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Connor S, Sit C, Anjari M, Lei M, Guerrero-Urbano T, Szyszko T, Cook G, Bassett P, Goh V. The ability of post-chemoradiotherapy DWI ADC mean and 18F-FDG SUV max to predict treatment outcomes in head and neck cancer: impact of human papilloma virus oropharyngeal cancer status. J Cancer Res Clin Oncol 2021; 147:2323-2336. [PMID: 34159420 PMCID: PMC8236463 DOI: 10.1007/s00432-021-03662-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the ability of post-chemo-radiotherapy (CRT) diffusion-weighted-MRI apparent diffusion coefficient (ADCmean) and 18F-FDG PET maximum standardized uptake value (SUVmax) to predict disease-free survival (DFS) in head and neck squamous cell carcinoma (HNSCC), and to determine whether this ability is influenced by human papillomavirus oropharyngeal cancer (HPV-OPC) status. METHODS This prospective cohort observational study included 65 participants (53 male, mean ± SD age 59.9 ± 7.9 years, 46 HPV-OPC) with stage III or IV HNSCC. Primary tumour and nodal ADCmean (pre-treatment, 6- and 12-weeks post-CRT) and SUVmax (12-weeks post-CRT) were measured. Variables were compared with 2-year DFS (independent t-test/Mann-Whitney test) and overall DFS (Cox regression), before and after accounting for HPV-OPC status. Variables were also compared between HPV-OPC and other HNSCC subgroups after stratifying for DFS. RESULTS Absolute post-CRT ADCmean values predicted 2-year DFS and overall DFS for all participants (p = 0.03/0.03, 6-week node; p = 0.02/0.03 12-week primary tumour) but not in the HPV-OPC subgroup. In participants with DFS, percentage interval changes in primary tumour ADCmean at 6- and 12-weeks were higher in HPV-OPC than other HNSCC (p = 0.01, 6 weeks; p = 0.005, 12 weeks). The 12-week post-CRT SUVmax did not predict DFS. CONCLUSION Absolute post-CRT ADCmean values predicted DFS in HNSCC but not in the HPV-OPC subgroup. Amongst participants with DFS, post-CRT percentage interval changes in primary tumour ADCmean were significantly higher in HPV-OPC than in other HNSCC. Knowledge of HPV-OPC status is crucial to the clinical utilisation of post-CRT DWI-MRI for the prediction of outcomes.
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Affiliation(s)
- S Connor
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College, London, SE1 7EH, UK.
- Department of Neuroradiology, Ruskin Wing, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
- Department of Radiology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT, UK.
| | - C Sit
- Department of Radiology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT, UK
| | - M Anjari
- Department of Radiology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT, UK
| | - M Lei
- Department of Oncology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT, UK
| | - T Guerrero-Urbano
- Department of Oncology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT, UK
| | - T Szyszko
- King's College London & Guy's and St. Thomas' PET Centre, London, SE1 7EH, UK
| | - G Cook
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College, London, SE1 7EH, UK
- King's College London & Guy's and St. Thomas' PET Centre, London, SE1 7EH, UK
| | - P Bassett
- Department of Oncology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT, UK
| | - V Goh
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College, London, SE1 7EH, UK
- Department of Radiology, Guy's Hospital, 2nd Floor, Tower Wing, Great Maze Pond, London, SE1 9RT, UK
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Connor S, Sit C, Anjari M, Szyszko T, Dunn J, Pai I, Cook G, Goh V. Correlations between DW-MRI and 18 F-FDG PET/CT parameters in head and neck squamous cell carcinoma following definitive chemo-radiotherapy. Cancer Rep (Hoboken) 2021; 4:e1360. [PMID: 33960739 PMCID: PMC8388179 DOI: 10.1002/cnr2.1360] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Posttreatment diffusion-weighted magnetic resonance imaging (DW-MRI) and 18F-fluorodeoxygluocose (18 F-FDG) positron emission tomography (PET) with computed tomography (PET/CT) have potential prognostic value following chemo-radiotherapy (CRT) for head and neck squamous cell carcinoma (HNSCC). Correlations between these PET/CT (standardized uptake value or SUV) and DW-MRI (apparent diffusion coefficient or ADC) parameters have only been previously explored in the pretreatment setting. AIM To evaluate stage III and IV HNSCC at 12-weeks post-CRT for the correlation between SUVmax and ADC values and their interval changes from pretreatment imaging. METHODS Fifty-six patients (45 male, 11 female, mean age 59.9 + - 7.38) with stage 3 and 4 HNSCC patients underwent 12-week posttreatment DW-MRI and 18 F-FDG PET/CT studies in this prospective study. There were 41/56 patients in the cohort with human papilloma virus-related oropharyngeal cancer (HPV OPC). DW-MRI (ADCmax and ADCmin) and 18 F-FDG PET/CT (SUVmax and SUVmax ratio to liver) parameters were measured at the site of primary tumors (n = 48) and the largest lymph nodes (n = 52). Kendall's tau evaluated the correlation between DW-MRI and 18 F-FDG PET/CT parameters. Mann-Whitney test compared the post-CRT PET/CT and DW-MRI parameters between those participants with and without 2-year disease-free survival (DFS). RESULTS There was no correlation between DW-MRI and 18 F-FDG PET/CT parameters on 12-week posttreatment imaging (P = .455-.794; tau = -0.075-0.25) or their interval changes from pretreatment to 12-week posttreatment imaging (P = .1-.946; tau = -0.194-0.044). The primary tumor ADCmean (P = .03) and the interval change in nodal ADCmin (P = .05) predicted 2-year DFS but none of the 18 F-FDG PET/CT parameters were associated with 2-year DFS. CONCLUSIONS There is no correlation between the quantitative DWI-MRI and 18 F-FDG PET/CT parameters derived from 12-week post-CRT studies. These parameters may be independent biomarkers however in this HPV OPC dominant cohort, only selected ADC parameters demonstrated prognostic significance. Study was prospectively registered at http://www.controlled-trials.com/ISRCTN58327080.
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Affiliation(s)
- Steve Connor
- School of Biomedical Engineering and Imaging SciencesSt Thomas' Hospital, King's CollegeLondonUK
- Department of NeuroradiologyKing's College Hospital NHS Foundation TrustLondonUK
- Department of RadiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Cherry Sit
- Department of RadiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Mustafa Anjari
- Department of RadiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Teresa Szyszko
- King's College London & Guy's and St. Thomas' PET CentreLondonUK
| | - Joel Dunn
- King's College London & Guy's and St. Thomas' PET CentreLondonUK
| | - Irumee Pai
- School of Biomedical Engineering and Imaging SciencesSt Thomas' Hospital, King's CollegeLondonUK
- Department of OtolaryngologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Gary Cook
- School of Biomedical Engineering and Imaging SciencesSt Thomas' Hospital, King's CollegeLondonUK
- King's College London & Guy's and St. Thomas' PET CentreLondonUK
| | - Vicky Goh
- School of Biomedical Engineering and Imaging SciencesSt Thomas' Hospital, King's CollegeLondonUK
- Department of RadiologyGuy's and St Thomas' NHS Foundation TrustLondonUK
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3
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Brown A, Shah S, Dluzewski S, Musaddaq B, Wagner T, Szyszko T, Wan S, Groves A, Mokbel K, Malhotra A. Unilateral axillary adenopathy following COVID-19 vaccination: a multimodality pictorial illustration and review of current guidelines. Clin Radiol 2021; 76:553-558. [PMID: 34053731 PMCID: PMC8118644 DOI: 10.1016/j.crad.2021.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/29/2021] [Indexed: 11/17/2022]
Abstract
We present a multimodality pictorial review of axillary lymphadenopathy in patients recently vaccinated against COVID-19. As the mass vaccination programme continues to be rolled out worldwide in an effort to combat the pandemic, it is important that radiologists consider recent COVID-19 vaccination in the differential diagnosis of unilateral axillary lymphadenopathy and are aware of typical appearances across all imaging methods. We review current guidelines on the management of unilateral axillary lymphadenopathy in the context of recent COVID-19 vaccination.
