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Alabed YZ. 68Ga-DOTATATE PET/CT Incidentally Detects Relapsed Chronic Lymphocytic Leukemia in Patient With Metastatic Neuroendocrine Tumor. Clin Nucl Med 2023; 48:e78-9. [PMID: 36607378 DOI: 10.1097/RLU.0000000000004386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
ABSTRACT A 54-year-old man with metastatic well-differentiated neuroendocrine tumor of the pancreas underwent 68Ga-DOTATATE PET/CT scan to evaluate treatment response. Patient was known for remote history of chronic lymphocytic leukemia (CLL), previously treated. Scan revealed diffusely increased abnormal tracer uptake throughout the marrow of the axial and proximal appendicular skeleton. Bone marrow biopsy revealed relapsed CLL. We present a rare case of relapsed CLL incidentally detected on 68Ga-DOTATATE PET/CT.
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Hu T, Zhang R, Zhang B, He S, Liu L, Zou Y, Huang J, Wang B, Hu P, Zhang Z. Case report: Uncommon multiple metastases from occult breast cancer revealed by 68Ga-DOTATATE PET/CT. Front Oncol 2023; 13:1106890. [PMID: 36910656 PMCID: PMC9992788 DOI: 10.3389/fonc.2023.1106890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
Occult breast cancer is an uncommon type of breast cancer and its diagnosis is challenging. It is usually invisible on multiple imaging examines. Metastases to the rectum and inguinal lymph nodes from occult breast lobular cancer are even rarer. 68Ga-DOTA peptides can image neuroendocrine tumors by targeting specific somatostatin receptors. Besides, other tumors, including breast cancer, have been shown to express somatostatin receptors. In this case, we presented a 63-year-old woman who underwent both 18F-FDG and 68Ga-DOTATATE PET/CT due to a rectal polyp. An endoscopic excision biopsy confirmed metastatic carcinoma of suspected breast origin, but subsequent ultrasound and MRI showed no signs of malignancy in the breast and adnexa uteri. PET/CT showed obvious 68Ga-DOTATATE activity in bilateral axillary and right inguinal lymph nodes with mild 18F-FDG uptake. Final histopathology at the left axillary, right inguinal lymph nodes, and rectum indicated metastases from breast cancer while the origin remained radiologically occult. Additionally, one uterine fibroids was found with positive uptake of 68Ga-DOTATATE and negative uptake of 18F-FDG. This case suggested that 68Ga-DOTATAE PET/CT may be an effective supplement in diagnosing OBC lymph node metastases with mild 18F-FDG uptake, and it may provide a new technology for the clinical diagnosis of occult breast cancer.
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Affiliation(s)
- Tianyuan Hu
- Department of Nuclear Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Rongqin Zhang
- Department of Nuclear Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China
| | - Bing Zhang
- Department of Nuclear Medicine and Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shanzhen He
- Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Lian Liu
- Department of Nuclear Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yan Zou
- Department of Nuclear Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Junhao Huang
- Department of Nuclear Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Bing Wang
- Department of Nuclear Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ping Hu
- Department of Nuclear Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhanwen Zhang
- Department of Nuclear Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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Priyadarshini S, Allison DB, Chauhan A. Comprehensive Assessment of Somatostatin Receptors in Various Neoplasms: A Systematic Review. Pharmaceutics 2022; 14:1394. [PMID: 35890290 PMCID: PMC9325105 DOI: 10.3390/pharmaceutics14071394] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
Abstract
Somatostatin receptors (SSTR) are expressed in various neoplasms and can be targeted for both diagnostics as well as therapeutics. This systematic review aims to compile and discuss the prevalence of somatostatin receptor expression in various neoplasms. We performed a literature search from Google Scholar and PubMed using relevant keywords to look for all publicly available data regarding SSTR expression in various cancers. Both histopathological and radiographical studies were included for SSTR assessment. We found that many cancers express SSTR with varying prevalence. SSTR is now a well-established theranostics biomarker. We now have highly sensitive and specific diagnostic modalities like gallium 68 DOTATATE and copper 64 DOTATATE scans to screen for SSTR-2 and then target it therapeutically with lutetium 177 DOTATATE. A thorough understanding of SSTR expression in other tumors will open the channels for exploring potential SSTR targeting.
