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Hovhannisyan-Baghdasarian N, Luporsi M, Captier N, Nioche C, Cuplov V, Woff E, Hegarat N, Livartowski A, Girard N, Buvat I, Orlhac F. Promising Candidate Prognostic Biomarkers in [ 18F]FDG PET Images: Evaluation in Independent Cohorts of Non-Small Cell Lung Cancer Patients. J Nucl Med 2024; 65:635-642. [PMID: 38453361 PMCID: PMC10995530 DOI: 10.2967/jnumed.123.266331] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 01/11/2024] [Indexed: 03/09/2024] Open
Abstract
The normalized distances from the hot spot of radiotracer uptake (SUVmax) to the tumor centroid (NHOC) and to the tumor perimeter (NHOP) have recently been suggested as novel PET features reflecting tumor aggressiveness. These biomarkers characterizing the shift of SUVmax toward the lesion edge during tumor progression have been shown to be prognostic factors in breast and non-small cell lung cancer (NSCLC) patients. We assessed the impact of imaging parameters on NHOC and NHOP, their complementarity to conventional PET features, and their prognostic value for advanced-NSCLC patients. Methods: This retrospective study investigated baseline [18F]FDG PET scans: cohort 1 included 99 NSCLC patients with no treatment-related inclusion criteria (robustness study); cohort 2 included 244 NSCLC patients (survival analysis) treated with targeted therapy (93), immunotherapy (63), or immunochemotherapy (88). Although 98% of patients had metastases, radiomic features including SUVs were extracted from the primary tumor only. NHOCs and NHOPs were computed using 2 approaches: the normalized distance from the localization of SUVmax or SUVpeak to the tumor centroid or perimeter. Bland-Altman analyses were performed to investigate the impact of both spatial resolution (comparing PET images with and without gaussian postfiltering) and image sampling (comparing 2 voxel sizes) on feature values. The correlation of NHOCs and NHOPs with other features was studied using Spearman correlation coefficients (r). The ability of NHOCs and NHOPs to predict overall survival (OS) was estimated using the Kaplan-Meier method. Results: In cohort 1, NHOC and NHOP features were more robust to image filtering and to resampling than were SUVs. The correlations were weak between NHOCs and NHOPs (r ≤ 0.45) and between NHOCs or NHOPs and any other radiomic features (r ≤ 0.60). In cohort 2, the patients with short OS demonstrated higher NHOCs and lower NHOPs than those with long OS. NHOCs significantly distinguished 2 survival profiles in patients treated with immunotherapy (log-rank test, P < 0.01), whereas NHOPs stratified patients regarding OS in the targeted therapy (P = 0.02) and immunotherapy (P < 0.01) subcohorts. Conclusion: Our findings suggest that even in advanced NSCLC patients, NHOC and NHOP features pertaining to the primary tumor have prognostic potential. Moreover, these features appeared to be robust with respect to imaging protocol parameters and complementary to other radiomic features and are now available in LIFEx software to be independently tested by others.
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Affiliation(s)
| | - Marie Luporsi
- LITO U1288, Institut Curie, PSL University, Inserm, Orsay, France
- Department of Nuclear Medicine, Institut Curie, Paris, France
| | - Nicolas Captier
- LITO U1288, Institut Curie, PSL University, Inserm, Orsay, France
| | | | - Vesna Cuplov
- LITO U1288, Institut Curie, PSL University, Inserm, Orsay, France
| | - Erwin Woff
- LITO U1288, Institut Curie, PSL University, Inserm, Orsay, France
- Department of Nuclear Medicine, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Nadia Hegarat
- Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France; and
| | - Alain Livartowski
- Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France; and
| | - Nicolas Girard
- Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France; and
- Paris Saclay Cancer Campus, UVSQ, Versailles, France
| | - Irène Buvat
- LITO U1288, Institut Curie, PSL University, Inserm, Orsay, France
| | - Fanny Orlhac
- LITO U1288, Institut Curie, PSL University, Inserm, Orsay, France
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Shagera QA, Karfis I, Sideris S, Guiot T, Woff E, Martinez-Chanza N, Roumeguere T, Gil T, Flamen P, Artigas C. Tumor Volume on PSMA PET as a Prognostic Biomarker in Prostate Cancer Patients Treated With Cabazitaxel. Clin Nucl Med 2023:00003072-990000000-00625. [PMID: 37385221 DOI: 10.1097/rlu.0000000000004763] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
PURPOSE The aim of this study was to evaluate the prognostic value of 68Ga-labeled prostate-specific membrane antigen (PSMA) PET/CT in metastatic castration-resistant prostate cancer patients receiving second-line chemotherapy with cabazitaxel. METHODS All patients with metastatic castration-resistant prostate cancer who underwent a PSMA PET/CT within 8 weeks before initiating the cabazitaxel treatment were retrospectively evaluated. The whole-body PSMA total tumor volume (PSMA-TV) was measured for each patient. Other factors such as prostate-specific antigen, hemoglobin, lactate dehydrogenase, and alkaline phosphatase were recorded. A log-rank cutoff finder was used to define the PSMA-TV optimal cutoff. Survival analyses were performed using Cox regression and Kaplan-Meier methods. RESULTS In total, 32 patients were included, receiving a median of 6 cycles of cabazitaxel (range, 2-10). After a median follow-up of 12 months, 28 patients presented disease progression, and 18 died. Baseline PSMA-TV presented a significant association with progression-free survival (PFS) and overall survival (OS; P = 0.035 and P = 0.002, respectively). Optimal PSMA-TV cutoffs were 515 mL for PFS and 473 mL for OS. Patients with low volume presented longer PFS and OS than those with high volume: median PFS, 21 versus 12 weeks, respectively (hazard ratio, 0.33; P = 0.017); and median OS, 24 versus 8.5 months, respectively (hazard ratio, 0.21; P = 0.002). On the multivariable analyses, PSMA-TV remained an independent predictor of OS (P = 0.016). CONCLUSION Our results show that total tumor volume measured on PSMA PET/CT is a prognostic biomarker in patients treated with cabazitaxel. High PSMA-TV before treatment initiation is associated with shorter PFS and OS.
