Tumor angiogenesis at baseline identified by 18F-Alfatide II PET/CT may predict survival among patients with locally advanced non-small cell lung cancer treated with concurrent chemoradiotherapy

Monitoring Sorafenib Resistance and Efficacy in Hepatocellular Carcinoma Using [18F]Alfatide II and [18F]Fluorodeoxyglucose Positron Emission Tomography

Integrin αvβ3 expression is associated with sorafenib resistance in hepatocellular carcinoma (HCC). Therefore, monitoring its expression in HCC may serve as a valuable indicator of the efficacy of sorafenib treatment. In this study, longitudinal positron emission tomography (PET) was performed to assess [18F]Alfatide II and [18F]fluorodeoxyglucose ([18F]FDG) as suitable probes for evaluating the treatment efficacy of sorafenib in a Huh-7 human (HCC) xenograft model. Huh-7 tumor cells were used to establish both normal and sorafenib-resistant cell lines, and xenograft models were developed. The mice were categorized into four groups based on the cell type and treatment: normal nontreatment, normal treatment, sorafenib-resistant nontreatment, and sorafenib-resistant treatment. Huh-7 tumor mice received intragastric injections of sorafenib (30 mg/kg/day) or vehicle for 15 consecutive days. Tumor size and weight were assessed throughout the study. Longitudinal microPET/computed tomography (CT) scans with [18F]Alfatide II and [18F]FDG were acquired to quantitatively measure angiogenesis on days -2, 3, 7, and 14 and metabolism on days -1, 4, 8, and 15 following therapy initiation. The tumor uptake (ID%/gmean) of each probe was calculated. No significant difference in [18F]FDG uptake was observed between the normal and sorafenib-resistant groups (P = 0.452); however, [18F]Alfatide II uptake differed significantly between the two groups (P < 0.001). Sorafenib successfully inhibited normal Huh-7 tumor growth, inducing significant differences in tumor size 9 days after sorafenib treatment (P < 0.05). The uptake of [18F]Alfatide II in the tumor lesions changed significantly on day 14 (P = 0.001). However, no change was observed in the uptake of [18F]FDG (P > 0.05). The PET imaging data of [18F]Alfatide II and [18F]FDG were validated through ex vivo immunohistochemistry analysis targeting integrin αvβ3, VEGF, and GULT-1. [18F]Alfatide II PET was more effective in monitoring sorafenib resistance and therapeutic efficacy in the Huh-7 human HCC xenograft model than [18F]FDG.

Clinical Translation of a Dual-Integrin αvβ3- and CD13-Targeting PET Tracer

PURPOSE

Angiogenesis is essential in the development and progression of tumors. This study aimed to investigate the clinical application of 68 Ga-labeled heterodimeric peptide ( 68 Ga-HX01) targeting integrin αvβ3 and CD13 in tumor neovascularization.

PATIENTS AND METHODS

Six healthy volunteers were recruited to study the biodistribution, pharmacokinetics, and radiation of 68 Ga-HX01. Twelve patients with various malignancies were enrolled to seek the preliminary clinical value of 68 Ga-HX01. In healthy volunteers, SUVs of each major organ on 68 Ga-HX01 PET were measured. The clinical data, lesion numbers, and uptake were recorded in patients. The integrin αvβ3 and CD13 expression of the resected tumors was checked via immunohistochemistry staining.

RESULTS

With a mean injected dose of 167.98 ± 26.32 MBq, 68 Ga-HX01 was well tolerated and safe without side effects in 6 healthy volunteers. The radiation absorbed effective dose of 68 Ga-HX01 was 1.94 × 10 -2 mSv/MBq, and the urinary bladder wall held the highest absorbed effective dose (0.15 ± 5.87 × 10 -2 mSv/MBq). In 12 patients with various malignancies, 68 Ga-HX01 PET could clearly visualize the lesions from the surrounding tissues. The SUV max values in tumors were significantly higher than those in the surrounding tissues ( P < 0.05). A positive correlation trend between tumor SUV max and semiquantitative integrin αvβ3 and CD13 expression was determined ( P < 0.05).

