Abstract
Complete initial resection can give cancer patients the best opportunity for long-term survival. There is unmet need in
surgical oncology for optical imaging that enables simple and precise visualization of tumors and consistent contrast with
surrounding normal tissues. Near-infrared (NIR) contrast agents and camera systems that can detect them represent an
area of active research and development. The investigational Tumor Paint agent BLZ-100 is a conjugate of a chlorotoxin
peptide and the NIR dye indocyanine green (ICG) that has been shown to specifically bind to a broad range of solid
tumors. Clinical efficacy studies with BLZ-100 are in progress, a necessary step in bringing the product into clinical
practice. To ensure a product that will be useful for and accepted by surgeons, the early clinical development of BLZ-
100 incorporates multiple tumor types and imaging devices so that surgeon feedback covers the range of anticipated
clinical uses. Key contrast agent characteristics include safety, specificity, flexibility in timing between dose and surgery,
and breadth of tumor types recognized. Imaging devices should use wavelengths that are optimal for the contrast agent,
be sensitive enough that contrast agent dosing can be adjusted for optimal contrast, include real-time video display of
fluorescence and white light image, and be simple for surgeons to use with minimal disruption of surgical flow. Rapid
entry into clinical studies provides the best opportunity for early surgeon feedback, enabling development of agents and
devices that will gain broad acceptance and provide information that helps surgeons achieve more complete and precise
resections.
