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CompletedNCT03824535Updated Apr 9, 2025Results posted

18F-FSPG PET/CT in Diagnosing Early Lung Cancer in Patients With Lung Nodules

A Phase 2 interventional study of Computed Tomography and Fludeoxyglucose F-18 in Cigarette Smoker, Current Smoker and Former Smoker, sponsored by Andrei Iagaru. Completed at 1 site in United States. Open to participants aged 45 Years and older. Per ClinicalTrials.gov, last updated 2025-04-09.

Sponsored by Andrei Iagaru · Phase 2, Interventional, and Diagnostic

Phase
Phase 2
Study type
Interventional
Enrollment
15
Allocation
Not applicable
Ages
45 Years and older
Sex
All
01

Study summary

This phase II trial studies how well 18F-FSPG positron emission tomography (PET)/computed tomography (CT) work in diagnosing early lung cancer in patients with indeterminate lung nodules. PET imaging with an imaging agent called 18F-FDG is often used in combination with a PET/CT scanner to evaluate cancers. Giving 18F-FSPG before a PET/CT scan may work better in helping researchers diagnose early lung cancer in patients with lung nodules.

Read the detailed description

PRIMARY OBJECTIVES:

I. Comparison of fluorine F 18 L-glutamate derivative BAY94-9392 (18F-FSPG) accumulation with fludeoxyglucose F-18 (18F-FDG) accumulation to assess whether (4S)-4-(3-18F-Fluoropropyl)-L-Glutamate (18F-FSPG)-PET is better at discriminating between benign and malignant nodules.

SECONDARY OBJECTIVES:

I. To develop and validate early lung cancer detection biomarkers that would directly impact the growing need to integrate imaging and non-invasive molecular diagnostics for indeterminate pulmonary nodules and allow physicians to avoid unnecessary invasive procedures in patients with benign lung disease.

OUTLINE:

Patients receive 18F-FSPG intravenously (IV) and, undergo a PET/CT scan over 30-60 minutes. Within 24 hours-14 days, patients receive 18F-FDG and undergo a second PET/CT scan over 30-60 minutes.

After completion of study, patients are followed up within 24-72 hours.

02

Conditions studied

  • Cigarette Smoker
  • Current Smoker
  • Former Smoker
  • Multiple Pulmonary Nodules
  • Pulmonary Nodule

Keywords

  • Indeterminate lung nodule
03

Who can participate

Ages eligible
45 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Pulmonary nodule between the size of 7 to 30 mm. Subjects with multiple nodules may be eligible if the dominant nodule is 7 to 30 mm
  • Undergoing standard of care 18F-FDG PET imaging (for indeterminate pulmonary nodule)
  • Current or former cigarette smoker, with >= 20 pack years
  • Documented informed consent

Exclusion criteria

Exclusion Criteria:

  • History or previous diagnosis of lung cancer
  • Cancer diagnosis within the last 5 years
  • Pregnant or nursing
04

Study design

Phase
Phase 2
Primary purpose
Diagnostic
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
15 participants (actual)

Study arms

  • Experimental
    Diagnostic (18F-FSPG PET/CT, 18F-FDG PET/CT)

    Patients receive 18F-FSPG IV and, undergo a PET/CT scan over 30-60 minutes. Within 24 hours-14 days, patients receive 18F-FDG IV and undergo a second PET/CT scan over 30-60 minutes.

