MRI + Biomarkers for Throat Cancer

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University Health Network, Toronto

Disqualifiers: Systemic disease, Previous tumor, Pregnancy, others

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

Compensation: Varies

Number of Visits: 4

60 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores new methods to study throat cancer using MRIs and the experimental drug pimonidazole. It aims to develop better markers to understand cancer in patients newly diagnosed with head and neck squamous cell carcinoma who are receiving curative treatment. Participants are divided into two groups: one undergoes an MRI and biopsy before and during radiation therapy, while the other receives an MRI right before surgery. This trial suits individuals with throat cancer who have a tumor larger than 3 cm and are scheduled for surgery or radiotherapy. As an unphased trial, it offers a unique opportunity to contribute to groundbreaking research that could enhance future cancer treatments.

Do I need to stop my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial team or your doctor.

What prior data suggests that MRI and oral pimonidazole are safe for use in this study?

Research shows that MRIs safely examine the body's interior. Unlike X-rays, MRIs do not use radiation, making them a painless and low-risk option for people of all ages.

Oral pimonidazole has been studied for its ability to identify low-oxygen areas in tumors. Although usually administered intravenously, animal studies have shown it can also be taken orally. However, detailed information about side effects in humans is not widely available.

This trial is in a "Not Applicable" phase, which might mean less detailed safety data. However, MRI is widely considered safe, and pimonidazole has been studied in different forms. Always consult a doctor to ensure it is appropriate. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it combines MRI technology with biomarkers like oral pimonidazole to potentially improve how throat cancer is diagnosed and monitored. Unlike traditional methods, which might rely solely on imaging or physical exams, this approach uses advanced imaging alongside a special compound to highlight low-oxygen areas in tumors, which can be more aggressive. This could help doctors tailor treatments more precisely and track how well a tumor is responding to therapy in real-time, potentially leading to more personalized and effective care for patients.

What evidence suggests that this trial's treatments could be effective for throat cancer?

Research has shown that MRI scans can help predict outcomes for patients with head and neck squamous cell carcinoma (HNSCC). Studies indicate that MRI can forecast overall survival and the likelihood of cancer recurrence. This information enables doctors to customize treatments more effectively. In this trial, participants in Cohort A will undergo MRI scans before and during radiotherapy, while those in Cohort B will have an MRI scan before surgery.

Studies have found that oral pimonidazole can detect low-oxygen areas in tumors, which are often more difficult to treat. This detection helps doctors understand tumor behavior and may predict how well a patient will respond to treatment. Participants in both Cohort A and Cohort B will take oral pimonidazole before their respective procedures. Both MRI and pimonidazole provide important insights that can guide treatment decisions for throat cancer. ^{6 7 8 9 10}

Are You a Good Fit for This Trial?

This trial is for adults over 18 with a confirmed diagnosis of Head and Neck Squamous Cell Carcinoma, who can lie on their back for an hour and are set to receive curative therapy. They must be able to understand the study details and consent, have decent kidney function, and not have had another solid tumor treated in the last five years or any condition that would exclude them from MRI scans.

Inclusion Criteria

You are able to comprehend both verbal and written instructions relating to the study, as well as provide a signed agreement of consent.

I am willing to have more MRI scans.

My kidneys work well enough (creatinine clearance is 30ml/min or more).

Exclusion Criteria

I was treated for a solid tumor within the last 5 years.

As judged by investigator evidence of systemic disease that makes unsuitable for study

Contra-indication for serial MRI scans

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline Assessment

Participants undergo a baseline fMRI scan and biopsy of the primary tumor

1 week

1 visit (in-person)

Radiotherapy (Cohort A)

Participants receive radiotherapy with biopsies and fMRI scans at week 2 and optionally at week 4

4 weeks

2-3 visits (in-person)

Surgery (Cohort B)

Participants undergo surgery with MRI scan within one week prior and tumor tissue collection

1 week

1 visit (in-person)

Follow-up

Participants are monitored for changes in fMRI and tumor microenvironment biomarkers

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Head and Neck MRI
• Oral Pimonidazole

Trial Overview

The HN-BIO study is testing how well functional MRI (fMRI) imaging combined with a drug called Oral Pimonidazole works as biomarkers in patients undergoing treatment for head and neck cancer. The goal is to improve understanding of the tumor environment which could lead to better treatments.

How Is the Trial Designed?

Group I: Cohort B Experimental Treatment 2 Interventions

Participants who are to receive standard of care curative surgery will have an MRI scan within one week prior to surgery. Tumor tissue from the surgery will also be collected for research. Oral pimonidazole will be taken the night before surgery.

Group II: Cohort A Experimental Treatment 2 Interventions

Participants who are to receive standard of care radiotherapy will have one biopsy and MRI scan before starting radiotherapy and during week two of radiotherapy. Participants will also have an the option to consent to an additional biopsy and MRI scan during week 4 of radiotherapy. Oral pimonidazole will be taken the night before each biopsy.

Who Is Running the Clinical Trial?

