Phase 3 VISUALIZE 2 Trial Aims to Confirm Abenacianine's Surgical Benefit

This is part 2 of a 2-part interview. Watch part 1 here.

Gavin Wright, MBBS, outlines what surgeons should take from the VISUALIZE trial results today, and what the ongoing phase 3 VISUALIZE 2 trial (NCT07499674) is designed to confirm about abenacianine (VGT-309), a tumor-targeted fluorescence imaging agent used during lung cancer surgery.

Wright says the clearest clinical takeaway is how easily a small tumor can be missed with minimally invasive techniques. A tumor sitting just a millimeter or two beneath the surface of the lung may be undetectable to a surgeon working without the ability to feel the tissue directly. He points to cases in which an entire section of lung has been removed only for the tumor to be missed by roughly two millimeters, leaving cancer behind and requiring the patient to undergo a second surgery. Fluorescence imaging with abenacianine is intended to reduce that risk by making tumor tissue visible under near-infrared light during the original procedure.

Because every patient in the VISUALIZE trial received both the agent and near-infrared imaging, the study could not compare outcomes against standard practice. Wright explains that VISUALIZE 2, a randomized phase 3 trial now underway, addresses that gap: all patients still receive abenacianine, but in 1 of every 10 patients, surgeons are not permitted to turn on the near-infrared imaging, creating a control group that reflects current surgical practice.

Looking further ahead, Wright says open questions remain about which tumor types and locations benefit most from the technology. He also points to a longer-term goal: developing an agent that could show surgeons how completely a tumor has responded to neoadjuvant immunotherapy before surgery begins, potentially allowing for smaller, more targeted resections. Wright calls that capability the holy grail for the field.

Read the full interview with Dr Wright.