    Diagnostic Test: Computed Tomography · Drug: Fludeoxyglucose F-18 · Drug: Fluorine F 18 L-glutamate Derivative BAY94-9392 · Diagnostic Test: Positron Emission Tomography (PET/CT)

Interventions

  • Diagnostic testComputed Tomography

    Undergo PET/CT

    Also known as: CAT, CAT Scan, Computerized Axial Tomography, computerized tomography, CT, CT SCAN, tomography

  • DrugFludeoxyglucose F-18

    Given IV

    Also known as: 18-FDG, FDG, fludeoxyglucose F 18, Fludeoxyglucose F18, Fluorine-18 2-Fluoro-2-deoxy-D-Glucose, Fluorodeoxyglucose F18

  • DrugFluorine F 18 L-glutamate Derivative BAY94-9392

    Given IV

    Also known as: (S)-4-(3-18F-fluoropropyl)-L-glutamic Acid, 18F-FSPG, BAY94-9392

  • Diagnostic testPositron Emission Tomography (PET/CT)

    Undergo PET/CT

    Also known as: Positron Emission Tomography/computer tomography, CT Scan, PET Scan, Positron Emission Tomography, medical imaging

05

What researchers measure

Primary outcomes

  1. Diagnostic Performance Metrics (Sensitivity, Specificity, PPV, NPV, and Accuracy) of Ultrasonography and Capnography for Malignant Lung Nodules

    The diagnostic performance of ultrasonography and capnography in detecting malignant lung nodules was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Sensitivity and specificity were calculated to determine the ability to correctly identify malignant and non-malignant nodules, respectively. Results were compared to a predefined threshold of 75%, with all percentages reported as proportions of the total number of nodules analyzed. Confidence intervals were calculated for each metric to ensure precision and reliability in the estimates.

    Time frame: Through study completion, an average of 2 years and 6 months

Secondary outcomes

  1. Improvement in Predictive Accuracy of Lung Nodule Diagnosis Using the C Statistic (Area Under the Curve, AUC)

    The predictive accuracy of the lung nodule diagnosis model was assessed using the C statistic, also referred to as the area under the receiver operating characteristic (ROC) curve (AUC). Improved performance was defined as a statistically significant increase (p \< 0.05) in the C statistic, determined using the DeLong test for comparing correlated ROC curves. The Mann-Whitney U test was also used to compare the distributions of the C statistic between diagnostic methods. Results are reported as the mean C statistic with 95% confidence intervals for each diagnostic method.

    Time frame: Through study completion, an average of 2 years and 6 months

06

Results

Posted Apr 9, 2025

Participant flow

Participant flow — Overall Study
MilestoneDiagnostic (18F-FSPG PET/CT, 18F-FDG PET/CT)
Started15
Completed15
Not completed0

Outcome measures

PrimaryDiagnostic Performance Metrics (Sensitivity, Specificity, PPV, NPV, and Accuracy) of Ultrasonography and Capnography for Malignant Lung Nodules

The diagnostic performance of ultrasonography and capnography in detecting malignant lung nodules was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Sensitivity and specificity were calculated to determine the ability to correctly identify malignant and non-malignant nodules, respectively. Results were compared to a predefined threshold of 75%, with all percentages reported as proportions of the total number of nodules analyzed. Confidence intervals were calculated for each metric to ensure precision and reliability in the estimates.

Time frame:
Through study completion, an average of 2 years and 6 months
Reported as:
Number · percentage
Diagnostic Performance Metrics (Sensitivity, Specificity, PPV, NPV, and Accuracy) of Ultrasonography and Capnography for Malignant Lung Nodules
percentageDiagnostic (18F-FSPG PET/CT)Diagnostic (18F-FDG PET/CT)
Sensitivity100 (100 to 100)70 (35 to 93)
Specificity100 (40 to 100)100 (40 to 100)
Positive Predictive Value (PPV)100 (100 to 100)100 (100 to 100)
Negative Predictive Value (NPV)100 (100 to 100)57 (34 to 77)
Accuracy100 (77 to 100)79 (49 to 95)
Statistical analysis
  • Diagnostic (18F-FSPG PET/CT) vs Diagnostic (18F-FDG PET/CT) · Wilcoxon (Mann-Whitney) · p = 0.02 (The threshold for statistical significance was set at p \< 0.05)
SecondaryImprovement in Predictive Accuracy of Lung Nodule Diagnosis Using the C Statistic (Area Under the Curve, AUC)

The predictive accuracy of the lung nodule diagnosis model was assessed using the C statistic, also referred to as the area under the receiver operating characteristic (ROC) curve (AUC). Improved performance was defined as a statistically significant increase (p \< 0.05) in the C statistic, determined using the DeLong test for comparing correlated ROC curves. The Mann-Whitney U test was also used to compare the distributions of the C statistic between diagnostic methods. Results are reported as the mean C statistic with 95% confidence intervals for each diagnostic method.

