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Bhoil A. Lesion Analysis in PERCIST 1.0: Clinical Ease versus Research Requisite-Where Does the Balance Exist? World J Nucl Med 2023; 22:100-107. [PMID: 37223629 PMCID: PMC10202569 DOI: 10.1055/s-0042-1750406] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Background Semiqualitative parameter SUVmax has been the most frequently used semiquantitative positron emission tomography (PET) parameter for response evaluation, but only metabolic activity of a single (most metabolic) lesion is predicted. Newer response parameters such as tumor lesion glycolysis (TLG) incorporating lesions' metabolic volume or whole-body metabolic tumor burden (MTBwb) are being explored for response evaluation. Evaluation and comparison of response with different semiquantitative PET parameters such as SUVmax and TLG in most metabolic lesion, multiple lesions (max of five), and MTBwb in advanced non-small cell lung cancer (NSCLC) patients were made. The different PET parameters were analyzed for response evaluation, overall survival (OS), and progression-free survival (PFS). Methods 18 F-FDG-PET/CT (18-fluorine-fluorodeoxyglucose positron emission tomography/computed tomography) imaging was performed in 23 patients (M = 14, F = 9, mean age = 57.6 years) with stage IIIB-IV advanced NSCLC before initiation of therapy with oral estimated glomerular filtration rate-tyrosine kinase inhibitor for early and late response evaluation. The quantitative PET parameters such as SUVmax and TLG were measured in single (most metabolic) lesion, multiple lesions, and MTBwb. The parameters SUVmax, TLG, and MTBwb were compared for early and late response evaluation and analyzed for OS and PFS Results No significant difference in change in response evaluation was seen in patients evaluated with most metabolic lesion, multiple lesions, or MTBwb. Difference in early (DC 22, NDC 1) and late (DC 20, NDC 3) response evaluation was seen that remained unchanged when lesions were measured in terms of number of lesions or the MTBwb. The early imaging was seen to be statistically significant to the OS compared with late imaging. Conclusions Single (most metabolic) lesion shows similar disease response and OS to multiple lesions and MTBwb. Response evaluation by late imaging offered no significant advantage compared with early imaging. Thus, early response evaluation with SUVmax parameter offers a good balance between clinical ease and research requisition.
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Affiliation(s)
- Amit Bhoil
- Department of Nuclear Medicine, Mahajan Imaging and Labs, New Delhi, India
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Bai JW, Qiu SQ, Zhang GJ. Molecular and functional imaging in cancer-targeted therapy: current applications and future directions. Signal Transduct Target Ther 2023; 8:89. [PMID: 36849435 PMCID: PMC9971190 DOI: 10.1038/s41392-023-01366-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 01/19/2023] [Accepted: 02/14/2023] [Indexed: 03/01/2023] Open
Abstract
Targeted anticancer drugs block cancer cell growth by interfering with specific signaling pathways vital to carcinogenesis and tumor growth rather than harming all rapidly dividing cells as in cytotoxic chemotherapy. The Response Evaluation Criteria in Solid Tumor (RECIST) system has been used to assess tumor response to therapy via changes in the size of target lesions as measured by calipers, conventional anatomically based imaging modalities such as computed tomography (CT), and magnetic resonance imaging (MRI), and other imaging methods. However, RECIST is sometimes inaccurate in assessing the efficacy of targeted therapy drugs because of the poor correlation between tumor size and treatment-induced tumor necrosis or shrinkage. This approach might also result in delayed identification of response when the therapy does confer a reduction in tumor size. Innovative molecular imaging techniques have rapidly gained importance in the dawning era of targeted therapy as they can visualize, characterize, and quantify biological processes at the cellular, subcellular, or even molecular level rather than at the anatomical level. This review summarizes different targeted cell signaling pathways, various molecular imaging techniques, and developed probes. Moreover, the application of molecular imaging for evaluating treatment response and related clinical outcome is also systematically outlined. In the future, more attention should be paid to promoting the clinical translation of molecular imaging in evaluating the sensitivity to targeted therapy with biocompatible probes. In particular, multimodal imaging technologies incorporating advanced artificial intelligence should be developed to comprehensively and accurately assess cancer-targeted therapy, in addition to RECIST-based methods.
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Affiliation(s)
- Jing-Wen Bai
- Fujian Key Laboratory of Precision Diagnosis and Treatment in Breast Cancer, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, 361100, Xiamen, China
- Xiamen Key Laboratory of Endocrine-Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, 361100, Xiamen, China
- Xiamen Research Center of Clinical Medicine in Breast and Thyroid Cancers, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, 361100, Xiamen, China
- Department of Breast-Thyroid-Surgery and Cancer Center, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, 361100, Xiamen, China
- Department of Medical Oncology, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, 361100, Xiamen, China
- Cancer Research Center of Xiamen University, School of Medicine, Xiamen University, 361100, Xiamen, China
| | - Si-Qi Qiu
- Diagnosis and Treatment Center of Breast Diseases, Clinical Research Center, Shantou Central Hospital, 515041, Shantou, China
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Shantou University Medical College, 515041, Shantou, China
| | - Guo-Jun Zhang
- Fujian Key Laboratory of Precision Diagnosis and Treatment in Breast Cancer, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, 361100, Xiamen, China.
- Xiamen Key Laboratory of Endocrine-Related Cancer Precision Medicine, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, 361100, Xiamen, China.
- Xiamen Research Center of Clinical Medicine in Breast and Thyroid Cancers, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, 361100, Xiamen, China.
- Department of Breast-Thyroid-Surgery and Cancer Center, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, 361100, Xiamen, China.
- Cancer Research Center of Xiamen University, School of Medicine, Xiamen University, 361100, Xiamen, China.
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Sidrak MMA, De Feo MS, Frantellizzi V, Marongiu A, Caponnetto S, Filippi L, Nuvoli S, Spanu A, Schillaci O, De Vincentis G. First-, Second-, and Third-Generation Radiolabeled Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors in Positron Emission Tomography: State of the Art, a Systematic Review. Cancer Biother Radiopharm 2023; 38:232-245. [PMID: 36622960 DOI: 10.1089/cbr.2022.0049] [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] [Indexed: 01/11/2023] Open
Abstract
Introduction: Lung cancer (LC) is a leading cause of death among men and women, with non-small cell LC (NSCLC) accounting for a substantial portion of the histopathological spectrum and epidermal growth factor receptor (EGFR) mutations being correlated with its manifestation and evolution. Positron emission tomography (PET)/computed tomography has been the most widely used instrument to assess and monitor LC in a noninvasive way, including EGFR-mutated NSCLC, and its course during therapy, indicating to the referring physician the response to ongoing treatment or the lack of it. This systematic review aims to evaluate the feasibility and safety of radiolabeled EGFR tyrosine kinase inhibitors (TKis) in PET in clinical practice. Materials and Methods: From 1999 to April 2022 a Medline search was conducted on four different databases such as PubMed, Cochrane Library, Scopus, and Web of Sciences. Clinical studies were assessed by Quality Assessment of Diagnostic accuracy Studies-2 (QUADAS-2) and preclinical studies were also reported in this review. Results: Nine clinical studies were QUADAS-2 assessed and risk-of-bias assessment, and it turned out acceptable as two out of eight studies had low risk of bias in all four domains for risk-of-bias assessment, and the other four studies had three low-risk domains. The overall assessment for applicability risks was low. Conclusions: Radiolabeled EGFR-TKis in PET are a valid tool in identifying patients who may benefit from TKi therapy and who may not as a means to start an effective treatment. Although the number of clinical studies conducted so far is meager, these new PET tracers are already proving to be very useful in clinical settings as patient prognosis can be better assessed.
