Tumor-targeted precision surgery

Surgery is the cornerstone of curative-intent treatment of patients with solid cancers. Complete removal of the tumor is pivotal for prolonged survival outcomes. Unfortunately, tumor-positive resection margins occur in 8-70% of cases depending on cancer type. Evidently, there is an unmet need for a technique to improve tumor detection and margin assessment in real-time during surgery. Intraoperative tumor-targeted near-infrared (NIR) fluorescence imaging enables visualization of (residual) tumor rapidly, non-invasively and in real-time with high spatial accuracy. The development and clinical translation of newly designed tumor-targeted NIR imaging agents is essential, because none of the available imaging agents can be used in all tumor types due to variable protein expression profiles. Development and clinical translation of imaging agents is a costly and time-consuming process, as it comprises many different stages and requires strict regulatory assessments to ensure patient safety and agent efficacy. To illustrate this process, a brief overview of the development and/or clinical translation of four promising tumor-targeted NIR imaging agents is presented, each currently in a different phase: OTL-38 (Pafolacianine - Cytalux), SGM-101, cRGD-ZW800-1 and AKRO-QC-ICG.