Contrast-Enhanced Ultrasound for Cervical Cancer

Overseen By Ji-Bin Liu, MD

Age: 18+

Sex: Female

Trial Phase: Phase < 1

Sponsor: Thomas Jefferson University

Disqualifiers: Pregnancy, Nursing, Unstable cardiac arrhythmias, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

5 Participants Needed

Trial Summary

Do I have to stop taking my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications. However, if you have received an investigational drug in the 30 days before the study or will receive one within 72 hours afterwards, you cannot participate.

What data supports the idea that Contrast-Enhanced Ultrasound for Cervical Cancer is an effective treatment?

The available research shows that Contrast-Enhanced Ultrasound (CEUS) is useful in assessing cervical cancer. For example, one study found that CEUS can help predict how well a cervical tumor will respond to chemotherapy. Another study showed that CEUS, when combined with regular ultrasound, is reliable for staging cervical cancer, which means it helps doctors understand how advanced the cancer is. These findings suggest that CEUS is effective in helping manage cervical cancer by providing important information about the tumor and its response to treatment. ^{1 2 3 4 5}

What safety data exists for Sonazoid (perflubutane) in clinical trials?

The safety of Sonazoid (perflubutane) was assessed in a phase 3 multicenter clinical trial focused on its efficacy for contrast-enhanced ultrasound in differentiating focal breast lesions. ^{6 7 8 9 10}

Is contrast-enhanced ultrasound a promising treatment for cervical cancer?

Yes, contrast-enhanced ultrasound is a promising treatment for cervical cancer. It helps doctors see the cancer more clearly, which can improve how they stage and treat the disease. It can also predict how well a tumor will respond to chemotherapy, making it a valuable tool in managing cervical cancer. ^{1 2 5 11 12}

What is the purpose of this trial?

This clinical trial compares the use of ultrasound for the detection of sentinel lymph nodes (SLNs) to the standard of care (which varies depending on cancer treatment). The ultrasound contrast agent is called Sonazoid and it consists of tiny gas-filled bubbles about the side of red blood cells. Diagnostic procedures, such as ultrasound with Sonazoid, may help identify more SLNs than standard of care in patients with cervical, vaginal, or vulvar cancer.

Eligibility Criteria

This trial is for women over 18 with cervical, vaginal, or vulvar cancer who can follow study procedures. They must not be pregnant/nursing and have no recent surgeries, unstable heart conditions, severe allergies to Sonazoid/eggs, or been on life support recently.

Inclusion Criteria

I have been diagnosed with cancer of the cervix, vagina, or vulva.

I am female.

If of child-bearing potential, must have a negative pregnancy test

Exclusion Criteria

Patients who have received an investigational drug in the 30 days before study drug administration, or will receive one within 72 hours afterwards

I was born with a heart defect.

I do not have serious heart rhythm problems.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Diagnostic Procedure

Patients receive perflubutane microbubble injections subdermally and then undergo ultrasound over 30 minutes before standard of care cancer treatment

30 minutes

Follow-up

Participants are monitored for safety and effectiveness after treatment

30 days

Treatment Details

Interventions

• Sonazoid

Trial Overview The trial tests a new ultrasound technique using Sonazoid contrast to find sentinel lymph nodes against the standard detection methods in female reproductive cancers. The goal is to see if this method identifies more lymph nodes.

Participant Groups

Group I: Diagnostic (perflubutane microbubble, ultrasound) Experimental Treatment 2 Interventions

Patients receive perflubutane microbubble injections subdermally and then undergo ultrasound over 30 minutes before standard of care cancer treatment.

Who Is Running the Clinical Trial?

Thomas Jefferson University

Lead Sponsor

Trials

475

Recruited

189,000+

National Cancer Institute (NCI)

Collaborator

Trials

14,080

Recruited

41,180,000+

Findings from Research

Quantitative contrast-enhanced ultrasonography (CEUS) effectively detects changes in cervical tumor perfusion after one cycle of neoadjuvant chemotherapy (NACT) in 38 patients with stage IB2 or IIA cervical cancer, indicating its potential as a predictive tool for treatment response.

Significant correlations were found between pre-treatment maximum intensity (IMAX) values and changes in tumor perfusion, suggesting that lower pre-treatment IMAX may predict a better response to NACT, even before observable size changes occur.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Can quantitative contrast-enhanced ultrasonography predict cervical tumor response to neoadjuvant chemotherapy? Peng, C., Liu, LZ., Zheng, W., et al.[2018]

Transrectal ultrasonography (TRUS) is effective for accurately measuring tumor size in advanced-stage cervical cancer before treatment, showing consistent results with clinical examinations and MRI.