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Affiliation(s)
- Marko Magdi Abdou Sidrak
- Nuclear Medicine, Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Rome, Italy
| | - Maria Silvia De Feo
- Nuclear Medicine, Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Rome, Italy
| | - Viviana Frantellizzi
- Nuclear Medicine, Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Rome, Italy
| | - Andrea Marongiu
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Salvatore Caponnetto
- Oncology B, Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Rome, Italy
| | - Luca Filippi
- Department of Nuclear Medicine, Santa Maria Goretti Hospital, Latina, Italy
| | - Susanna Nuvoli
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Angela Spanu
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Giuseppe De Vincentis
- Nuclear Medicine, Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Rome, Italy
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Xu D, Yu F, Guo T, Zhou Y, Zhang J, Li Y, Jiang S, Mao J, Yang X, Chu L, Chu X, Wang S, Ni J, Zhu Z. Clinical value of PET/CT in identifying patients with oligometastatic/oligoprogressive disease among first-line tyrosine kinase inhibitor-treated advanced EGFR-mutant non-small cell lung cancer: Implications from survival comparisons. Br J Radiol 2022; 95:20220035. [PMID: 35611637 PMCID: PMC10162049 DOI: 10.1259/bjr.20220035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Local therapy (LT) could potentially prolong the survival of patient with advanced epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) receiving tyrosine kinase inhibitors (TKIs) and harboring oligometastatic/oligoprogressive disease (OMD/OPD). However, the optimal imaging method for identifying patients with OMD/OPD remains controversial. The objective of this study was to investigate the clinical value of incorporating PET/CT in detecting patients with OMD/OPD. METHODS Consecutive cases with metastatic EGFR-mutant NSCLC undergoing first-line EGFR-TKI treatment were retrospectively screened and those receiving baseline PET/CT and brain magnetic resonance imaging (MRI) or complete conventional imaging (CIM), including brain MRI, chest computed tomography (CT), abdomen ultrasound or CT and bone scintigraphy were included. OMD/OPD was defined as metastases/progressions documented at a maximum of five lesions and three organs, otherwise was defined as multiple metastatic/progressive disease (MMD/MPD). Progression-free survival (PFS) and overall survival (OS) were analyzed. RESULTS Of the 392 patients evaluated, baseline OMD was detected in 22.7% (53/233) of patients by PET/CT and in 18.2% (29/159) of patients by CIM (p = 0.171). Among the patients evaluated with baseline PET/CT, patients with OMD had longer PFS (p = 0.016) and tendency of improved OS (p = 0.058) than those with MMD. However, this result was not observed with patients evaluated using baseline CIM. With a median follow-up of 24.2 (range, 1.1-124.6) months, 297 patients had their first disease progression (FPD), of whom 164 (55.2%) had adequate imaging scans to analyze the tumor distributions at FPD comprehensively. OPD was detected in 63.0% (34/54) and 35.0% (39/110) of patients among the PET/CT and CIM assessed group (p = 0.003), respectively. Among the PET/CT assessed group, patients with OPD had significantly longer post-progressive overall survival (OS2) than those with MPD (p = 0.011). However, no significant difference of OS2 in the CIM assessed group was found. CONCLUSION Patients with OMD/OPD, evaluated by PET/CT but not CIM, generally had more favorable survival outcomes than those with MMD/MPD among patients with metastatic NSCLC undergoing first-line EGFR-TKI treatment. ADVANCES IN KNOWLEDGE PET/CT seems to affect the survival of patients under first-line EGFR-TKI treated metastatic NSCLC with OMD/OPD.
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Huang YE, Tsai YH, Huang YJ, Lung JH, Ho KW, Yen TC, Chan SC, Chen ST, Tsai MF, Hung MS. 18F-Fluorodeoxyglucose PET/CT for Early Prediction of Outcomes in Patients with Advanced Lung Adenocarcinomas and EGFR Mutations Treated with First-Line EGFR-TKIs. Cancers (Basel) 2022; 14:1507. [PMID: 35326662 DOI: 10.3390/cancers14061507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Epithelial growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are the first-line therapy for patients with advanced-stage lung adenocarcinoma with EGFR mutations. However, 17–31% of these patients do not respond to therapy, making early evaluation of treatment response crucial. This prospective study investigates the value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for timely prediction of response and survival of these patients. We evaluated 30 patients with stage IIIB/IV lung adenocarcinomas and EGFR mutations, receiving first-line EGFR-TKI therapy. 18F-FDG PET/CT was performed before and two weeks after initiation of treatment. Positron Emission Tomography Response Criteria in Solid Tumors served as an independent predictor of non-progressive disease; baseline and change of metabolic tumor volume represented independent predictors of progression-free survival and overall survival, respectively. Therefore, 18F-FDG PET/CT is an early predictor of outcomes and individual prognosis of patients with stage IIIB/IV lung adenocarcinomas and EGFR mutations receiving first-line EGFR-TKI therapy. Abstract This study aims to investigate the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in early prediction of response and survival following epithelial growth factor receptor (EGFR)–tyrosine kinase inhibitor (TKI) therapy in patients with advanced lung adenocarcinomas and EGFR mutations. Thirty patients with stage IIIB/IV lung adenocarcinomas and EGFR mutations receiving first-line EGFR-TKIs were prospectively evaluated between November 2012 and May 2015. EGFR mutations were quantified by delta cycle threshold (dCt). 18F-FDG PET/CT was performed before and 2 weeks after treatment initiation. PET response was assessed based on PET Response Criteria in Solid Tumors (PERCIST). Baseline and percentage changes in the summed standardized uptake value, metabolic tumor volume (bsumMTV and ΔsumMTV, respectively), and total lesion glycolysis of ≤5 target lesions/patient were calculated. The association between parameters (clinical and PET) and non-progression disease after 3 months of treatment in CT based on the Response Evaluation Criteria in Solid Tumors Version 1.1 (nPD3mo), progression-free survival (PFS), and overall survival (OS) were tested. The median follow-up time was 19.6 months. The median PFS and OS were 12.0 and 25.3 months, respectively. The PERCIST criteria was an independent predictor of nPD3mo (p = 0.009), dCt (p = 0.014) and bsumMTV (p = 0.014) were independent predictors of PFS, and dCt (p = 0.014) and ΔsumMTV (p = 0.005) were independent predictors of OS. 18F-FDG PET/CT achieved early prediction of outcomes in patients with advanced lung adenocarcinomas and EGFR mutations receiving EGFR-TKIs.
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6
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Eaton KD, Romine PE, Martins RG, Leblond A, Carr LL, Vesselle HJ. Adaptive Fluorodeoxyglucose-Positron Emission Tomography Based Chemotherapy Selection for Metastatic Non-small Cell Lung Cancer. Cureus 2021; 13:e18804. [PMID: 34796077 PMCID: PMC8590825 DOI: 10.7759/cureus.18804] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives The change in tumor fluorodeoxyglucose (FDG) uptake by positron emission tomography (PET) scan after one cycle of platinum-based chemotherapy has been shown to predict progression-free and overall survival (PFS and OS) among advanced non-small cell lung cancer (NSCLC) patients. Using early FDG-PET response to determine subsequent chemotherapy, we aim to evaluate the role that adaptive chemotherapy regimens have on later CT response, PFS, and OS in patients with advanced NSCLC. Materials and Methods Chemotherapy-naïve patients with metastatic NSCLC received carboplatin and paclitaxel (CP) on day one and repeated FDG-PET on day 18. PET-responding patients continued CP chemotherapy for a total of four cycles. PET non-responders were switched to alternate docetaxel and gemcitabine (DG) for three additional cycles. The primary outcome was the CT Response Evaluation Criteria in Solid Tumors (RECIST 1.0) response. Secondary endpoints included PFS and OS. Results Forty-six patients initiated treatment with chemotherapy on trial and were evaluable by PET/CT. Of these, 19 (41%) met the FDG-PET criteria for the response after a single cycle of CP. Only one non-responding patient had a CT response. Despite the lack of CT response in the DG arm, no trend for worse PFS or OS was seen between the two arms. Conclusions This work demonstrates that changing chemotherapy in the event of non-response by PET did not lead to improved CT RECIST response. However, non-responding patients who switched chemotherapy had similar PFS and OS to those who responded by PET and continued the same regimen.
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Affiliation(s)
- Keith D Eaton
- Medical Oncology, University of Washington, Seattle, USA
| | | | | | - Antoine Leblond
- Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, CAN
| | | | - Hubert J Vesselle
- Nuclear Medicine, Fred Hutchinson Cancer Research Center, Seattle, USA
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Amrane K, Campedel L, Le Meur C, Abgral R, Kharroubi D, Cadranel J. Case Report: Two Rare Cases of Complete Metabolic Response to Crizotinib in Patients With Rearranged ROS1 and ALK Metastatic Non-small Lung Cancer. Front Med (Lausanne) 2021; 8:691253. [PMID: 34660618 PMCID: PMC8514716 DOI: 10.3389/fmed.2021.691253] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/20/2021] [Indexed: 11/13/2022] Open
Abstract
Crizotinib is a tyrosine kinase inhibitor (TKI) indicated in first-line treatment of rearranged c-ros oncogene 1 (ROS1) and anaplastic lymphoma kinase (ALK) metastatic non-small-cell lung cancer (NSCLC). However, the common response reported after treatment is partial and few complete responses have been reported in PROFILE studies with computed tomography (CT) evaluation. To date, only one case report of complete metabolic response on 2-deoxy-2-[18F] fluoro-D-glucose positron emission tomography-computed tomography (18F-FDG-PET/CT) was published, reporting on a patient with ROS1 rearranged NSCLC. We highlighted the 18F-FDG-PET/CT useful approach for therapeutic assessment of TKI in metastatic mutated NSCLC reporting two complete metabolic responses in patients treated with crizotinib for a rearranged ROS1 and a metastatic ALK NSCLC.