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Juntikka T, Vaittinen S, Vahlberg T, Jyrkkiö S, Minn H. Somatostatin Receptors and Chemokine Receptor CXCR4 in Lymphomas: A Histopathological Review of Six Lymphoma Subtypes. Front Oncol 2021; 11:710900. [PMID: 34307181 PMCID: PMC8299948 DOI: 10.3389/fonc.2021.710900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/24/2021] [Indexed: 12/14/2022] Open
Abstract
Background Somatostatin receptors (SSTR) and chemokine receptor CXCR4 are expressed in lymphomas, while the abundance is known to be heterogeneous in different subtypes of lymphomas. Targeting tumor cells expressing these receptors might add to therapeutic opportunities while radiolabeled ligands for both imaging and therapy have been developed. The aim of this study was to establish SSTR subtype 2, 3 and 5 and also CXCR4 status immunohistochemically in six different lymphoma subtypes: diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), mantle cell lymphoma (MCL), mucosa-associated marginal B-cell lymphoma (MALT), Hodgkin lymphoma (HL) and peripheral T-cell lymphoma (PTCL). Material and Methods This study included a total of 103 lymphoma patients (24 DLBCL, 22 FL, 18 HL, 9 MALT, 20 MCL and 10 PTCL) diagnosed in the Southwest hospital district of Finland during 2010-2019. SSTR 2, 3 and 5 and CXCR4 expression was analyzed immunohistochemically (IHC) in lymphoma samples obtained from local archival Biobank tissue repository. Immunopositivity of each receptor was scored on a four-point scale accounting for staining intensity and proportion of positively stained tumor cells. Results Of different SSTR subtypes SSTR2 immunopositivity was most common and seen predominantly at the cell membrane of the malignant cells in 46-56% of DLBCL, HL and FL. CXCR4 co-expression was frequently present in these cases. SSTR3 and SSTR5 IHC were negative in DLBCL and FL but in HL SSTR expression was more heterogenous and SSTR3 and SSTR5 positivity was found in cytoplasm in 35% and 25% of cases. 2/4 blastoid MCL variants and one pleomorphic MCL variant had positive CXCR4 IHC whilst all other MCL cases (85%) were negative for all receptors. 30% (n=3) of the PTCL patients had positive SSTR5 IHC and CXCR4. MALT lymphomas were negative for all receptors. Conclusion SSTR2 and CXCR4 are found in DLBCL, FL and HL and co-expression of these receptors is common. Although in general expression of SSTRs and CXCR4 is heterogenous and very low in some subtypes such as MCL and MALT there are also patients with abundant expression. The latter are candidates for trials studying SSTR2 and/or CXCR4 based treatments in the future.
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Affiliation(s)
- Tiina Juntikka
- Department of Oncology and Radiotherapy, Turku University Hospital, University of Turku, Turku, Finland
| | - Samuli Vaittinen
- Department of Pathology, Turku University Hospital, University of Turku, Turku, Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
| | - Sirkku Jyrkkiö
- Department of Oncology and Radiotherapy, Turku University Hospital, University of Turku, Turku, Finland
| | - Heikki Minn
- Department of Oncology and Radiotherapy, Turku University Hospital, University of Turku, Turku, Finland
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Abstract
In-111 pentetreotide (Octreoscan) is a radiolabeled somatostatin analog with high binding affinity to somatostatin receptors (SSTR) used in somatostatin receptor scintigraphy (SRS). Pentetreotide labelled with In-111 is widely used due to its high affinity to SSTR 2 and 5. SSTR are expressed on neuroendocrine cells as well as several non-neural and non-endocrine cells with varying levels of density. We retrospectively reviewed articles and publications related to octreoscan accumulation in sites that classically do not have high concentrations of SSTR as well as in organs and tissues from diseases which are not usually diagnosed by octreoscan. The significance of a positive uptake as assessed by octreoscan in non-somatostatin receptor related diseases is not fully understood yet. Localization of octreotide in non-oncological disease states such as inflammation is due to presence of SSTR in activated immunological cells, over-expression by activated cells in the respective tissue and SSTR expression by blood vessels. In granulomatous diseases, over-expression of SSTR2 preferential binding sites were detected in epitheloid and giant cells. The purpose of the current study is to identify octreoscan localization in non-somatostatin receptor related disease sites to better understand the mechanism of this nonspecific accumulation which may help expand the clinical utilization of functional imaging utilizing somatostatin receptor scintigraphy in diagnosis and perhaps therapy.
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Affiliation(s)
- Eldrin Bhanat
- Department of Radiation Oncology, Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA
| | - Christian A Koch
- Medicover GmbH and Technical University of Dresden, Dresden, Germany
- Department of Medicine/Endocrinology, University of Louisville, Louisville, KY, 40292, USA
| | - Rinkuben Parmar
- Department of Microbiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Vishnu Garla
- Department of Medicine/Endocrinology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Vani Vijayakumar
- Division of Nuclear Medicine and Department of Radiology, University of Mississippi Medical Center, Jackson, MS, USA.
