title: First-in-Human Ultrasound Molecular Imaging With a VEGFR2-Specific Ultrasound Molecular Contrast Agent (BR55) in Prostate Cancer: A Safety and Feasibility Pilot Study.
abstract: BR55, a vascular endothelial growth factor receptor 2 (VEGFR2)-specific ultrasound molecular contrast agent (MCA), has shown promising results in multiple preclinical models regarding cancer imaging. In this first-in-human, phase 0, exploratory study, we investigated the feasibility and safety of the MCA for the detection of prostate cancer (PCa) in men using clinical standard technology.
  
  
  
  Imaging with the MCA was performed in 24 patients with biopsy-proven PCa scheduled for radical prostatectomy using a clinical ultrasound scanner at low acoustic power. Safety monitoring was done by physical examination, blood pressure and heart rate measurements, electrocardiogram, and blood sampling. As first-in-human study, MCA dosing and imaging protocol were necessarily fine-tuned along the enrollment to improve visualization. Imaging data were correlated with radical prostatectomy histopathology to analyze the detection rate of ultrasound molecular imaging with the MCA.
  
  
  
  Imaging with MCA doses of 0.03 and 0.05 mL/kg was adequate to obtain contrast enhancement images up to 30 minutes after administration. No serious adverse events or clinically meaningful changes in safety monitoring data were identified during or after administration. BR55 dosing and imaging were fine-tuned in the first 12 patients leading to 12 subsequent patients with an improved MCA dosing and imaging protocol. Twenty-three patients underwent radical prostatectomy. A total of 52 lesions were determined to be malignant by histopathology with 26 (50%) of them seen during BR55 imaging. In the 11 patients that were scanned with the improved protocol and underwent radical prostatectomy, a total of 28 malignant lesions were determined: 19 (68%) were seen during BR55 ultrasound molecular imaging, whereas 9 (32%) were not identified.
  
  
  
  Ultrasound molecular imaging with BR55 is feasible with clinical standard technology and demonstrated a good safety profile. Detectable levels of the MCA can be reached in patients with PCa opening the way for further clinical trials.
authors.affiliation: From the *Department of Urology, Academic Medical Center, Amsterdam, the Netherlands; †Bracco Suisse SA, Geneva Research Centre and Manufacturing Site, Plan-les-Ouates, Switzerland; ‡Advice-US Consulting, Nernier, France; and §Department of Pathology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Martijn
authors.initials: M
authors.lastname: Smeenge
authors.forename: François
authors.initials: F
authors.lastname: Tranquart
authors.forename: Christophe K
authors.initials: CK
authors.lastname: Mannaerts
authors.forename: Theo M
authors.initials: TM
authors.lastname: de Reijke
authors.forename: Marc J
authors.initials: MJ
authors.lastname: van de Vijver
authors.forename: M Pilar
authors.initials: MP
authors.lastname: Laguna
authors.forename: Sibylle
authors.initials: S
authors.lastname: Pochon
authors.forename: Jean J M C H
authors.initials: JJMCH
authors.lastname: de la Rosette
authors.forename: Hessel
authors.initials: H
authors.lastname: Wijkstra
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D005240:Feasibility Studies; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D015203:Reproducibility of Results; D014463:Ultrasonography / Q000379:methods*; D042461:Vascular Endothelial Growth Factor A; D040301:Vascular Endothelial Growth Factor Receptor-2
chemical_list: D003287:Contrast Media; D042461:Vascular Endothelial Growth Factor A; C000588866:KDR protein, human; D040301:Vascular Endothelial Growth Factor Receptor-2