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Affiliation(s)
- Karim Amrane
- Department of Oncology, Pitié Salpêtrière Hospital, Paris, France.,Department of Oncology, Centre Hospitalier des Pays de Morlaix, Morlaix, France
| | - Luca Campedel
- Department of Oncology, Pitié Salpêtrière Hospital, Paris, France
| | - Coline Le Meur
- Department of Oncology, Centre Hospitalier des Pays de Morlaix, Morlaix, France
| | - Ronan Abgral
- Department of Nuclear Medicine, University Hospital of Brest, Brest, France
| | - Dris Kharroubi
- Department of Nuclear Medicine, Pitié Salpêtrière Hospital, Paris, France
| | - Jacques Cadranel
- Department of Pneumology and Thoracic Oncology, Tenon Hospital, AP-HP and Sorbonne Université, Paris, France
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Kim C, Liu SV, Crawford J, Torres T, Chen V, Thompson J, Tan M, Esposito G, Subramaniam DS, Giaccone G. A Phase I Trial of Dasatinib and Osimertinib in TKI Naïve Patients With Advanced EGFR-Mutant Non-Small-Cell Lung Cancer. Front Oncol 2021; 11:728155. [PMID: 34568058 PMCID: PMC8457399 DOI: 10.3389/fonc.2021.728155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/21/2021] [Accepted: 08/19/2021] [Indexed: 12/25/2022] Open
Abstract
Background Osimertinib is an effective first-line therapy option for EGFR-mutant NSCLC, but virtually all patients develop resistance. CRIPTO, through Src activation, has been implicated in resistance to EGFR tyrosine kinase inhibitor (EGFR-TKI) therapy. Dasatinib, a Src inhibitor, has shown preclinical synergy with EGFR-TKI therapy. Method This is a single-arm phase I/II trial of osimertinib and dasatinib in TKI-naïve advanced EGFR-mutant NSCLC (NCT02954523). A 3 + 3 design was used in the phase I to establish the recommended phase II dose (RP2D). Osimertinib 80 mg QD was combined with dasatinib 70 mg BID (DL2), 50 mg BID (DL1), 70 mg QD (DL-1), and 50 mg QD (DL-2). Results Ten patients (DL2: 3, DL1: 6, DL -1: 1) were enrolled. 3 (50%) of 6 patients at DL1 experienced a DLT (grade 3 headaches/body pain, neutropenia, rash, one each). Common treatment-related adverse events included pleural effusion (n=10), diarrhea (n=8), rash (n=7), transaminitis (n=7), thrombocytopenia (n=7), and neutropenia (n=7). While the MTD was not determined by protocol-defined DLT criteria, DL-2 was chosen as the RP2D, considering overall tolerability. Nine (90%) patients had a PR, including 1 unconfirmed PR. Median PFS was 19.4 months and median OS 36.1 months. The trial was closed to accrual prematurely due to slow accrual after the approval of osimertinib as first-line therapy. Conclusions The combination of dasatinib and osimertinib demonstrated anticancer activity. The treatment was limited by chronic toxicities mainly attributed to dasatinib. To improve the safety and tolerability of Src and EGFR co-inhibition, Src inhibitors with a more favorable safety profile should be utilized in future studies. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT02954523.
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Affiliation(s)
- Chul Kim
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States
| | - Stephen V Liu
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States
| | - Jennifer Crawford
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States
| | - Tisdrey Torres
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States
| | - Vincent Chen
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States
| | - Jillian Thompson
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States
| | - Ming Tan
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC, United States
| | - Giuseppe Esposito
- Department of Radiology, Georgetown University Hospital, Washington, DC, United States
| | - Deepa S Subramaniam
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States.,AstraZeneca Plc., Gaithersburg, MD, United States
| | - Giuseppe Giaccone
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States.,Weill-Cornell Medicine, New York, NY, United States
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Valerio L, Guidoccio F, Giani C, Tardelli E, Puccini G, Puleo L, Minaldi E, Boni G, Elisei R, Volterrani D. [18F]-FDG-PET/CT Correlates With the Response of Radiorefractory Thyroid Cancer to Lenvatinib and Patient Survival. J Clin Endocrinol Metab 2021; 106:2355-2366. [PMID: 33901285 DOI: 10.1210/clinem/dgab278] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT 18F-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography ([18F]-FDG-PET/CT)-positive metastatic lesions in radioiodine-refractory differentiated thyroid cancer (RAI-R DTC) have a poor prognosis and lenvatinib represents the best therapy. OBJECTIVE We investigated the role of [18F]-FDG-PET/CT in the evaluation of metabolic response and prediction of the outcome of RAI-R DTC patients treated with lenvatinib. METHODS Patients (n = 33) with progressive metastatic RAI-R DTC who were treated with lenvatinib were investigated at baseline and during follow-up with biochemical (thyroglobulin and thyroglobulin antibodies), morphological (whole-body CT scan) and metabolic ([18F]-FDG-PET/CT) evaluation. RESULTS Nineteen (57.6%) patients showed the greatest metabolic response at the first [18F]-FDG-PET/CT scan, performed after 4 weeks of lenvatinib, while 5/33 (15.1%) patients had this response later. Moreover, 66.7% of patients had both a metabolic response at the first [18F]-FDG-PET/CT scan and a morphological response at the first CT scan. We observed a correlation between the metabolic response at [18F]-FDG-PET/CT scan performed after 4 weeks of treatment and the biochemical response at the same time in 60.6% of patients. The median overall survival (OS) was significantly longer in patients with either a metabolic response at last [18F]-FDG-PET/CT (40.00 vs 8.98 months) or a morphological response at last CT scan (37.22 vs 9.53 months) than in those without response. Moreover, the OS was longer in patients with a metabolic response at [18F]-FDG-PET/CT performed after 4 weeks of treatment (36.53 vs 11.28 months). CONCLUSIONS Our data show that [18F]-FDG-PET/CT can early predict the response to lenvatinib and correlates with the OS of RAI-R DTC patients treated with this drug.
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Affiliation(s)
- Laura Valerio
- University Hospital of Pisa, Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa 56124, Italy
| | - Federica Guidoccio
- University Hospital of Pisa, Department of Diagnostic and Imaging, Unit of Nuclear Medicine, Pisa 56126, Italy
| | - Carlotta Giani
- University Hospital of Pisa, Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa 56124, Italy
| | - Elisa Tardelli
- University Hospital of Pisa, Department of Diagnostic and Imaging, Unit of Nuclear Medicine, Pisa 56126, Italy
| | - Giulia Puccini
- University Hospital of Pisa, Department of Diagnostic and Imaging, Unit of Nuclear Medicine, Pisa 56126, Italy
| | - Luciana Puleo
- University Hospital of Pisa, Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa 56124, Italy
| | - Elisa Minaldi
- University Hospital of Pisa, Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa 56124, Italy
| | - Giuseppe Boni
- University Hospital of Pisa, Department of Diagnostic and Imaging, Unit of Nuclear Medicine, Pisa 56126, Italy
| | - Rossella Elisei
- University Hospital of Pisa, Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa 56124, Italy
| | - Duccio Volterrani
- University Hospital of Pisa, Department of Diagnostic and Imaging, Unit of Nuclear Medicine, Pisa 56126, Italy
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Chen YH, Wang TF, Chu SC, Lin CB, Wang LY, Lue KH, Liu SH, Chan SC. Incorporating radiomic feature of pretreatment 18F-FDG PET improves survival stratification in patients with EGFR-mutated lung adenocarcinoma. PLoS One 2020; 15:e0244502. [PMID: 33370365 PMCID: PMC7769431 DOI: 10.1371/journal.pone.0244502] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 12/10/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To investigate the survival prognostic value of the radiomic features of 18F-FDG PET in patients who had EGFR (epidermal growth factor receptor) mutated lung adenocarcinoma and received targeted TKI (tyrosine kinase inhibitor) treatment. METHODS Fifty-one patients with stage III-IV lung adenocarcinoma and actionable EGFR mutation who received first-line TKI were retrospectively analyzed. All patients underwent pretreatment 18F-FDG PET/CT, and we calculated the PET-derived radiomic features. Cox proportional hazard model was used to examine the association between the radiomic features and the survival outcomes, including progression-free survival (PFS) and overall survival (OS). A score model was established according to the independent prognostic predictors and we compared this model to the TNM staging system using Harrell's concordance index (c-index). RESULTS Forty-eight patients (94.1%) experienced disease progression and 41 patients (80.4%) died. Primary tumor SUV entropy > 5.36, and presence of pleural effusion were independently associated with worse OS (both p < 0.001) and PFS (p = 0.001, and 0.003, respectively). We used these two survival predictors to devise a scoring system (score 0-2). Patients with a score of 1 or 2 had a worse survival than those with a score of 0 (HR for OS: 3.6, p = 0.006 for score 1, and HR: 21.8, p < 0.001 for score 2; HR for PFS: 2.2, p = 0.027 for score 1 and HR: 8.8, p < 0.001 for score 2). Our scoring system surpassed the TNM staging system (c-index = 0.691 versus 0.574, p = 0.013 for OS, and c-index = 0.649 versus 0.517, p = 0.004 for PFS). CONCLUSIONS In this preliminary study, combining PET radiomics with clinical risk factors may improve survival stratification in stage III-IV lung adenocarcinoma with actionable EFGR mutation. Our proposed scoring system may assist with optimization of individualized treatment strategies in these patients.
