How Fluorescent Tracers Could Transform Lung Cancer Surgery

Although cancer surgery can treat patients with solid tumors, surgeons can leave cancer behind in the form of a positive margin, an unseen involved lymph node, or an additional missed tumor. Abenacianine (VGT-309), an investigational, tumor-targeted fluorescent imaging agent, is designed to address that problem by making tumors glow, or fluoresce, once injected into a patient, helping surgeons see cancer they might otherwise miss.

Sunil Singhal, MD, William Maul Measey Professor and chief of Thoracic Surgery at the University of Pennsylvania Perelman School of Medicine, spoke with CancerNetwork^® about the background of the technology and how it is intended to improve outcomes in lung cancer surgery. Additionally, he detailed findings from the phase 2b VISUALIZE trial (NCT06145048), which demonstrated the ability to improve intraoperative localization, identification of occult lesions, margin assessment, and lymph node detection when administering abenacianine during standard-of-care lung cancer surgery.

Transcript:

CancerNetwork: What was the background for the study assessing intraoperative molecular imaging with this agent, VGT-309, during lung cancer surgery?

Singhal: The story goes back almost 2 decades, where many people in the field have been thinking about how to improve cancer surgery. Cancer surgery is one of the best ways to cure people of cancer across the board for any solid cancer: prostate, breast, colon, and lung cancer. The best thing you can do for somebody is take out the cancer. The problem is that in many instances, when you take out the cancer, you leave something behind, whether it’s a positive margin, which means that there’s cancer in the staple line. It could mean that there’s cancer in the lymph nodes that you may have missed. It’s possible that there are extra cancers that you would have missed. The concept of making cancers easier to see is the basis of this technology, and that is injecting a dye into patients that goes to tumors and makes tumors glow or fluoresce. In that method, the surgeons can see the tumors better, know where to cut, make sure they get everything out, and ideally do a better operation for the patient.

This trial showed that 45% of patients had at least 1 clinically significant event. In practical terms, what does that number mean for a patient’s outcome?

What that says is, essentially, if you had 100 patients, in 45 of those 100 patients, using the dye made a meaningful difference in the operation. Whether it was the ability to find something that the surgeon didn’t see, identify the border of the cancer that the surgeon missed, or a situation where the surgeon can’t even find the cancer without the ability to put their fingers or hands in. In that sense, [you] avoid having to make a massive operation or a massive cut or take more tissue than necessary because the dye and the tracer can make the cancer more visible.

Reference

Herrera LJ, Wright GM, Kim JY, Reisenauer JS, Rice DC, Singhal S. Phase II multicenter clinical trial of intraoperative molecular imaging with abenacianine during lung cancer surgery. Ann Surg Oncol. Published online July 26, 2026. doi:10.1245/s10434-026-19951-0