Time frame:
Through study completion, an average of 2 years and 6 months
Reported as:
Mean · probability
Improvement in Predictive Accuracy of Lung Nodule Diagnosis Using the C Statistic (Area Under the Curve, AUC)
probabilityBaseline Diagnostic (18F-FSPG PET/CT)Improved Diagnostic (18F-FDG PET/CT)
Improvement in Predictive Accuracy of Lung Nodule Diagnosis Using the C Statistic (Area Under the Curve, AUC)0.84 ± 0.11.0 ± 0.0
Statistical analysis
  • Baseline Diagnostic (18F-FSPG PET/CT) vs Improved Diagnostic (18F-FDG PET/CT) · Wilcoxon (Mann-Whitney) · p = 0.004 (The threshold for statistical significance was predefined as p \< 0.05)
  • Baseline Diagnostic (18F-FSPG PET/CT) vs Improved Diagnostic (18F-FDG PET/CT) · Wilcoxon (Mann-Whitney) · p = 0.05 (The threshold for statistical significance was predefined as p ≤ 0.05.)
  • Baseline Diagnostic (18F-FSPG PET/CT) vs Improved Diagnostic (18F-FDG PET/CT) · Wilcoxon (Mann-Whitney) · p = 0.06 (The threshold for statistical significance was predefined as p \< 0.05.)

Adverse events

Collected over Within 24 to 72hours after the 18F-FSPG PET/CT. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Diagnostic (18F-FSPG PET/CT, 18F-FDG PET/CT)0/15 (0%)0/15 (0%)0/15 (0%)

Baseline characteristics

Age, Categorical
Age, Categorical(Participants)Diagnostic (18F-FSPG PET/CT, 18F-FDG PET/CT)
<=18 years0
Between 18 and 65 years2
>=65 years13
Sex: Female, Male
Sex: Female, Male(Participants)Diagnostic (18F-FSPG PET/CT, 18F-FDG PET/CT)
Female5
Male10
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)Diagnostic (18F-FSPG PET/CT, 18F-FDG PET/CT)
Hispanic or Latino1
Not Hispanic or Latino14
Unknown or Not Reported0
Race (NIH/OMB)
Race (NIH/OMB)(Participants)Diagnostic (18F-FSPG PET/CT, 18F-FDG PET/CT)
American Indian or Alaska Native0
Asian1
Native Hawaiian or Other Pacific Islander0
Black or African American2
White11
More than one race0
Unknown or Not Reported1
Region of Enrollment
Region of Enrollment(participants)Diagnostic (18F-FSPG PET/CT, 18F-FDG PET/CT)
United States15
07

Study locations

1 site
  • Stanford Cancer Institute Palo Alto
    Palo Alto, California 94304, United States
08

References and documents

Study documents

  • Protocol and statistical analysis plan · Jun 8, 2023
  • Informed consent form · Oct 24, 2023

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: No

09

Registry details

Key details

Study ID
NCT03824535
Lead sponsor
Andrei Iagaru
Collaborators
Canary Foundation, Boston University, United States Department of Defense
Responsible party
Andrei Iagaru (Associate Professor of Radiology (Nuclear Medicine), Stanford University) — Sponsor-investigator
First posted
Jan 31, 2019
Start date
Feb 4, 2019
Primary completion
Jul 30, 2021
Completion
Jul 30, 2021
Results posted
Apr 9, 2025
Last update
Apr 9, 2025

Study contacts

Carina Mari Aparici
principal investigator · Stanford Cancer Institute Palo Alto

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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