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Affiliation(s)
| | | | | | | | - Erwin Woff
- From the Departments of Nuclear Medicine
| | | | - Thierry Roumeguere
- Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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Noortman WA, Aide N, Vriens D, Arkes LS, Slump CH, Boellaard R, Goeman JJ, Deroose CM, Machiels JP, Licitra LF, Lhommel R, Alessi A, Woff E, Goffin K, Le Tourneau C, Gal J, Temam S, Delord JP, van Velden FHP, de Geus-Oei LF. Development and External Validation of a PET Radiomic Model for Prognostication of Head and Neck Cancer. Cancers (Basel) 2023; 15:2681. [PMID: 37345017 DOI: 10.3390/cancers15102681] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 06/23/2023] Open
Abstract
AIM To build and externally validate an [18F]FDG PET radiomic model to predict overall survival in patients with head and neck squamous cell carcinoma (HNSCC). METHODS Two multicentre datasets of patients with operable HNSCC treated with preoperative afatinib who underwent a baseline and evaluation [18F]FDG PET/CT scan were included (EORTC: n = 20, Unicancer: n = 34). Tumours were delineated, and radiomic features were extracted. Each cohort served once as a training and once as an external validation set for the prediction of overall survival. Supervised feature selection was performed using variable hunting with variable importance, selecting the top two features. A Cox proportional hazards regression model using selected radiomic features and clinical characteristics was fitted on the training dataset and validated in the external validation set. Model performances are expressed by the concordance index (C-index). RESULTS In both models, the radiomic model surpassed the clinical model with validation C-indices of 0.69 and 0.79 vs. 0.60 and 0.67, respectively. The model that combined the radiomic features and clinical variables performed best, with validation C-indices of 0.71 and 0.82. CONCLUSION Although assessed in two small but independent cohorts, an [18F]FDG-PET radiomic signature based on the evaluation scan seems promising for the prediction of overall survival for HNSSC treated with preoperative afatinib. The robustness and clinical applicability of this radiomic signature should be assessed in a larger cohort.
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Affiliation(s)
- Wyanne A Noortman
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- TechMed Centre, University of Twente, 7522 NB Enschede, The Netherlands
| | - Nicolas Aide
- Nuclear Medicine Department, Centre Hospitalier Universitaire de Caen, 14000 Caen, France
| | - Dennis Vriens
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Lisa S Arkes
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Technical Medicine, Delft University of Technology, 2628 CD Delft, The Netherlands
| | - Cornelis H Slump
- TechMed Centre, University of Twente, 7522 NB Enschede, The Netherlands
| | - Ronald Boellaard
- Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands
| | - Jelle J Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Christophe M Deroose
- Nuclear Medicine and Molecular Imaging, Department of Imaging & Pathology, University Hospitals Leuven, KU Leuven, 3000 Leuven, Belgium
| | - Jean-Pascal Machiels
- Department of Medical Oncology, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
- Institute for Experimental and Clinical Research (IREC, pôle MIRO), Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium
| | - Lisa F Licitra
- Department of Head and Neck Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan, 20133 Milan, Italy
| | - Renaud Lhommel
- Division of Nuclear Medicine, Institut de Recherche Clinique, Cliniques Universitaires Saint Luc, 1200 Brussels, Belgium
| | - Alessandra Alessi
- Department of Nuclear Medicine-PET Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Erwin Woff
- Nuclear Medicine Department, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B.), 1070 Bruxelles, Belgium
| | - Karolien Goffin
- Nuclear Medicine and Molecular Imaging, Department of Imaging & Pathology, University Hospitals Leuven, KU Leuven, 3000 Leuven, Belgium
| | - Christophe Le Tourneau
- Department of Drug Development and Innovation, Institut Curie, Paris-Saclay University, 75005 Paris, France
| | - Jocelyn Gal
- Epidemiology and Biostatistics Department, Centre Antoine Lacassagne, University Côte d'Azur, 06100 Nice, France
| | - Stéphane Temam
- Department of Head and Neck Surgery Gustave Roussy, 94805 Villejuif, France
| | | | - Floris H P van Velden
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- TechMed Centre, University of Twente, 7522 NB Enschede, The Netherlands
- Department of Radiation Science & Technology, Delft University of Technology, 2628 CD Delft, The Netherlands
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Delbart W, Marin G, Stamatopoulos B, de Wind R, Sirtaine N, Demetter P, Vercruyssen M, Woff E, Karfis I, Ghanem GE, Flamen P, Wimana Z. Disturbing the Redox Balance Using Buthionine Sulfoximine Radiosensitized Somatostatin Receptor-2 Expressing Pre-Clinical Models to Peptide Receptor Radionuclide Therapy with 177Lu-DOTATATE. Cancers (Basel) 2023; 15:cancers15082332. [PMID: 37190261 DOI: 10.3390/cancers15082332] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/14/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023] Open
Abstract
Peptide receptor radionuclide therapy with 177Lu-DOTATATE improves the outcome of patients with somatostatin receptor (SSTR)-expressing neuroendocrine tumours. Nevertheless, stable disease has been the main response pattern observed, with some rare complete responses. Lu-177 exerts about two-thirds of its biological effects via the indirect effects of ionizing radiation that generate reactive oxygen species, eventually leading to oxidative damage and cell death. This provides a rationale for targeting the antioxidant defence system in combination with 177Lu-DOTATATE. In the present study, the radiosensitizing potential and the safety of depleting glutathione (GSH) levels using buthionine sulfoximine (BSO) during 177Lu-DOTATATE therapy were assessed in vitro and in vivo using a xenograft mouse model. In vitro, the combination resulted in a synergistic effect in cell lines exhibiting a BSO-mediated GSH decrease. In vivo, BSO neither influenced 177Lu-DOTATATE biodistribution nor induced liver, kidney or bone marrow toxicity. In terms of efficacy, the combination resulted in reduced tumour growth and metabolic activity. Our results showed that disturbing the cell redox balance using a GSH synthesis inhibitor increased 177Lu-DOTATATE efficacy without additional toxicity. Targeting the antioxidant defence system opens new safe treatment combination opportunities with 177Lu-DOTATATE.
