The development of fluorescence guided surgery for pancreatic cancer: from bench to clinic

Abstract

Surgeons face major challenges in achieving curative R0 resection for pancreatic cancers. When the lesion is localized, they must appropriately visualize the tumor, determine appropriate resection margins, and ensure complete tumor clearance. Real-time surgical navigation using fluorescence-guidance has enhanced the ability of surgeons to see the tumor and has the potential to assist in achieving more oncologically complete resections. When there is metastatic disease, fluorescence enhancement can help detect these lesions and prevent unnecessary and futile surgeries. Areas covered: This article reviews different approaches for delivery of a fluorescence signal, their pre-clinical and clinical developments for fluorescence guided surgery, the advantages/challenges of each, and their potential for advancements in the future. Expert commentary: A variety of molecular imaging techniques are available for delivering tumor-specific fluorescence signals. Significant advancements have been made in the past 10 years due to the large body of literature on targeted therapies and this has translated into rapid developments of tumor-specific probes.

Molecular imaging of the urokinase plasminogen activator receptor: opportunities beyond cancer

“…Targeting this natural interaction between uPA and uPAR with ATF or ATFlike constructs has been employed for magneticresonance imaging, near-infrared imaging, photoacoustic imaging, and nuclear-imaging [198][199][200][201][202][203][204]. With a molecular weight of 18.5 kilodalton, ATF is cleared rapidly by the kidneys resulting in quick imaging times (30 min to 2 h) but also minimizing the time available to get sufficient contrast [216]. Conjugating ATF to nanoparticles (NPs) enhances blood circulation times resulting in optimal imaging times around 24-48 h after injection in vivo [198,199,202,204].…”

Engineering of a novel subnanomolar affinity fibronectin III domain binder targeting human programmed death-ligand 1

“…Therefore, it is a prime candidate for future development as an imaging agent to predict and monitor immune checkpoint blockade therapies. For example, the binder can further be radiolabeled for positron emission tomography (PET) imaging and fluorescently labeled for endoscopy and guided surgery using hPD-L1 expression as a marker in human cancers (Natarajan et al, 2013;Lwin et al, 2018). Further studies are warranted to determine the serum stability, thermostability and efficacies as an in vivo imaging agent.…”

ASO Author Reflections: Fluorescent Anti-CEA IR800 for Tumor Labeling

“…The ideal fluorescent probe would be efficient and cost effective to synthesize, with rapid pharmacokinetics, and high sensitivity and specificity. 3 Due to the heterogeneity in probe design, there is variability in dosing, timing of imaging, and choice of imaging devices. Further studies are necessary to optimize these variables and determine the definition of an adequate signal for FGS.…”