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Affiliation(s)
- Yu-Hung Chen
- Department of Nuclear Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Department of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Tso-Fu Wang
- Department of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Hematology and Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Sung-Chao Chu
- Department of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Hematology and Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chih-Bin Lin
- Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ling-Yi Wang
- Epidemiology and Biostatistics Consulting Center, Department of Medical Research and Department of Pharmacy, Tzu Chi General Hospital, Hualien, Taiwan
| | - Kun-Han Lue
- Department of Medical Imaging and Radiological Sciences, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Shu-Hsin Liu
- Department of Nuclear Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Department of Medical Imaging and Radiological Sciences, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Sheng-Chieh Chan
- Department of Nuclear Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Department of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
- * E-mail:
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11
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Dejust S, Moubtakir A, Prevost A, El Farsaoui K, Morland D. 18F-FDG PET/CT Evaluation of Crizotinib and Lorlatinib Therapy in Metastatic ROS-1-Positive Non-Small Cell Lung Cancer. Clin Nucl Med 2020; 45:209-10. [PMID: 31977471 DOI: 10.1097/RLU.0000000000002912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
ROS-1-positive non-small cell lung cancers (NSCLCs) are rare (approximately 1% of all NSCLCs) and require a first-line treatment by crizotinib. Crizotinib resistance is frequent within the first 12 months of treatment. Lorlatinib is a novel tyrosine kinase inhibitor of ROS-1 recently indicated for metastatic or locally advanced crizotinib-resistant NSCLC. We report the use of lorlatinib as second-line with a complete tumoral response after only 3 months of treatment. This case shows the major role of F-FDG PET/CT in treatment evaluation and monitoring targeted therapy in metastatic NSCLC.
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12
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Sun W, He G, Zhang M, Zhao Y, Yu H, Li Y, Wu W, Ji T. 99mTc-3PRGD 2 SPECT Predicts the Outcome of Endostar and Cisplatin Therapy in Xenograft Animals. Dose Response 2019; 17:1559325819882544. [PMID: 31673250 PMCID: PMC6804356 DOI: 10.1177/1559325819882544] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/03/2019] [Accepted: 08/11/2019] [Indexed: 11/16/2022] Open
Abstract
Aims: Our study was designed to investigate the usefulness of 99mTc-3PRGD2 single-photon emission computed tomography (SPECT) for noninvasively monitoring the response of integrin αvβ3 expression to antiangiogenic treatment with endostar and cisplatin in xenograft animals. Methods: 99mTc-3PRGD2 SPECT imaging was performed at days 0, 7, 14, and 21. Tumors were harvested at all imaging time points for Western blotting and histopathological analysis. Result: In 99mTc-3PRGD2 SPECT imaging, the radioactivity accumulation of NaCl group rised gradually in the first half and dispersed on day 21 due to the necrosis of the tumor. While the radioactivity accumulation of treated groups gradually decreased throughout the course. The downtrend of tumor to nontumor ratio in endostar-treated group was more remarkable than cisplatin-treated group. The expression of intergrin αvβ3 of treated groups was lower than NaCl group from day 14. The expression of intergrin αvβ3 of endostar-treated group was significantly lower than cisplatin-treated group from baseline onward. Conclusion: It’s demonstrated that the 99mTc-3PRGD2 could noninvasively visualize and semiquantify tumor angiogenesis in the xenograft model and monitor the response to the antiangiogenic therapy of endostar and cisplatin effectively. It also can predict the outcome of endostar and cisplatin therapy in xenograft animals.
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Affiliation(s)
- Wei Sun
- Institute of Pediatrics, First Hospital, Jilin University, Changchun, Jilin, China
| | - Guifu He
- Department of Nuclear Medicine, Jilin Provincial Tumor Hospital, Changchun, Jilin, China
| | - Mingming Zhang
- Department of Molecular Biology, College of Basic Medical Sciences, Jilin University, Changchun, Jilin, China
| | - Yi Zhao
- Department of Nuclear Medicine, Jilin Provincial Tumor Hospital, Changchun, Jilin, China
| | - Hongmei Yu
- Department of Blood Transfusion, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China
| | - Yi Li
- State Key Laboratory of Inorganic Synthesis and Preparative Chemistry, College of Chemistry, Jilin University, Changchun, Jilin, China
| | - Wei Wu
- Department of Nuclear Medicine, Jilin Provincial Tumor Hospital, Changchun, Jilin, China
| | - Tiefeng Ji
- Department of Radiology, First Hospital, Jilin University, Changchun, Jilin, China
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13
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Altine B, Gai Y, Han N, Jiang Y, Ji H, Fang H, Niyonkuru A, Bakari KH, Rajab Arnous MM, Liu Q, Zhang Y, Lan X. Preclinical Evaluation of a Fluorine-18 ( 18F)-Labeled Phosphatidylinositol 3-Kinase Inhibitor for Breast Cancer Imaging. Mol Pharm 2019; 16:4563-4571. [PMID: 31553879 DOI: 10.1021/acs.molpharmaceut.9b00690] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Breast cancer is one of the commonest malignancies in women, especially in middle-aged and elderly women. Abnormal activation of the phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/AKt/mTOR) pathway has been found to be involved in breast cancer proliferation. Pictilisib (GDC-0941) is a potent inhibitor of PI3K with high affinity and is undergoing phase 2 clinical trials. In this study, we aimed to develop a noninvasive PI3K radiotracer to help determine the mechanism of the PI3K/AKt/mTOR pathway to aid in diagnosis. We designed a new 18F-radiolabeled radiotracer based on the structure of pictilisib, to evaluate noninvasively abnormal activation of the PI3K/AKT/mTOR pathway. To increase the water solubility, and to decrease hepatobiliary and gastrointestinal uptake of the tracer, pictilisib was modified with triethylene glycol di(p-toluenesulfonate) (TsO-PEG3-OTs) to obtain TsO-PEG3-GDC-0941 as the precursor for 18F labeling. A nonradiolabeled reference compound [19F]-PEG3-GDC-0941 was also prepared. Breast cancer cell lines, MCF-7 and MDA-MB-231, were used as high- and low-expression PI3K models, respectively. PET imaging and ex vivo biodistribution assays of [18F]-PEG3-GDC-0941 in MCF-7 and MDA-MB-231 xenografts were also performed, and the results were compared. The precursor compound and reference standard compound were successfully synthesized and identified using NMR and mass spectroscopy. The 18F radiolabeling was achieved with a high yield (61 ± 1%) at a high molar activity (2100 ± 100 MBq/mg). MicroPET images and biodistribution studies showed a higher uptake of the radiotracer in MCF-7 tumors than in MDA-MB-231 tumors (7.56 ± 1.01%ID/g vs 4.07 ± 0.68%ID/g, 1 h postinjection). Additionally, the MCF-7 tumor uptake was significantly decreased when a blocking dose of GDC-0941 was coinjected, indicating high specificity. The liver was found to be the major excretory organ with 5.82 ± 0.88%ID/g at 30 min postinjection for MCF-7 mice. This radiotracer holds great potential for patient screening, diagnosis, and therapy prediction of PI3K-related diseases.