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Affiliation(s)
- Wendy Delbart
- Nuclear Medicine Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
- Laboratory of Oncology and Experimental Surgery, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
| | - Gwennaëlle Marin
- Medical Physics Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
| | - Basile Stamatopoulos
- Laboratory of Clinical Cell Therapy, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
| | - Roland de Wind
- Pathology Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
| | - Nicolas Sirtaine
- Pathology Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
| | - Pieter Demetter
- Pathology Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
| | - Marie Vercruyssen
- Haematology Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
| | - Erwin Woff
- Nuclear Medicine Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
| | - Ioannis Karfis
- Nuclear Medicine Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
| | - Ghanem E Ghanem
- Laboratory of Oncology and Experimental Surgery, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
| | - Patrick Flamen
- Nuclear Medicine Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
| | - Zéna Wimana
- Nuclear Medicine Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
- Laboratory of Oncology and Experimental Surgery, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium
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Woff E, Salvatore L, Marmorino F, Genovesi D, Critchi G, Guiot T, Ameye L, Sclafani F, Hendlisz A, Flamen P. Combined Metabolically Active Tumor Volume and Early Metabolic Response Improve Outcome Prediction in Metastatic Colorectal Cancer. J Nucl Med 2021; 63:549-555. [PMID: 34326124 DOI: 10.2967/jnumed.120.245357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/29/2021] [Indexed: 11/16/2022] Open
Abstract
Stratification of metastatic colorectal cancer (mCRC) patients is mostly based on clinical and biological characteristics. This study aimed to validate the prognostic value of 18F-FDG PET/CT-based biomarkers such as baseline whole-body metabolically active tumor volume (WB-MATV) and early metabolic response (mR) in mCRC. Methods: The development cohort included chemorefractory mCRC patients enrolled in two prospective Belgian multicenter trials evaluating last-line treatments (multikinase inhibitors). The validation cohort included mCRC patients from an Italian center treated with chemotherapy and bevacizumab as first-line. Baseline WB-MATV was defined as the sum of metabolically active volumes of all target lesions identified on the baseline 18F-FDG PET/CT. Early metabolic response (mR) assessment was performed following usual response criteria (PERCIST-30%, PERCIST-15%, EORTC) and the so-called CONSIST method, which defines response as a decrease of SULmax ≥ 15% for all target lesions. Baseline WB-MATV and early mR assessment were investigated along with usual clinical factors and correlated with overall and progression-free survival (OS/PFS). Results: Clinical factors, baseline WB-MATV and early mR were evaluable in 192/239 and 94/125 patients of the development and validation cohorts, respectively. Except for PERCIST-30%, all response methods were equivalent in terms of outcome prediction and CONSIST was found to be the most accurate. Baseline WB-MATV and early mR using CONSIST method were independent prognostic parameters after adjustment for clinical factors in the development and validation sets for both OS (HR WB-MATV: 1.87 (1.17-2.97), P = 0.005, and HR early mR: 1.79 (1.08-2.95), P = 0.02 for the validation set), and PFS (HR WB-MATV: 1.94 (1.27-2.97), P = 0.002, and HR early mR: 1.69 (1.04-2.73), P = 0.03 for the validation set). Conclusion: Baseline WB-MATV and early mR are strong independent prognostic biomarkers for OS/PFS in mCRC, regardless of treatment received. Therefore, combining these biomarkers improves risk stratification for OS/PFS in mCRC.
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Affiliation(s)
- Erwin Woff
- Nuclear Medicine Department, Institut Jules Bordet - Universitē Libre de Bruxelles (ULB), Belgium
| | - Lisa Salvatore
- Medical Oncology Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy
| | - Federica Marmorino
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Italy
| | - Dario Genovesi
- Nuclear Medicine Department, Fondazione Toscana "Gabriele Monasterio", Italy
| | - Gabriela Critchi
- Nuclear Medicine Department, Institut Jules Bordet - Universitē Libre de Bruxelles (ULB), Belgium
| | - Thomas Guiot
- Nuclear Medicine Department, Institut Jules Bordet - Universitē Libre de Bruxelles (ULB), Belgium
| | - Lieveke Ameye
- Data centre, Institut Jules Bordet - Universitē Libre de Bruxelles (ULB), Belgium
| | - Francesco Sclafani
- Medical Oncology Department, Institut Jules Bordet - Universitē Libre de Bruxelles (ULB), Belgium
| | - Alain Hendlisz
- Medical Oncology Department, Institut Jules Bordet - Universitē Libre de Bruxelles (ULB), Belgium
| | - Patrick Flamen
- Nuclear Medicine Department, Institut Jules Bordet - Universitē Libre de Bruxelles (ULB), Belgium
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Dal Lago L, Sarrand J, Woff E, Awada A, Vouche M, Pepersack T. Sarcoidosis Versus Lymphoma? Eur J Case Rep Intern Med 2021; 8:002250. [PMID: 33768069 DOI: 10.12890/2021_002250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/20/2021] [Indexed: 11/05/2022] Open
Abstract
An association between lymphoma and sarcoidosis was first suggested in 1960. We report a case of sarcoidosis-lymphoma syndrome, which is a diagnostically challenging condition. We conclude that an associated lymphoma should be considered in all patients with suspected sarcoidosis, especially those who do not respond to treatment or who present with persistent haematological abnormalities. Splenomegaly should prompt splenectomy to rule out lymphoma if a less invasive approach has failed to confirm the diagnosis. LEARNING POINTS Clinical consideration should be given to an associated lymphoma in all patients with sarcoidosis, especially those who do not respond to treatment or who present with persistent haematological abnormalities.Splenomegaly should raise the possibility of splenectomy to rule out associated lymphoma.