CONCLUSIONS

For clinical use, 68 Ga-HX01 is safe with low radiation absorbed effective dose. It also indicates the efficiency of dual integrin αvβ3 and CD13-targeting PET radiotracer in tumor diagnosis, which may assist in patient prognosis and selecting eligible patients for antiangiogenic therapy.

Concurrent chemoradiotherapy plus immunotherapy for locally advanced non-small-cell lung cancer: clinical efficacy and prognostic analysis

OBJECTIVE

To evaluate the efficacy of concurrent chemoradiotherapy (CCRT) combined with immunotherapy (IT) for locally advanced non-small-cell lung cancer (LA-NSCLC). Short-term treatment outcomes during the two-year follow-up were recorded, and 2-year survival data were collected to analyze prognosis and identify factors affecting short-term outcome. Additionally, a predictive model was developed.

METHODS

We conducted a retrospective analysis of 90 LA-NSCLC patients admitted between February 2018 and February 2020. Patients were grouped according to their treatment regimens: 45 patients treated with 4-6 cycles of CCRT followed by 1 year of Sintilimab therapy were assigned to the observation group, and 45 patients treated with cisplatin/carboplatin + albumin-bound paclitaxel for 4-6 cycles after CCRT were assigned to the control group. Short-term adverse reactions were recorded for both groups. Patients were followed up after 4-6 cycles of IT or chemotherapy, and short-term efficacy and toxicity were evaluated. During the 2-year follow-up, overall survival (OS) and progression-free survival (PFS) were recorded, and survival curves were plotted. The Cox proportional hazards model was used to identify factors influencing PFS in the observation group, and a predictive model was developed. The predictive value of relevant indicators for prognosis was assessed using receiver operating characteristic (ROC) curves.

RESULTS

The observation group showed superior short-term efficacy, with higher objective response rates (ORR) and disease control rates (DCR) compared to the control group (both P < 0.05). Regarding toxicity, the control group exhibited more severe adverse effects, particularly grade III and higher gastrointestinal reactions, leukopenia, thrombocytopenia, and anemia (all P < 0.05). The PFS was significantly higher in the observation group than that of the control group (P < 0.05). Additionally, the incidence of pneumonia was higher in the observation group, but it demonstrated better 2-year OS (P < 0.05). Cox multivariate analysis revealed that factors influencing PFS in the observation group included distant metastasis, tumor differentiation, platelet-to-lymphocyte ratio (PLR), and prealbumin (PAB). ROC analysis showed that the areas under the curve (AUC) for predicting prognosis based on PLR and PAB were 0.662 and 0.774, respectively, and the combined AUC of these indicators was 0.812.

CONCLUSIONS

CCRT combined with IT is an effective treatment for LA-NSCLC, improving survival outcomes. The predictive model developed may help assess prognosis and guide early clinical intervention. Attention should be given to pneumonia prevention and management during IT. Moreover, the combination of PLR and PAB enhances prognostic prediction for NSCLC patients undergoing CCRT plus IT.

Radionuclide-based theranostics - a promising strategy for lung cancer

PURPOSE

This review aims to provide a comprehensive overview of the latest literature on personalized lung cancer management using different ligands and radionuclide-based tumor-targeting agents.

BACKGROUND

Lung cancer is the leading cause of cancer-related deaths worldwide. Due to the heterogeneity of lung cancer, advances in precision medicine may enhance the disease management landscape. More recently, theranostics using the same molecule labeled with two different radionuclides for imaging and treatment has emerged as a promising strategy for systemic cancer management. In radionuclide-based theranostics, the target, ligand, and radionuclide should all be carefully considered to achieve an accurate diagnosis and optimal therapeutic effects for lung cancer.

METHODS

We summarize the latest radiotracers and radioligand therapeutic agents used in diagnosing and treating lung cancer. In addition, we discuss the potential clinical applications and limitations associated with target-dependent radiotracers as well as therapeutic radionuclides. Finally, we provide our views on the perspectives for future development in this field.