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Ruuska T, Ramírez Escalante Y, Vaittinen S, Gardberg M, Kiviniemi A, Marjamäki P, Kemppainen J, Jyrkkiö S, Minn H. Somatostatin receptor expression in lymphomas: a source of false diagnosis of neuroendocrine tumor at 68Ga-DOTANOC PET/CT imaging. Acta Oncol 2018; 57:283-289. [PMID: 28686510 DOI: 10.1080/0284186x.2017.1342864] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND 68Ga-DOTANOC PET/CT is routinely used to image neuroendocrine tumors (NETs). A case of lymphoma initially thought to be NET based on a positive 68Ga-DOTANOC PET/CT was recently seen at our institution. This prompted us to determine prospectively somatostatin receptor (SSTR) status in patients with lymphoma by immunohistochemical analysis of SSTR subtypes 2, 3 and 5 (SSTR2,3,5) and 68Ga-DOTANOC PET/CT imaging. MATERIAL AND METHODS Twenty-one patients with newly diagnosed lymphoma were referred to 68Ga-DOTANOC and FDG PET/CT prior to any treatment. Tracer uptake was evaluated visually by two nuclear medicine specialists. Maximum standardized uptake values (SUVmax) were determined from 14 nodal and two extranodal regions with highest uptake in each patient. Lesions were then graded with Deauville score (1-5) on FDG PET/CT and modified Krenning score (0-4) on 68Ga-DOTANOC PET/CT, respectively. SSTR2,3,5 status was analyzed from routine biopsies of lymphomatous tissue and matched to corresponding PET/CT findings. RESULTS About 20/21 patients had FDG-positive lymphoma (Deauville score ≥3). Uptake of 68Ga-DOTANOC was regarded as positive if Krenning score was ≥2 and resulted in 13/21 (62%) patients having 68Ga-DOTANOC-positive lymphomas. The highest uptake of 68Ga-DOTANOC was seen in Hodgkin's lymphoma of nodular sclerosis subtype and in diffuse large B-cell lymphoma (SUVmax median 9.8 and 9.7, respectively). Both cases showed strong SSTR2 immunopositivity in tumor cells. Some patients had SSTR2 immunopositivity predominantly in endothelial and dendritic cells and follicular centers of lymph nodes contributing to a positive PET/CT with probably low tumor-specific uptake. SSTR3 and SSTR5 were negative in most lymphoma subtypes. CONCLUSIONS According to this pilot study, 68Ga-DOTANOC PET/CT is positive in some lymphoma subtypes which express SSTRs. These tumors present a potential risk of being misinterpreted as NETs if a representative tumor sample is not available. Lymphomas with high expression of SSTRs may be amenable to treatments targeting these receptors.
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Affiliation(s)
- Tiina Ruuska
- University of Turku, Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
- Turku PET Centre, Turku University Hospital, University of Turku, Turku, Finland
| | | | - Samuli Vaittinen
- Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Maria Gardberg
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - Aida Kiviniemi
- Department of Radiology, Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Päivi Marjamäki
- Turku PET Centre, Turku University Hospital, University of Turku, Turku, Finland
| | - Jukka Kemppainen
- Turku PET Centre, Turku University Hospital, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Sirkku Jyrkkiö
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Heikki Minn
- Turku PET Centre, Turku University Hospital, University of Turku, Turku, Finland
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
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Yamaga LYI, Cunha ML, Campos Neto GC, Garcia MRT, Yang JH, Camacho CP, Wagner J, Funari MBG. 68Ga-DOTATATE PET/CT in recurrent medullary thyroid carcinoma: a lesion-by-lesion comparison with 111In-octreotide SPECT/CT and conventional imaging. Eur J Nucl Med Mol Imaging 2017; 44:1695-1701. [PMID: 28429044 DOI: 10.1007/s00259-017-3701-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/03/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to prospectively compare the detection rate of 68Ga-DOTATATE PET-CT with 111In-octreotide SPECT-CT and conventional imaging (CI) in medullary thyroid carcinoma (MTC) patients with increased calcitonin (Ctn) levels but negative CI after thyroidectomy. METHODS Fifteen patients with raised Ctn levels and/or CI evidence of recurrence underwent 68Ga-DOTATATE PET-CT, 111In-octreotide SPECT-CT and CI. Histopathology, CI and biochemical/clinical/imaging follow-up were used as the reference standard. PET/CT, SPECT/CT and CI were compared in a lesion-based and organ-based analysis. RESULTS PET/CT evidenced recurrence in 14 of 15 patients. There were 13 true positive (TP), 1 true negative (TN), 1 false positive (FP) and no false negative (FN) cases, resulting in a sensitivity and accuracy of 100% and 93%. SPECT/CT was positive in 6 of 15 cases. There were 6 TP, 2 TN, 7 FN and no FP cases, resulting in a sensitivity of 46% and accuracy of 53%. CI procedures detected tumor lesions in 14 of 15 patients. There were 13 TP, 1TN, 1 FP and no FN cases with a sensitivity of 100% and accuracy of 93%. A significantly higher number of lesions was detected by PET/CT (112 lesions, p = 0.005) and CI (109 lesions, p = 0.005) in comparison to SPECT/CT (16 lesions). There was no significant difference between PET/CT and CI for the total number of detected lesions (p = 0.734). PET/CT detected more lesions than SPECT/CT regardless of the organ. PET/CT detected more bone lesions but missed some neck nodal metastases evidenced by CI. The number of lesions per region demonstrated by PET/CT and CI were similar in the other sites. CONCLUSION 68Ga-DOTATATE PET/CT is superior to 111In-octreotide SPECT/CT for the detection of recurrent MTC demonstrating a significantly higher number of lesions. 68Ga-DOTATATE PET/CT showed a superior detection rate compared to CI in demonstrating bone metastases.