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Affiliation(s)
- Lissandra Dal Lago
- Medical Oncology Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Julie Sarrand
- Medical Oncology Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Erwin Woff
- Nuclear Medicine Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Ahmad Awada
- Medical Oncology Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Michaël Vouche
- Department of Radiology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Thierry Pepersack
- Medical Oncology Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
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7
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Camera S, Akin Telli T, Woff E, Vandeputte C, Kehagias P, Guiot T, Critchi G, Wissam Y, Bregni G, Trevisi E, Pretta A, Senti C, Leduc S, Gkolfakis P, Hoerner F, Rothé F, Sclafani F, Flamen P, Deleporte A, Hendlisz A. Prognostic Value of the Pace of Tumor Progression as Assessed by Serial 18F-FDG PET/CT Scan and Liquid Biopsy in Refractory Colorectal Cancer: The CORIOLAN Trial. Cancers (Basel) 2020; 12:cancers12102752. [PMID: 32987838 PMCID: PMC7601470 DOI: 10.3390/cancers12102752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/22/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 12/27/2022] Open
Abstract
Simple Summary Management of chemorefractory colorectal cancer patient is challenging, and reliable tools which can predict individual patient prognosis and help the decision making are needed. In this study, we hypothesized that the natural pace of cancer growth and progression, as assessed by early changes of a number of imaging and circulating biomarkers which are surrogates of tumor burden (i.e., metabolically active tumor volume, carcinoembryonic antigen, circulating tumor cells and circulating tumor DNA), could predict patient prognosis. By prospectively recruiting 47 eligible patients who had measurements of these biomarkers taken two weeks apart in the absence of any active anti-cancer treatment, we failed to demonstrate our hypothesis. On the other hand, we found that baseline assessment of the same biomarkers was associated with survival outcomes. Larger studies are needed to confirm these findings and translate them into applications for clinical practice. Abstract Introduction: Decision making in refractory colorectal cancer (rCRC) is challenging, with limited data available to predict patient outcome. We conducted a study to assess the pace of cancer progression as a potential prognostic and decision tool. Methods: CORIOLAN was a prospective, single-center, single-arm trial recruiting refractory CRC patients with an ECOG performance status of ≤1 and an estimated life expectancy of ≥12 weeks. 18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan and blood sample collection were carried out at baseline and after 2 weeks with no cancer treatment given between these timepoints. The primary objective was to evaluate the association between pace of cancer progression as defined by changes of the whole-body metabolically active tumor volume (WB-MATV) and overall survival (OS). Exploratory objectives included evaluation of the prognostic value of circulating cell-free DNA (cfDNA), circulating tumor cells (CTCs) and carcinoembryonic antigen (CEA). Results: 47 eligible patients who had received a median number of 5 (range 2–8) prior treatments were enrolled. At the time of analysis, 45 deaths had occurred, with 26% of patients dying within 12 weeks. The median OS was 6.3 months (range 0.4–14.3). The median relative delta between WB-MATV at baseline and 2 weeks was +21%. Changes of WB-MATV, however, failed to predict OS (hazard ratio (HR) 1.3, p = 0.383). Similarly, no association was observed between changes of any of the circulating biomarkers investigated and prognosis. By contrast, high WB-MATV (4.2 versus 9.4 months; HR 3.1, p = 0.003), high CEA (4.4 versus 7.0 months; HR 1.9, p = 0.053), high cfDNA (4.7 versus 7.0 months; HR 2.2, p = 0.015) and high CTC count (3.3 versus 7.5 months; HR 6.5, p < 0.001) at baseline were associated with worse OS. Conclusions: In this study, approximately 1 out of 4 refractory CRC patients who were judged to have a life expectancy >12 weeks actually died within 12 weeks. Baseline assessment of WB-MATV, cfDNA, CTCs and CEA, but not early change evaluation of the same, may help to refine patient prognostication and guide management decisions.
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Affiliation(s)
- Silvia Camera
- Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium; (S.C.); (T.A.T.); (Y.W.); (G.B.); (E.T.); (A.P.); (P.G.); (A.D.); (A.H.)
| | - Tugba Akin Telli
- Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium; (S.C.); (T.A.T.); (Y.W.); (G.B.); (E.T.); (A.P.); (P.G.); (A.D.); (A.H.)
| | - Erwin Woff
- Department of Nuclear Medicine, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium; (E.W.); (T.G.); (G.C.); (P.F.)
| | - Caroline Vandeputte
- GUTS lab, Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium; (C.V.); (P.K.); (C.S.); (S.L.)
| | - Pashalina Kehagias
- GUTS lab, Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium; (C.V.); (P.K.); (C.S.); (S.L.)
| | - Thomas Guiot
- Department of Nuclear Medicine, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium; (E.W.); (T.G.); (G.C.); (P.F.)