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Affiliation(s)
- A Brown
- Radiology Department, Royal Free Hospital, Pond Street, London, NW3 2QG, UK.
| | - S Shah
- Department of Nuclear Medicine, Royal Free Hospital, London, NW3 2QG, UK
| | - S Dluzewski
- Radiology Department, Royal Free Hospital, Pond Street, London, NW3 2QG, UK
| | - B Musaddaq
- Radiology Department, Royal Free Hospital, Pond Street, London, NW3 2QG, UK
| | - T Wagner
- Department of Nuclear Medicine, Royal Free Hospital, London, NW3 2QG, UK
| | - T Szyszko
- Department of Nuclear Medicine, Royal Free Hospital, London, NW3 2QG, UK
| | - S Wan
- Institute of Nuclear Medicine, University College London, WC1E 6BT, UK
| | - A Groves
- Institute of Nuclear Medicine, University College London, WC1E 6BT, UK
| | - K Mokbel
- London Breast Institute, The Princess Grace Hospital, 42-52 Nottingham Place, London, W1U 5NY, UK
| | - A Malhotra
- Radiology Department, Royal Free Hospital, Pond Street, London, NW3 2QG, UK
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Shah S, Wagner T, Nathan M, Szyszko T. COVID-19 vaccine-related lymph node activation - patterns of uptake on PET-CT. BJR Case Rep 2021; 7:20210040. [PMID: 34131510 PMCID: PMC8171126 DOI: 10.1259/bjrcr.20210040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 11/05/2022] Open
Abstract
In a bid to end the current COVID-19 crisis, many countries including UK have begun a mass immunization programme. Immunization can cause transient inflammation thereby causing increased metabolic activity at injection site and hypermetabolic lymph nodes. Various vaccinations and local injections have been known to cause diagnostic dilemma due to false-positive uptake on FDG PET-CT. In this pictorial case review, we present five cases demonstrating various patterns of uptake including an ipsilateral deltoid muscle, axillary, supraclavicular, and subpectoral lymph nodes post COVID-19 vaccination. A careful history of COVID-19 vaccination and normal size and morphology of lymph node on unenhanced low-dose CT will aid the diagnosis. All patients undergoing FDG PET-CT will require detailed documentation of the vaccination history including the time interval since vaccination. Knowledge about these patterns of uptake on PET-CT will ensure accurate interpretation by Nuclear Medicine physicians and radiologists during the current vaccination drive.
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Affiliation(s)
- Sweni Shah
- Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Thomas Wagner
- Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Malavika Nathan
- Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Teresa Szyszko
- Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
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Harris H, Szyszko T, Barwick T, Silickas J, Lyons O, Price N, Sallam M, Bell R. Visual Scoring Improves the Utility of 18F-FDG PET/CT in the Diagnosis of Aortic Graft Infection. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.535] [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: 11/24/2022]
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Seet C, Szyszko T, Perera R, Donati T, Modarai B, Patel S, Tyrrell M, Sallam M, Bell R, Price N, Lyons O. Streptococcus pneumoniae as a Cause of Mycotic and Infected Aneurysms in Patients without Respiratory Features: Challenging Diagnoses Aided by 16S PCR. Ann Vasc Surg 2019; 60:475.e11-475.e17. [PMID: 31075452 DOI: 10.1016/j.avsg.2019.02.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 02/10/2019] [Accepted: 02/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Streptococcus pneumoniae is considered a rare cause of mycotic aneurysms. The microbiological diagnosis of mycotic aneurysms can be difficult, and many patients have negative blood culture results. METHODS We describe a series of four consecutive cases of mycotic aneurysms caused by S. pneumoniae with no respiratory features or extravascular septic foci. In two patients with negative blood culture results, 16S PCR was used for the diagnosis of S. pneumoniae infection. RESULTS Four men with mycotic aneurysms affecting the aorta, axillary, and popliteal arteries caused by S. pneumoniae presented to our center between 2015 and 2016. All were treated with at least one month of intravenous antibiotics, followed by at least 4 weeks of oral antibiotics. Two were additionally managed using endovascular surgical techniques, and one underwent an open surgical repair. The fourth patient presented with bilateral popliteal aneurysms, one of which ruptured and was managed using surgical ligation and bypass, whereas the other side subsequently ruptured and was repaired endovascularly. Three of the four patients are currently off antibiotics and considered cured, while one died of an unrelated cause. CONCLUSIONS S. pneumoniae should be considered a potential causative agent of mycotic aneurysms. Diagnosis can be confirmed using 16S PCR, especially in patients where peripheral blood cultures are uninformative.
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Affiliation(s)
- Christopher Seet
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, St Thomas' Hospital, London, UK.
| | - Teresa Szyszko
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, St Thomas' Hospital, London, UK
| | - Ranmith Perera
- Department of Cellular Pathology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Tommaso Donati
- Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Bijan Modarai
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, St Thomas' Hospital, London, UK
| | - Sanjay Patel
- Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mark Tyrrell
- Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Morad Sallam
- Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rachel Bell
- Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nicholas Price
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Oliver Lyons
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine and Sciences, BHF Centre of Research Excellence, King's College London, St Thomas' Hospital, London, UK; Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Parsai A, Miquel ME, Jan H, Kastler A, Szyszko T, Zerizer I. Improving liver lesion characterisation using retrospective fusion of FDG PET/CT and MRI. Clin Imaging 2019; 55:23-28. [DOI: 10.1016/j.clinimag.2019.01.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/19/2019] [Accepted: 01/22/2019] [Indexed: 12/23/2022]
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Phillips M, Szyszko T, Hall P, Rashid S, Khadeir R, Lim L, Steele J, Conibear J, Wells P, Ellis S, Feng X, Thomson J, Johnston A, Wu BW, Bomalaski J, Pacey S, Cook G, Szlosarek P. Abstract B33: Expansion study of pegylated arginine deiminase (ADI-PEG20), pemetrexed, and cisplatin in patients with ASS1-deficient non-squamous non-small cell lung cancer (TRAP). Clin Cancer Res 2018. [DOI: 10.1158/1557-3265.aacriaslc18-b33] [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: 11/16/2022]
Abstract
Abstract
Background: Loss of the metabolic tumor suppressor argininosuccinate synthetase 1 (ASS1) sensitizes non-squamous non-small cell lung cancer (NSCLC) cells to arginine deprivation with pegylated arginine deiminase (ADI-PEG20), which also disrupts thymidine pools and potentiates pemetrexed (Pem) cytotoxicity. In the phase I dose-escalation TRAP study (NCT02029690) we showed that ADI-PEG20 with first-line PEM and cisplatin (Cis) chemotherapy (ADIPemCis) produced a 100% disease control rate (DCR) (n = 9) of ASS1-deficient thoracic cancers, with no additional toxicity (Beddowes et al., 2017). Here, we present the TRAP expansion cohort experience in non-squamous NSCLC.