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Affiliation(s)
- Lilian Yuri Itaya Yamaga
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05651-901, Brazil. .,, Rua Jose Maximo Monteiro de Oliveira, 196, Parque dos Príncipes, Osasco, São Paulo, CEP 06030-362, Brazil.
| | - Marcelo L Cunha
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05651-901, Brazil
| | - Guilherme C Campos Neto
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05651-901, Brazil
| | - Marcio R T Garcia
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05651-901, Brazil
| | - Ji H Yang
- Multiple Neoplasia Outpatiet Clinic, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Cleber P Camacho
- Multiple Neoplasia Outpatiet Clinic, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jairo Wagner
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05651-901, Brazil
| | - Marcelo B G Funari
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05651-901, Brazil
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Stollberg S, Kämmerer D, Neubauer E, Schulz S, Simonitsch-Klupp I, Kiesewetter B, Raderer M, Lupp A. Differential somatostatin and CXCR4 chemokine receptor expression in MALT-type lymphoma of gastric and extragastric origin. J Cancer Res Clin Oncol 2016; 142:2239-47. [PMID: 27544389 DOI: 10.1007/s00432-016-2220-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 08/15/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE Whereas the different somatostatin receptor (SSTR) subtypes and the chemokine receptor CXCR4 are known to be expressed in a wide variety of human malignancies, comprehensive data are still lacking for MALT-type lymphomas. METHODS Overall, 55 cases of MALT-type lymphoma of both gastric and extragastric origin were evaluated for the SSTR subtype and CXCR4 expression by means of immunohistochemistry using novel monoclonal rabbit antibodies. The stainings were rated by means of the immunoreactive score and correlated with clinical data. RESULTS While the CXCR4 was detected in 92 % of the cases investigated, the SSTR subtypes were much less frequently present. The SSTR5 was expressed in about 50 % of the cases, followed by the SSTR3, the SSTR2A, the SSTR4 and the SSTR1, which were present in 35, 27, 18 or 2 %, respectively, of the tumors only. Gastric lymphomas displayed a significantly higher SSTR3, SSTR4 and SSTR5 expression than extragastric tumors. A correlation between CXCR4 and Ki-67 expression was seen in gastric lymphomas, whereas primarily in extragastric tumors SSTR5 negativity was associated with poor patient outcome. CONCLUSIONS The CXCR4 may serve as a promising target for diagnostics and therapy of MALT-type lymphomas, while the SSTRs appear not suitable in this respect.
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Affiliation(s)
- Susann Stollberg
- Institute of Pharmacology and Toxicology, Jena University Hospital, Friedrich Schiller University Jena, Drackendorfer Str. 1, 07747, Jena, Germany
| | - Daniel Kämmerer
- Department of General and Visceral Surgery, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Elisa Neubauer
- Institute of Pharmacology and Toxicology, Jena University Hospital, Friedrich Schiller University Jena, Drackendorfer Str. 1, 07747, Jena, Germany
| | - Stefan Schulz
- Institute of Pharmacology and Toxicology, Jena University Hospital, Friedrich Schiller University Jena, Drackendorfer Str. 1, 07747, Jena, Germany
| | | | | | - Markus Raderer
- Department of Internal Medicine I, University of Vienna, Vienna, Austria
| | - Amelie Lupp
- Institute of Pharmacology and Toxicology, Jena University Hospital, Friedrich Schiller University Jena, Drackendorfer Str. 1, 07747, Jena, Germany.