University Health Network, Toronto

Lead Sponsor

Trials

1,555

Recruited

526,000+

Published Research Related to This Trial

The article focuses on MR imaging for head and neck tumors, providing insights into imaging techniques and their relevance in clinical practice.

The authors clarify that the study is not associated with the two National Institutes of Health grants that were mistakenly referenced, ensuring accurate attribution of funding sources.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Correction to: Differentiation of Malignant and Benign Head and Neck Tumors with Amide Proton Transfer-Weighted MR Imaging. Yu, L., Li, C., Luo, X., et al.[2020]

The administration of technetium-99m BRU 59-21 in ten head and neck cancer patients was found to be safe, with only mild adverse events reported, indicating its potential for clinical use.

The uptake of this novel hypoxic marker correlated significantly with pimonidazole staining, suggesting that it effectively identifies tumor hypoxia, which is important for understanding tumor behavior and treatment response.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Phase 1 study to identify tumour hypoxia in patients with head and neck cancer using technetium-99m BRU 59-21. Hoebers, FJ., Janssen, HL., Olmos, AV., et al.[2016]

Dynamic magnetic resonance (MR) imaging was performed on 79 head and neck lesions, but it did not improve the sensitivity for detecting malignancy compared to traditional imaging methods.

While dynamic imaging did not effectively differentiate between benign and malignant lesions, it may help in assessing vascularity and recurrence risk, particularly for lesions with specific signal intensity curve patterns.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dynamic MR imaging in the head and neck. Takashima, S., Noguchi, Y., Okumura, T., et al.[2015]

Magnetic resonance imaging (MRI) is essential for evaluating head and neck tumors, providing detailed anatomical information crucial for diagnosing and staging both primary tumors and lymph node metastases.

Advanced MRI techniques, including diffusion and perfusion imaging, offer insights into the biological and physiological characteristics of tumors, helping to identify imaging biomarkers that can inform treatment response and disease follow-up.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Advanced magnetic resonance imaging techniques for tumors of the head and neck. Santos Armentia, E., Martín Noguerol, T., Suárez Vega, V.[2021]

The study found that the average hypoxic fraction (pHF) in FaDu tumours was about 12%, indicating a significant level of hypoxia, which is important because hypoxic cells are more resistant to radiation therapy.

However, the variability in pHF alone could not fully explain the differences in how these tumours responded to radiation, suggesting that other factors, such as clonogen density, need to be considered to better predict treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Does heterogeneity of pimonidazole labelling correspond to the heterogeneity of radiation-response of FaDu human squamous cell carcinoma? Yaromina, A., Hölscher, T., Eicheler, W., et al.[2015]

In a study involving 20 patients with untreated locally advanced head and neck cancer, 18F-FMISO-PET scans taken at 2 hours post-injection showed a high correlation with those taken at 4 hours, indicating that earlier imaging can provide reliable data.

The results suggest that the total examination time for FMISO-PET can be reduced by omitting the 4-hour scan without losing important quantitative information, which could improve patient comfort and efficiency in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of Optimal Post-Injection Timing of Hypoxic Imaging with 18F-Fluoromisonidazole-PET/CT. Kawamura, M., Yoshimura, M., Shimizu, Y., et al.[2022]

Dynamic contrast-enhanced MRI successfully distinguished between tumor and nontumor nodes in the cervical lymph nodes of 21 patients with squamous cell carcinoma, highlighting its potential as a diagnostic tool.

The study identified significant differences in contrast enhancement parameters between tumor and nontumor nodes, suggesting that dynamic imaging can effectively aid in the assessment of cervical lymph node involvement in head and neck cancers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Challenges in dynamic contrast-enhanced MRI imaging of cervical lymph nodes to detect metastatic disease. Noworolski, SM., Fischbein, NJ., Kaplan, MJ., et al.[2019]

In a study of 17 patients with untreated head and neck squamous cell carcinoma (HNSCC), [(18)F]FMISO-PET imaging was used to assess tumor hypoxia, revealing that high uptake of [(18)F]FMISO was associated with significantly lower local control rates and disease-specific survival rates after treatment.

The results suggest that [(18)F]FMISO-PET can be a useful tool for predicting treatment outcomes in HNSCC, indicating that tumors with high hypoxia may respond poorly to radiotherapy or surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

18F-fluoromisonidazole positron emission tomography before treatment is a predictor of radiotherapy outcome and survival prognosis in patients with head and neck squamous cell carcinoma. Kikuchi, M., Yamane, T., Shinohara, S., et al.[2022]

In a study of 28 locoregionally advanced head-and-neck cancer patients treated with platinum-based chemotherapy and intensity-modulated radiotherapy, excellent locoregional control was achieved despite 90% showing detectable hypoxia on pretreatment PET scans.

