseek: Inject 0.2-0.4 mL in multiple divided injections or a single injection overlying the intact primary tumor or excision biopsy site.
Other Names:
  • technetium Tc 99m tilmanocept

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Concordance of Blue Dye and Lymphoseek
Time Frame: Surgery after injections of Lymphoseek and blue dye
The proportion of lymph nodes detected intraoperatively by blue dye that were also detected by Lymphoseek.
Surgery after injections of Lymphoseek and blue dye

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Reverse Concordance of Blue Dye and Lymphoseek
Time Frame: Surgery after injections of Lymphoseek and blue dye
The proportion of lymph nodes detected intraoperatively by Lymphoseek that were also detected by blue dye.
Surgery after injections of Lymphoseek and blue dye

Collaborators and Investigators

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

Sponsor

Navidea Biopharmaceuticals

Investigators

  • Study Director: Richard Orahood, M.D., Navidea Biopharmaceuticals

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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

April 1, 2008

Primary Completion (Actual)

June 1, 2009

Study Completion (Actual)

July 1, 2009

Study Registration Dates

First Submitted

April 30, 2008

First Submitted That Met QC Criteria

May 2, 2008

First Posted (Estimate)

May 5, 2008

Study Record Updates

Last Update Posted (Estimate)

June 17, 2013

Last Update Submitted That Met QC Criteria

June 6, 2013

Last Verified

June 1, 2013

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • NEO3-05

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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