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Affiliation(s)
- Bouhari Altine
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan 430022 , China.,Hubei Province Key Laboratory of Molecular Imaging , Wuhan 430022 , China
| | - Yongkang Gai
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan 430022 , China.,Hubei Province Key Laboratory of Molecular Imaging , Wuhan 430022 , China
| | - Na Han
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan 430022 , China.,Hubei Province Key Laboratory of Molecular Imaging , Wuhan 430022 , China
| | - Yaqun Jiang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan 430022 , China.,Hubei Province Key Laboratory of Molecular Imaging , Wuhan 430022 , China
| | - Hao Ji
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan 430022 , China.,Hubei Province Key Laboratory of Molecular Imaging , Wuhan 430022 , China
| | - Hanyi Fang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan 430022 , China.,Hubei Province Key Laboratory of Molecular Imaging , Wuhan 430022 , China
| | - Alexandre Niyonkuru
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan 430022 , China.,Hubei Province Key Laboratory of Molecular Imaging , Wuhan 430022 , China
| | - Khamis Hassan Bakari
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan 430022 , China.,Hubei Province Key Laboratory of Molecular Imaging , Wuhan 430022 , China
| | - Maher Mohamad Rajab Arnous
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan 430022 , China.,Hubei Province Key Laboratory of Molecular Imaging , Wuhan 430022 , China
| | - Qingyao Liu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan 430022 , China.,Hubei Province Key Laboratory of Molecular Imaging , Wuhan 430022 , China
| | - Yongxue Zhang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan 430022 , China.,Hubei Province Key Laboratory of Molecular Imaging , Wuhan 430022 , China
| | - Xiaoli Lan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan 430022 , China.,Hubei Province Key Laboratory of Molecular Imaging , Wuhan 430022 , China
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14
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Ordu C. Are the metabolic evaluation criteria sufficient for FDG PET/CT after chemo-radiotherapy in non-small cell lung cancer? J Thorac Dis 2019; 11:S1263-S1266. [PMID: 31245104 DOI: 10.21037/jtd.2019.02.49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Cetin Ordu
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
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15
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Werner RA, Bundschuh RA, Higuchi T, Javadi MS, Rowe SP, Zsótér N, Kroiss M, Fassnacht M, Buck AK, Kreissl MC, Lapa C. Volumetric and texture analysis of pretherapeutic 18F-FDG PET can predict overall survival in medullary thyroid cancer patients treated with Vandetanib. Endocrine 2019; 63:293-300. [PMID: 30206772 PMCID: PMC6394453 DOI: 10.1007/s12020-018-1749-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/04/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE The metabolically most active lesion in 2-deoxy-2-(18F)fluoro-D-glucose (18F-FDG) PET/CT can predict progression-free survival (PFS) in patients with medullary thyroid carcinoma (MTC) starting treatment with the tyrosine kinase inhibitor (TKI) vandetanib. However, this metric failed in overall survival (OS) prediction. In the present proof of concept study, we aimed to explore the prognostic value of intratumoral textural features (TF) as well as volumetric parameters (total lesion glycolysis, TLG) derived by pre-therapeutic 18F-FDG PET. METHODS Eighteen patients with progressive MTC underwent baseline 18F-FDG PET/CT prior to and 3 months after vandetanib initiation. By manual segmentation of the tumor burden at baseline and follow-up PET, intratumoral TF and TLG were computed. The ability of TLG, imaging-based TF, and clinical parameters (including age, tumor marker doubling times, prior therapies and RET (rearranged during transfection) mutational status) for prediction of both PFS and OS were evaluated. RESULTS The TF Complexity and the volumetric parameter TLG obtained at baseline prior to TKI initiation successfully differentiated between low- and high-risk patients. Complexity allocated 10/18 patients to the high-risk group with an OS of 3.3 y (vs. low-risk group, OS = 5.3 y, 8/18, AUC = 0.78, P = 0.03). Baseline TLG designated 11/18 patients to the high-risk group (OS = 3.5 y vs. low-risk group, OS = 5 y, 7/18, AUC = 0.83, P = 0.005). The Hazard Ratio for cancer-related death was 6.1 for Complexity (TLG, 9.5). Among investigated clinical parameters, the age at initiation of TKI treatment reached significance for PFS prediction (P = 0.02, OS, n.s.). CONCLUSIONS The TF Complexity and the volumetric parameter TLG are both independent parameters for OS prediction.
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Affiliation(s)
- Rudolf A Werner
- Department of Nuclear Medicine, University Hospital Wuerzburg, Wuerzburg, Germany.
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of Nuclear Medicine and Molecular Imaging, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Comprehensive Heart Failure Center, University Hospital Wuerzburg, Wuerzburg, Germany.
| | - Ralph A Bundschuh
- Department of Nuclear Medicine, University Medical Center Bonn, Bonn, Germany
| | - Takahiro Higuchi
- Department of Nuclear Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
- Comprehensive Heart Failure Center, University Hospital Wuerzburg, Wuerzburg, Germany
- Department of Biomedical Imaging, National Cardiovascular and Cerebral Research Center, Suita, Japan
| | - Mehrbod S Javadi
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of Nuclear Medicine and Molecular Imaging, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven P Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of Nuclear Medicine and Molecular Imaging, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Matthias Kroiss
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, Wuerzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Wuerzburg, Wuerzburg, Germany
- Würzburger Schilddrüsenzentrum, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, Wuerzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Wuerzburg, Wuerzburg, Germany
- Würzburger Schilddrüsenzentrum, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Andreas K Buck
- Department of Nuclear Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
- Comprehensive Heart Failure Center, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Michael C Kreissl
- Department of Nuclear Medicine, Hospital Augsburg, Augsburg, Germany
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Constantin Lapa
- Department of Nuclear Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
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16
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Li X, Fu Q, Zhu Y, Wang J, Liu J, Yu X, Xu W. CD147-mediated glucose metabolic regulation contributes to the predictive role of 18 F-FDG PET/CT imaging for EGFR-TKI treatment sensitivity in NSCLC. Mol Carcinog 2018; 58:247-257. [PMID: 30320488 DOI: 10.1002/mc.22923] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 07/18/2018] [Revised: 09/26/2018] [Accepted: 10/09/2018] [Indexed: 12/18/2022]
Abstract
The aim of this study is to investigate the role of CD147 in glucose metabolic regulation and its association with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) treatment sensitivity prediction using 18 F-fluorodeoxyglucose (18 F-FDG) PET/CT imaging in non-small cell lung cancer (NSCLC). In this study, four human NSCLC cell lines with different EGFR-TKI responses were used to detect p-EGFR/EGFR and CD147 expression via Western blotting and flow cytometric analyses. Radioactive uptake of 18 F-FDG by established stable NSCLC cell lines (HCC827, H1975) with different levels of CD147 expression and the corresponding xenografts was assessed through γ-radioimmunoassays in vitro and micro-PET/CT imaging in vivo to study the role of CD147 in glucose metabolic reprogramming. Correlation analyses were performed to investigate the association between CD147 expression and PD-L1 expression in stable NSCLC cell lines. Higher CD147 expression was found in EGFR-TKI-sensitive NSCLC cell lines than in relatively resistant NSCLC cell lines (HCC827>PC9>A549>H1975). CD147 could promote 18 F-FDG uptake by HCC827 and H1975 cells in vitro and in vivo through an EGFR-initiated Akt/mTOR-dependent signaling pathway. Programmed cell death-ligand 1 (PD-L1) expression was positively correlated with CD147 expression in human NSCLC cell lines. EGFR-TKI treatment sensitivity prediction in NSCLC using 18 F-FDG PET/CT imaging significantly correlated with CD147-mediated glucose metabolic regulation via the Akt/mTOR-dependent pathway. Moreover, PD-L1 expression in NSCLC cell lines could be regulated by CD147, suggesting a potential immunosuppression induced by the upregulation of tumor glucose metabolism.
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Affiliation(s)
- Xiaofeng Li
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Qiang Fu
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yanjia Zhu
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Jian Wang
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Jianjing Liu
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xiaozhou Yu
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Wengui Xu
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
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17
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Fernández Pérez G, Sánchez Escribano R, García Vicente AM, Luna Alcalá A, Ceballos Viro J, Delgado Bolton RC, Vilanova Busquets JC, Sánchez Rovira P, Fierro Alanis MP, García Figueiras R, Alés Martínez JE. SEOM-SERAM-SEMNIM guidelines on the use of functional and molecular imaging techniques in advanced non-small-cell lung cancer. Radiologia (Engl Ed) 2018; 60:332-46. [PMID: 29807678 DOI: 10.1016/j.rx.2018.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/18/2018] [Indexed: 12/11/2022]
Abstract
Imaging in oncology is an essential tool for patient management but its potential is being profoundly underutilized. Each of the techniques used in the diagnostic process also conveys functional information that can be relevant in treatment decision making. New imaging algorithms and techniques enhance our knowledge about the phenotype of the tumor and its potential response to different therapies. Functional imaging can be defined as the one that provides information beyond the purely morphological data, and include all the techniques that make it possible to measure specific physiological functions of the tumor, whereas molecular imaging would include techniques that allow us to measure metabolic changes. Functional and molecular techniques included in this document are based on multi-detector computed tomography (CT), 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), magnetic resonance imaging (MRI), and hybrid equipments, integrating PET with CT (PET/CT) or MRI (PET-MRI). Lung cancer is one of the most frequent and deadly tumors although survival is increasing thanks to advances in diagnostic methods and new treatments. This increased survival poises challenges in terms of proper follow-up and definitions of response and progression, as exemplified by immune therapy-related pseudoprogression. In this consensus document, the use of functional and molecular imaging techniques will be addressed to exploit their current potential and explore future applications in the diagnosis, evaluation of response and detection of recurrence of advanced NSCLC.
