Fluorescent Imaging Helps Identify Lung Cancer Lesions During Surgery

A tumor-highlighting technology called OTL38 enhances the visualization of lung cancer tissue through near-infrared imaging, providing surgeons with a significantly better chance of finding and removing more cancer than previously possible. The results of a phase 2 clinical trial for OTL38 were presented at the 56th Annual Meeting of The Society of Thoracic Surgeons, Jan. 25-28, 2020, in New Orleans. Six institutions participated in the trial — the University of Pittsburgh, the University of Pennsylvania, Harvard University, Cleveland Clinic, Leiden University, and the University of Texas MD Anderson Cancer Center.

OTL38 is composed of near-infrared dye and a targeting molecule. The molecule attaches to folic-acid-based receptors on cancer cells and can be illuminated during surgery using a special endoscope to guide surgeons in identifying the precise location of tumor tissue. In a phase 2 clinical trial, researchers determined that the OTL38 molecular imaging tool helped improve surgical outcomes for 26% of the 92 patients who participated in the trial — about one in four patients.

Surgeons traditionally use x-rays, MRIs, CT scans, PET scans, and/or ultrasound to determine the size and location of tumors before surgery. These imaging modalities are rarely used during surgery. OTL38 is believed to be the first targeted fluorescent marker to detect cancerous tissue not previously identified on preoperative scans and do so in real time, while the surgeon is operating, and to provide this type of benefit for lung cancer.

Research has shown that 30% to 55% of patients with nonsmall cell lung cancer (NSCLC) develop recurrence after surgery, which often is caused by microscopic clusters of cancer cells that were undetected by standard staging methods. “Use of advanced near-infrared imaging techniques such as OTL38 may provide surgeons with powerful tools to improve the quality of lung cancer operations by better identifying small, hard-to-find tumors, finding previously undetected cancers at the time of surgery, and better assessing if the entire tumor has been removed,” said Inderpal (Netu) S. Sarkaria, MD, from the University of Pittsburgh Medical Center.

The completion of the OTL38 phase 2 trial in lung cancer advances the technology closer to FDA approval and commercialization. Phase 3 trials are underway.

This press conference took place Jan. 27, 2020, at the STS 56th Annual Meeting in New Orleans. Courtesy of The Society of Thoracic Surgeons.