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Liu D, Balkin ER, Jia F, Ruthengael VC, Smith CJ, Lewis MR. Targeted antisense radiotherapy and dose fractionation using a (177)Lu-labeled anti-bcl-2 peptide nucleic acid-peptide conjugate. Nucl Med Biol 2015; 42:704-10. [PMID: 26081917 DOI: 10.1016/j.nucmedbio.2015.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 05/22/2015] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The overall goal of these studies was to test the hypothesis that simultaneous down-regulation of a tumor survival gene and delivery of internally emitted cytotoxic radiation will be more effective than either treatment modality alone. The objectives were to evaluate the therapeutic efficacy of a (177)Lu-labeled anti-bcl-2-PNA-Tyr(3)-octreotate antisense conjugate in a mouse model bearing human non-Hodgkin's lymphoma (NHL) tumor xenografts and to optimize targeted antisense radiotherapy by dose fractionation. METHODS In the initial therapy studies, tumor-bearing mice were given saline, nonradioactive DOTA-anti-bcl-2-PNA-Tyr(3)-octreotate, (177)Lu-DOTA-Tyr(3)-octreotate, (177)Lu-DOTA-PNA-peptide alone, or (177)Lu-DOTA-PNA-peptide followed by a chase dose of nonradioactive PNA-peptide. The MTD of (177)Lu-DOTA-anti-bcl-2-PNA-Tyr(3)-octreotate was then determined. Subsequently single dose MTD and four weekly fractionated doses were directly compared, followed by histopathologic evaluation. RESULTS Antisense radiotherapy using 4.44 MBq of the (177)Lu-DOTA-PNA-peptide followed by nonradioactive PNA-peptide was significantly more effective than other low dose treatment regimens. A dose of 18.5 MBq of (177)Lu-DOTA-PNA-peptide was determined to be the approximate maximum tolerated dose (MTD). The median times to progression to a 1cm(3) tumor volume were 32 and 49 days for single dose MTD and fractionated dose (4 × 4.63 MBq) groups, respectively. Histopathology revealed metastases in the single dose groups, but not in the dose fractionation group. CONCLUSIONS Targeted antisense radiotherapy using (177)Lu-DOTA-anti-bcl-2-PNA-Tyr(3)-octreotate and DOTA-PNA-peptide conjugate effectively inhibited tumor progression in a mouse model of NHL. Furthermore, a dose fractionation regimen had a significant advantage over a single high dose, in terms of tumor growth inhibition and prevention of metastasis. ADVANCES IN KNOWLEDGE AND IMPLICATIONS FOR PATIENT CARE Down-regulating bcl-2, an anti-apoptotic proto-oncogene, is a mechanism to reverse chemotherapy resistance or failure in humans with NHL. We have developed a (177)Lu-DOTA-anti-bcl-2-PNA-Tyr(3)-octreotate conjugate for targeted antisense radiotherapy, in which down-regulation of bcl-2 and delivery of cytotoxic radiation occur simultaneously. Our previous studies have shown highly specific inhibition of bcl-2 protein, additive in vitro cytotoxic effects on human lymphoma cells, and favorable biodistribution and dosimetric properties. Lutetium-177 targeted antisense radiotherapy demonstrates a significant advantage over conventional (177)Lu-peptide receptor radionuclide therapy in a mouse model of NHL. Our preclinical studies identified an effective combination of antisense and radionuclide therapy, with the goal of future clinical trials in patients.
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Affiliation(s)
- Dijie Liu
- Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO 65201; Department of Veterinary Medicine Surgery, University of Missouri, Columbia, MO 65211
| | - Ethan R Balkin
- Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO 65201; Department of Veterinary Medicine Surgery, University of Missouri, Columbia, MO 65211; Area of Pathobiology, University of Missouri, Columbia, MO 65211
| | - Fang Jia
- Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO 65201; Department of Veterinary Medicine Surgery, University of Missouri, Columbia, MO 65211
| | - Varyanna C Ruthengael
- Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO 65201; Department of Veterinary Medicine Surgery, University of Missouri, Columbia, MO 65211
| | - C Jeffrey Smith
- Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO 65201; Department of Radiology, University of Missouri, Columbia, MO 65212
| | - Michael R Lewis
- Research Service, Harry S. Truman Memorial Veterans' Hospital, Columbia, MO 65201; Department of Veterinary Medicine Surgery, University of Missouri, Columbia, MO 65211; Area of Pathobiology, University of Missouri, Columbia, MO 65211; Nuclear Science and Engineering Institute, University of Missouri, Columbia, MO 65211.