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18
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Lin Y, Wang C, Gao W, Cui R, Liang J. Overwhelming rapid metabolic and structural response to apatinib in radioiodine refractory differentiated thyroid cancer. Oncotarget 2017; 8:42252-61. [PMID: 28178685 DOI: 10.18632/oncotarget.15036] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/08/2017] [Indexed: 12/31/2022] Open
Abstract
Currently, patients with radioiodine refractory differentiated thyroid cancer (RAIR-DTC) have limited treatment options. In this study, we aimed to assess the short-term efficacy and safety of apatinib in RAIR-DTC. Ten adult patients were prospectively enrolled to receive oral apatinib (750 mg q.d). The primary endpoints were change in serum thyroglobulin (Tg) concentration, disease control rate (DCR) and objective response rate (ORR) based on RECIST 1.1 criteria. The secondary endpoints included change in glucose metabolism, evaluated by maximum standard uptake value (SUVmax), and safety. As early as 2 weeks after apatinib treatment, the serum Tg concentration decreased by 21.0% in 8 patients available for detection without interference, and a further sharp decline by 81.4% compared with the baseline level occurred at 8 weeks post-treatment. The DCR and ORR were 100% (10/10) and 90% (9/10), respectively. The sum of tumor diameter shrank to 22.8±8.1 mm from 38.8±15.7 mm (P=0.001). Moreover, a significant decrease in SUVmax was observed from 6.53±5.14 to 2.56±1.67 and 2.45±1.48 at 4-week and 8-week time-points after treatment (P=0.032 and 0.020), respectively. The common grade 3 adverse events (AEs) included hand-foot-skin reaction (50%), hypertension (30%), and hypocalcemia (20%). No severe AE related to apatinib was observed during treatment. Hence, apatinib seems to be a promising therapeutic option for RAIR-DTC patients. Apart from RECIST 1.1 criteria, the biochemical marker (Tg) and glucose metabolism index (SUVmax) could be adopted in assessing the early response to TKI in RAIR-DTC.
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19
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Dai D, Xu W, Wang Q, Li X, Zhu Y. [Current Status and Progress in Molecular Imaging of Non-small Cell Lung
Cancer for Molecular Targeted EGFR-TKI Treatment Sensitivity and
Treatment Tolerance Prediction]. Zhongguo Fei Ai Za Zhi 2017; 20:852-856. [PMID: 29277186 PMCID: PMC5973391 DOI: 10.3779/j.issn.1009-3419.2017.12.10] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
肺癌80%以上为非小细胞肺癌(non-small cell lung cancer, NSCLC),表皮生长因子受体(epidermal growth factor receptor, EGFR)介导的信号通路与NSCLC发生发展密切相关。针对EGFR的小分子EGFR赖氨酸激酶抑制剂(EGFR-tyrosine kinase inhibitor, EGFR-TKI)被应用于NSCLC的临床治疗,正电子发射计算机断层显像(positron emission tomography/computed tomgraphy, PET/CT)能够无创地对NSCLC患者全身EGFR表达及突变状况进行连续动态监测。18F-FDG PET/CT显像对于EGFR活化突变、EGFR-TKI治疗疗效具有预测价值,并且能够在体直接观察到药物与全身肿瘤病灶EGFR靶向结合的具体情况,通过治疗前后的PET-CT显像,实现治疗前高敏人群筛选和治疗全过程的动态监测、治疗策略指导,对实现NSCLC的EGFR-TKI精准治疗至关重要。
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Affiliation(s)
- Dong Dai
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Wengui Xu
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Qi Wang
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Xiaofeng Li
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Yanjia Zhu
- Department of Molecular Imaging and Nuclear Medicine, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
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Fernández-Pérez G, Sánchez-Escribano R, García-Vicente AM, Luna-Alcalá A, Ceballos-Viro J, Delgado-Bolton RC, Vilanova-Busquets JC, Sánchez-Rovira P, Fierro-Alanis MP, García-Figueiras R, Alés-Martínez JE. SEOM-SERAM-SEMNIM guidelines on the use of functional and molecular imaging techniques in advanced non-small-cell lung cancer. Clin Transl Oncol 2018; 20:837-52. [PMID: 29256154 DOI: 10.1007/s12094-017-1795-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/04/2017] [Indexed: 12/17/2022]
Abstract
Imaging in oncology is an essential tool for patient management but its potential is being profoundly underutilized. Each of the techniques used in the diagnostic process also conveys functional information that can be relevant in treatment decision-making. New imaging algorithms and techniques enhance our knowledge about the phenotype of the tumor and its potential response to different therapies. Functional imaging can be defined as the one that provides information beyond the purely morphological data, and include all the techniques that make it possible to measure specific physiological functions of the tumor, whereas molecular imaging would include techniques that allow us to measure metabolic changes. Functional and molecular techniques included in this document are based on multi-detector computed tomography (CT), 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), magnetic resonance imaging (MRI), and hybrid equipments, integrating PET with CT (PET/CT) or MRI (PET-MRI). Lung cancer is one of the most frequent and deadly tumors although survival is increasing thanks to advances in diagnostic methods and new treatments. This increased survival poises challenges in terms of proper follow-up and definitions of response and progression, as exemplified by immune therapy-related pseudoprogression. In this consensus document, the use of functional and molecular imaging techniques will be addressed to exploit their current potential and explore future applications in the diagnosis, evaluation of response and detection of recurrence of advanced NSCLC.
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Abstract
Significant advances in understanding the genomic landscape of non-small cell lung cancer (NSCLC) together with the coupling discovery of key oncogenic drivers and the development of effective targeted and immunotherapeutic agents have revolutionized the management of this malignancy. Although these therapies have resulted in improved outcomes for a subgroup of patients, their benefit may not necessarily be reflected by conventional response assessment criteria, because these therapeutic agents differ in their mechanism of action and response time compared with cytotoxic chemotherapy. Here the authors review available therapies in NSCLC and the utility of PET in therapeutic response assessment.
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22
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Cremonesi M, Gilardi L, Ferrari ME, Piperno G, Travaini LL, Timmerman R, Botta F, Baroni G, Grana CM, Ronchi S, Ciardo D, Jereczek-Fossa BA, Garibaldi C, Orecchia R. Role of interim 18F-FDG-PET/CT for the early prediction of clinical outcomes of Non-Small Cell Lung Cancer (NSCLC) during radiotherapy or chemo-radiotherapy. A systematic review. Eur J Nucl Med Mol Imaging 2017; 44:1915-1927. [PMID: 28681192 DOI: 10.1007/s00259-017-3762-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 03/20/2017] [Accepted: 06/14/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Non-Small Cell Lung Cancer (NSCLC) is characterized by aggressiveness and includes the majority of thorax malignancies. The possibility of early stratification of patients as responsive and non-responsive to radiotherapy with a non-invasive method is extremely appealing. The distribution of the Fluorodeoxyglucose (18F-FDG) in tumours, provided by Positron-Emission-Tomography (PET) images, has been proved to be useful to assess the initial staging of the disease, recurrence, and response to chemotherapy and chemo-radiotherapy (CRT). OBJECTIVES In the last years, particular efforts have been focused on the possibility of using ad interim 18F-FDG PET (FDGint) to evaluate response already in the course of radiotherapy. However, controversial findings have been reported for various malignancies, although several results would support the use of FDGint for individual therapeutic decisions, at least in some pathologies. The objective of the present review is to assemble comprehensively the literature concerning NSCLC, to evaluate where and whether FDGint may offer predictive potential. METHODS Several searches were completed on Medline and the Embase database, combining different keywords. Original papers published in the English language from 2005 to 2016 with studies involving FDGint in patients affected by NSCLC and treated with radiation therapy or chemo-radiotherapy only were chosen. RESULTS Twenty-one studies out of 970 in Pubmed and 1256 in Embase were selected, reporting on 627 patients. CONCLUSION Certainly, the lack of univocal PET parameters was identified as a major drawback, while standardization would be required for best practice. In any case, all these papers denoted FDGint as promising and a challenging examination for early assessment of outcomes during CRT, sustaining its predictivity in lung cancer.
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Affiliation(s)
- Marta Cremonesi
- Radiation Research Unit, European Institute of Oncology, Milano, Italy.
| | - Laura Gilardi
- Division of Nuclear Medicine, European Institute of Oncology, Milano, Italy
| | | | - Gaia Piperno
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | | | - Robert Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Francesca Botta
- Medical Physics Unit, European Institute of Oncology, Milano, Italy
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano University, Milano, Italy
| | - Chiara Maria Grana
- Division of Nuclear Medicine, European Institute of Oncology, Milano, Italy
| | - Sara Ronchi
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Delia Ciardo
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, European Institute of Oncology, Milano, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
| | | | - Roberto Orecchia
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy.,Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Milano, Italy
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23
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Valtorta S, Moro M, Prisinzano G, Bertolini G, Tortoreto M, Raccagni I, Pastorino U, Roz L, Sozzi G, Moresco RM. Metabolic Evaluation of Non-Small Cell Lung Cancer Patient-Derived Xenograft Models Using 18F-FDG PET: A Potential Tool for Early Therapy Response. J Nucl Med 2016; 58:42-47. [PMID: 27765858 DOI: 10.2967/jnumed.116.176404] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 03/30/2016] [Accepted: 06/22/2016] [Indexed: 01/01/2023] Open
Abstract
Lung cancer heterogeneity makes response to therapy extremely hard to predict. Patient-derived xenografts (PDXs) are a reliable preclinical model that closely recapitulates the main characteristics of the parental tumors and may represent a useful asset for testing new therapies. Here, using PET imaging, we investigated whether lung cancer PDXs reproduce the metabolic characteristics of the corresponding parental tumors. METHODS We performed longitudinal 18F-FDG PET studies on 9 different PDX groups obtained by implanting primary-cancer fragments harvested from patients into mice. The SUVmax of each PDX was calculated and compared with the SUVmax of the corresponding parental tumor. RESULTS Tumor growth rate and uptake varied among the different PDXs and confirmed the preservation of individual characteristics. The intragroup reproducibility of PET measurements was good. Furthermore, PDXs from tumors with a higher metabolic rate displayed a rank order of uptake similar to that of the parental tumors. CONCLUSION PDXs reproduced the glucose metabolism of the parental tumors and therefore represent a promising preclinical model for the early assessment of therapy efficacy.