CONCLUSIONS

Radionuclide-based theranostics show great potential in tailored medical care. We expect that this review can provide an understanding of the latest advances in radionuclide therapy for lung cancer and promote the application of radioligand theranostics in personalized medicine.

Treatment patterns and prognosis of patients with inoperable stage III NSCLC after completion of concurrent chemoradiotherapy ± immune checkpoint inhibition: a decade-long single-center historical analysis

PURPOSE

To investigate the impact of treatment time and patterns in inoperable stage III non-small cell lung cancer (NSCLC) following concurrent chemoradiotherapy (cCRT) ± immune checkpoint inhibitors (ICIs).

METHODS

Patients were stratified by treatment year: A (2011-2014), B (2015-2017) and C (2018-2020). Tumor- and treatment-related characteristics regarding locoregional recurrence-free survival (LRRFS), progression-free survival (PFS) and overall survival (OS) were investigated.

RESULTS

One hundred and thirty-six consecutive patients were analyzed. All patients completed thoracic radiotherapy (TRT) to a total dose ≥ 60.0 Gy; 36 (26%) patients received ICI. Median PFS in subgroups A, B and C was 8.0, 8.2 and 26.3 months (p = 0.007). Median OS was 19.9 months, 23.4 months and not reached (NR), respectively. In group C, median LRRFS and PFS were 27.2 vs. NR; and 14.2 vs. 26.3 months in patients treated with and without ICI. On multivariate analysis planning target volume (PTV) ≥ 700 cc was a negative prognosticator of LRRFS (HR 2.194; p = 0.001), PFS (HR 1.522; p = 0.042) and OS (HR 2.883; p = 0.001); ICI was a predictor of LRRFS (HR 0.497; p = 0.062), PFS (HR 0.571; p = 0.071) and OS (HR 0.447; p = 0.1). In the non-ICI cohort, multivariate analyses revealed PTV ≥ 700 cc (p = 0.047) and a maximum standardized uptake value (SUVmax) ≥ 13.75 (p = 0.012) were predictors of PFS; PTV ≥ 700 cc (p = 0.017), SUVmax ≥ 13.75 (p = 0.002) and a total lung V20 ≥ 30% (V20 ≥ 30) (p < 0.05) were predictors of OS.

CONCLUSIONS

Patients treated after 2018 had improved survival regardless of ICI use. Implementation of ICI resulted in further significant increase of all tested survival endpoints. PTV ≥ 700 cc and ICI were only prognosticators for LRRFS, PFS and OS in the analyzed cohort.

New PET Tracers: Current Knowledge and Perspectives in Lung Cancer

PET/CT with the tracer 2-[¹⁸F]fluoro-2-deoxy-D-glucose ([¹⁸F]FDG) has improved diagnostic imaging in cancer and is routinely used for diagnosing, staging and treatment planning in lung cancer patients. However, pitfalls of [¹⁸F]FDG-PET/CT limit the use in specific settings. Additionally, lung cancer is still the leading cause of cancer associated death and has high risk of recurrence after curative treatment. These circumstances have led to the continuous search for more sensitive and specific PET tracers to optimize lung cancer diagnosis, staging, treatment planning and evaluation. The objective of this review is to present and discuss current knowledge and perspectives of new PET tracers for use in lung cancer. A literature search was performed on PubMed and clinicaltrials.gov, limited to the past decade, excluding case reports, preclinical studies and studies on established tracers such as [¹⁸F]FDG and DOTATE. The most relevant papers from the search were evaluated. Several tracers have been developed targeting specific tumor characteristics and hallmarks of cancer. A small number of tracers have been studied extensively and evaluated head-to-head with [¹⁸F]FDG-PET/CT, whereas others need further investigation and validation in larger clinical trials. At this moment, none of the tracers can replace [¹⁸F]FDG-PET/CT. However, they might serve as supplementary imaging methods to provide more knowledge about biological tumor characteristics and visualize intra- and inter-tumoral heterogeneity.