The primary aim was to determine the diagnostic performance of 18F-fluciclovine PET when combined with MRI (CE-T1W MRI), compared to that of MRI (CE-T1W MRI) alone. Results demonstrated that the overall ability of the readers to assess the diagnostic performance of 18F-fluciclovine with MRI had a Positive Predictive Value (PPV) of more than 90%. 18F-fluciclovine is a synthetic amino acid labeled with the radioisotope F 18, enabling PET imaging to visualize the increased amino acid transport that occurs in malignant tumors such as glioma. Glioma is a serious and life-threatening condition accounting for about 80% of all malignant brain tumors.
18F-fluciclovine under the tradename Axumin® (fluciclovine F 18 injection) is an FDA-approved molecular imaging agent indicated for PET imaging in men with suspected prostate cancer recurrence based on elevated blood levels of prostate specific antigen (PSA) following prior treatment. 18F-fluciclovine PET imaging is being investigated for the detection and continuing assessment of glioma. (For additional product information please see the end of this news release.)
Results of the study were presented in a Poster Session, “A blinded image evaluation study to determine the diagnostic efficacy of 18F-fluciclovine PET, as an adjunct to MRI imaging, in adults with glioma,” by Matthew P. Miller, PhD, Blue Earth Diagnostics, Oxford, UK at the 23rd Annual Scientific Meeting and Education Day of the Society for Neuro-Oncology, in New Orleans, La., from November 15 - 18, 2018.
“It is a great pleasure to share results from the 18F-fluciclovine PET blinded image evaluation study in glioma with the prestigious clinical community at the Society of Neuro-Oncology,” said Jonathan Allis, D. Phil., CEO of Blue Earth Diagnostics. “18F-fluciclovine PET is designated as an Orphan Drug by the FDA and EMA for the diagnosis of glioma, and Blue Earth Diagnostics is investigating its potential use in adults with glioma as part of our mission to develop and commercialize innovative PET imaging agents to address unmet medical needs in cancer. We look forward to publishing the full results of this study in an upcoming peer-reviewed medical journal.”
“Glioma is a serious and potentially life-threatening disease, and the ability to identify the location and extent of a tumor is important in planning appropriate treatment for patients, in both initial diagnosis and subsequent monitoring for recurrence,” said Peter Gardiner, MB ChB, MRCP, FFPM, CMO of Blue Earth Diagnostics. “PET imaging provides additional insight beyond MRI into the biology and treatment response of gliomas1.”
“Guidelines from the Response Assessment in Neuro-Oncology (RANO) working group and the European Association for Neuro-Oncology (EANO) emphasize the clinical value of PET imaging with superiority of amino acid PET over glucose PET and provides a framework for the use of PET to assist in the management of patients with glioma1,” said Matthew P. Miller, PhD, Head of Imaging at Blue Earth Diagnostics and lead author on the BED006 study. “18F-fluciclovine is a synthetic amino acid taken up by certain cancer cells. This blinded image evaluation study examined the diagnostic performance of 18F-fluciclovine PET imaging, in conjunction with various types of MRI, for imaging of suspected glioma when interpreted by readers unfamiliar with 18F-fluciclovine PET. Results indicated a Positive Predictive Value (PPV) of more than 90% for each of the three blinded readers and consistent image interpretation across these readers. Additionally, 18F-fluciclovine PET with MRI (CE-T1W MRI) identified additional regions suspicious for glioma that MRI alone was unable to identify, which subsequent biopsies confirmed as malignant.”