Methods: Good-performance (ECOG 0-1) NSCLC patients (pts) with nonresectable disease were enrolled in a phase I TRAP expansion cohort at the maximum tolerated dose (MTD) of ADIPemCis, using tumoral ASS1 loss as a selection biomarker. Pem (500mg/m2) and Cis (75mg/m2) were given every 3 weeks with weekly IM ADI-PEG20 (36mg/m2) for a maximum of 4 cycles with maintenance ADI-PEG20 or Pem in responding pts. Primary endpoint was tumor response rate (RECIST 1.1), with secondary endpoints including progression-free survival (PFS), overall survival (OS), and toxicity. We measured plasma arginine and citrulline concentrations, ADI-PEG20 antibodies, early molecular responses by 18-FLT-PET/CT, and biopsied pts on progression to explore resistance mechanisms.
Results: 21 ASS1-deficient non-squamous NSCLC pts (median age 60) were enrolled out of 70 screened pts; 14% (3/21) had stable brain metastases at entry. Plasma arginine decreased with a reciprocal increase in plasma citrulline. The partial response rate was 48% (n=10/21) with a DCR of 85.7% (n=18/21). Median PFS was 2.6 months and median OS was 5.3 months. 23.8% (n=5/21) pts experienced grade 3/4 treatment-related toxicities, the most common being non-febrile neutropenia (14.3%). A partial metabolic response was detected in 57.1% (n=4/7) pts by 24 hrs of arginine deprivation using 18-FLT-PET/CT with EORTC response criteria. Upregulation of ASS1 expression was observed in 1/3 biopsies on progression.
Conclusions: The ADIPemCis regimen is active in ASS1-deficient non-squamous NSCLC pts with a higher than expected response rate. However, the short survival (PFS and OS) compared with ASS1-agnostic historical controls indicates that ASS1 loss selects for a biologically more aggressive phenotype of NSCLC. Further studies are warranted exploring rationale combinations with ADIPemCis in patients with ASS1-deficient non-squamous NSCLC.
Citation Format: Melissa Phillips, Teresa Szyszko, Peter Hall, Sukaina Rashid, Ramsay Khadeir, Louise Lim, Jeremy Steele, John Conibear, Paula Wells, Stephen Ellis, Xiaoxing Feng, Jim Thomson, Amanda Johnston, Bor-Wen Wu, John Bomalaski, Simon Pacey, Gary Cook, Peter Szlosarek. Expansion study of pegylated arginine deiminase (ADI-PEG20), pemetrexed, and cisplatin in patients with ASS1-deficient non-squamous non-small cell lung cancer (TRAP) [abstract]. In: Proceedings of the Fifth AACR-IASLC International Joint Conference: Lung Cancer Translational Science from the Bench to the Clinic; Jan 8-11, 2018; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(17_Suppl):Abstract nr B33.
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Affiliation(s)
| | | | - Peter Hall
- 1Barts Cancer Institute, London, United Kingdom,
| | | | - Ramsay Khadeir
- 3Queen Mary University of London, London, United Kingdom,
| | - Louise Lim
- 1Barts Cancer Institute, London, United Kingdom,
| | | | | | - Paula Wells
- 1Barts Cancer Institute, London, United Kingdom,
| | | | | | - Jim Thomson
- 4Polaris Pharmaceuticals, Inc., San Diego, CA,
| | | | - Bor-Wen Wu
- 4Polaris Pharmaceuticals, Inc., San Diego, CA,
| | | | - Simon Pacey
- 5Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Gary Cook
- 3Queen Mary University of London, London, United Kingdom,
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Affiliation(s)
- Ramsay Khadeir
- Peter W. Szlosarek: Center for Molecular Oncology, Barts Cancer Institute - a Cancer Research UK Center of Excellence, Queen Mary University of London, John Vane Science Center, London, UK and Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Teresa Szyszko
- Peter W. Szlosarek: Center for Molecular Oncology, Barts Cancer Institute - a Cancer Research UK Center of Excellence, Queen Mary University of London, John Vane Science Center, London, UK and Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Peter W Szlosarek
- Peter W. Szlosarek: Center for Molecular Oncology, Barts Cancer Institute - a Cancer Research UK Center of Excellence, Queen Mary University of London, John Vane Science Center, London, UK and Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
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10
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O'Doherty J, Jauregui-Osoro M, Brothwood T, Szyszko T, Marsden PK, O'Doherty MJ, Cook GJR, Blower PJ, Lewington V. 18F-Tetrafluoroborate, a PET Probe for Imaging Sodium/Iodide Symporter Expression: Whole-Body Biodistribution, Safety, and Radiation Dosimetry in Thyroid Cancer Patients. J Nucl Med 2017; 58:1666-1671. [PMID: 28385795 PMCID: PMC6205602 DOI: 10.2967/jnumed.117.192252] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/01/2017] [Indexed: 11/16/2022] Open
Abstract
We report the safety, biodistribution, and internal radiation dosimetry, in humans with thyroid cancer, of 18F-tetrafluoroborate (18F-TFB), a novel PET radioligand for imaging the human sodium/iodide symporter (hNIS). Methods: Serial whole-body PET scans of 5 subjects with recently diagnosed thyroid cancer were acquired before surgery for up to 4 h after injection of 184 ± 15 MBq of 18F-TFB. Activity was determined in whole blood, plasma, and urine. Mean organ-absorbed doses and effective doses were calculated via quantitative image analysis and using OLINDA/EXM software. Results: Images showed a high uptake of 18F-TFB in known areas of high hNIS expression (thyroid, salivary glands, and stomach). Excretion was predominantly renal. No adverse effects in relation to safety of the radiopharmaceutical were observed. The effective dose was 0.0326 ± 0.0018 mSv/MBq. The critical tissues/organs receiving the highest mean sex-averaged absorbed doses were the thyroid (0.135 ± 0.079 mSv/MBq), stomach (0.069 ± 0.022 mSv/MBq), and salivary glands (parotids, 0.031 ± 0.011 mSv/MBq; submandibular, 0.061 ± 0.031 mSv/MBq). Other organs of interest were the bladder (0.102 ± 0.046 mSv/MBq) and kidneys (0.029 ± 0.009 mSv/MBq). Conclusion: Imaging using 18F-TFB imparts a radiation exposure similar in magnitude to many other 18F-labeled radiotracers. 18F-TFB shows a biodistribution similar to 99mTc-pertechnetate, a known nonorganified hNIS tracer, and is pharmacologically and radiobiologically safe in humans. Phase 2 trials for 18F-TFB as an hNIS imaging agent are warranted.
