Trial Information

Evaluation of Ferumoxytol Enhanced MRI for the Detection of Lymph Node Involvement in Prostate Cancer

Background:

- Prostate cancer is the most common non-cutaneous malignancy among men in Western world.
Accurate lymph node staging is important in treatment planning for prostate cancer.

- Conventional imaging modalities (e.g. computed tomography [CT] and magnetic resonance
imaging [MRI]) are used for the evaluation of lymph node involvement in many cancer
types, including prostate cancer, however diagnosis is based on node enlargement which
is neither sensitive nor specific in prostate cancer.

- As a consequence, the standard of care is to remove numerous lymph nodes during
prostatectomy to ascertain lymph node status.

- A prior imaging agent for detecting lymph node involvement, dextran coated ultrasmall
superparamagnetic iron oxide particles (USPIO), also known as Ferumoxtran-10
(Combidex(Registered Trademark), AMAG Pharmaceuticals, Inc. Lexington, MA, US) was
shown to localize lymph node metastases with much greater accuracy than unenhanced MRI.
Although a large study in lymph node imaging in prostate cancer was successfully
conducted using ferumoxtran-10, the FDA Advisory Panel did not recommend broad use
approval of this agent.

- A derivative of ferumoxtran-10, Ferumoxytol (Feraheme(Registered Trademark) AMAG
Pharmaceuticals, Inc. Lexington, MA, US) has been approved for iron replacement
therapy. It is a semisynthetic carbohydrate coated, magnetic iron oxide preparation.
This compound is taken up by normal lymph nodes, excluded from malignant nodal tissue.
A single study of Ferumoxytol enhanced MRI demonstrated some efficacy of this agent at
24 hours but only one dose was used, MRI at later time points was not performed.

- Initial results of the NCI trial (11-C-0098) revealed that using the dose of 7.5 mg/kg
Fe is safe and it yields a more homogenous and accurate signal changes in benign lymph
nodes in comparison with the 4 and 6 mg/kg Fe doses. However, utility of this initial
result could not be validated in depiction of signal change difference between benign
and malignant lymph nodes with prostate cancer metastases.

Primary Objective

-To determine the optimal dose of Ferumoxytol for enhancing lymph nodes in patients with
prostate cancer.

Eligibility

- Subject must be male and be >=18 years old.

- Subject must have a documented diagnosis of prostate cancer.

--Those enrolling in the lymph node involvement subgroup must have imaging evidence of
lymph node involvement (with a size of greater than or equal to 1.5cm)

- Eastern Cooperative Oncology Group Performance score of 0 to 2.

- Subjects must be scheduled to undergo prostatectomy and nodal dissection for presumed
prostate cancer.

Design:

- Subjects with prostate cancer scheduled for prostatectomy at the NIH Clinical Center
will undergo pre-injection, 24, 48 (optional) hours post-Ferumoxytol injection MRI
consisting of T1 weighted (W), T2W and T2*W MRI at 3 Tesla magnet.

- In the dose finding cohorts, each dose (4mg/kg Fe, 6mg/kg Fe, 7.5mg/kg Fe) will have an
equal number of patients (estimated enrollment will be 5 evaluable patients for each
group, making a total of 3x5=15 patients) will be enrolled sequentially. In the lymph
node involvement cohort, 5 evaluable subjects will be enrolled.

- Subjects in the dose finding cohorts will undergo clinically indicated prostatectomy,
nodal dissection for prostate cancer; histology of resected lymph nodes will be
correlated with imaging.

- Subjects in the lymph node involvement cohort may be scheduled to undergo prostatectomy
and nodal dissection or core needle biopsy of the lymph node(s) as part of their
clinical work-up and histology of resected or biopsied lymph nodes will be correlated
with imaging.