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van der Doelen MJ, Mehra N, van Oort IM, Looijen-Salamon MG, Janssen MJR, Custers JAE, Slootbeek PHJ, Kroeze LI, Bruchertseifer F, Morgenstern A, Haberkorn U, Kratochwil C, Nagarajah J, Gerritsen WR. Clinical outcomes and molecular profiling of advanced metastatic castration-resistant prostate cancer patients treated with 225Ac-PSMA-617 targeted alpha-radiation therapy. Urol Oncol 2020; 39:729.e7-729.e16. [PMID: 33353867 DOI: 10.1016/j.urolonc.2020.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 09/24/2020] [Revised: 11/22/2020] [Accepted: 12/07/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Targeted alpha-radiation therapy (TAT) with 225Ac-labeled prostate-specific membrane antigen (PSMA) ligands is a promising novel treatment option for metastatic castration-resistant prostate cancer (mCRPC) patients. However, limited data are available on efficacy, quality of life (QoL), and pretherapeutic biomarkers. The aim of this study was to evaluate the efficacy of 225Ac-PSMA TAT and impact on QoL in advanced mCRPC, and to explore predictive biomarkers on pretherapeutic metastatic tissue biopsies. METHODS Observational cohort study including consecutive patients treated with 225Ac-PSMA TAT between February 2016 and July 2018. Primary endpoint was overall survival (OS). Furthermore, prostate-specific antigen (PSA) changes, radiological response, safety, QoL, and xerostomia were evaluated. Biopsies were analyzed with immunohistochemistry and next-generation sequencing. RESULTS Thirteen patients were included. Median OS was 8.5 months for the total cohort and 12.6 months for PSMA radioligand therapy-naïve patients. PSA declines of ≥90% and ≥50% were observed in 46% and 69% of patients, respectively. Six patients were radiologically evaluable; 50% showed partial response. All patients showed >90% total tumor volume reduction on PET imaging. Patients experienced clinically relevant decrease of pain and QoL improvement in physical and role functioning domains. Xerostomia persisted during follow-up. Patients with high baseline immunohistochemical PSMA expression or DNA damage repair alterations tended to have longer OS. CONCLUSIONS TAT with 225Ac-PSMA resulted in remarkable survival and biochemical responses in advanced mCRPC patients. Patients experienced clinically relevant QoL improvement, although xerostomia was found to be nontransient. Baseline immunohistochemical PSMA expression and DNA damage repair status are potential predictive biomarkers of response to 225Ac-PSMA TAT.
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Affiliation(s)
- Maarten J van der Doelen
- Radboud University Medical Center, Department of Medical Oncology, Nijmegen, The Netherlands; Radboud University Medical Center, Department of Urology, Nijmegen, The Netherlands.
| | - Niven Mehra
- Radboud University Medical Center, Department of Medical Oncology, Nijmegen, The Netherlands
| | - Inge M van Oort
- Radboud University Medical Center, Department of Urology, Nijmegen, The Netherlands
| | | | - Marcel J R Janssen
- Radboud University Medical Center, Department of Radiology and Nuclear Medicine, Nijmegen, The Netherlands
| | - José A E Custers
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Psychology, Nijmegen, The Netherlands
| | - Peter H J Slootbeek
- Radboud University Medical Center, Department of Medical Oncology, Nijmegen, The Netherlands
| | - Leonie I Kroeze
- Radboud University Medical Center, Department of Pathology, Nijmegen, The Netherlands
| | - Frank Bruchertseifer
- European Commission, Joint Research Centre, Nuclear Safety and Security, Karlsruhe, Germany
| | - Alfred Morgenstern
- European Commission, Joint Research Centre, Nuclear Safety and Security, Karlsruhe, Germany
| | - Uwe Haberkorn
- University Hospital Heidelberg, Department of Nuclear Medicine, Germany
| | | | - James Nagarajah
- Radboud University Medical Center, Department of Radiology and Nuclear Medicine, Nijmegen, The Netherlands; Technical University Munich, Klinikum rechts der Isar, Department of Nuclear Medicine, Munich, Germany
| | - Winald R Gerritsen
- Radboud University Medical Center, Department of Medical Oncology, Nijmegen, The Netherlands
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Meijer TWH, Looijen-Salamon MG, Lok J, van den Heuvel M, Tops B, Kaanders JHAM, Span PN, Bussink J. Glucose and glutamine metabolism in relation to mutational status in NSCLC histological subtypes. Thorac Cancer 2019; 10:2289-2299. [PMID: 31668020 PMCID: PMC6885430 DOI: 10.1111/1759-7714.13226] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 05/27/2019] [Revised: 09/27/2019] [Accepted: 09/28/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Both hypoxia and oncogenic mutations rewire tumor metabolism. In this study, glucose and glutamine metabolism-related markers were examined in stage I - resectable stage IIIA non-small cell lung cancer (NSCLC). Furthermore, expression of metabolism-related markers was correlated with mutational status to examine mutations associated with rewired tumor metabolism. METHODS Mutation analysis was performed for 97 tumors. Glucose and glutamine metabolism-related marker expression was measured by immunofluorescent staining (protein) and qPCR (mRNA) (n = 81). RESULTS Glutamine metabolism-related markers were significantly higher in adeno- than squamous cell NSCLCs. Glucose transporter 1 (GLUT1) protein expression