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Affiliation(s)
- Silvia Valtorta
- National Researches Council (CNR), Molecular Bioimaging and Physiology Institute (IBFM), Segrate, Italy.,Medicine and Surgery Department and Tecnomed Foundation, University of Milano-Bicocca, Monza, Italy
| | - Massimo Moro
- Tumor Genomics Unit, Experimental Oncology and Molecular Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Prisinzano
- National Researches Council (CNR), Molecular Bioimaging and Physiology Institute (IBFM), Segrate, Italy.,Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Bertolini
- Tumor Genomics Unit, Experimental Oncology and Molecular Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Tortoreto
- Molecular Pharmacology Unit, Experimental Oncology and Molecular Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; and
| | - Isabella Raccagni
- Medicine and Surgery Department and Tecnomed Foundation, University of Milano-Bicocca, Monza, Italy.,Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ugo Pastorino
- Thoracic Surgery Unit, Surgery Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Roz
- Tumor Genomics Unit, Experimental Oncology and Molecular Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriella Sozzi
- Tumor Genomics Unit, Experimental Oncology and Molecular Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosa Maria Moresco
- Medicine and Surgery Department and Tecnomed Foundation, University of Milano-Bicocca, Monza, Italy .,Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
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24
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Zhang Z, Zhao X, Ding C, Wang J, Zhang J, Wang F. (99m)Tc-3PRGD2 SPECT/CT Imaging for Monitoring Early Response of EGFR-TKIs Therapy in Patients with Advanced-Stage Lung Adenocarcinoma. Cancer Biother Radiopharm 2016; 31:238-45. [PMID: 27563805 DOI: 10.1089/cbr.2016.2052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE This study was aimed to assess the efficacy of (99m)Tc-3PRGD2 imaging for evaluating both early treatment response to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and prognosis in advanced-stage lung adenocarcinoma. MATERIAL AND METHODS Eighteen patients with lung adenocarcinoma were enrolled for EGFR-TKIs therapy. (99m)Tc-3PRGD2 SPECT/CT and planar imaging were performed pre- and post-therapy. The tumor to nontumor (T/NT) ratio and percentage change in T/NT ratio were assessed for the treatment response. Receiver operator characteristic (ROC) analysis was utilized to analyze the power of identifying responders based on the changes in T/NT ratios. RESULTS After treatment, 10 patients had partial response (PR), and 6 patients stable disease (SD), while 2 patients progressive disease (PD). The mean changes in T/NT ratios on SPECT/CT and planar images in PR group were 35.8% and 15.0% and in SD group were 8.9% and 0.7%, while in PD group were 76.1% and 18.7%, respectively. For ROC analysis, using a cutoff value of 23.8% decrease in T/NT ratio on SPECT/CT images, the sensitivity and specificity in identifying responders were 80.0% and 87.5%, respectively. The median progression-free survival (PFS) for patients with responders and nonresponders (on (99m)Tc-3PRGD2 SPECT/CT) was 18 months (95% CI 5.8-30.2 months) and 7 months (95% CI 5.2-8.8 months), respectively (p = 0.006). CONCLUSION (99m)Tc-3PRGD2 imaging can evaluate the early response to EGFR-targeted therapy and predict the PFS of lung adenocarcinoma patients.
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Affiliation(s)
- Zhaoqi Zhang
- 1 Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University , Shijiazhuang, China
| | - Xinming Zhao
- 1 Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University , Shijiazhuang, China
| | - Cuimin Ding
- 2 Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University , Shijiazhuang, China
| | - Jianfang Wang
- 1 Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University , Shijiazhuang, China
| | - Jingmian Zhang
- 1 Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University , Shijiazhuang, China
| | - Fan Wang
- 3 Medical Isotopes Research Center, Peking University , Beijing, China
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25
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Fecher D, Hofmann E, Buck A, Bundschuh R, Nietzer S, Dandekar G, Walles T, Walles H, Lückerath K, Steinke M. Human Organotypic Lung Tumor Models: Suitable For Preclinical 18F-FDG PET-Imaging. PLoS One 2016; 11:e0160282. [PMID: 27501455 PMCID: PMC4976941 DOI: 10.1371/journal.pone.0160282] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 07/15/2016] [Indexed: 12/20/2022] Open
Abstract
Development of predictable in vitro tumor models is a challenging task due to the enormous complexity of tumors in vivo. The closer the resemblance of these models to human tumor characteristics, the more suitable they are for drug-development and –testing. In the present study, we generated a complex 3D lung tumor test system based on acellular rat lungs. A decellularization protocol was established preserving the architecture, important ECM components and the basement membrane of the lung. Human lung tumor cells cultured on the scaffold formed cluster and exhibited an up-regulation of the carcinoma-associated marker mucin1 as well as a reduced proliferation rate compared to respective 2D culture. Additionally, employing functional imaging with 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography (FDG-PET) these tumor cell cluster could be detected and tracked over time. This approach allowed monitoring of a targeted tyrosine kinase inhibitor treatment in the in vitro lung tumor model non-destructively. Surprisingly, FDG-PET assessment of single tumor cell cluster on the same scaffold exhibited differences in their response to therapy, indicating heterogeneity in the lung tumor model. In conclusion, our complex lung tumor test system features important characteristics of tumors and its microenvironment and allows monitoring of tumor growth and -metabolism in combination with functional imaging. In longitudinal studies, new therapeutic approaches and their long-term effects can be evaluated to adapt treatment regimes in future.
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Affiliation(s)
- David Fecher
- Department of Tissue Engineering and Regenerative Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
- * E-mail:
| | - Elisabeth Hofmann
- Department of Tissue Engineering and Regenerative Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Andreas Buck
- Department of Nuclear Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Ralph Bundschuh
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - Sarah Nietzer
- Department of Tissue Engineering and Regenerative Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Gudrun Dandekar
- Department of Tissue Engineering and Regenerative Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
- Translational Center ´Regenerative Therapies for Oncology and Musculoskeletal Diseases`Wuerzburg, branch of the Fraunhofer Institute Interfacial Engineering and Biotechnology (IGB), Wuerzburg, Germany
| | - Thorsten Walles
- Department of Cardiothoracic Surgery, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Heike Walles
- Department of Tissue Engineering and Regenerative Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
- Translational Center ´Regenerative Therapies for Oncology and Musculoskeletal Diseases`Wuerzburg, branch of the Fraunhofer Institute Interfacial Engineering and Biotechnology (IGB), Wuerzburg, Germany
| | - Katharina Lückerath
- Department of Nuclear Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Maria Steinke
- Department of Tissue Engineering and Regenerative Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
- Translational Center ´Regenerative Therapies for Oncology and Musculoskeletal Diseases`Wuerzburg, branch of the Fraunhofer Institute Interfacial Engineering and Biotechnology (IGB), Wuerzburg, Germany
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26
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Abstract
For several decades, cytotoxic chemotherapeutic agents were considered the basis of anticancer treatment for patients with metastatic tumors. A decrease in tumor burden, assessed by volumetric computed tomography and magnetic resonance imaging, according to the response evaluation criteria in solid tumors (RECIST), was considered as a radiological response to cytotoxic chemotherapies. In addition to RECIST-based dimensional measurements, a metabolic response to cytotoxic drugs can be assessed by positron emission tomography (PET) using 18F-fluoro-thymidine (FLT) as a radioactive tracer for drug-disrupted DNA synthesis. The decreased 18FLT-PET uptake is often seen concurrently with increased apparent diffusion coefficients by diffusion-weighted imaging due to chemotherapy-induced changes in tumor cellularity. Recently, the discovery of molecular origins of tumorogenesis led to the introduction of novel signal transduction inhibitors (STIs). STIs are targeted cytostatic agents; their effect is based on a specific biological inhibition with no immediate cell death. As such, tumor size is not anymore a sensitive end point for a treatment response to STIs; novel physiological imaging end points are desirable. For receptor tyrosine kinase inhibitors as well as modulators of the downstream signaling pathways, an almost immediate inhibition in glycolytic activity (the Warburg effect) and phospholipid turnover (the Kennedy pathway) has been seen by metabolic imaging in the first 24 h of treatment. The quantitative imaging end points by magnetic resonance spectroscopy and metabolic PET (including 18F-fluoro-deoxy-glucose, FDG, and total choline) provide an early treatment response to targeted STIs, before a reduction in tumor burden can be seen.