Post-therapy evaluations are more accurately performed with MRI, as the use of contrast agents in both TRUS and MRI did not enhance the accuracy of tumor assessments either before or after treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Multimodal endocavitary ultrasound versus MRI and clinical findings in pre- and post-treatment advanced cervical cancer. Preliminary report. Csutak, C., Badea, R., Bolboaca, SD., et al.[2018]

In a study of 88 women with locally advanced cervical cancer, 2D grayscale ultrasound showed a sensitivity of 64.6% and specificity of 65% in detecting residual disease after neoadjuvant treatment, indicating moderate diagnostic performance.

Color Doppler ultrasound improved sensitivity to 87.1% for detecting residual disease but had low specificity (21.4%), while the best results for identifying macroscopic residual disease (≥ 6 mm) were achieved with a 2D ultrasound cut-off of 12 mm, yielding a sensitivity of 95% and specificity of 70.6%.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

PRospective Imaging of CErvical cancer and neoadjuvant treatment (PRICE) study: role of ultrasound to assess residual tumor in locally advanced cervical cancer patients undergoing chemoradiation and radical surgery. Testa, AC., Moro, F., Pasciuto, T., et al.[2018]

In a study of 51 patients with locally advanced cervical cancer, 2D and 3D transvaginal ultrasound (TV-US) demonstrated high diagnostic accuracy for evaluating parametrial involvement after neoadjuvant chemotherapy, achieving a sensitivity of 100% post-treatment.

The agreement between ultrasound and MRI in identifying parametrial infiltration was strong, with a concordance rate of 90% after chemotherapy, suggesting that TV-US could be a reliable method for assessing treatment response and could be integrated into preoperative evaluations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of Parametrial Status in Locally Advanced Cervical Cancer Patients after Neoadjuvant Chemotherapy: A Prospective Study on Diagnostic Accuracy of Three-Dimensional Transvaginal Ultrasound. Perniola, G., Fischetti, M., Tomao, F., et al.[2020]

In a study of 39 patients with stage IB and II cervical cancer, contrast-enhanced ultrasonography (CEUS) significantly improved the accuracy of tumor size evaluation compared to conventional transabdominal ultrasonography (TA-US), with reliability scores indicating a strong correlation with post-operative pathology.

The combination of transrectal ultrasonography (TR-US) and CEUS provided the highest consistency in tumor staging, comparable to magnetic resonance imaging (MRI), making it a valuable tool for assessing cervical cancer staging.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contrast-Enhanced Ultrasonography for Transabdominal and Transrectal Ultrasound in Staging Cervical Cancer: A Reliability Study. Zhang, J., Xiang, JD., Jia, C., et al.[2023]

Contrast-enhanced ultrasound (CEUS) using Sonazoid significantly improved the accuracy of diagnosing focal breast lesions compared to unenhanced ultrasound, with an accuracy rate of 87.2% versus 65.5%.

CEUS also demonstrated higher specificity than both unenhanced ultrasound and contrast-enhanced MRI, while maintaining a low incidence of mild adverse reactions (3.3%), indicating it is a safe and effective diagnostic tool.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of sonazoid (perflubutane) for contrast-enhanced ultrasound in the differentiation of focal breast lesions: phase 3 multicenter clinical trial. Miyamoto, Y., Ito, T., Takada, E., et al.[2016]

In a study of 31 patients with focal nodular hyperplasia (FNH) of the liver, contrast-enhanced ultrasonography (CEUS) using Sonazoid revealed characteristic vascular patterns, including central artery and stellate vascularity in 77.4% of lesions.

Most lesions (93.5%) remained either hyperechoic or isoechoic during the Kupffer phase, indicating that CEUS can effectively aid in the noninvasive diagnosis of FNH.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Focal Nodular Hyperplasia of the Liver: Contrast-Enhanced Ultrasonographic Features With Sonazoid. Lee, J., Jeong, WK., Lim, HK., et al.[2022]

Using Sonazoid for contrast-enhanced ultrasonography (CEUS) significantly improves the detection of hepatocellular carcinoma (HCC) in patients with liver cirrhosis, leading to an increase in life expectancy by 1.99 quality-adjusted life-years (QALY).

CEUS surveillance is cost-effective, with an incremental cost-effectiveness ratio (ICER) of $18,384 per QALY, which is below the commonly accepted threshold of $50,000/QALY, making it a viable option for HCC surveillance globally.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cost-effectiveness analysis on the surveillance for hepatocellular carcinoma in liver cirrhosis patients using contrast-enhanced ultrasonography. Tanaka, H., Iijima, H., Nouso, K., et al.[2020]

In an animal study with 6 beagle dogs, the ultrasound contrast agent Sonazoid demonstrated a dose-dependent increase in acoustic intensity in brain tissue, indicating its effectiveness for visualizing brain perfusion.