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Jain S, Sharma P, Dhull VS, Bal C, Kumar R. Lymphoma as a second malignancy in a patient with neuroendocrine tumor: mimicking dedifferentiation on dual-tracer PET/CT with 68Ga-DOTANOC and 18F-FDG. Clin Nucl Med 2014; 39:358-9. [PMID: 24217543 DOI: 10.1097/RLU.0b013e31828e98c5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Neuroendocrine tumors (NETs) are rare tumors which express somatostatin receptors (SSTRs). We here present a case of a 50-year-old female patient with metastatic bronchial carcinoid. She underwent 68Ga-DOTANOC PET/CT and 18F-FDG PET/CT which suggested a diagnosis of poorly differentiated NET. Biopsy of the lesion, however, revealed a second malignancy in the form of diffuse large B-cell lymphoma. Thus, very rarely, other primary tumors can mimic NETs on dual-tracer PET/CT, and biopsy is advised in doubtful cases.
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Mattoon JS, Bryan JN. The future of imaging in veterinary oncology: Learning from human medicine. Vet J 2013; 197:541-52. [DOI: 10.1016/j.tvjl.2013.05.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 04/10/2013] [Accepted: 05/06/2013] [Indexed: 10/26/2022]
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Kong FL, Ford RJ, Yang DJ. Managing lymphoma with non-FDG radiotracers: current clinical and preclinical applications. Biomed Res Int 2013; 2013:626910. [PMID: 23841079 DOI: 10.1155/2013/626910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 05/27/2013] [Indexed: 11/18/2022]
Abstract
Nuclear medicine imaging modalities such as positron emission tomography (PET) and single-photon emission computed tomography (SPECT) have played a prominent role in lymphoma management. PET with [(18)F]Fluoro-2-deoxy-D-glucose (FDG) is the most commonly used tool for lymphoma imaging. However, FDG-PET has several limitations that give the false positive or false negative diagnosis of lymphoma. Therefore, development of new radiotracers with higher sensitivity, specificity, and different uptake mechanism is in great demand in the management of lymphoma. This paper reviews non-FDG radiopharmaceuticals that have been applied for PET and SPECT imaging in patients with different types of lymphoma, with attention to diagnosis, staging, therapy response assessment, and surveillance for disease relapse. In addition, we introduce three radiolabeled anti-CD20 antibodies for radioimmunotherapy, which is another important arm for lymphoma treatment and management. Finally, the relatively promising radiotracers that are currently under preclinical development are also discussed in this paper.
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Ferone D, Pivonello R, Kwekkeboom DJ, Gatto F, Ameri P, Colao A, de Krijger RR, Minuto F, Lamberts SWJ, van Hagen PM, Hofland LJ. Immunohistochemical localization and quantitative expression of somatostatin receptors in normal human spleen and thymus: Implications for the in vivo visualization during somatostatin receptor scintigraphy. J Endocrinol Invest 2012; 35:528-34. [PMID: 21765239 DOI: 10.3275/7871] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND [111In-DTPA-D-Phe1]-octreotide scintigraphy allows the visualization of SRIF receptor (SSR)-expressing tumors, including thymic tumors, and normal tissues. While the spleen is clearly visualized, the thymus is not depicted, although both contain SSR. AIM We evaluated whether the heterogeneity, the type, and the amount of SSR might explain this contrasting finding. MATERIALS, METHODS, AND RESULTS By ligand-binding the number of [125I-Tyr11]-SRIF- 14 binding sites resulted comparable between the two tissues, whereas the number of [125I-Tyr3]-octreotide sites was significantly higher in the spleen (p<0.001). Quantitative RTPCR showed a significantly higher expression of sst2A mRNA in the spleen, whereas a significantly higher expression of SRIF and sst3 in the thymus. The highest density of sst2A in the spleen is in line with the in vivo uptake of [111In-DTPA-D-Phe1]- octreotide, which is considered a sst2-preferring ligand. The specificity is confirmed by the evidence that in vivo [111In-DTPA- D-Phe1]-octreotide uptake can be abolished during chronic administration of "cold" octreotide. Immunohistochemistry confirmed a preferential expression of sst2A on microenvironmental cells and of sst3 on lymphoid cells. CONCLUSIONS The heterogeneity of SSR expression and the higher SRIF content explain the lack of thymus visualization during scintigraphy, whereas thymic tumors, which do not express SRIF, are visualized. Apart from the affinity of the radioligand, also the efficacy of the internalization is crucial for the in vivo uptake, and both heterogeneity and SRIF content affect this process. These observations might have an important impact when interpretating in vivo visualization of SSR-positive lesions, and when treatment with novel SRIF analogs is considered.
