TY - JOUR
T1 - Comparative evaluation of [99mTc]tilmanocept for sentinel lymph node mapping in breast cancer patients
T2 - Results of two phase 3 trials
AU - Wallace, Anne M.
AU - Han, Linda K.
AU - Povoski, Stephen P.
AU - Deck, Kenneth
AU - Schneebaum, Schlomo
AU - Hall, Nathan C.
AU - Hoh, Carl K.
AU - Limmer, Karl K.
AU - Krontiras, Helen
AU - Frazier, Thomas G.
AU - Cox, Charles
AU - Avisar, Eli
AU - Faries, Mark
AU - King, Dennis W.
AU - Christman, Lori
AU - Vera, David R.
N1 - Funding Information:
ACKNOWLEDGMENT The clinical trials described herein were supported by Navidea Biopharmaceuticals (Dublin, OH). Other contributors of study patients include Barbara A. Michna, MD, of the Alabama Center for Medical Research, Alabama City, AL, and Alice P. Chung, MD, of the John Wayne Cancer Institute, Santa Monica, CA.
PY - 2013/8
Y1 - 2013/8
N2 - Background: Sentinel lymph node (SLN) surgery is used worldwide for staging breast cancer patients and helps limit axillary lymph node dissection. [ 99mTc]Tilmanocept is a novel receptor-targeted radiopharmaceutical evaluated in 2 open-label, nonrandomized, within-patient, phase 3 trials designed to assess the lymphatic mapping performance. Methods: A total of 13 centers contributed 148 patients with breast cancer. Each patient received [99mTc]tilmanocept and vital blue dye (VBD). Lymph nodes identified intraoperatively as radioactive and/or blue stained were excised and histologically examined. The primary endpoint, concordance (lower boundary set point at 90 %), was the proportion of nodes detected by VBD and [ 99mTc]tilmanocept. Results: A total of 13 centers contributed 148 patients who were injected with both agents. Intraoperatively, 207 of 209 nodes detected by VBD were also detected by [99mTc]tilmanocept for a concordance rate of 99.04 % (p < 0.0001). [99mTc]tilmanocept detected a total of 320 nodes, of which 207 (64.7 %) were detected by VBD. [99mTc]Tilmanocept detected at least 1 SLN in more patients (146) than did VBD (131, p < 0.0001). In 129 of 131 patients with ≥1 blue node, all blue nodes were radioactive. Of 33 pathology-positive nodes (18.2 % patient pathology rate), [99mTc]tilmanocept detected 31 of 33, whereas VBD detected only 25 of 33 (p = 0.0312). No pathology-positive SLNs were detected exclusively by VBD. No serious adverse events were attributed to [ 99mTc]tilmanocept. Conclusion: [99mTc]Tilmanocept demonstrated success in detecting a SLN while meeting the primary endpoint. Interestingly, [99mTc]tilmanocept was additionally noted to identify more SLNs in more patients. This localization represented a higher number of metastatic breast cancer lymph nodes than that of VBD.
AB - Background: Sentinel lymph node (SLN) surgery is used worldwide for staging breast cancer patients and helps limit axillary lymph node dissection. [ 99mTc]Tilmanocept is a novel receptor-targeted radiopharmaceutical evaluated in 2 open-label, nonrandomized, within-patient, phase 3 trials designed to assess the lymphatic mapping performance. Methods: A total of 13 centers contributed 148 patients with breast cancer. Each patient received [99mTc]tilmanocept and vital blue dye (VBD). Lymph nodes identified intraoperatively as radioactive and/or blue stained were excised and histologically examined. The primary endpoint, concordance (lower boundary set point at 90 %), was the proportion of nodes detected by VBD and [ 99mTc]tilmanocept. Results: A total of 13 centers contributed 148 patients who were injected with both agents. Intraoperatively, 207 of 209 nodes detected by VBD were also detected by [99mTc]tilmanocept for a concordance rate of 99.04 % (p < 0.0001). [99mTc]tilmanocept detected a total of 320 nodes, of which 207 (64.7 %) were detected by VBD. [99mTc]Tilmanocept detected at least 1 SLN in more patients (146) than did VBD (131, p < 0.0001). In 129 of 131 patients with ≥1 blue node, all blue nodes were radioactive. Of 33 pathology-positive nodes (18.2 % patient pathology rate), [99mTc]tilmanocept detected 31 of 33, whereas VBD detected only 25 of 33 (p = 0.0312). No pathology-positive SLNs were detected exclusively by VBD. No serious adverse events were attributed to [ 99mTc]tilmanocept. Conclusion: [99mTc]Tilmanocept demonstrated success in detecting a SLN while meeting the primary endpoint. Interestingly, [99mTc]tilmanocept was additionally noted to identify more SLNs in more patients. This localization represented a higher number of metastatic breast cancer lymph nodes than that of VBD.
UR - http://www.scopus.com/inward/record.url?scp=84880300454&partnerID=8YFLogxK
U2 - 10.1245/s10434-013-2887-8
DO - 10.1245/s10434-013-2887-8
M3 - Article
C2 - 23504141
AN - SCOPUS:84880300454
SN - 1068-9265
VL - 20
SP - 2590
EP - 2599
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 8
ER -