18F-Fluciclovine PET/CT in Multiple Myeloma

Last updated: August 22, 2025
Sponsor: National Cancer Institute (NCI)
Overall Status: Active - Recruiting

Phase

2

Condition

Multiple Myeloma

Leukemia

Cancer

Treatment

18F-FDG PET/CT

18F-fluciclovine injection

Clinical Study ID

NCT06103838
10001525
001525-C
  • Ages 18-120
  • All Genders

Study Summary

Background:

Multiple myeloma (MM) is an incurable cancer of certain blood cells. MM often returns after treatment, and most people survive only 5 to 8 years after diagnosis. To improve survival, researchers need to find ways to identify returning disease earlier.

Objective:

To find out if the radiotracer 18F-fluciclovine (a substance injected into the blood during imaging scans) is better at detecting MM than the one (18F-FDG) currently used for this purpose.

Eligibility:

Adults aged 18 years or older with MM. The MM may be newly diagnosed (NDMM); or it may have returned or failed to respond after at least 1 prior line of treatment (RRMM).

Design:

Participants will be screened. They will have blood tests. They will have a positron emission tomography (PET) or computed tomography (CT) scan using 18F-FDG. The radiotracer will be injected into a vein. Then participants will lie on a table while the PET/CT scan takes images of their body.

All participants will have 3 study visits. During each visit they will have:

Two PET/CT scans. One with 18F-FDG, one with 18F-fluciclovine.

An optional magnetic resonance imaging scan.

A bone marrow biopsy. An area on the hip will be numbed; a needle will be inserted to draw out a sample of the soft tissue from inside the bone.

These tests may be spread over 30 days for each visit.

NDMM participants will have their second study visit 2 to 4 weeks after they complete their usual treatment for the disease. RRMM participants will have their second visit 6 months after their first.

All participants will have a third study visit after 5 years or when their disease progresses.

Eligibility Criteria

Inclusion

  • INCLUSION CRITERIA:

  • Participants must have a documented diagnosis of MM defined by the IMWG Criteria.Participants at diagnosis must have had a serum M-protein >= 3 g/dL and/or bonemarrow plasma cells >= 10% and at least one of the following:

  • Anemia: Hemoglobin <=10 g/dL, or

  • Renal Failure: serum creatinine >= 2.0 mg/dL, or

  • Hypercalcemia: Ca >= 10.5 mg/dL, or

  • Lytic bone lesions on X-ray, CT, or PET/CT, or

  • >= 2 focal lesions on spinal MRI, or

  • >= 60% bone marrow plasma cells, or

  • Involved/un-involved serum free light chain ration >= 100

  • Participants must have measurable disease defined by any one of the following:

  • Monoclonal bone marrow plasma cells > 5%

  • Serum monoclonal protein >= 0.2 g/dl

  • Urine monoclonal protein > 200 mg/24 hr

  • Serum immunoglobulin free light chain > 10 mg/dL AND abnormal kappa/lambdaratio

  • A measurable lesion on PET/CT or MRI

  • Participants fit criteria for one of the following categories:

  • Newly diagnosed multiple myeloma (NDMM)

  • Relapsed and/or refractory multiple myeloma (RRMM) with at least 1 prior lineof therapy

  • Age >=18 years.

  • ECOG performance status <= 2

  • Negative serum or urine pregnancy test at screening for WOCBP.

  • Women of child-bearing potential and men must agree to use effective contraception (hormonal or barrier method of birth control; abstinence) 24 hours prior to and forthe 24 hours after each 18F-fluciclovine administration.

  • Ability of subject to understand and the willingness to sign a written informedconsent document.

Exclusion

EXCLUSION CRITERIA:

  • History of allergic reactions attributed to compounds of similar chemical orbiologic composition to 18F-FDG

  • History of allergic reactions attributed to compounds of similar chemical orbiologic composition to 18F-fluciclovine or other similar agents.

  • Subjects with severe claustrophobia unresponsive to oral anxiolytics or unwilling totake them.

  • Uncontrolled intercurrent illness including, psychiatric illness/social situationsthat would limit compliance with study requirements.

  • Because there is an unknown but potential risk for adverse events in nursing infantssecondary to treatment of the mother with 18F-fluciclovine, breastfeeding should bediscontinued if the mother is treated with 18F-fluciclovine until 3 days after 18F-fluciclovine.

Study Design

Total Participants: 60
Treatment Group(s): 2
Primary Treatment: 18F-FDG PET/CT
Phase: 2
Study Start date:
March 25, 2024
Estimated Completion Date:
December 06, 2031

Study Description

Background:

  • Multiple myeloma (MM) is an incurable malignancy of plasma cells that leads to destructive bone lesions, renal damage, anemia, and hypercalcemia. MM is the second most common hematologic malignancy. The American Cancer Society estimates that annually over 34,000 new cases of MM will occur in the U.S. and over 12,000 deaths due to MM in 2022.

  • Overall survival (OS) has improved significantly over the past 20 years with the development of proteasome inhibitors (PIs), immunomodulatory agents (IMiDs) and anti-CD38 monoclonal antibodies. However, despite these advances, patients ultimately relapse requiring multiple subsequent lines of therapy. As MM evolves, it generally becomes more refractory, and patients ultimately succumb to their disease.

  • With multiple lines of efficacious therapies, the correct early identification of relapsed disease is important to trigger initiation of a new line of therapy.

  • Limitations in conventional imaging highlight a need for molecular imaging agents with better sensitivity for detecting and measuring tumor burden to improve staging and treatment selection for patients with MM and plasma cell dyscrasias.

  • 18F-fluciclovine is a radionuclide approved by the FDA for evaluating suspected prostate cancer recurrence but has shown additional ability in detecting MM lesions.

Objective:

To determine the concordance between 18F-fluciclovine PET/CT and 18F-FDG PET/CT in participants with multiple myeloma

Eligibility:

  • Participants >= 18 years old

  • Eastern Cooperative Oncology Group (ECOG) Performance score of 0 to 2

  • Participants must have a documented diagnosis of MM defined by the International Myeloma Working Group (IMWG) Criteria

  • Participants fit criteria for one of the following categories:

    • Newly diagnosed multiple myeloma (NDMM) without previous treatment (or within the first 3 cycles of front-line treatment)

    • Relapsed and/or Refractory multiple myeloma (RRMM) with at least 1 prior line of therapy

Design:

This is an open-label, single center phase 2 study evaluating 18F-fluciclovine PET/CT imaging in up to 50 participants with multiple myeloma. Participants will be enrolled into one of two cohorts based on disease status; newly diagnosed multiple myeloma (NDMM) participants will be enrolled into Cohort 1 and relapsed refractory multiple myeloma (RRMM) participants will be enrolled into Cohort 2. All subjects will undergo an 18F-fluciclovine injection followed by a static whole-body PET/CT at three time points: Timepoint #1, Timepoint #2 (after induction for NDMM or at 6 months for RRMM) and Timepoint #3 (at progression or at 5 years). Results will be compared to 18F-FDG PET/CT imaging at those same timepoints.

Connect with a study center

  • National Institutes of Health Clinical Center

    Bethesda, Maryland 20892
    United States

    Site Not Available

  • National Institutes of Health Clinical Center

    Bethesda 4348599, Maryland 4361885 20892
    United States

    Active - Recruiting

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