Intraoperative Pancreatic Cancer Detection using Tumor-Specific Multimodality Molecular Imaging

Area of Science:

• Oncology
• Surgical Oncology
• Medical Imaging

Background:

• Pancreatic ductal adenocarcinoma (PDAC) management involves critical intraoperative decisions regarding metastatic disease identification and complete tumor resection.
• Multimodality molecular imaging offers crucial intraoperative information for surgeons.
• This study reports the first-in-human use of cetuximab-IRDye800, a near-infrared fluorescent agent targeting epidermal growth factor receptor, for intraoperative PDAC detection.

Purpose of the Study:

• To assess the safety and feasibility of intraoperative, tumor-specific detection of PDAC using cetuximab-IRDye800.
• To evaluate the efficacy of multimodality molecular imaging in identifying primary tumors and potential metastases during surgery.

Main Methods:

• A dose-escalation study was conducted involving patients undergoing surgical resection for suspected PDAC.
• Patients received unlabeled cetuximab followed by cetuximab-IRDye800 (50 mg or 100 mg).
• Multi-instrument fluorescence imaging was performed intraoperatively, alongside ex vivo fluorescence and photoacoustic imaging.

Main Results:

• Fluorescence imaging demonstrated significantly higher intensity in tumors (0.09 ± 0.06) compared to normal pancreatic tissue (0.02 ± 0.01) and pancreatitis (0.04 ± 0.01) (p < 0.001), achieving 96.1% sensitivity and 67.0% specificity.
• Photoacoustic imaging revealed a 3.7-fold higher signal in tumor sites versus surrounding tissue.
• Seven patients with resectable pancreatic masses were enrolled.

Conclusions:

• Intraoperative, tumor-specific detection of PDAC using cetuximab-IRDye800 with multimodal molecular imaging is safe and feasible.
• This approach aids in the detection of primary tumors and metastases.
• The study demonstrates the potential of this technology to improve surgical decision-making and patient outcomes.