Pilot Study of TumorGlow for Intraoperative Molecular Imaging of Sarcoma Metastases to the Lungs in Pediatric Patients

This is a phase 1 single dose, open-label study to determine the safety of a single 5 mg/kg dose of ICG (TumorGlow) used with Near Infrared (NIR) fluorescent for pediatric subjects with suspected metastatic sarcoma to the lung scheduled to undergo thoracic surgery per CT/PET or other imaging based on standard of care.

Following the screening visit to confirm eligibility, subject assent and parental/legal guardian consent for enrollment will be obtained prior to commencement of any study procedures. The screening period will be up to 60 days prior to ICG infusion. All subjects enrolled will be infused with 5 mg/kg ICG intravenously up to 5-days prior to the planned surgery (Day 0).

After ICG infusion is completed (Day 0), subjects during the surgery will undergo white light evaluation and/or palpation, and the number and the location of all suspicious nodules and lesions identified in this step will be recorded as such following the study procedure guideline as described in  (Day 1). Following white light assessment, but prior to any surgical removal of lesions/nodules, subjects will undergo assessment with NIR fluorescent light imaging to localize any lesions or nodules.

All identified lesions will be removed as determined by the surgeon. All removed lesions identified either using white light, NIR imaging or both will be documented as such and examined back table for fluorescence under NIR imaging including margin status. Positive margins are defined as fluorescent areas identified within (less than or equal to) 5mm of the inside staple line by back table measurement. Following the resection and prior to closing the subject, the field will be illuminated with the imaging system again to detect and remove any remaining fluorescence positive nodules. All specimens removed after the back table examination will be sent to pathology for evaluation including margin status by a pathologist that is blinded to the fluorescent status of lesions or nodules.

Inclusion criteria

• 1. Male and female children (12 - 17 years of age) with a primary diagnosis, or a high clinical suspicion of a solid tumor with metastasis to the lung warranting surgery based on CT/PET or other imaging 2. Are scheduled to undergo surgical resection for suspected metastasis 3. Female subjects of childbearing potential (including those less than 2 years postmenopausal) agree to use an acceptable form of contraception from the time of signing informed consent until 30 days after infusion of ICG. Male subjects who are are sexually active (and capable of producing sperm) with a partner that could become pregnant, must agree to use an acceptable form of contraception from the time of signing informed consent until 30 days after infusion of ICG.

Exclusion criteria

• 1. Any medical condition that in the opinion of the investigators could potentially jeopardize the safety of the subject 2. History of anaphylactic reactions to ICG. Subjects with a medical history of 'idiopathic anaphylaxis' will require evaluation 3. A positive serum pregnancy test at screening for female subjects of childbearing potential. Note that subjects with a positive pregnancy test on the day of infusion will be discontinued from study and will not receive the study drug.

• Presence of any psychological, familial, sociological condition or geographical challenges potentially hampering compliance with the study protocol and follow-up schedule 5. Impaired liver function defined as values > 3x the upper limit of normal (ULN) for alanine aminotransferase (ALT),aspartate aminotransferase (AST), or alkaline phosphatase (ALP), or >2x ULN for total bilirubin except in subjects with Gilbert's syndrome. *For subjects with Gilbert's syndrome, total bilirubin levels exceeding 3 mg/dL will be excluded.* 6. Received an investigational agent in another investigational drug or vaccine trial within 30 days prior to the administration of study drug 7. History of uncontrolled hypertension. (e.g., history of an emergency room [ER] admission for hypertensive crisis or ≥ 3 BP medications) 8. Known sensitivity to fluorescent light