Lymphoseek® – A Receptor-Targeted Agent for Lymphatic Mapping

On March 13, 2013, the US FDA approved Lymphoseek® (technetium Tc 99m tilmanocept) injection.  Following two supplemental NDA approvals in June 2014 and October 2014, Lymphoseek is now indicated for: 

  • Lymphatic mapping to locate lymph nodes in patients with solid tumors for which this procedure is a component of surgical management
  • Guiding Sentinel Lymph Node Biopsy (SLNB) in patients with clinically node negative squamous cell carcinoma (SCC) of the oral cavity, breast cancer or melanoma.

Lymphoseek® (Technetium Tc99m Tilmanocept) Injection is a first-in-class mannose receptor (CD206) binding radiopharmaceutical agent developed for use in external lymph node imaging (lymphoscintigraphy), intra-operative lymphatic mapping (ILM)   and sentinel lymph node biopsy.

In addition to Phase 3 clinical trials in breast cancer and melanoma which supported the Lymphoseek approval, Navidea completed an additional Phase 3 clinical trial in patients with head and neck cancer. Positive topline results demonstrated that Lymphoseek met the primary efficacy endpoint of accurately identifying sentinel lymph nodes (SLNs) in subjects with squamous cell carcinoma of the oral cavity, as compared to the removal of all lymph nodes during multiple level nodal dissection surgery of the head and neck. Additional studies of Lymphoseek in other cancer types by the company or by investigators are either anticipated or ongoing.

Lymphoseek was recommended by CHMP for European approval in Sentinel Lymph Node Detection for melanoma, breast and certain head and neck cancers in September 2014. 

How Might Lymphoseek Be Used?

Intra-operative lymphatic mapping, together with lymphoscintigraphy, has become the cancer diagnostic  evaluation procedure of choice for oncology surgeons as the information provided helps them focus on high-risk nodes and reduces patient exposure to unnecessary surgical complications. During an ILM procedure, a radioactive tracing agent, such as Lymphoseek, is injected at the site of the primary tumor and follows the drainage path of the tumor to the nearest lymph node or nodes.  After injection of the radioactive agent, external gamma detection-based imaging can be performed to assist in the pre-operative localization of nodes. A gamma detection device is then used to track the pathway of the tracing agent. Lymph nodes in the potential drainage path are identified using the radioactive tracing agent.

Oncologists generally believe that if nodes that first drain the primary tumor show no sign of malignancy, the downstream nodes are likely to be clear of disease, and the removal of other nearby lymph nodes is clinically unnecessary. The ability to rapidly locate and biopsy lymph nodes provides vital information to the physician in determining if the cancer has spread or if it is localized to the site of the primary tumor and, therefore, enables surgical management to be tailored specifically to each patient’s burden of disease.

U.S. Lymphoseek Indication and Important Safety Information

Lymphoseek is a radioactive diagnostic agent indicated with or without scintigraphic imaging for:

  • Lymphatic mapping using a handheld gamma counter to locate lymph nodes draining a primary tumor site in patients with solid tumors for which this procedure is a component of intraoperative management.
  • Guiding sentinel lymph node biopsy using a handheld gamma counter in patients with clinically node negative squamous cell carcinoma of the oral cavity, breast cancer or melanoma.

Important Safety Information

In clinical trials with Lymphoseek, no serious hypersensitivity reactions were reported, however Lymphoseek may pose a risk of such reactions due to its chemical similarity to dextran. Serious hypersensitivity reactions have been associated with dextran and modified forms of dextran (such as iron dextran drugs).

Prior to the administration of Lymphoseek, patients should be asked about previous hypersensitivity reactions to drugs, in particular dextran and modified forms of dextran. Resuscitation equipment and trained personnel should be available at the time of Lymphoseek administration, and patients observed for signs or symptoms of hypersensitivity following injection.

Any radiation-emitting product may increase the risk for cancer. Adhere to dose recommendations and ensure safe handling to minimize the risk for excessive radiation exposure to patients or health care workers.

In clinical trials, no patients experienced serious adverse reactions and the most common adverse reactions were injection site irritation and/or pain (<1%).


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