| | - Gabriela Critchi
- Department of Nuclear Medicine, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium; (E.W.); (T.G.); (G.C.); (P.F.)
| | - Yacine Wissam
- Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium; (S.C.); (T.A.T.); (Y.W.); (G.B.); (E.T.); (A.P.); (P.G.); (A.D.); (A.H.)
| | - Giacomo Bregni
- Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium; (S.C.); (T.A.T.); (Y.W.); (G.B.); (E.T.); (A.P.); (P.G.); (A.D.); (A.H.)
| | - Elena Trevisi
- Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium; (S.C.); (T.A.T.); (Y.W.); (G.B.); (E.T.); (A.P.); (P.G.); (A.D.); (A.H.)
| | - Andrea Pretta
- Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium; (S.C.); (T.A.T.); (Y.W.); (G.B.); (E.T.); (A.P.); (P.G.); (A.D.); (A.H.)
| | - Chiara Senti
- GUTS lab, Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium; (C.V.); (P.K.); (C.S.); (S.L.)
| | - Sophia Leduc
- GUTS lab, Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium; (C.V.); (P.K.); (C.S.); (S.L.)
| | - Paraskevas Gkolfakis
- Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium; (S.C.); (T.A.T.); (Y.W.); (G.B.); (E.T.); (A.P.); (P.G.); (A.D.); (A.H.)
| | - Frédéric Hoerner
- Clinical Trial Conduct Unit (CTCU), Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium;
| | - Françoise Rothé
- Breast cancer translational research laboratory, Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium;
| | - Francesco Sclafani
- Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium; (S.C.); (T.A.T.); (Y.W.); (G.B.); (E.T.); (A.P.); (P.G.); (A.D.); (A.H.)
- Correspondence: ; Tel.: +32-2-541-7397; Fax: +32-2-538-0858
| | - Patrick Flamen
- Department of Nuclear Medicine, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium; (E.W.); (T.G.); (G.C.); (P.F.)
| | - Amelie Deleporte
- Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium; (S.C.); (T.A.T.); (Y.W.); (G.B.); (E.T.); (A.P.); (P.G.); (A.D.); (A.H.)
| | - Alain Hendlisz
- Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium; (S.C.); (T.A.T.); (Y.W.); (G.B.); (E.T.); (A.P.); (P.G.); (A.D.); (A.H.)
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Camera S, Akin Telli T, Woff E, Kehagias P, Guiot T, Critchi G, Bregni G, Trevisi E, Pretta A, Deleruelle A, Senti C, Leduc S, Shaza L, Hoerner F, Vandeputte C, Sclafani F, Flamen P, Hendlisz A, Deleporte A, Rothe F. 18F-FDG PET scan and liquid biopsy as tools to assess the pace of tumor progression and to predict overall survival (OS) in refractory colorectal cancer (rCRC): The CORIOLAN trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16012 Background: Decision making in rCRC patients (pts) who have exhausted all available therapies is challenging. Clinical trials, treatment re-challenge and best supportive care are possible options. There are limited data, however, to predict pt outcome and guide treatment choices. Methods: CORIOLAN was a prospective, single-centre, single-arm trial. Eligible pts had to have an ECOG PS of ≤1, a life expectancy of ≥12 weeks (wks) and had to have received prior standard chemotherapy and targeted agents. No cancer treatment was allowed within 4 wks prior to study entry. 18F-FDG PET scan and blood sample collection were carried out at baseline and after 2 wks. No treatment was given between these timepoints, while further management was left to the treating physician. The primary objective was to evaluate the association between tumour metabolic progression index as defined by changes of the whole-body metabolically active tumour volume (WB-MATV) and OS. Exploratory objectives included evaluation of the prognostic value of circulating biomarkers such as cell-free DNA (cfDNA), circulating tumour cells (CTCs, CellTracks Analyzer II, CellSearch) and CEA. Validated cut-off values, Kaplan-Meier method, Cox proportional hazards model and logrank tests were used (R version 3.5.1). Results: From 2012 to 2018, 47 eligible pts were enrolled. Median age: 65 years (38-82). ECOG PS 1: 64%. Males: 53%. Left-sided tumours: 71%. Metastases: lung (83%), liver (66%), lymph-nodes (45%), peritoneum (30%), bone (21%). Known RAS/BRAF mutations: 57%/0%. Median number of prior treatments: 5 (2-8). At the time of analysis, 45 deaths had occurred, with 26% of pts dying within 12 wks. The median relative delta between WB-MATV at baseline and after 2 wks was +21%. Changes of WB-MATV, however, failed to predict OS (p≥0.383). Similarly, no association was observed between changes of any of the circulating biomarkers investigated and prognosis. By contrast, low WB-MATV (9.4 vs 4.2 months, HR 0.65, p = 0.003), low cfDNA (7.0 vs 4.7 months, HR 0.58, p = 0.015), low CTC count (7.5 vs 3.3 months, HR 0.67, p < 0.001) and low CEA (7.0 vs 4.4 months, HR 0.58, p = 0.053) at baseline were associated with longer OS. Conclusions: This study confirms the inaccuracy of life expectancy estimation for rCRC pts based on a physician judgement largely relying on conventional criteria. Baseline assessment of WB-MATV, cfDNA, CTCs and CEA, but not early change evaluation of the same, may help to refine pt prognostication and guide management decisions. Clinical trial information: NCT01591590 .