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Affiliation(s)
- Jim O'Doherty
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London, United Kingdom; and
| | - Maite Jauregui-Osoro
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London, United Kingdom; and
| | - Teresa Brothwood
- Department of Nuclear Medicine, Guy's & St. Thomas' Hospital NHS Foundation Trust, Great Maze Pond, London, United Kingdom
| | - Teresa Szyszko
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London, United Kingdom; and
| | - Paul K Marsden
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London, United Kingdom; and
| | - Michael J O'Doherty
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London, United Kingdom; and
| | - Gary J R Cook
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London, United Kingdom; and
| | - Philip J Blower
- PET Imaging Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, St. Thomas' Hospital, London, United Kingdom; and
| | - Val Lewington
- Department of Nuclear Medicine, Guy's & St. Thomas' Hospital NHS Foundation Trust, Great Maze Pond, London, United Kingdom
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11
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Beddowes E, Spicer J, Chan PY, Khadeir R, Corbacho JG, Repana D, Steele JP, Schmid P, Szyszko T, Cook G, Diaz M, Feng X, Johnston A, Thomson J, Sheaff M, Wu BW, Bomalaski J, Pacey S, Szlosarek PW. Phase 1 Dose-Escalation Study of Pegylated Arginine Deiminase, Cisplatin, and Pemetrexed in Patients With Argininosuccinate Synthetase 1-Deficient Thoracic Cancers. J Clin Oncol 2017; 35:1778-1785. [PMID: 28388291 PMCID: PMC6141244 DOI: 10.1200/jco.2016.71.3230] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [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] [Indexed: 12/29/2022] Open
Abstract
Purpose Pegylated arginine deiminase (ADI-PEG 20) depletes essential amino acid levels in argininosuccinate synthetase 1 (ASS1) -negative tumors by converting arginine to citrulline and ammonia. The main aim of this study was to determine the recommended dose, safety, and tolerability of ADI-PEG 20, cisplatin, and pemetrexed in patients with ASS1-deficient malignant pleural mesothelioma (MPM) or non-small-cell lung cancer (NSCLC). Patients and Methods Using a 3 + 3 + 3 dose-escalation study, nine chemotherapy-naïve patients (five MPM, four NSCLC) received weekly ADI-PEG 20 doses of 18 mg/m2, 27 mg/m2, or 36 mg/m2, together with pemetrexed 500 mg/m2 and cisplatin 75 mg/m2 which were given every three weeks (maximum of six cycles). Patients achieving stable disease or better could continue ADI-PEG 20 monotherapy until disease progression or withdrawal. Adverse events were assessed by Common Terminology Criteria for Adverse Events version 4.03, and pharmacodynamics and immunogenicity were also evaluated. Tumor response was assessed by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 for NSCLC and by modified RECIST criteria for MPM. Results No dose-limiting toxicities were reported; nine of 38 reported adverse events (all grade 1 or 2) were related to ADI-PEG 20. Circulating arginine concentrations declined rapidly, and citrulline levels increased; both changes persisted at 18 weeks. Partial responses were observed in seven of nine patients (78%), including three with either sarcomatoid or biphasic MPM. Conclusion Target engagement with depletion of arginine was maintained throughout treatment with no dose-limiting toxicities. In this biomarker-selected group of patients with ASS1-deficient cancers, clinical activity was observed in patients with poor-prognosis tumors. Therefore, we recommend a dose for future studies of weekly ADI-PEG 20 36 mg/m2 plus three-weekly cisplatin 75 mg/m2 and pemetrexed 500 mg/m2.
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Affiliation(s)
- Emma Beddowes
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - James Spicer
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Pui Ying Chan
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Ramsay Khadeir
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Javier Garcia Corbacho
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Dimitra Repana
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Jeremy P. Steele
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Peter Schmid
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Teresa Szyszko
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Gary Cook
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Monica Diaz
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Xiaoxing Feng
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Amanda Johnston
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Jim Thomson
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Michael Sheaff
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Bor-Wen Wu
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - John Bomalaski
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Simon Pacey
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
| | - Peter W. Szlosarek
- Emma Beddowes, Javier Garcia Corbacho, and Simon Pacey, University of Cambridge, Cambridge; James Spicer, Dimitra Repana, Teresa Szyszko, and Gary Cook, King's College London; Pui Ying Chan, Jeremy P. Steele, Peter Schmid, Michael Sheaff, and Peter W. Szlosarek, St Bartholomew’s Hospital; Ramsay Khadeir, Peter Schmid, and Peter W. Szlosarek, Queen Mary University of London, London, United Kindgom; and Monica Diaz, Xiaoxing Feng, Amanda Johnston, Jim Thomson, Bor-Wen Wu, and John Bomalaski, Polaris Pharmaceuticals, San Diego, CA
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Phillips M, Szyszko T, Hall P, Cook GJR, Khadeir R, Steele JPC, Spicer JF, Feng X, Hategan M, Rashid S, Johnston A, Bomalaski JS, Shamash J, Pacey S, Sheaff M, Szlosarek PW. Expansion study of ADI-PEG 20, pemetrexed and cisplatin in patients with ASS1-deficient malignant pleural mesothelioma (TRAP). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.8553] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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
8553 Background: Argininosuccinate synthetase 1 (ASS1)-deficient malignant pleural mesothelioma (MPM) cells are sensitive to arginine deprivation with pegylated arginine deiminase (ADI-PEG20), which also potentiates the cytotoxic effect of pemetrexed (PEM). In the phase I dose-escalation TRAP study (NCT02029690) we showed that ADI-PEG20 with first-line PEM and cisplatin (CIS) chemotherapy (ADIPEMCIS) produced a 100% disease control rate (DCR) in patients (pts; n = 9) with ASS1-deficient thoracic cancers, with no additional toxicity (Beddowes et al 2017). Here, we present the TRAP expansion cohort experience in MPM. Methods: Good performance (ECOG 0-1) MPM pts with non-resectable disease and measurable by modified RECIST, were enrolled in a phase I TRAP expansion cohort at the maximum tolerated dose (MTD) of ADIPEMCIS, using tumoral ASS1 loss as a selection biomarker. PEM (500mg/m2) and CIS (75mg/m2) were given every 3 weeks with weekly IM ADI-PEG20 (36mg/m2) for a maximum of 6 cycles with maintenance ADI-PEG20 in responding pts. Primary endpoint was tumor response rate (modified RECIST), with secondary endpoints including progression-free survival (PFS), overall survival (OS), and toxicity. We measured plasma arginine and citrulline concentrations, ADI-PEG20 antibodies, and biopsied patients on progression to explore resistance mechanisms. Results: 31 ASS1-deficient MPM pts (median age 67) were enrolled (11 epithelioid, 10 biphasic and 10 sarcomatoid) out of 92 screened pts. Plasma arginine decreased with a reciprocal increase in plasma citrulline. The partial response rate was 35.5% (95% CI 19.2%-54.6%) with a DCR of 93.5% (95% CI 78.6%-99.2%). Median PFS was 5.6 months (95% CI 4-6) and median OS was 10.1 months (95% CI 6.7-17.7). 10/31 pts (32.3%) experienced grade 3/4 treatment-related toxicities, the most common being neutropenia (16.1%). Upregulation of ASS1 expression was observed in 2/3 biopsies on progression. Conclusions: The ADIPEMCIS regimen is active in ASS1-deficient MPM pts, including non-epithelioid disease. Based on these data the ATOMIC-meso phase 2/3 trial has opened comparing ADIPEMCIS versus PEMCISPlacebo, focusing on pts with non-epithelioid MPM. Clinical trial information: NCT02029690.
