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Dartmouth Is Helping Brain Surgeons See Tumors More Clearly

Mar 06, 2017

Research showing the effectiveness of a new targeted fluorescent agent for guiding brain tumor surgery — a dye that was recently FDA-approved for a first in-human study at Dartmouth — was published in Clinical Cancer Research. The paper, entitled "Simultaneous in vivo fluorescent markers for perfusion, protoporphyrin metabolism and EGFR expression for optically guided identification of orthotopic glioma," shows the potential for this new agent, called ABY-029, to significantly improve cancer surgery outcomes over the perfusion and metabolic dyes currently used in clinical practice.

"Current methods aren't very specific," says Dartmouth engineering professor and lead author Jonathan Elliott, "The dyes often either show up in healthy tissue, or don't show up at the edges of tumors where they are most difficult to delineate. The results of this research show that ABY-029 can provide additional contrast and may greatly improve brain cancer resection rates."

Normalized ABY-029 Fluorescence

A color map representation of the ABY-029 fluorescence signal in an epidermal growth factor receptor (EGFR) tumor. Strong spatial agreement between ABY-029 fluorescence and EGFR-stained IHC images were observed in the tumor core and at distant regions of tumor invasion.

Fluorescence guided surgery is a technique that uses fluorescent dyes to highlight cancer during surgery, allowing the surgeon to home in on malignant tissue and remove it. Gliomas — any tumor that arises from the supportive (“gluey”) tissue of the brain — are notoriously difficult to remove completely, resulting in cancer recurrence and lower survival rates. ABY-029 targets epidermal growth factor receptor (EGFR), a molecule that is expressed on most glioma cells but not in normal brain tissue.

"The really exciting thing," continues Elliott, "is that the study brings us one step closer to providing patients and surgeons with personalized fluorescent dyes — being able to select the particular dye that will stick to their particular tumor — to achieve the most complete cancer removal for each patient."

Additional authors on the study include Dartmouth engineering professors Scott Davis, Kimberley Samkoe, Keith Paulsen, David Roberts, and Brian Pogue.

ABY-029 will soon be tested in six to 12 patients with recurrent glioma, a type of tumor that starts in the brain or spine.

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