Sonazoid provided a more uniform contrast enhancement in gray-scale harmonic imaging compared to harmonic power Doppler imaging, although it also caused some signal attenuation in deeper brain regions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Harmonic imaging of the brain parenchyma in a dog model following NC100100 (Sonazoid) bolus injection. Meyer, K., Seidel, G., Algermissen, C.[2019]

Contrast enhanced ultrasonography (CEUS) using Sonazoid demonstrated diagnostic efficacy for detecting hepatic metastasis that is comparable to 18-fluoro-2-deoxyglucose (FDG) PET/CT, with both methods showing 100% sensitivity.

In a study involving 109 patients with gastrointestinal tract cancer, CEUS and PET/CT had similar specificity and accuracy rates, indicating that CEUS is a viable alternative for diagnosing liver metastases.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Diagnostic value of sonazoid for hepatic metastasis: comparison with FDG PET/CT. Hiraoka, A., Kume, M., Miyagawa, M., et al.[2016]

In a study of 49 women with cervical cancer and 21 healthy controls, contrast-enhanced ultrasonography (CEUS) showed a significant difference in contrast distribution, with 89% of women with tumors exhibiting focal contrast compared to only 3% of healthy participants.

Semi-quantitative analysis of CEUS parameters demonstrated high accuracy in distinguishing tumors from healthy tissue, with area under the curve (AUC) values of 0.92 and 0.94 for total contrast and maximal intensity, respectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Pilot Study on Diagnostic Performance of Contrast-Enhanced Ultrasonography for Detection of Early Cervical Cancer. Pálsdóttir, K., Epstein, E.[2019]

In a study of 108 patients with cervical cancer, contrast-enhanced ultrasound (CEUS) showed strong correlation with MRI in measuring tumor size and assessing local invasion, indicating it is a reliable alternative for evaluation.

CEUS is a less expensive and non-invasive method for assessing tumor size and invasion in cervical cancer, demonstrating good concordance with MRI for detecting invasions to surrounding structures.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contrast-enhanced ultrasonography vs MRI for evaluation of local invasion by cervical cancer. Zheng, W., Chen, K., Peng, C., et al.[2020]

References

1. Ireland pubmed.ncbi.nlm.nih.gov

Can quantitative contrast-enhanced ultrasonography predict cervical tumor response to neoadjuvant chemotherapy? [2018]

2. Romania pubmed.ncbi.nlm.nih.gov

Multimodal endocavitary ultrasound versus MRI and clinical findings in pre- and post-treatment advanced cervical cancer. Preliminary report. [2018]

3. England pubmed.ncbi.nlm.nih.gov

PRospective Imaging of CErvical cancer and neoadjuvant treatment (PRICE) study: role of ultrasound to assess residual tumor in locally advanced cervical cancer patients undergoing chemoradiation and radical surgery. [2018]

4. Switzerland pubmed.ncbi.nlm.nih.gov

Evaluation of Parametrial Status in Locally Advanced Cervical Cancer Patients after Neoadjuvant Chemotherapy: A Prospective Study on Diagnostic Accuracy of Three-Dimensional Transvaginal Ultrasound. [2020]

5. England pubmed.ncbi.nlm.nih.gov

Contrast-Enhanced Ultrasonography for Transabdominal and Transrectal Ultrasound in Staging Cervical Cancer: A Reliability Study. [2023]

6. United States pubmed.ncbi.nlm.nih.gov

Efficacy of sonazoid (perflubutane) for contrast-enhanced ultrasound in the differentiation of focal breast lesions: phase 3 multicenter clinical trial. [2016]

7. England pubmed.ncbi.nlm.nih.gov

Focal Nodular Hyperplasia of the Liver: Contrast-Enhanced Ultrasonographic Features With Sonazoid. [2022]

8. Netherlands pubmed.ncbi.nlm.nih.gov

Cost-effectiveness analysis on the surveillance for hepatocellular carcinoma in liver cirrhosis patients using contrast-enhanced ultrasonography. [2020]

9. United States pubmed.ncbi.nlm.nih.gov

Harmonic imaging of the brain parenchyma in a dog model following NC100100 (Sonazoid) bolus injection. [2019]

10. Greece pubmed.ncbi.nlm.nih.gov

Diagnostic value of sonazoid for hepatic metastasis: comparison with FDG PET/CT. [2016]

11. England pubmed.ncbi.nlm.nih.gov

A Pilot Study on Diagnostic Performance of Contrast-Enhanced Ultrasonography for Detection of Early Cervical Cancer. [2019]

12. England pubmed.ncbi.nlm.nih.gov

Contrast-enhanced ultrasonography vs MRI for evaluation of local invasion by cervical cancer. [2020]