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Affiliation(s)
| | | | - Peter Hall
- St Bartholomew's Hospital, London, United Kingdom
| | - Gary J. R. Cook
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Ramsay Khadeir
- Queen Mary, University of London, London, United Kingdom
| | | | | | | | - Mirela Hategan
- Early Phase Clinical Trials Team, Cambridge Cancer Centre, Cambridge, United Kingdom
| | | | | | | | | | - Simon Pacey
- St Bartholomew's Hospital, London, United Kingdom
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Szlosarek PW, Steele JP, Nolan L, Gilligan D, Taylor P, Spicer J, Lind M, Mitra S, Shamash J, Phillips MM, Luong P, Payne S, Hillman P, Ellis S, Szyszko T, Dancey G, Butcher L, Beck S, Avril NE, Thomson J, Johnston A, Tomsa M, Lawrence C, Schmid P, Crook T, Wu BW, Bomalaski JS, Lemoine N, Sheaff MT, Rudd RM, Fennell D, Hackshaw A. Arginine Deprivation With Pegylated Arginine Deiminase in Patients With Argininosuccinate Synthetase 1-Deficient Malignant Pleural Mesothelioma: A Randomized Clinical Trial. JAMA Oncol 2017; 3:58-66. [PMID: 27584578 DOI: 10.1001/jamaoncol.2016.3049] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024]
Abstract
IMPORTANCE Preclinical studies show that arginine deprivation is synthetically lethal in argininosuccinate synthetase 1 (ASS1)-negative cancers, including mesothelioma. The role of the arginine-lowering agent pegylated arginine deiminase (ADI-PEG20) has not been evaluated in a randomized and biomarker-driven study among patients with cancer. OBJECTIVE To assess the clinical impact of arginine depletion in patients with ASS1-deficient malignant pleural mesothelioma. DESIGN, SETTING, AND PARTICIPANTS A multicenter phase 2 randomized clinical trial, the Arginine Deiminase and Mesothelioma (ADAM) study, was conducted between March 2, 2011, and May 21, 2013, at 8 academic cancer centers. Immunohistochemical screening of 201 patients (2011-2013) identified 68 with advanced ASS1-deficient malignant pleural mesothelioma. INTERVENTIONS Randomization 2:1 to arginine deprivation (ADI-PEG20, 36.8 mg/m2, weekly intramuscular) plus best supportive care (BSC) or BSC alone. MAIN OUTCOMES AND MEASURES The primary end point was progression-free survival (PFS) assessed by modified Response Evaluation Criteria in Solid Tumors (RECIST) (target hazard ratio, 0.60). Secondary end points were overall survival (OS), tumor response rate, safety, and quality of life, analyzed by intention to treat. We measured plasma arginine and citrulline levels, anti-ADI-PEG20 antibody titer, ASS1 methylation status, and metabolic response by 18F-fluorodeoxyglucose positron-emission tomography. RESULTS Median (range) follow-up in 68 adults (median [range] age, 66 [48-83] years; 19% female) was 38 (2.5-39) months. The PFS hazard ratio was 0.56 (95% CI, 0.33-0.96), with a median of 3.2 months in the ADI-PEG20 group vs 2.0 months in the BSC group (P = .03) (absolute risk, 18% vs 0% at 6 months). Best response at 4 months (modified RECIST) was stable disease: 12 of 23 (52%) in the ADI-PEG20 group vs 2 of 9 (22%) in the BSC group (P = .23). The OS curves crossed, so life expectancy was used: 15.7 months in the ADI-PEG20 group vs 12.1 months in the BSC group (difference of 3.6 [95% CI, -1.0 to 8.1] months; P = .13). The incidence of symptomatic adverse events of grade at least 3 was 11 of 44 (25%) in the ADI-PEG20 group vs 4 of 24 (17%) in the BSC group (P = .43), the most common being immune related, nonfebrile neutropenia, gastrointestinal events, and fatigue. Differential ASS1 gene-body methylation correlated with ASS1 immunohistochemistry, and longer arginine deprivation correlated with improved PFS. CONCLUSIONS AND RELEVANCE In this trial, arginine deprivation with ADI-PEG20 improved PFS in patients with ASS1-deficient mesothelioma. Targeting arginine is safe and warrants further clinical investigation in arginine-dependent cancers. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01279967.
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Affiliation(s)
- Peter W Szlosarek
- Center for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, John Vane Science Center, London, England2Barts Health NHS Trust, St Bartholomew's Hospital, London, England
| | - Jeremy P Steele
- Barts Health NHS Trust, St Bartholomew's Hospital, London, England
| | - Luke Nolan
- Southampton University Hospital NHS Foundation Trust, Southampton, England
| | - David Gilligan
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, England
| | - Paul Taylor
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, England
| | - James Spicer
- Division of Cancer Studies, King's College London, Guy's Hospital, London, England
| | - Michael Lind
- University of Hull, Castle Hill Hospital, Cottingham, England
| | | | - Jonathan Shamash
- Barts Health NHS Trust, St Bartholomew's Hospital, London, England
| | - Melissa M Phillips
- Center for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, John Vane Science Center, London, England2Barts Health NHS Trust, St Bartholomew's Hospital, London, England
| | - Phuong Luong
- Center for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, John Vane Science Center, London, England
| | - Sarah Payne
- Barts Health NHS Trust, St Bartholomew's Hospital, London, England
| | - Paul Hillman
- Barts Health NHS Trust, St Bartholomew's Hospital, London, England
| | - Stephen Ellis
- Barts Health NHS Trust, St Bartholomew's Hospital, London, England
| | - Teresa Szyszko
- King's College London, St Thomas' Hospital, London, England
| | - Gairin Dancey
- Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, England
| | - Lee Butcher
- University College London Cancer Institute, University College London, London, England
| | - Stephan Beck
- University College London Cancer Institute, University College London, London, England
| | | | - Jim Thomson
- Polaris Pharmaceuticals Inc, San Diego, California
| | | | - Marianne Tomsa
- Center for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, John Vane Science Center, London, England
| | - Cheryl Lawrence
- Center for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, John Vane Science Center, London, England
| | - Peter Schmid
- Barts Health NHS Trust, St Bartholomew's Hospital, London, England14Center for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, John Vane Science Center, London, England
| | - Timothy Crook
- Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, England
| | - Bor-Wen Wu
- Polaris Pharmaceuticals Inc, San Diego, California
| | | | - Nicholas Lemoine
- Center for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, John Vane Science Center, London, England
| | - Michael T Sheaff
- Barts Health NHS Trust, St Bartholomew's Hospital, London, England
| | - Robin M Rudd
- Barts Health NHS Trust, St Bartholomew's Hospital, London, England
| | - Dean Fennell
- University of Leicester, Leicester Royal Infirmary, Leicester, England
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Center, University College London, London, England
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Szlosarek PW, Szyszko T, Pacey S, Spicer JF, Phillips M, Steele JPC, Barba A, Diaz M, Johnston A, Wu BW, Bomalaski JS, Cook GJR. 18-FLT-PET/CT as an imaging biomarker in patients with ASS1-deficient thoracic cancers treated with ADI-PEG20, pemetrexed and cisplatin. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.11567] [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: 11/20/2022] Open
Affiliation(s)
| | | | - Simon Pacey
- St Bartholomew's Hospital, London, United Kingdom
| | - James F. Spicer
- King's College London at Guy's Hospital, London, United Kingdom
| | | | | | | | | | | | - Bor-Wen Wu
- Polaris Pharmaceuticals Inc, San Diego, CA
| | | | - Gary J. R. Cook
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
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Pacey S, Spicer JF, Chan PY, Hategan M, Repana D, Steele JP, Schmid P, Cook GJR, Diaz M, Johnston A, Baird R, Barba A, Khadeir R, Sheaff M, Roca J, Szyszko T, Bomalaski J, Szlosarek PW. Abstract B23: A phase 1 study in patients with mesothelioma or non small cell lung tumours requiring arginine to assess ADI-PEG 20 with pemetrexed and cisplatin (TRAP study). Clin Trials 2016. [DOI: 10.1158/1535-7163.targ-15-b23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Szlosarek PW, Spicer JF, Szyszko T, Cook GJR, Chan PY, Hategan M, Repana D, Steele JP, Schmid P, Diaz M, Johnston A, Sheaff M, Khadeir R, Bomalaski JS, Pacey S. Phase I study of ADI-PEG 20 in combination with pemetrexed and cisplatin (TRAP) in patients with ASS1-deficient mesothelioma and non-squamous lung cancer. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.tps2612] [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: 11/20/2022] Open