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Affiliation(s)
- Natalie J Serkova
- Department of Anesthesiology, University of Colorado Comprehensive Cancer Center, Aurora, CO, USA; Developmental Therapeutics Program, University of Colorado Comprehensive Cancer Center, Aurora, CO, USA
| | - S Gail Eckhardt
- Developmental Therapeutics Program, University of Colorado Comprehensive Cancer Center, Aurora, CO, USA; Division of Medical Oncology, Anschutz Medical Center, University of Colorado Denver, Aurora, CO, USA
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27
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Abstract
Treatment advances have improved outcomes in patients with lung cancer, with a number of targeted therapies and immunotherapies now approved for patients with metastatic disease. Along with longer survival, modern treatment paradigms have increased therapeutic decision-making complexity underscoring informative imaging as paramount in guiding clinical care. In this review, we summarize challenges the thoracic oncologist encounters in common clinical settings. In addition, we explore unmet needs for future investigations with particular focus on positron emission tomography technology and immunotherapies.
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28
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Kitajima K, Doi H, Kanda T, Yamane T, Tsujikawa T, Kaida H, Tamaki Y, Kuribayashi K. Present and future roles of FDG-PET/CT imaging in the management of lung cancer. Jpn J Radiol 2016; 34:387-99. [PMID: 27121156 DOI: 10.1007/s11604-016-0546-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/12/2016] [Indexed: 12/19/2022]
Abstract
Integrated positron emission tomography/computed tomography (PET/CT) using 2-[(18)F]fluoro-2-deoxy-D-glucose ((18)F-FDG) has emerged as a powerful tool for combined metabolic and anatomic evaluation in clinical oncologic imaging. This review discusses the utility of (18)F-FDG PET/CT as a tool for managing patients with lung cancer. We discuss different patient management stages, including diagnosis, initial staging, therapy planning, early treatment response assessment, re-staging, and prognosis.
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Affiliation(s)
- Kazuhiro Kitajima
- Division of Nuclear Medicine and PET Center, Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Hiroshi Doi
- Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tomonori Kanda
- Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Tomohiko Yamane
- Department of Nuclear Medicine, Saitama International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Tetsuya Tsujikawa
- Department of Biomedical Imaging Research Center, Fukui University, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Fukui, 910-1193, Japan
| | - Hayato Kaida
- Department of Radiology, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Yukihisa Tamaki
- Department of Radiation Oncology, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Kozo Kuribayashi
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
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29
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van Gool MH, Aukema TS, Sinaasappel M, Valdés Olmos RA, Klomp HM. Tumor heterogeneity on (18)F-FDG-PET/CT for response monitoring in non-small cell lung cancer treated with erlotinib. J Thorac Dis 2016; 8:E200-3. [PMID: 27076970 DOI: 10.21037/jtd.2016.02.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Response monitoring using fluorodeoxyglucose positron emission tomography acquired together with low dose computed tomography (FDG-PET/CT) textural features has potential in targeted treatment with erlotinib in non-small cell lung cancer (NSCLC) patients. Patients with substantial decrease of metabolic activity during erlotinib treatment will probably benefit from continued treatment. However, various aspects of the method (quantification tools, cut-off values, etc.) need to be standardized before the software becomes widely available in a similar manner as standardized uptake value (SUV) measurements. Heterogeneity on FDG-PET/CT opened an additional window for innovation but simultaneously a new challenge for molecular hybrid imaging.
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Affiliation(s)
- Matthijs H van Gool
- 1 Department of Surgical Oncology, 2 Department of Nuclear Medicine, 3 Department of Physics, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Tjeerd S Aukema
- 1 Department of Surgical Oncology, 2 Department of Nuclear Medicine, 3 Department of Physics, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Michiel Sinaasappel
- 1 Department of Surgical Oncology, 2 Department of Nuclear Medicine, 3 Department of Physics, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Renato A Valdés Olmos
- 1 Department of Surgical Oncology, 2 Department of Nuclear Medicine, 3 Department of Physics, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Houke M Klomp
- 1 Department of Surgical Oncology, 2 Department of Nuclear Medicine, 3 Department of Physics, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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30
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Scarsbrook AF, Barrington SF. PET-CT in the UK: current status and future directions. Clin Radiol 2016; 71:673-90. [PMID: 27044903 DOI: 10.1016/j.crad.2016.02.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/25/2016] [Accepted: 02/29/2016] [Indexed: 12/19/2022]
Abstract
Combined positron-emission tomography and computed tomography (PET-CT) has taken the oncological world by storm since being introduced into the clinical domain in the early 21(st) century and is firmly established in the management pathway of many different tumour types. Non-oncological applications of PET-CT represent a smaller but steadily growing area of interest. PET-CT continues to be the focus of a large number of research studies and keeping up-to-date with the literature is important but represents a challenge. Consequently guidelines recommending PET-CT usage need to be revised regularly to encompass new developments. The purpose of this article is twofold: first, it provides a detailed review of the evidence-base underpinning the major uses of PET-CT in clinical practice, which may be of value to a wide-range of individuals, including those directly involved with PET-CT and to a much larger group with limited exposure, but for whom a précis of the current state-of-play may help inform other radiology and multidisciplinary team (MDT) work; the second purpose is as a companion to revised guidelines on evidence-based indications for PET-CT in the UK (being published concurrently) providing a detailed commentary on new indications with a summary of emerging data supporting these additional clinical uses of the technique.
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Affiliation(s)
- A F Scarsbrook
- Department of Nuclear Medicine, Level 1, Bexley Wing, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
| | - S F Barrington
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St. Thomas' Hospital, London SE1 7EH, UK
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31
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Bernard-Gauthier V, Bailey JJ, Berke S, Schirrmacher R. Recent Advances in the Development and Application of Radiolabeled Kinase Inhibitors for PET Imaging. Molecules 2015; 20:22000-27. [PMID: 26690113 DOI: 10.3390/molecules201219816] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 11/18/2015] [Accepted: 12/01/2015] [Indexed: 12/20/2022] Open
Abstract
Over the last 20 years, intensive investigation and multiple clinical successes targeting protein kinases, mostly for cancer treatment, have identified small molecule kinase inhibitors as a prominent therapeutic class. In the course of those investigations, radiolabeled kinase inhibitors for positron emission tomography (PET) imaging have been synthesized and evaluated as diagnostic imaging probes for cancer characterization. Given that inhibitor coverage of the kinome is continuously expanding, in vivo PET imaging will likely find increasing applications for therapy monitoring and receptor density studies both in- and outside of oncological conditions. Early investigated radiolabeled inhibitors, which are mostly based on clinically approved tyrosine kinase inhibitor (TKI) isotopologues, have now entered clinical trials. Novel radioligands for cancer and PET neuroimaging originating from novel but relevant target kinases are currently being explored in preclinical studies. This article reviews the literature involving radiotracer design, radiochemistry approaches, biological tracer evaluation and nuclear imaging results of radiolabeled kinase inhibitors for PET reported between 2010 and mid-2015. Aspects regarding the usefulness of pursuing selective vs. promiscuous inhibitor scaffolds and the inherent challenges associated with intracellular enzyme imaging will be discussed.
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32
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Ma Q, Min K, Wang T, Chen B, Wen Q, Wang F, Ji T, Gao S. 99mTc-3PRGD2 SPECT/CT predicts the outcome of advanced nonsquamous non-small cell lung cancer receiving chemoradiotherapy plus bevacizumab. Ann Nucl Med 2015; 29:519-27. [DOI: 10.1007/s12149-015-0975-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 04/12/2015] [Indexed: 10/23/2022]
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33
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Abstract
This article reviews the major treatment response evaluation guidelines in the domain of cancer imaging and how the potential of PET imaging, particularly with fluorodeoxyglucose, is increasingly explored in this important aspect of cancer management. Certain disease-specific response criteria (such as in lymphoma) are also reviewed with emphasis on the changes made over time and the main areas of concern in PET interpretation. The major present clinical applications are illustrated and potential new areas are discussed with regard to clinical applications in the future. Finally, the evolving role of newer and novel PET metrics, which hold promise in treatment response evaluation, is illustrated with examples.
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Affiliation(s)
- Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, Jerbai Wadia Road, Parel, Mumbai 400012, India.
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Ranade
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, Jerbai Wadia Road, Parel, Mumbai 400012, India
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