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Affiliation(s)
- Silvia Camera
- Gastrointestinal Unit, Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Tugba Akin Telli
- Gastrointestinal Unit, Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Erwin Woff
- Nuclear Medicine Department, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pashalina Kehagias
- GUTS Lab, Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Thomas Guiot
- Nuclear Medicine Department, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Gabriela Critchi
- Nuclear Medicine Department, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Giacomo Bregni
- Gastrointestinal Unit, Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Elena Trevisi
- Gastrointestinal Unit, Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Andrea Pretta
- Gastrointestinal Unit, Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Amélie Deleruelle
- GUTS Lab, Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Chiara Senti
- GUTS Lab, Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Sophia Leduc
- GUTS Lab, Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Leila Shaza
- Gastrointestinal Unit, Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Frédéric Hoerner
- Clinical Trial Conduct Unit (CTCU), Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Caroline Vandeputte
- GUTS Lab, Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Francesco Sclafani
- Gastrointestinal Unit, Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Patrick Flamen
- Nuclear Medicine Department, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Alain Hendlisz
- Gastrointestinal Unit, Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Amélie Deleporte
- Gastrointestinal Unit, Department of Medical Oncology, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Francoise Rothe
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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Woff E, Hendlisz A, Salvatore L, Marmorino F, Falcone A, Genovesi D, Giorgetti A, Critchi G, Ameye L, Paesmans M, Guiot T, Levillain H, Flamen P. Development and validation of a prognostic score for overall survival integrating baseline metabolically active tumor volume measured by 18F-FDG PET/CT and clinical factors for metastatic colorectal cancer patients. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3543 Background: This study aimed to develop and validate a prognostic score integrating baseline metabolically active tumor volume (MATV) and clinical factors in metastatic colorectal cancer (mCRC) patients. Methods: The development cohort included chemorefractory mCRC patients enrolled in two prospective multicenter non-randomized trials evaluating sorafenib/regorafenib as last line therapy. The validation cohort included mCRC patients from another center, treated with chemotherapy and bevacizumab as first line. Baseline MATV was defined as the sum of metabolically active volumes of all target lesions identified on the baseline 18F-FDG PET/CT. MATV optimal cutoff for OS prediction was determined from the development cohort with Contal and O’Quigley’s method. MATV, age, gender, BMI, ECOG PS, years since diagnosis, and KRAS status were included in a multivariate analysis. A prognostic score to predict OS was developed from the development cohort using Cox proportional hazards model. Results: MATV and clinical factors were evaluable respectively in 155 and 122 patients of the development and validation cohorts. In univariate analysis, MATV with cutoff set at 100 cm³ identified two risk groups with different median OS (mOS) in both the development (4.5 vs 10.9 months, HR: 2.64; p < 0.001) and validation cohorts (20.9 vs 42.9 months, HR: 2.39; p < 0.001). A multivariate analysis identified four independent negative predictors of OS (high MATV, short time since diagnosis, poor PS, BMI < 25). Combining these factors in a prognostic score for OS (best cutoff:-2) allowed to identify two risk groups with different mOS in the development (4.4 vs 13.4 months, HR: 3.67; p < 0.001) and validation cohorts (25 vs 63.8 months, HR: 2.5; p = 0.001). Conclusions: In mCRC patients, the high prognostic value of baseline MATV found in the development cohort was confirmed by external validation, independently of patients’ treatment. In both the development and validation cohorts the prognostic score for OS allowed to identify two risk groups of mCRC patients with significantly different mOS. MATV and our prognostic score for OS should provide a firm basis for risk stratification, in clinical practice and research trials.
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Affiliation(s)
- Erwin Woff
- Nuclear Medicine Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Alain Hendlisz
- Medical Oncology Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lisa Salvatore
- Oncologia Medica, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Roma, Italy
| | - Federica Marmorino
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Alfredo Falcone
- Department of Translational Research and New Technologies in Medicine and Surgery, Unit of Medical Oncology 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Dario Genovesi
- Nuclear Medicine Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Assuero Giorgetti
- Nuclear Medicine Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Gabriela Critchi
- Nuclear Medicine Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lieveke Ameye
- Data Centre, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marianne Paesmans
- Data Centre, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Thomas Guiot
- Nuclear Medicine Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Hugo Levillain
- Nuclear Medicine Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Patrick Flamen
- Nuclear Medicine Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
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Woff E, Kehagias P, Vandeputte C, Ameye L, Guiot T, Paesmans M, Hendlisz A, Flamen P. Combining 18F-FDG PET/CT-Based Metabolically Active Tumor Volume and Circulating Cell-Free DNA Significantly Improves Outcome Prediction in Chemorefractory Metastatic Colorectal Cancer. J Nucl Med 2019; 60:1366-1372. [PMID: 30850494 DOI: 10.2967/jnumed.118.222919] [Citation(s) in RCA: 10] [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: 11/03/2018] [Accepted: 02/11/2019] [Indexed: 12/26/2022] Open
Abstract
Baseline whole-body metabolically active tumor volume (WB-MATV) measured by 18F-FDG PET/CT and circulating cell-free DNA (cfDNA) have been separately validated as predictors of overall and progression-free survival (OS/PFS) in chemorefractory metastatic colorectal cancer (mCRC) patients. This study assessed the correlation between WB-MATV and cfDNA, evaluating the added prognostic value of these in combination, along with clinical parameters. Methods: Of 141 mCRC patients included in a prospective multicenter trial, 132 were evaluable for OS/PFS. cfDNA was extracted from 3 mL of plasma and quantified using a fluorometer. All target lesions were delineated on 18F-FDG PET/CT, and their metabolic volumes were summed to obtain the WB-MATV. Results: Baseline WB-MATV and cfDNA were strongly correlated (r = 0.70; P < 0.001) but showed discordance in 23 of 132 (17%) patients. A multivariate analysis identified 3 independent negative predictors of PFS (high cfDNA, short time since diagnosis, and body mass index < 30) and 5 of OS (high cfDNA, high WB-MATV, body mass index < 30, poor performance status, and short time since diagnosis). Combining WB-MATV and cfDNA increased the overall prognostic value and allowed identification of a subgroup of patients with low cfDNA and high WB-MATV who were associated with intermediate survival (median OS of 8.1 for low-cfDNA/high-MATV patients vs. 12.7 mo for low-cfDNA/low-MATV patients; hazard ratio, 2.04; P = 0.02). Conclusion: This study confirms the added prognostic value of combined circulating cfDNA and PET-based WB-MATV in chemorefractory mCRC patients. The combination of these two biomarkers should provide a firm basis for risk stratification, both in clinical practice and in research trials.