Affiliation(s)
| | | | | | - Gary J. R. Cook
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | | | | | - Dimitra Repana
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Peter Schmid
- Queen Mary, University of London, London, United Kingdom
| | | | | | | | - Ramsay Khadeir
- Queen Mary, University of London, London, United Kingdom
| | | | - Simon Pacey
- The University of Cambridge, Addenbrookes Hospital, Cambridge, United Kingdom
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Papastefanou VP, Islam S, Szyszko T, Grantham M, Sagoo MS, Cohen VML. Metabolic activity of primary uveal melanoma on PET/CT scan and its relationship with monosomy 3 and other prognostic factors. Br J Ophthalmol 2014; 98:1659-65. [PMID: 25084771 PMCID: PMC4251304 DOI: 10.1136/bjophthalmol-2014-305304] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose To correlate the metabolic activity of primary uveal melanoma on positron emission tomography (PET)/CT scan with known clinical and pathological prognostic factors. Methods A retrospective cohort analysis of eyes enucleated for uveal melanoma that underwent preoperative imaging with a PET/CT scan was performed. Tumour dimensions were recorded and classified using Collaborative Ocular Melanoma Study (COMS) and American Joint Committee on Cancer (AJCC) Tumour - Nodes - Metastases (TNM) criteria. Metabolic activity was determined by measurement of the maximal standardised uptake value (SUVmax) on PET/CT scans. SUVmax of >2.5 and >4 was also used as cut-off value for metabolic positivity. Chromosome 3 and 8 status was determined using fluorescence in situ hybridisation analysis. Pearson correlation, χ2 test and non-parametric tests were used. p<0.05 was considered statistically significant. Results Seventy-six uveal melanomas were imaged preoperatively with a PET/CT scan. Overall 92% of tumours had a SUVmax >2.5 and 67% had a SUVmax >4. Monosomy 3 was found in 35 melanomas, of which 94% had an SUVmax >2.5 and 80% had an SUVmax >4. Only 57% of disomy 3 melanomas had an SUVmax >4. SUVmax was significantly increased in tumours with monosomy 3 (p=0.043) but not in tumours with chromosome 8 gain (p=0.49). SUVmax and increasing tumour size were positively correlated (p<0.05). Using the AJCC criteria, there was a significant difference in SUVmax among prognostic groups (p=0.024). There was no correlation with histopathological cell type (p=0.923). Conclusions Metabolic activity of uveal melanoma on PET/CT scan is positively correlated with monosomy 3, increasing tumour size and TNM prognostic groups. No association with chromosome 8 gain or histopathology cell type was noted. SUVmax >4 is a relative but not an absolute indicator of monosomy 3 status.
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Affiliation(s)
| | - Shahriar Islam
- Department of Nuclear Medicine, St Bartholomew`s Hospital, London, UK
| | - Teresa Szyszko
- Department of Nuclear Medicine, St Bartholomew`s Hospital, London, UK
| | | | - Mandeep S Sagoo
- Ocular Oncology Service, St Bartholomew's and Moorfields Eye Hospital, London, UK UCL Institute of Ophthalmology, London, UK
| | - Victoria M L Cohen
- Ocular Oncology Service, St Bartholomew's and Moorfields Eye Hospital, London, UK
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Szlosarek PW, Luong P, Phillips MM, Baccarini M, Stephen E, Szyszko T, Sheaff MT, Avril N. Metabolic response to pegylated arginine deiminase in mesothelioma with promoter methylation of argininosuccinate synthetase. J Clin Oncol 2013; 31:e111-3. [PMID: 23319692 DOI: 10.1200/jco.2012.42.1784] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Peter W Szlosarek
- Barts Cancer Institute, Barts and The London School of Medicine, Queen Mary University of London, Charterhouse Square, London EC1M6BQ, England, UK.
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Abstract
In the clinical setting the vast majority of positron emission tomography (PET) procedures use the glucose analogue F-18 fluorodeoxyglucose (FDG) to visualize the increased glucose consumption of malignant lesions. Co-registered PET/CT has improved the diagnostic accuracy compared to either imaging procedure alone, particularly in ovarian cancer. FDG-PET/CT demonstrates primary malignant ovarian tumors; however, it is often unable to accurately differentiate between benign and malignant pelvic masses and to visualize borderline ovarian tumors. FDG-PET/CT has a suggested role for staging, by improving treatment planning in individual cases, but it is particularly helpful in the setting of disease recurrence when CA125 tumor marker levels are rising and conventional imaging (CT or MR) is inconclusive or negative. The aim of this review is to demonstrate the value of FDG-PET-CT in diagnosis and management of patients with ovarian malignancies, outlining its advantages and limitations.
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Affiliation(s)
- Ewa Nowosinska
- Department of Nuclear Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK
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20
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Navalkissoor S, Szyszko T, Rankin S, Gnanasegaran G. Differential uptake of 18F-FDG in patients with synchronous lung cancers. Ann Nucl Med 2011; 25:299-302. [PMID: 21234727 DOI: 10.1007/s12149-010-0457-8] [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] [Received: 10/20/2010] [Accepted: 11/21/2010] [Indexed: 10/18/2022]
Abstract
(18)F-fluoro-2-deoxy-D: -glucose positron emission tomography ((18)F-FDG PET/CT) has developed into the standard of care for investigating patients with non-small cell lung cancer (NSCLC) to determine the optimal treatment. However, although the majority of patients with NSCLC do have intense uptake of tracer, false negatives do occur and should be considered. We report cases of patients that have synchronous NSCLCs. In both cases, there was intense uptake of FDG in one tumour type, with very low grade uptake in the separate tumour. Histology confirmed separate lung malignancies, demonstrating that differential FDG uptake may not always be inflammatory and should be considered to have a separate malignant aetiology.
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21
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Perez A, Turajlic S, Szyszko T, O'Doherty M, Calonje E, Harries M, Acland K. Generalized melanosis and melanuria in a patient with metastatic melanoma. Clin Exp Dermatol 2010; 35:e37-9. [PMID: 20500171 DOI: 10.1111/j.1365-2230.2009.03545.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A Perez
- Skin Tumour Unit, St John's Institute of Dermatology, Guys and St Thomas NHS Trust, London, UK
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22
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Abstract
Pheochromocytomas are tumors derived from chromaffin cells of the adrenal medulla that synthesize, store, metabolize, and usually, but not always, secrete catecholamines. Although pheochromocytomas are the cause of hypertension in only a small number of patients, they can precipitate life-threatening hypertension or cardiac arrhythmias caused by excessive and episodic catecholamine secretion. This article reviews the genetics, clinical presentation, and imaging of pheochromocytoma, with special emphasis on new positron emission tomographic radiopharmaceutical agents.
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Affiliation(s)
- Sameer Khan
- Departments of Nuclear Medicine and Imaging, Imperial College Healthcare Trust, Du Cane Road, London W12 0HS, United Kingdom
| | - Zarni Win
- Departments of Nuclear Medicine and Imaging, Imperial College Healthcare Trust, Du Cane Road, London W12 0HS, United Kingdom
| | - Teresa Szyszko
- Departments of Nuclear Medicine and Imaging, Imperial College Healthcare Trust, Du Cane Road, London W12 0HS, United Kingdom
| | - Claire Lloyd
- Departments of Nuclear Medicine and Imaging, Imperial College Healthcare Trust, Du Cane Road, London W12 0HS, United Kingdom
| | - Joel Dunn
- Departments of Nuclear Medicine and Imaging, Imperial College Healthcare Trust, Du Cane Road, London W12 0HS, United Kingdom
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Adil Al-Nahhas
- Departments of Nuclear Medicine and Imaging, Imperial College Healthcare Trust, Du Cane Road, London W12 0HS, United Kingdom.
