Investigación de Pheochromocytoma y Paraganglioma: Diagnóstico, Biología Molecular y Técnicas de Imagen
Este estudio de fase 1 tiene como objetivo investigar los genotipos específicos, los fenotipos bioquímicos y de imagen de los pacientes con diversos feocromocitomas y paragangliomas, al tiempo que explora posibles opciones de tratamiento para las formas metastásicas de estas condiciones utilizando cultivos celulares, líneas celulares y modelos animales.
Imágenes de PPGLs con [18F]-DOPA
+ Imágenes de PPGL con [18F]-6F-DA
Neoplasias+4
+ Neoplasias por tipo histológico
+ Neoplasias de Células Germinales y Embrionarias
Estudio Diagnóstico
Resumen
Fecha de inicio: 22 de marzo de 2000
Fecha en la que se inscribió al primer participante.Pheochromocytomas (PHEOs) and paragangliomas (PGLs) are rare and clinically important chromaffin cell tumors that typically arise from the adrenal gland or from extra-adrenal paraganglia, respectively. The clinical features and consequences of PHEO/PGL result from the release of catecholamines (norepinephrine and/or epinephrine). An undetected PHEO/PGL poses a hazard to patients undergoing surgery, childbirth, or general anesthesia, due to the potential for excess catecholamine secretion, which can result in significant, often catastrophic outcomes. Diagnosing and localizing a PHEO/PGL can be challenging. Plasma and urinary catecholamines as well as their metabolites and radio-iodinated metaiodobenzylguanidine (MIBG) scanning can yield false-positive/negative results in patients harboring the tumor. Computed tomography (CT) and magnetic resonance imaging (MRI) lack sufficient specificity. The molecular mechanisms by which genotypic changes predispose to the development of PHEO/PGL remain unknown - even in patients with identified pathogenic variants. Moreover, in patients with hereditary predispositions, PHEOs/PGLs differ in terms of their growth, malignant potential, catecholamine phenotype, responses to standard screening tests, various imaging modalities and therefore subsequently, different therapeutic options. This protocol focuses on developmental, molecular, genetic, epigenetic, proteomic, metabolomics, immunologic and other types of studies to investigate the bases for predisposition to develop PHEOs/PGLs and for expression of different neurochemical and other phenotypes and malignant potentials including therapeutic responses. Furthermore, this protocol will also use new imaging approaches, for example \[18F\]-6F-dopamine (\[18F\]-6F-DA), and \[18F\]-L-3,4-dihydroxyphenylalanine (\[18F\]-FDOPA) positron emission tomography (PET)/CT, as well as dynamic contrast-enhanced MRI.
Protocolo
Esta sección proporciona detalles del plan del estudio, incluyendo cómo está diseñado y qué se está evaluando.Se reclutarán 3000 pacientes
Número total de participantes que el ensayo clínico espera reclutar.Estudio Diagnóstico
Elegibilidad
Los investigadores buscan pacientes que cumplan ciertos criterios, conocidos como criterios de elegibilidad: estado general de salud o tratamientos previos.Cualquier sexo
Sexo biológico de los participantes elegibles para inscribirse.De 3 a 120 años
Rango de edades de los participantes que pueden unirse al estudio.Voluntarios sanos no permitidos
Indica si personas sanas, sin la condición que se estudia, pueden participar.Condiciones
Patología
Criterios
* INCLUSION CRITERIA: Patients are eligible for inclusion in this study if they are adults or children of age 3 years old and up with known, sporadic or familial PHEO/PGL, on the basis of one or more of the following: 1. High levels of blood or urinary catecholamines, metanephrines, methoxytyramine or chromogranin A. 2. Highly suspected presence of PHEO/PGL based on imaging studies, even with normal biochemistry. 3. Personal or family history of PHEO/PGL or genetic pathogenic variants known to predispose individuals to develop PHEO/PGL. Signed informed consent is required. The informed consent may be signed by the patient, parent/guardian in pediatric patients or legally authorized representative (LAR) in adults who lack-decision making capacity to consent to research participation. Patients must have an outside general practitioner or endocrinologist. Patients with metastatic disease must also have an outside oncologist. Family Members of Patients Arm (Linkage Analysis) Participants are eligible for inclusion in this study arm if they are: * Adult family members of patients enrolled in this study; * The index family member in this study has a suspected hereditary PHEO/PGL based on previous genetic testing and other suspicious hereditory patterns such as family history of multiple individuals with PHEO/PGL; early age of disease onset; multiplicity of primary tumors; recurrence, etc. and * Signed informed consent form is required EXCLUSION CRITERIA: Potential patients will be excluded on the basis of one or more of the following: 1. Pregnant or breastfeeding women 2. Severe cardiac dysfunction 3. Currently on dialysis A pregnancy test is performed in women of childbearing age (up to age 55) as a screening after consenting. If a patient is found to have a positive pregnancy test, her participation in this protocol will be terminated. The patient can enroll or re-enroll in the protocol when she is no longer pregnant or breastfeeding. In-person participating patients who are not willing to return to the NIH (e.g., after surgery or an initial evaluation) for more than 2 years may be removed from the protocol. SPECIFIC INCLUSION/EXCLUSION CRITERIA FOR IMAGING STUDIES WITHIN OUR PROTOCOL: In adult patients (Excludes Linkage Analysis Arm) Imaging studies are not done in patients that have the following exclusion criteria: * Inability to lie still for the entire imaging time (e.g., cough, severe arthritis, etc.). * Inability to complete the needed investigational and standard-of-care imaging examinations due to other reasons (e.g., severe claustrophobia, radiation phobia, etc.) * Any additional medical conditions, serious illness, or other extenuating circumstance that, in the opinion of the Principal Investigator, may significantly interfere with study compliance. In pediatric patients: Inclusion criteria for research PET imaging in children: * Children over 10 years old with very high suspicion of sporadic or familial PHEO/PGL based on at least one of the following: * The presence of new onset of symptoms typical of PHEO/PGL such as hypertension or hypertensive episodes, sweating, headaches, pallor, palpitations, drug resistant hypertension, etc. * Family history of PHEO/PGL or genetic pathogenic variants known to predispose individuals to develop these tumors. * The presence of a tumor on conventional imaging including ultrasound, CT and/or MRI or \[123I\]-MIBG or PET imaging not limited to \[18F\]-FDG. * Children must give informed assent and be willing to return to the NIH for follow-up. Exclusion criteria for research PET imaging in children: * Children of less than 10 years of age. * Children with impaired mental capacity that precludes informed assent. * Inability to lie still for the entire imaging time (e.g., cough, turbulent children, severe claustrophobia, etc.).
Plan de Estudio
Conoce todos los tratamientos administrados en este estudio, su descripción detallada y en qué consisten.Un solo grupo de intervención está designado en este estudio
0% de probabilidad de ser asignado al grupo placebo
Grupos de Tratamiento
Grupo I
ExperimentalObjetivos del Estudio
Objetivos Primarios
Objetivos Secundarios
Centros del Estudio
Estos son los hospitales, clínicas o centros de investigación donde se lleva a cabo el estudio. Puedes encontrar la ubicación más cercana a ti y su estado de reclutamiento.Este estudio tiene una ubicación
National Institutes of Health Clinical Center
Bethesda, United StatesAbrir National Institutes of Health Clinical Center en Google Maps