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Affiliation(s)
- Erwin Woff
- Nuclear Medicine Department, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pashalina Kehagias
- Gastro-Oncology Translational Laboratory, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Caroline Vandeputte
- Gastro-Oncology Translational Laboratory, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lieveke Ameye
- Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium; and
| | - Thomas Guiot
- Nuclear Medicine Department, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marianne Paesmans
- Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium; and
| | - Alain Hendlisz
- Medical Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Patrick Flamen
- Nuclear Medicine Department, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Woff E, Hendlisz A, Ameye L, Garcia C, Kamoun T, Guiot T, Paesmans M, Flamen P. Validation of Metabolically Active Tumor Volume and Total Lesion Glycolysis as 18F-FDG PET/CT–derived Prognostic Biomarkers in Chemorefractory Metastatic Colorectal Cancer. J Nucl Med 2018; 60:178-184. [DOI: 10.2967/jnumed.118.210161] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/11/2018] [Indexed: 12/15/2022] Open
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Nguyen T, de Wind A, Woff E, Heimann P, Vercruyssen M, Spilleboudt C, Maerevoet M, Meuleman N, Cantinieaux B, Michiels S, Bron D. Prognostic value of KI-67, MIPI score and SUV MAX of the PET scan: Result of a single center experience with mantle-cell lymphomas. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- T. Nguyen
- Hematology; Institut Jules Bordet, ULB; Brussels Belgium
| | - A. de Wind
- Pathology; Institut Jules Bordet, ULB; Brussels Belgium
| | - E. Woff
- Nuclear Medicine; Institut Jules Bordet, ULB; Brussels Belgium
| | - P. Heimann
- Molecular Biology; Institut Jules Bordet, ULB; Brussels Belgium
| | - M. Vercruyssen
- Hematology; Institut Jules Bordet, ULB; Brussels Belgium
| | - C. Spilleboudt
- Hematology; Institut Jules Bordet, ULB; Brussels Belgium
| | - M. Maerevoet
- Hematology; Institut Jules Bordet, ULB; Brussels Belgium
| | - N. Meuleman
- Hematology; Institut Jules Bordet, ULB; Brussels Belgium
| | | | - S. Michiels
- Hematology; Institut Jules Bordet, ULB; Brussels Belgium
| | - D. Bron
- Hematology; Institut Jules Bordet, ULB; Brussels Belgium
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Woff E, Kehagias P, Vandeputte C, Kamoun T, Guiot T, Ameye L, Geboes KP, Delaunoit T, Demolin G, Peeters M, D'Hondt LA, Janssens J, Carrasco J, Holbrechts S, Goeminne JC, Van Laethem JL, Vergauwe P, Paesmans M, Flamen P, Hendlisz A. Baseline cell-free DNA (cfDNA) and metabolic tumor volume (MTV) independently predict outcome in metastatic chemorefractory colorectal cancer (mCRC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.11569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11569 Background: No validated prognostic biomarker is currently available for mCRC. This trial assessed cfDNA and MTV before treatment with regorafenib as prognostic biomarkers for progression-free survival (PFS) and overall survival (OS) in mCRC. Methods: After signed informed consent, mCRC patients were enrolled in a prospective non-randomized trial aiming to define unlikelihood to benefit from regorafenib (EudraCT number: 2012-005655-16) and assessed for cfDNA and FDG PET/CT MTV at baseline. cfDNA was extracted from 3mL of plasma and quantified using the Qubit 2.0 fluorometer. All target lesions were delineated on FDG PET/CT using a PERCIST-based threshold and their volumes were summed to obtain total MTV. MTV and cfDNA optimal cutoffs for OS and PFS prediction were determined by the Contal and O’Quigley’s method. MTV, cfDNA, age, gender, Body Mass Index (low, normal, high, obese), ECOG PS, number of chemotherapy lines (NCL), previous use of bevacizumab and presence of a KRAS mutation were included in a multivariate analysis. Results: MTV and cfDNA of 132 evaluable/141 eligible patients were well correlated (Spearman’s correlation coefficient = 0.70; p < 0.001) and risk groups for both PFS and OS were identified on the basis of cfDNA (cfDNA < 1 µg/mL; cfDNA≥1 µg/mL) and MTV (MTV < 100 cm³; 100-300 cm³; > 300 cm³). The multivariate analysis retained cfDNA, MTV, NCL, and obesity as independent parameters for PFS prediction, and cfDNA, MTV, NCL, BMI, and previous use of bevacizumab as independent parameters for OS prediction. Prognostic scores for PFS and OS were developed based on regression coefficients from the final Cox proportional hazards models. Prognostic scores for PFS (1.8 vs 5.3 months, HR: 3.15 for score ≥-3 vs < -3, (95% CI, 2.08-4.76); p < 0.001) and for OS (4.2 vs 13.9 months, HR: 4.59 for score ≥-6 vs < -6: (95% CI, 2.92-7.21); p < 0.001) both identified patients with much contrasted outcomes. Conclusions: Baseline cfDNA and MTV along with BMI parameters predict outcome in patients with mCRC before regorafenib onset. These parameters not related to treatment should be considered, if validated in further studies, as stratification factors in future clinical trials. Clinical trial information: 2012-005655-16.