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Affiliation(s)
- D Ferone
- Department of Endocrinological and Medical Sciences and Center of Excellence for Biomedical Research, University of Genoa, Viale Benedetto XV, 6-16132-Genoa, Italy.
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Apostolopoulos DJ, Papandrianos NI, Symeonidis A, Spyridonidis T, Alexiou S, Zampakis P, Savvopoulos C, Vassilakos PJ, Matsouka P. Technetium-99m depreotide imaging by single photon emission tomography/low resolution computed tomography in malignant lymphomas: comparison with gallium-67 citrate. Ann Nucl Med 2010; 24:639-47. [PMID: 20799079 DOI: 10.1007/s12149-010-0405-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Accepted: 07/02/2010] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Previous studies have demonstrated the feasibility of targeting lymphoma lesions with somatostatin receptor binding agents, mainly with In-111-pentetreotide. In the present work another somatostatin analog, Tc-99m depreotide, is investigated. METHODS One-hundred and six patients, 47 with Hodgkin's (HL) and 59 with various types of non-Hodgkin's lymphoma (NHL), were imaged with both Tc-99m depreotide and Ga-67 citrate. Planar whole-body and single photon emission tomography/low resolution computerized tomography (SPECT/CT) images were obtained. A total of 142 examinations were undertaken at different phases of the disease. Depreotide and gallium findings were compared visually and semi-quantitatively, with reference to the results of conventional work-up and the patients' follow-up data. RESULTS In most HL, intermediate- and low-grade B-cell, as well as in T-cell NHL, depreotide depicted more lesions than Ga-67 and/or exhibited higher tumor uptake. The opposite was true in aggressive B-cell NHL. However, there were notable exceptions in all lymphoma subtypes. During initial staging, 93.3% of affected lymph nodes above the diaphragm, 100% of inguinal nodes and all cases with splenic infiltration were detected by depreotide. On the basis of depreotide findings, 32% of patients with early-stage HL were upstaged. However, advanced HL and NHL cases were frequently downstaged, due to low sensitivity for abdominal lymph node (22.7%), liver (45.5%) and bone marrow involvement (36.4%). Post-therapy, depreotide detected 94.7% of cases with refractory disease or recurrence. Its overall specificity was moderate (57.1%). Rebound thymic hyperplasia, various inflammatory processes and sites of unspecific uptake were the commonest causes of false positive findings. The combination of depreotide and gallium enhanced sensitivity (100%), while various false positive results of either agent could be avoided. CONCLUSION Except perhaps for early-stage HL, Tc-99m depreotide as a stand-alone imaging modality has limited value for the initial staging of lymphomas. Post-therapy, however, depreotide scintigraphy seems useful in the evaluation of certain anatomic areas, particularly in non-aggressive lymphoma types. The combination with Ga-67 potentially enhances sensitivity and specificity. If fluorodeoxyglucose positron emission tomography is not available or in case of certain indolent lymphoma types, Tc-99m depreotide may have a role as an adjunct to conventional imaging procedures.
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Saeed P, Tanck MW, Freling N, Baldeschi L, Mourits MP, Bennink RJ. Somatostatin Receptor Scintigraphy for Optic Nerve Sheath Meningiomas. Ophthalmology 2009; 116:1581-6. [DOI: 10.1016/j.ophtha.2009.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 02/04/2009] [Accepted: 02/04/2009] [Indexed: 01/28/2023] Open
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Abstract
Tumor receptors play an important role in carcinogenesis and tumor growth and have been some of the earliest targets for tumor-specific therapy, for example, the estrogen receptor in breast cancer. Knowledge of receptor expression is key for therapy directed at tumor receptors and traditionally has been obtained by assay of biopsy material. Tumor receptor imaging offers complementary information that includes evaluation of the entire tumor burden and characterization of the heterogeneity of tumor receptor expression. The nature of the ligand-receptor interaction poses a challenge for imaging--notably, the requirement for a low molecular concentration of the imaging probe to avoid saturating the receptor and increasing the background because of nonspecific uptake. For this reason, much of the work to date in tumor receptor imaging has been done with radionuclide probes. In this overview of tumor receptor imaging, aspects of receptor biochemistry and biology that underlie tumor receptor imaging are reviewed, with the estrogen-estrogen receptor system in breast cancer as an illustrative example. Examples of progress in radionuclide receptor imaging for 3 receptor systems--steroid receptors, somatostatin receptors, and growth factor receptors-are highlighted, and recent investigations of receptor imaging with other molecular imaging modalities are reviewed.