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24
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Al-Nahhas A, Win Z, Szyszko T, Singh A, Khan S, Rubello D. What can gallium-68 PET add to receptor and molecular imaging? Eur J Nucl Med Mol Imaging 2008; 34:1897-901. [PMID: 17713764 DOI: 10.1007/s00259-007-0568-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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25
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Khan S, Lloyd C, Szyszko T, Win Z, Rubello D, Al-Nahhas A. PET imaging in endocrine tumours. MINERVA ENDOCRINOL 2008; 33:41-52. [PMID: 18414356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The role of PET in the assessment of endocrine tumours has been, until recently, restricted to the use of (18)F-fluoro-deoxy-D-glucose ((18)F-FDG). Being a marker of metabolically active lesions that show high grading and low differentiation, FDG is not ideal for this purpose since the majority of endocrine tumours are slow growing and highly differentiated. It is however useful when dedifferentiation takes place and provides excellent prognostic information. A number of hormone precursors and amino acids are labelled with (11)C and used successfully in the management of parathyroid, adrenal and pituitary tumours. However, the short half-life of (11)C radiopharmaceuticals restricts their use to centres with access to an on-site cyclotron, while the high cost of production may limit their use to research purposes. A promising new positron-emission tomography (PET) tracer is Gallium-68 obtained by elution from a long shelf-life generator that makes it economic and cyclotron-independent. Its short half-life and flexible labelling ability to a wide range of peptides and antibodies makes it ideal for PET imaging. In addition to imaging GEP-NETs and phaeochromocytoma, it has the potential to be used in a wider range of endocrine tumours.
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Affiliation(s)
- S Khan
- Department of Nuclear Medicine, Hammersmith Hospital and Imperial College, London, UK
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26
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Sebastian AJ, Szyszko T, Al-Nahhas A, Nijran K, Tait NP. Evaluation of Hepatic Angiography Procedures and Bremsstrahlung Imaging in Selective Internal Radiation Therapy: A Two-Year Single-Center Experience. Cardiovasc Intervent Radiol 2008; 31:643-9. [DOI: 10.1007/s00270-008-9298-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Revised: 12/10/2007] [Accepted: 12/13/2007] [Indexed: 10/22/2022]
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Khodjibekova M, Szyszko T, Singh A, Tait P, Rubello D, Al-Nahhas A. Treatment of primary and secondary liver tumours with selective internal radiation therapy. J Exp Clin Cancer Res 2007; 26:561-570. [PMID: 18365553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
When HCC is diagnosed at an early stage or liver is affected by a solitary metastasis they can be curable by surgical resection, but this may not be feasible when an extensive tumoural involvement is present. In these cases, possible non-surgical therapies include systemic chemotherapy, chemical ablation (ethanol or acetic acid), radiofrequency ablation, microwave ablation, cryotherapy and transarterial chemoembolisation. All the above mentioned treatments have advantages and disadvantages. In the present paper we reported our experience with selective internal radiation therapy (SIRT) of non-operable HCC and metastatic liver using 99Yttrium (99Y) radioactive microspheres, and our data are compared and discussed with those reported in the literature. A MEDLINE-based review of the literature has been made in the period between 1990 and April 2007. Detailed information on patients selection criteria, SIRT procedure, dose calculation, safety and adverse reactions, follow-up schedule, and clinical efficacy are provided. On the basis of our data, in agreement with those of the literature, SIRT has added another effective method for treatment of primary and secondary liver tumours, being successful in a large number of patients in different experiences. Moreover, SIRT is well tolerated and has minimal adverse effects. Despite being regarded as non-curative, it has been associated with improved survival, reduction in tumour marker, and regression in the number and size of lesions. Follow-up with imaging is essential to assess the response to therapy, and in this respect FDG PET has been shown to be more sensitive than CT, particularly in the early stages.
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Affiliation(s)
- M Khodjibekova
- Department of Nuclear Medicine, Hammersmith Hospital, London, United Kingdom
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28
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Al-Nahhas A, Win Z, Szyszko T, Singh A, Nanni C, Fanti S, Rubello D. Gallium-68 PET: a new frontier in receptor cancer imaging. Anticancer Res 2007; 27:4087-4094. [PMID: 18225576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Neuroendocrine tumours (NET) are rare tumours that occur most commonly in the GI tract. Various labelled somatostatin analogues are used to image NET expressing somatostatin receptors (SSTR). In traditional nuclear medicine, most peptides used in imaging NET have been labelled with indium-111, the commonest being indium-111-octreotide (111In-octreotide). Unfortunately, the unfavourable physical qualities of In-111 make it unsuitable for detecting small tumour deposits. The recent introduction of gallium-68-1,4, 7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetic acid (gallium-68-DOTA) compounds for positron emission tomography (PET) imaging has significantly improved the quality of imaging NET through improved resolution of PET and higher affinity of the new generation of peptides to SSTR. In the present paper, we discuss the clinical and research applications of PET radio-tracers for evaluating NET, in particular gallium-68-DOTA compounds. The recent introduction of PET imaging with gallium-68 has major bearings in current and future clinical practice. Its labelling with DOTA compounds has cleared the way for somatostatin receptor imaging with a viable PET agent, with all its inherent imaging advantages compared to single photon imaging. The pre-clinical and clinical applications of this technique has been successful in a variety of tumours, particularly NET and its labelling with other ligands and molecules will improve the management of other tumours and the assessment of infection.
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Affiliation(s)
- A Al-Nahhas
- Department of Nuclear Medicine, Hammersmith Hospital, London, UK
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Khodjibekova M, Szyszko T, Khan S, Nijran K, Tait P, Al-Nahhas A. Selective internal radiation therapy with Yttrium-90 for unresectable liver tumours. Rev Recent Clin Trials 2007; 2:212-216. [PMID: 18474007 DOI: 10.2174/157488707781662742] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Primary and secondary liver tumours are common malignancies that are being treated more aggressively nowadays than decades ago. Surgery is the most effective method of treatment but is only suitable for a minority of patients with well-defined and easily accessible tumours. Surgical resection is contraindicated in patients with massive involvement of the liver or in cases where the disease involves the confluence of vessels at the porta hepatis. These patients may benefit from a variety of ablative and embolic therapies including selective internal radiation therapy (SIRT) with Yttrium-90 microspheres. SIRT has been introduced in the 1980's but the technology has been refined and made more available only recently. The microspheres are injected directly into the hepatic arteries, through a trans-femoral angiographic approach, and are delivered selectively to tumours due to their preferential blood supply by hepatic arteries. SIRT can therefore target small volumes disease with a higher dose of radiation compared with external-beam radiation and is associated the relatively low toxicity and a good response irrespective of tumor origin. Assessment of response to therapy is best performed with metabolic imaging using (18)F-FDG PET scanning. Although it is not considered as a cure, it has been shown to improve quality of life and prolong survival, with the main cause of death being extra-hepatic spread. The technical and clinical demands of patient selection, treatment planning, administration, and clinical follow-up require an interdisciplinary team willing to work cooperatively to achieve the best result for the patient.