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Affiliation(s)
- Erwin Woff
- Nuclear Medicine Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pashalina Kehagias
- Gastro-Oncology Translational Laboratory, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Caroline Vandeputte
- Gastro-Oncology Translational Laboratory, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Tarek Kamoun
- Nuclear Medicine Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Thomas Guiot
- Nuclear Medicine Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lieveke Ameye
- Data Centre, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | | | | | - Marc Peeters
- Antwerp University Hospital, Department of Oncology, Edegem, Belgium
| | | | | | | | | | | | | | | | - Marianne Paesmans
- Data Centre, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Patrick Flamen
- Nuclear Medicine Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Alain Hendlisz
- Medical Oncology Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
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Woff E, Hendlisz A, Garcia C, Deleporte A, Delaunoit T, Maréchal R, Holbrechts S, Van den Eynde M, Demolin G, Vierasu I, Lhommel R, Gauthier N, Guiot T, Ameye L, Flamen P. Monitoring metabolic response using FDG PET-CT during targeted therapy for metastatic colorectal cancer. Eur J Nucl Med Mol Imaging 2016; 43:1792-801. [PMID: 27072811 PMCID: PMC4969337 DOI: 10.1007/s00259-016-3365-x] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/08/2016] [Indexed: 12/19/2022]
Abstract
Introduction The introduction of targeted drugs has had a significant impact on the approach to assessing tumour response. These drugs often induce a rapid cytostatic effect associated with a less pronounced and slower tumoural volume reduction, thereby impairing the correlation between the absence of tumour shrinkage and the patient’s unlikelihood of benefit. The aim of the study was to assess the predictive value of early metabolic response (mR) evaluation after one cycle, and its interlesional heterogeneity to a later metabolic and morphological response assessment performed after three cycles in metastatic colorectal cancer (mCRC) patients treated with combined sorafenib and capecitabine. Methods This substudy was performed within the framework of a wider prospective multicenter study on the predictive value of early FDG PET-CT response assessment (SoMore study). A lesion-based response analysis was performed, including all measurable lesions identified on the baseline PET. On a per-patient basis, a descriptive 4-class response categorization was applied based upon the presence and proportion of non-responding lesions. For dichotomic response comparison, all patients with at least one resistant lesion were classified as non-responding. Results On baseline FDG PET-CT, 124 measurable “target” lesions were identified in 38 patients. Early mR assessments showed 18 patients (47 %) without treatment resistant lesions and 12 patients (32 %) with interlesional response heterogeneity. The NPV and PPV of early mR were 85 % (35/41) and 84 % (70/83), respectively, on a per-lesion basis and 95 % (19/20) and 72 % (13/18), respectively, on a dichotomized per-patient basis. Conclusions Early mR assessment performed after one cycle of sorafenib-capecitabine in mCRC is highly predictive of non-response at a standard response assessment time. The high NPV (95 %) of early mR could be useful as the basis for early treatment discontinuation or adaptation to spare patients from exposure to non-effective drugs.
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Affiliation(s)
- Erwin Woff
- Nuclear Medicine Department, Institut Jules Bordet, Université libre de Bruxelles, 1 rue Héger-Bordet, 1000, Brussels, Belgium.
| | - Alain Hendlisz
- Medical Oncology Department, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Camilo Garcia
- Nuclear Medicine Department, Institut Jules Bordet, Université libre de Bruxelles, 1 rue Héger-Bordet, 1000, Brussels, Belgium
| | - Amelie Deleporte
- Medical Oncology Department, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | | | - Raphaël Maréchal
- Gastroenterology Medico-Surgical Department, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium
| | | | - Marc Van den Eynde
- Oncology Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | | | - Irina Vierasu
- Nuclear Medicine Department, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Renaud Lhommel
- Nuclear Medicine Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Namur Gauthier
- Nuclear Medicine Department, CHC Saint-Joseph, Liège, Belgium
| | - Thomas Guiot
- Nuclear Medicine Department, Institut Jules Bordet, Université libre de Bruxelles, 1 rue Héger-Bordet, 1000, Brussels, Belgium
| | - Lieveke Ameye
- Data center Department, Institut Jules Bordet, Université libre de Bruxelles, Brussels, Belgium
| | - Patrick Flamen
- Nuclear Medicine Department, Institut Jules Bordet, Université libre de Bruxelles, 1 rue Héger-Bordet, 1000, Brussels, Belgium
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Bron D, Dewind R, Cantinieaux B, Woff E, Roelandts M, Moerman C, Lemort M, Heimann P, De Wilde V, Meuleman N, Maerevoet M. [Practical approach of lymphomas: major role of general practitioner who has to face all these emerging drugs]. Rev Med Brux 2015; 36:237-247. [PMID: 26591307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Malignant lymphoma and other lymphoproliferative disorders represent a group of malignant hemopathies where immunotherapy has allowed spectacular progresses over the last ten years. The recent W.H.O. classification, based upon tumor immunology, and cytogenetical anomalies, allows a better identification of each lymphoma and the comparison of homogeneous populations within various clinical studies. The increase in the incidence of non-Hodgkin lymphoma is related to the aging of the population as well as to other factors that are still to be analysed - a real challenge for the future. We have tried to offer an overview of the latest therapeutical advances while focusing on the major role of general practitioner. The most frequency askeed questions will be discussed.
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Woff E, Garcia C, Tant L, Muylle K, Ghanem G, Bourgeois P, Flamen P. Imaging of tumour-induced osteomalacia using a gallium-68 labelled somatostatin analogue. Case Reports 2010. [DOI: 10.1136/bcr.02.2010.2750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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