Monitoring Breast Cancer Immunotherapy Treatment With Advanced Positron Emission Tomography Magnetic Resonance Imaging (PET/MRI)

Monitoring Breast Cancer Immunotherapy Treatment With Advanced PET/MRI: A Pilot Study

This clinical study will investigate the utility of Fludeoxyglucose (18F) fluoromisonidazole (FMISO), in patients diagnosed with triple negative breast cancer (stage II-IV disease), to monitor and predict the effect of immunotherapy. This is a parallel imaging study to current treatment strategies and no clinical decisions or outcomes will be based on the imaging. If promising, this data will be used to design larger trials. A total of 20 patients will be recruited for this study. This trial will not designate the participant's treatment plan; they will be eligible based on their treatment plan designated from their oncologist.

Study Overview

• Status: Recruiting
• Conditions: Triple Negative Breast Cancer
• Intervention / Treatment: Drug: [18F]FMISO-PET with contrast-enhanced MRI

Detailed Description

Pre-study visit/Consent

This visit will take about 1 hour. Participants will be asked to sign this consent form before any study procedures. Once consented, vital signs will be taken, a blood draw to determine kidney function, and a pregnancy test will be performed for women of childbearing potential. Participants will be asked to fill out an MRI questionnaire and they will be given an additional information sheet on the gadolinium-based contrast agent, Prohance, that the FDA requires for all patients receiving this type of drug. Because the PET/MRI is smaller than most MRI scanners, participants will have a PET/MRI fit test to ensure a proper fit. If eligible for this study, participants will be scheduled for the first PET imaging visit which will occur before they start immunotherapy.

Imaging visits

During this study participants will be scheduled for up to 3 imaging visits. The first imaging visit must be performed before participants start immunotherapy and is necessary for remaining eligible for this study. If, for some reason, the participant misses the following (i.e, 2nd) scheduled imaging visit, they are still eligible to continue in this study as long as they can complete a second imaging visit after finishing the 1st cycle of immunotherapy and before starting the 4th cycle of immunotherapy.

Imaging Visit #1

This visit will take about 4 hours and will take place before the participant starts immunotherapy. No special preparation is required before the study. Upon arrival at the Advanced Imaging Facility (AIF) participants will have a chance to have any remaining questions answered about the procedure. Baseline vital signs, including resting blood pressure, pulse rate, and breathing rate, will be measured and recorded. Women of childbearing potential will have a pregnancy test. An intravenous, plastic catheter will be placed in the arm and participants will be injected with the investigational radioactive drug, [18F]FMISO. Afterwards participants will wait 120 minutes to allow the drug to distribute throughout their body. Participants will then be positioned in the PET/MRI scanner. Based on the PET/MRI fit test, participants will either be positioned face down on their stomach or on their back. Once positioned in the PET/MRI, participants will be imaged for up to 60 minutes during which time they must remain still. During imaging, participants will receive an injection of FDA approved gadolinium-contrast agent called Prohance (gadoteridol) to improve the images.

During any of the imaging visits, if the PET/MRI is unavailable due to scheduling problems or maintenance, participants may be imaged in the PET/CT scanner located in an adjacent room in the AIF. Participants will be scanned for up to 60 minutes. Before or after the PET/CT, but during this visit, participants will receive a separate MRI scan.

When all procedures are complete, the plastic tube will be removed. Unless participants cannot have children because of surgery or other medical reasons, they must agree to use an effective form of birth control for 24 hours after taking the study drug. Effective forms of birth control include birth control pills, patch, intrauterine device (IUD), condom, sponge, diaphragm with spermicide, or avoiding sexual activity that could cause pregnancy. Participants may resume normal activities after that 24-hour waiting period. Participants will be contacted by telephone 48 hours after the procedure to make sure they have not had any type of reaction from the investigational drug.

Imaging Visit #2

The second imaging visit will take about 4 hours and will be scheduled after the participant has finished their 1st cycle of immunotherapy and before they start their 2nd cycle.

No special preparation is required before the study. Upon arrival at the Advanced Imaging Facility (AIF) participants will have a chance to have any remaining questions answered about the procedure. Baseline vital signs, including resting blood pressure, pulse rate, and breathing rate, will be measured and recorded. Women of childbearing potential will have a pregnancy test. An intravenous, plastic catheter will be placed in the arm and participants will be injected with the investigational radioactive drug, [18F]FMISO. Afterwards participants will wait 120 minutes to allow the drug to distribute throughout their body. Participants will then be positioned in the PET/MRI scanner. Based on the PET/MRI fit test, participants will either be positioned face down on their stomach or on their back. Once positioned in the PET/MRI, participants will be imaged for up to 60 minutes during which time they must remain still. During imaging, participants will receive an injection of FDA approved gadolinium-contrast agent called Prohance (gadoteridol) to improve the images.

If participants miss this imaging visit but have completed the 1st imaging visit, they are still eligible to continue in this study if they can complete Imaging Visit #3.

When all procedures are complete, the plastic tube will be removed. Unless participants cannot have children because of surgery or other medical reasons, they must agree to use an effective form of birth control for 24 hours after taking the study drug. Effective forms of birth control include birth control pills, patch, IUD, condom, sponge, diaphragm with spermicide, or avoiding sexual activity that could cause pregnancy. Participants may resume normal activities after that 24-hour waiting period. Participants will be contacted by telephone 48 hours after the procedure to make sure they have not had any type of reaction from the investigational drug.