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Affiliation(s)
- Malika Khodjibekova
- Department of Nuclear Medicine, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
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30
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Jiao LR, Szyszko T, Al-Nahhas A, Tait P, Canelo R, Stamp G, Wasan H, Lowdell C, Philips R, Thillainayagam A, Bansi D, Rubello D, Limongelli P, Woo K, Habib NA. Clinical and imaging experience with yttrium-90 microspheres in the management of unresectable liver tumours. Eur J Surg Oncol 2007; 33:597-602. [PMID: 17433608 DOI: 10.1016/j.ejso.2007.02.021] [Citation(s) in RCA: 34] [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: 12/20/2006] [Accepted: 02/12/2007] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Selective internal radiation therapy (SIRT) is emerging as a new therapeutic modality in recent years for management of non-resectable hepatic malignancies. Our experience in clinical application of this treatment is reported here. MATERIAL AND METHODS From June 2004, patients whose liver tumours were no longer amenable for any conventional treatment with either chemotherapy or surgery were considered for yttrium-90 microspheres treatment after discussion at our multidisciplinary meeting. A pre-treatment planning was carried out with visceral angiography and technetium-99m macroaggregated albumin (MAA) for assessment of both tumour volume and extrahepatic shunting in addition to a baseline PET and CT scans, respectively. Two weeks later, a second visceral angiogram was performed to deliver the calculated dosage of microspheres into the arterial system supplying the tumour. Patients were then followed up with tumour markers, repeat PET and CT scans of abdomen at 6 weeks and 3 monthly thereafter. RESULT Twenty-one patients (F=11, M=10; age range 40-75 years, mean=58 years) received yttrium-90 microspheres consisting of liver metastases from colorectal primary (n=10) and non-colorectal primaries (n=8), and primary liver tumours (n=3). One patient received 2 treatments. The mean administered activity of microspheres delivered was 1.9 GBq (range 1.2-2.5 GBq). Injection of microspheres had no immediate effect on either clinical haematology or liver function tests. At follow-up, 86% of patients showed decreased activity on PET scan at 6 weeks (p=0.01). The mean pre-treatment SUV was 12.2+/-3.7 and the mean post-treatment SUV was 9.3+/-3.7, indicating a significant improvement measured with PET activity. Only 13% showed a reduction in the size of tumour on CT scan. For patients with colorectal liver metastases, there was no significant reduction in CEA level (127+/-115 vs 75+/-72 micro/l, p=0.39). Complications were seen in 4 patients (19%) including radiation hepatitis (n=2), cholecystitis (n=1) and duodenal ulceration (n=1). All resolved without surgical intervention. Seven patients died at follow-up from progressive extrahepatic disease (33%). CONCLUSION SIRT should be considered for patients with advanced liver cancer. It has a significant effect on liver disease in the absence of extrahepatic disease. PET imaging has an integral role in the assessment of patients treated with yttrium-90 SIR-Spheres.
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Affiliation(s)
- L R Jiao
- Department of HPB Surgery, Hammersmith Hospital and Imperial College School of Medicine, London, United Kingdom
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Szyszko T, Al-Nahhas A, Tait P, Rubello D, Canelo R, Habib N, Jiao L, Wasan H, Bansi D, Thillainayagam A, Nijran K, Stamp G, O'Rourke E. Management and prevention of adverse effects related to treatment of liver tumours with 90Y microspheres. Nucl Med Commun 2007; 28:21-4. [PMID: 17159545 DOI: 10.1097/mnm.0b013e3280121a8f] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIM Selective internal radiation therapy with 90Y microspheres (SIR spheres) is increasingly used in the treatment of extensive liver tumours. Careful selection and preparation of patients are necessary to avoid possible adverse effects. We aimed to evaluate the incidence and severity of adverse effects resulting from the administration of SIR spheres during therapy. MATERIALS AND METHODS Between June 2004 and August 2006, 21 patients (11 women and 10 men; age range 40-75 years; mean, 58 years) with a wide range of extensive liver tumours were treated with SIR spheres. The mean administered dose was 1.87 GBq (range 1.2-2.5 GBq). During the follow-up period of 26 months, all adverse effects were monitored and classified according to the National Cancer Institute criteria. RESULTS Four patients had adverse effects: one case of cholecystitis followed by fibrosis and portal hypertension, one case of peptic ulceration and two cases of radiation hepatitis. All cases responded to appropriate therapy. CONCLUSION Proper selection of patients and accurate interpretation of pre-treatment investigations are vital for minimizing adverse effects following therapy with SIR spheres. In our experience, all adverse effects were moderate with no life-threatening consequences.
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Affiliation(s)
- Teresa Szyszko
- Department of Nuclear Medicine, S. Maria della Misericordia Hospital, Rovigo, Italy
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Szyszko T, Al-Nahhas A, Canelo R, Habib N, Jiao L, Wasan H, Pagou M, Tait P. Assessment of response to treatment of unresectable liver tumours with 90Y microspheres: value of FDG PET versus computed tomography. Nucl Med Commun 2007; 28:15-20. [PMID: 17159544 DOI: 10.1097/mnm.0b013e328011453b] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Selective internal radiation therapy (SIRT) with SIR spheres (90Y microspheres) is a treatment option for liver tumours in patients in whom other therapies are inappropriate or have failed. This study aims to assess the value of FDG PET in assessing the response to SIRT as compared to computed tomography (CT). MATERIAL AND METHODS Twenty-one patients (11 F, 10 M; age range 40-75 years, mean, 58 years) received SIR spheres at the Hammersmith Hospital. One patient received two treatments. Most patients had colorectal metastases (n=10), while the others (n=11) had liver metastasis from different primaries. The mean administered dose was 1.9 GBq (range, 1.2-2.5 GBq). Follow-up was done with FDG PET and CT at 6 weeks, and 6-monthly thereafter. Pre-therapy and post-therapy CT and PET scans were assessed visually (RECIST criteria for CT) and semi-quantitative for PET using the standardized uptake value (SUV). RESULT Eighty-six percent of patients showed decreased PET activity at 6 weeks while only 13% showed a partial response in the size of tumour on CT scan. The mean pre-treatment SUV was 12.2+/-3.7 and the mean post-treatment SUV was 9.3+/-3.7 (P=0.01). CT imaging showed progressive disease in 27% patients and stable liver disease in 60% patients. Based on FDG PET results one patient had surgery for down-staged tumour. CONCLUSION FDG PET imaging is more sensitive than CT in the assessment of early response to SIR spheres, allowing clinicians to proceed with further therapeutic options.
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Affiliation(s)
- Teresa Szyszko
- Department of Nuclear Medicine, Hammersmith Hospital, Du Cane Road, London, UK
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Schmitt JO, Edgar LJ, Liu L, Nagarajan R, Szyszko T, Podsiadlo S, Wojciech G. Close‐spaced crystal growth and characterization of BP crystals. ACTA ACUST UNITED AC 2005. [DOI: 10.1002/pssc.200460624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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)
- J. O. Schmitt
- Department of Chemical Engineering, Kansas State University, Manhattan, Kansas 66506, USA
- Faculty of Chemistry, Warsaw University of Technology, Noakowskiego 3, 00 – 664 Warszawa, Poland
| | - L J.H. Edgar
- Department of Chemical Engineering, Kansas State University, Manhattan, Kansas 66506, USA
| | - L. Liu
- Department of Chemical Engineering, Kansas State University, Manhattan, Kansas 66506, USA
| | - R. Nagarajan
- Department of Chemical Engineering, Kansas State University, Manhattan, Kansas 66506, USA
| | - T. Szyszko
- Faculty of Chemistry, Warsaw University of Technology, Noakowskiego 3, 00 – 664 Warszawa, Poland
| | - S. Podsiadlo
- Faculty of Chemistry, Warsaw University of Technology, Noakowskiego 3, 00 – 664 Warszawa, Poland
| | - G. Wojciech
- Institute of Physics, Warsaw University of Technology, Koszykowa 75, 00 – 662 Warszawa, Poland
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