NSRG-15. FIRST IN HUMAN USE OF CANVAS IMAGING SYSTEM FOR VISUALIZATION OF TOZULERISTIDE-INDUCED TUMOR FLUORESCENCE

Maximal safe surgical resection is a critical component of pediatric brain tumor treatment. Tozuleristide (BLZ-100) is an investigational imaging agent given 1-36 hours prior to surgery to facilitate fluorescence-guided tumor resection. We evaluated one commercially available device (Fluobeam) and two investigational imaging devices in a pediatric phase 1 clinical study. The Fluobeam was of limited use in neurosurgery due to inadequate resolution, black and white imaging, and disruption of surgical flow. The investigational Synchronized Infrared Imaging System (SIRIS) is an open-field, free-standing imaging device which improved resolution and color display, but still was not suitable for neurosurgery flow and required repositioning of the surgical microscope. The investigational Canvas imaging system was developed for potential use in pediatric neurosurgery, attaching directly to the surgical microscope. The Canvas acquired real-time imaging of tozuleristide-induced tumor fluorescence throughout neurosurgical tumor resection with minimal to no disruption of surgical procedure. Fluorescent, color images and white light/fluorescent overlay images were displayed on the Canvas monitor throughout neurosurgery without repositioning of the surgical microscope and in line with the microscope field of view. The Canvas system also captured video of tozuleristide-facilitated fluorescent tumor resection in a young child with a posterior fossa tumor. Tozuleristide used with the Canvas imaging system may provide a valuable tool to support safe neurosurgical tumor resection without disruption of surgical flow compared to other standard intra-operative tumor imaging options such as ultrasound or MRI. Further evaluation of the tozuleristide/Canvas combination is planned in a multi-institutional pediatric brain tumor clinical study.