Imaging Visit #3

The third PET imaging visit will take about 4 hours and will be scheduled after participants finish their 2nd cycle of immunotherapy and before they start their 4th cycle of immunotherapy

No special preparation is required before the study. Upon arrival at the Advanced Imaging Facility (AIF) participants will have a chance to have any remaining questions answered about the procedure. Baseline vital signs, including resting blood pressure, pulse rate, and breathing rate, will be measured and recorded. Women of childbearing potential will have a pregnancy test. An intravenous, plastic catheter will be placed in the arm and participants will be injected with the investigational radioactive drug, [18F]FMISO. Afterwards participants will wait 120 minutes to allow the drug to distribute throughout their body. Participants will then be positioned in the PET/MRI scanner. Based on the PET/MRI fit test, participants will either be positioned face down on their stomach or on their back. Once positioned in the PET/MRI, participants will be imaged for up to 60 minutes during which time they must remain still. During imaging, participants will receive an injection of FDA approved gadolinium-contrast agent called Prohance (gadoteridol) to improve the images.

When all procedures are complete, the plastic tube will be removed. Unless participants cannot have children because of surgery or other medical reasons, they must agree to use an effective form of birth control for 24 hours after taking the study drug. Effective forms of birth control include birth control pills, patch, IUD, condom, sponge, diaphragm with spermicide, or avoiding sexual activity that could cause pregnancy. Participants may resume normal activities after that 24-hour waiting period. Participants will be contacted by telephone 48 hours after the procedure to make sure they have not had any type of reaction from the investigational drug.

The study team will follow participants for up to 5 years or to disease progression by reviewing their medical records including pathology data obtained from surgery to see how they are doing.

• Study Type: Interventional
• Enrollment (Estimated): 20
• Phase: Early Phase 1

Contacts and Locations

• Study Contact: Name: Sebastian Eady; Phone Number: 205-996-2636; Email: smeady@uabmc.edu

Study Locations

• United States
  • Alabama
    • Birmingham, Alabama, United States, 35249
      • Recruiting
      • UAB
      • Contact: Sebastian Eady; Phone Number: 205-966-2636; Email: smeady@uabmc.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Patients must be ≥ 18 years old and ≤ 75 years old
2. Triple negative breast cancer (TNBC) patients (biopsy-proven) stage II-IV eligible
3. >50%Programmed death-ligand 1 (PD-L1) positive
4. Eligible for immunotherapy who are naïve to beginning any immunotherapy treatment
5. May not be pregnant or breastfeeding
6. Subjects must be willing to sign consent
7. Adequate creatinine clearance per institutional guidelines and within 30 days
8. Estimated life expectancy of greater than one year
9. Patients must have one lesion with RECIST measurable disease (greater than 1 cm in diameter, measured from diagnostic breast MRI or staging CT)

Exclusion Criteria:

1. Inability to provide informed consent
2. Weight over 350 lbs., due to the scanner bore size
3. Lactating, known or suspected pregnancy. Women with child-bearing potential must a have a negative serum Human chorionic gonadotropin (β-hCG) pregnancy test within 48 hours or a negative urine β-hCG pregnancy test within 24 hours of each PET imaging study.
4. Contraindication for MRI study (e.g. non-removable metal implants or certain tattoos)
5. Unable to lie still on the imaging table for one (1) hour
6. contraindication for gadolinium-based contrast agent, ProHance (gadoteridol)
7. Have received immunotherapy in the neoadjuvant or adjuvant setting

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

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Breast [18F]FMISO-PET with contrast-enhanced magnetic resonance (MR); The patient will have a plastic peripheral intravenous catheter placed in the arm for administration of 10 millicuries (mCi)/10milliliters (mL) [18F]FMISO (≤ 15 µg/injected dose) followed by an uptake of 120 minutes. The injection will be infused nominally over one minute followed by a saline flush. After uptake, the patient will be scanned on the PET/MR for 60 minutes and will receive a contrast injection of gadoteridol during the dynamic sequence of the exam. The patient can be scanned on the PET/CT if the PET/MR is unavailable. During this study patients will be scheduled for up to 3 imaging visits. The first imaging visit will be at baseline prior to starting immunotherapy and is required for study eligibility. If for some reason the patient cannot complete the remaining 2 imaging visits, only one additional imaging visit during the identified times is necessary to remain eligible.

Drug: [18F]FMISO-PET with contrast-enhanced MRI; Triple negative breast cancer patients that are planning to undergo immunotherapy and consent to this study will have 3 imaging visits. Imaging visit 1 will take place before the patients start immunotherapy. Imaging Visit 2 will take place after the patient completes the 1st cycle of immunotherapy and before they start their 2nd cycle. Imaging Visit 3 will take place when the patient completes the 2nd cycle of immunotherapy and before they start the 4th cycle.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Baseline measure of PET standardized uptake value (SUV).	Compare baseline metrics from PET/MRI	Baseline
Baseline measure of apparent diffusion coefficient (ADC) in mm2/sec from MRI.	Compare baseline metrics from PET/MRI.	Baseline

Collaborators and Investigators

• Sponsor: University of Alabama at Birmingham
• Investigators: Principal Investigator: Janis O'Malley, MD, University of Alabama at Birmingham

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): August 1, 2028
• Study Completion (Estimated): August 1, 2028

Study Registration Dates

• First Submitted: April 22, 2021
• First Submitted That Met QC Criteria: April 22, 2021
• First Posted (Actual): April 27, 2021

Study Record Updates

• Last Update Posted (Actual): June 2, 2026
• Last Update Submitted That Met QC Criteria: May 30, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neoplasms by Site; Neoplasms; Skin Diseases; Breast Diseases; Breast Neoplasms; Skin and Connective Tissue Diseases; Triple Negative Breast Neoplasms
• Other Study ID Numbers: IRB-300007307 R21-072; Radiology Research Pilot Award (Other Grant/Funding Number: UAB)

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
• product manufactured in and exported from the U.S.: No