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Molecular guided oncology surgery has the potential to transform the way decisions about resection are done, and can be
critically important in areas such as neurosurgery where the margins of tumor relative to critical normal tissues are not
readily apparent from visual or palpable guidance. Yet there are major financial barriers to advancing agents into
clinical trials with commercial backing. We observe that development of these agents in the standard biological
therapeutic paradigm is not viable, due to the high up front financial investment needed and the limitations in the revenue
models of contrast agents for imaging. The hypothesized solution to this problem is to develop small molecular
biologicals tagged with an established fluorescent reporter, through the chemical agent approval pathway, targeting a
phase 0 trials initially, such that the initial startup phase can be completely funded by a single NIH grant. In this way,
fast trials can be completed to de-risk the development pipeline, and advance the idea of fluorescence-guided surgery
(FGS) reporters into human testing. As with biological therapies the potential successes of each agent are still moderate,
but this process will allow the field to advance in a more stable and productive manner, rather than relying upon isolated
molecules developed at high cost and risk. The pathway proposed and tested here uses peptide synthesis of an epidermal
growth factor receptor (EGFR)-binding Affibody molecules, uniquely conjugated to IRDye 800CW, developed and
tested in academic and industrial laboratories with well-established records for GMP production, fill and finish, toxicity
testing, and early phase clinical trials with image guidance.
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