About the Phase 3 Blinded Image Evaluation (BIE) Study in Glioma (BED006)
Study BED006 was a prospective, Phase 3, Blinded Image Evaluation (BIE) study of 18F-fluciclovine PET data sets derived from a previous prospective Phase 2 study, designed to evaluate the efficacy of 18F-fluciclovine PET combined with MRI imaging, as compared to MRI alone, in adults with glioma. The primary objective of the study was to determine the positive predictive value (PPV) of 18F-fluciclovine PET when combined with MRI (CE-T1W MRI), compared to MRI (CE-T1W MRI) alone. Secondary objectives included determining the diagnostic performance of 18F-fluciclovine PET and MRI compared with various types of MRI: CE-T1W MRI alone; fluid-attenuated inversion recovery (“FLAIR”) (or T2-weighted MRI) alone; and FLAIR (or T2W) MRI and CE-T1W MRI in combination. The study also assessed the reproducibility of interpretation of 18F-fluciclovine PET with MRI (CE-T1W MRI) image evaluation when interpreted by naïve readers.
Thirty-five 18F-fluciclovine PET and MRI (CE-T1W and FLAIR [or T2W]) image datasets with corresponding histopathological standard-of-truth data collected from patients who received 18F-fluciclovine for the imaging of suspected glioma in a previously conducted, prospective Phase 2 clinical trial (JapicCTI-132289) were evaluated. Three independent, blinded readers assessed images captured by cranial PET scan, a mean of 13.1 minutes after the injection of 18F-fluciclovine. Reader reproducibility was assessed by determining agreement in diagnostic performance parameters.
Results demonstrated the diagnostic performance of 18F-fluciclovine PET imaging, in conjunction with MRI, with a PPV of more than 90% for each of the three readers, regardless of whether images were positive or negative on MRI. The sensitivity of 18F-fluciclovine with MRI (CE-T1W MRI) (range 65.8 - 71.1%) was shown to be higher than that of MRI alone (CE-T1W MRI) (42.1%) but not as high as FLAIR (or T2W) MRI alone (86.8%). The 88.9% specificity of 18F-fluciclovine with MRI (CE-T1W MRI) was equal to that of MRI (CE-T1W MRI) alone and higher than FLAIR (or T2W) MRI alone (33.3%). Agreement across readers indicated high concordance, with 89.4% of PET scans in agreement.
Blue Earth Diagnostics is pursuing regulatory filings for the use of 18F-fluciclovine PET imaging in adults for the detection and continuing assessment of the disease. The compound has been granted Orphan Drug status by both the U.S. Food and Drug Administration (FDA) and the European Medicines Agency for the diagnosis of glioma.
About 18F-fluciclovine PET in Glioma
18F-fluciclovine PET is a diagnostic imaging radiopharmaceutical for PET imaging that consists of a synthetic amino acid labeled with the radioisotope F 18, enabling the visualization of the increased amino acid transport that occurs in malignant tumors. 18F-fluciclovine, under the trade name Axumin®, is approved by the U.S. Food and Drug Administration (FDA) for PET imaging in men with biochemically recurrent prostate cancer. It is also under investigation by Blue Earth Diagnostics for use in adults for the detection and continuing assessment of glioma. 18F-fluciclovine has been granted Orphan Drug status by both the FDA and the European Medicines Agency for the diagnosis of glioma. The compound was invented at Emory University in Atlanta, Ga., with much of the fundamental clinical development work carried out by physicians at Emory University’s Department of Radiology and Imaging Sciences.
Glioma, the most commonly occurring type of primary brain tumor, is a serious and life-threatening condition. Cancer of the brain and central nervous system (CNS) is the twelfth most common cause of cancer death worldwide. Glioma accounts for about 25% of all brain tumors, and 80% of all malignant brain tumors. The most aggressive form of glioma, glioblastoma multiforme, is associated with significant morbidity and mortality with relatively low 5-year survival estimates after diagnosis. Current treatment options for patients with glioma include surgery, radiation and chemotherapy. Accurate evaluation of the location and extent of a glioma tumor is essential before or during surgery and radiotherapy and in assessing the continuing status of the disease. The detection and assessment of gliomas typically involves magnetic resonance imaging (MRI), which may be complemented by metabolic imaging using an appropriate amino acid-based PET radiopharmaceutical, as recommended in the Response Assessment in Neuro-Oncology (RANO) working group and European Association for Neuro-Oncology (EANO) guidelines.1