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Affiliation(s)
- David A Mankoff
- Division of Nuclear Medicine, University of Washington, Seattle, Washington, USA.
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Kostakoglu L, Coleman M, Goldsmith SJ. Hodgkin’s Disease and Lymphomas. Clin Nucl Med. [DOI: 10.1007/978-3-540-28026-2_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Affiliation(s)
- S N Reske
- Universitätsklinikum Ulm Klinik für Nuklearmedizin, Ulm, Germany
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Hematological, reticuloendothelial and lymphatic disorders. Clin Nucl Med 2006. [DOI: 10.1201/b13348-69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
In nuclear oncology, despite the fast-growing diffusion of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET), single-photon emission computed tomography (SPECT) studies can still play an useful clinical role in several applications. The main limitation of SPECT imaging with tumor-seeking agents is the lack of the structural delineation of the pathologic processes they detect; this drawback sometimes renders SPECT interpretation difficult and can diminish its diagnostic accuracy. Fusion with morphological studies can overcome this limitation by giving an anatomical map to scintigraphic data. In the past, software-based fusion of independently performed SPECT and CT images proved to be time-consuming and impractical for routine use. The recent development of dual-modality integrated imaging systems that provide functional (SPECT) and anatomical (CT) images in the same scanning session, with the acquired images coregistered by means of the hardware, has opened a new era in this field. The first reports indicate that SPECT/CT is very useful in cancer imaging because it is able to provide further information of clinical value in several cases. In SPECT, studies of lung cancer and malignant lymphomas using different radiopharmaceutical, hybrid images are of value in providing the correct localization of tumor sites, with a precise detection of the involved organs, and the definition of their functional status, and in allowing the exclusion of disease in sites of physiologic tracer uptake. Therefore, in lung cancer and lymphomas, hybrid SPECT/CT can play a role in the diagnosis of the primary tumor, in the staging of the disease, in the follow-up, in the monitoring of therapy, in the detection of recurrence, and in dosimetric estimations for target radionuclide therapy.
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Affiliation(s)
- Orazio Schillaci
- Department of Biopathology and Diagnostic Imaging, University Tor Vergata, Rome, Italy.
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Ferone D, Boschetti M, Resmini E, Giusti M, Albanese V, Goglia U, Albertelli M, Vera L, Bianchi F, Minuto F. Neuroendocrine-Immune Interactions: The Role of Cortistatin/Somatostatin System. Ann N Y Acad Sci 2006; 1069:129-44. [PMID: 16855140 DOI: 10.1196/annals.1351.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Hormones and neuropeptides may influence the activities of lymphoid organs and cells via endocrine and local autocrine/paracrine pathways. A paradigm of the interactions between the neuroendocrine and immune system is sophisticatedly represented in the thymus. Indeed, receptors for these molecules are heterogeneously expressed in all subsets of thymic cells, and the communications are tuned by feedback circuitries. Herein, we focus on somatostatin (SS), a ubiquitous peptide that regulates several physiological cell processes and acts via five specific receptor (SSR) subtypes (sst(1-5)). Neuronal and accessory cells, so-called neuroendocrine cells, and immune cells, heterogeneously express SSRs. The functional characterization of SSRs in vivo by nuclear medicine techniques opened a complex scenario on the significance of SS/SSR pathway in immune system and related diseases. Several studies have established that SSR scintigraphy may benefit patients with chronic inflammatory and granulomatous diseases, as well as lymphoproliferative diseases. The results are sufficiently promising to warrant larger studies aimed at defining the exact role of these techniques. The development of SS analogs with antisecretory and antiproliferative effects has radically changed the management of neuroendocrine tumors. Moreover, very important recent findings, emerging from in vitro studies on SSR physiology in immune cells, will certainly expand the potential applications of SS analogs for in vivo diagnostic and therapeutic options. Indeed, the anti-inflammatory and analgesic effects of these drugs remain incompletely understood, but may prove useful in a number of autoimmune diseases. Because SS expression is absent in different immune tissues where SSRs are present, the existence of another ligand was hypothesized. In fact, it has been recently demonstrated that human lymphoid tissues and immune cells may express cortistatin (CST). CST is known to bind SSRs and shares many pharmacological and functional properties with SS. However, CST has also properties distinct from SS, and the higher expression of CST in immune cells supports the hypothesis that CST rather than SS may act as a potential endogenous ligand for SSRs in the human immune system.
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Affiliation(s)
- Diego Ferone
- Department of Endocrinological and Metabolic Sciences, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy.
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Current Awareness in Hematological Oncology. Hematol Oncol 2005; 23:136-43. [DOI: 10.1002/hon.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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