The presence or absence of hypoxia, as indicated by mid-treatment PET scans, did not correlate with patient outcomes, suggesting that hypoxia may not be a reliable predictor of treatment success in this context.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prospective trial incorporating pre-/mid-treatment [18F]-misonidazole positron emission tomography for head-and-neck cancer patients undergoing concurrent chemoradiotherapy. Lee, N., Nehmeh, S., Schöder, H., et al.[2022]

Magnetic resonance imaging (MRI) is highly effective in predicting the resectability of head and neck tumors near the carotid arteries, achieving 100% sensitivity for identifying unresectable cases.

The study, which included 49 patients, found that tumors involving more than 270 degrees of the carotid artery are likely unresectable, while those involving 270 degrees or less can typically be surgically removed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Carotid artery invasion by head and neck masses: prediction with MR imaging. Yousem, DM., Hatabu, H., Hurst, RW., et al.[2004]

Oral administration of pimonidazole HCl is effective for detecting hypoxia in tumors, showing similar binding efficacy to intravenous administration in a study involving 12 dogs with cancer.

Pimonidazole binding was consistently higher than that of the control marker CCI-103F, indicating its potential as a superior hypoxia marker, particularly in regions with higher pH levels.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison of oral and intravenous pimonidazole in canine tumors using intravenous CCI-103F as a control hypoxia marker. Kleiter, MM., Thrall, DE., Malarkey, DE., et al.[2016]

A prospective feasibility study was conducted to evaluate the use of ferumoxytol as a contrast agent for dynamic contrast-enhanced MRI in patients with node-positive head and neck squamous cell carcinomas (HNSCC) or melanoma, involving five enrolled patients.

The study was prematurely terminated due to an FDA black box warning, but it aimed to provide valuable clinical and imaging data for future research in molecular imaging despite the early halt.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Data from a terminated study on iron oxide nanoparticle magnetic resonance imaging for head and neck tumors. Elhalawani, H., Awan, MJ., Ding, Y., et al.[2021]

The newly developed hypoxia tracer [(18)F]FPIMO showed strong hypoxia-driven retention in tumor cells, achieving impressive retention ratios compared to established tracers, indicating its potential for assessing tumor hypoxia.

Despite its promising retention in vitro, [(18)F]FPIMO demonstrated lower absolute tumor signal and contrast in PET imaging compared to the established tracer [(18)F]FAZA, primarily due to rapid metabolism and high accumulation in liver and kidneys.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

PET imaging of tumor hypoxia using 18F-labeled pimonidazole. Busk, M., Jakobsen, S., Horsman, MR., et al.[2016]

Citations

1.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC1805057/

Head and neck cancer: how imaging predicts treatment ...

Pretreatment imaging findings have predictive value for patient outcome, independently from the currently used TNM classification, and may be used to tailor ...

2.

sciencedirect.com

sciencedirect.com/science/article/pii/S2405631625000648

Improving outcome prediction in oropharyngeal carcinoma ...

Outcome prediction of head and neck squamous cell carcinoma by MRI ... MRI-directed Adaptive radiation boost in poor prognosis head and neck cancer.

3.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC7554007/

Outcome prediction of head and neck squamous cell ...

MRI radiomics can predict overall survival and relapse-free survival in oral and HPV-negative oropharyngeal cancer. • MRI radiomics provides additional ...

4.

ascopubs.org

ascopubs.org/doi/10.1200/EDBK_389718

Personalizing Surveillance in Head and Neck Cancer

MRI with contrast has superior soft-tissue resolution, particularly when malignancy involves the intracranial structures, skull base, orbit, ...

5.

cancerimagingarchive.net

cancerimagingarchive.net/collection/hnscc/

HNSCC - The Cancer Imaging Archive (TCIA)

This collection contains imaging, radiation therapy, and clinical data from 627 head and neck squamous cell carcinoma (HNSCC) patients at MD Anderson Cancer ...

6.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC7701930/

The role of imaging in head and neck cancer

In this work, we present an overview of main modalities of imaging and principles of their application especially in head and neck cancer.

7.

myssmi.com

myssmi.com/blog/what-to-expect-during-a-head-neck-mri-a-complete-patient-guide

What to Expect During a Head & Neck MRI

Unlike X-rays or CT scans magnetic resonance imaging (MRI) does not use radiation, making it a safe and painless option for patients of all ages ...

8.

asha.org

asha.org/practice-portal/clinical-topics/head-and-neck-cancer/?srsltid=AfmBOooq0HApUGhzmbkgL3zskX-bfJ6MaMSK9g7spmWbWeFIeEz_8oX6

Head and Neck Cancer

Head and neck cancer includes malignant tumors that most commonly arise from the moist squamous cell mucosa or lining of the head and neck regions.

9.

mayoclinic.org

mayoclinic.org/tests-procedures/mri/about/pac-20384768

MRI

MRI is a noninvasive way for a medical professional to examine your organs, tissues and skeletal system. It produces high-resolution images of the inside of ...

10.

radiologyinfo.org

radiologyinfo.org/en/info/head-neck-cancer

Head and Neck Cancers

Current and accurate information for patients about head and neck cancer. Learn how doctors diagnose, evaluate and treat these cancers.