was higher in solid compared to lepidic adenocarcinomas (P < 0.01). In adenocarcinomas, mRNA expression of glutamine transporter SLC1A5 correlated with tumor size (r(p) = 0.41, P = 0.005). Furthermore, SLC1A5 protein expression was significantly higher in adenocarcinomas with worse pTNM stage (r(s) = 0.39, P = 0.009). EGFR-mutated tumors showed lower GLUT1 protein (P = 0.017), higher glutaminase 2 (GLS2) protein (P = 0.025) and higher GLS2 mRNA expression (P = 0.004), compared to EGFR wild-type tumors. GLS mRNA expression was higher in KRAS-mutated tumors (P = 0.019). TP53-mutated tumors showed higher GLUT1 expression (P = 0.009). CONCLUSIONS NSCLC is a heterogeneous disease, with differences in mutational status and metabolism-related marker expression between adeno- and squamous cell NSCLCs, and also within adenocarcinoma subtypes. GLUT1 and SLC1A5 expression correlate with aggressive tumor behavior in adenocarcinomas but not in squamous cell NSCLCs. Therefore, these markers could steer treatment modification for subgroups of adenocarcinoma patients. TP53, EGFR and KRAS mutations are associated with expression of glucose and glutamine metabolism-related markers in NSCLC.
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Affiliation(s)
- Tineke W H Meijer
- Radiotherapy and OncoImmunology Laboratory, Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Jasper Lok
- Radiotherapy and OncoImmunology Laboratory, Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michel van den Heuvel
- Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bastiaan Tops
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johannes H A M Kaanders
- Radiotherapy and OncoImmunology Laboratory, Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul N Span
- Radiotherapy and OncoImmunology Laboratory, Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johan Bussink
- Radiotherapy and OncoImmunology Laboratory, Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
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Meijer TWH, de Geus-Oei LF, Visser EP, Oyen WJG, Looijen-Salamon MG, Visvikis D, Verhagen AFTM, Bussink J, Vriens D. Tumor Delineation and Quantitative Assessment of Glucose Metabolic Rate within Histologic Subtypes of Non-Small Cell Lung Cancer by Using Dynamic 18F Fluorodeoxyglucose PET. Radiology 2016; 283:547-559. [PMID: 27846378 DOI: 10.1148/radiol.2016160329] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose To assess whether dynamic fluorine 18 (18F) fluorodeoxyglucose (FDG) positron emission tomography (PET) has added value over static 18F-FDG PET for tumor delineation in non-small cell lung cancer (NSCLC) radiation therapy planning by using pathology volumes as the reference standard and to compare pharmacokinetic rate constants of 18F-FDG metabolism, including regional variation, between NSCLC histologic subtypes. Materials and Methods The study was approved by the institutional review board. Patients gave written informed consent. In this prospective observational study, 1-hour dynamic 18F-FDG PET/computed tomographic examinations were performed in 35 patients (36 resectable NSCLCs) between 2009 and 2014. Static and parametric images of glucose metabolic rate were obtained to determine lesion volumes by using three delineation strategies. Pathology volume was calculated from three orthogonal dimensions (n = 32). Whole tumor and regional rate constants and blood volume fraction (VB) were computed by using compartment modeling. Results Pathology volumes were larger than PET volumes (median difference, 8.7-25.2 cm3; Wilcoxon signed rank test, P < .001). Static fuzzy locally adaptive Bayesian (FLAB) volumes corresponded best with pathology volumes (intraclass correlation coefficient, 0.72; P < .001). Bland-Altman analyses showed the highest precision and accuracy for static FLAB volumes. Glucose metabolic rate and 18F-FDG phosphorylation rate were higher in squamous cell carcinoma (SCC) than in adenocarcinoma (AC), whereas VB was lower (Mann-Whitney U test or t test, P = .003, P = .036, and P = .019, respectively). Glucose metabolic rate, 18F-FDG phosphorylation rate, and VB were less heterogeneous in AC than in SCC (Friedman analysis of variance). Conclusion Parametric images are not superior to static images for NSCLC delineation. FLAB-based segmentation on static 18F-FDG PET images is in best agreement with pathology volume and could be useful for NSCLC autocontouring. Differences in glycolytic rate and VB between SCC and AC are relevant for research in targeting agents and radiation therapy dose escalation. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Tineke W H Meijer
- From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis)
| | - Lioe-Fee de Geus-Oei
- From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis)
| | - Eric P Visser
- From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis)
| | - Wim J G Oyen
- From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis)
| | - Monika G Looijen-Salamon
- From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis)
| | - Dimitris Visvikis
- From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis)
| | - Ad F T M Verhagen
- From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis)
| | - Johan Bussink
- From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis)
| | - Dennis Vriens
- From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis)
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