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Jain Y, Agrawal A, Joshi A, Menon S, Prakash G, Murthy V, Purandare N, Shah S, Puranik A, Choudhury S, Shukla V, Dev I, Prabhash K, Noronha V, Rangarajan V. Can 18 F FDG PET/CT metabolic parameters be used to noninvasively differentiate between different histopathological subtypes and Fuhrman grades of renal cell cancer? Nucl Med Commun 2024; 45:601-611. [PMID: 38686492 DOI: 10.1097/mnm.0000000000001844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
AIM To evaluate relationship between metabolic PET metabolic parameters and size of the primary tumor, various histopathological subtypes of renal cell carcinoma (RCC) and Fuhrman grade of the tumors. MATERIAL AND METHODS Retrospective analysis of 93 biopsy-proven RCC patients who underwent pretreatment flourine 18 flourodeoxyglucose PET/computed tomography ( 18 F FDG PET/CT) was performed. Quantitative PET parameters, size of the primary tumor, histopathological subtypes and Fuhrman grades of the tumor were extracted. We tried to assess if there was any significant difference in the metabolic patterns of various histopathological subtypes of RCCs, Fuhrman grade of the tumors and size of the primary tumor. RESULTS A significant correlation was noted between the size of primary tumor and maximum standardized uptake value (SUV max ), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) ( P < 0.01, P < 0.001 and P < 0.001, respectively). SUV max values correlated significantly with the histopathological subtype ( P < 0.001). Further sub-analyses was also done by segregating the patients into Low grade (Fuhrman grade 1 and 2) vs. High grade (Fuhrman grade 3 and 4). SUV max , MTV and TLG were significantly different between high grade vs. low grade tumors. ROC analysis yielded cut off values for SUV max , MTV and TLG to differentiate between high grade from low grade tumors. CONCLUSION FDG PET/CT with the use of metabolic PET parameters can differentiate between different histopathological subtypes of RCC. Incorporation of metabolic parameters into clinical practice can potentially noninvasively identify patients with low-grade vs. high-grade RCC.
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Affiliation(s)
- Yash Jain
- Department of Nuclear Medicine and Moleular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Archi Agrawal
- Department of Nuclear Medicine and Moleular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Gagan Prakash
- Department of Uro Oncology, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai and
| | - Nilendu Purandare
- Department of Nuclear Medicine and Moleular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Sneha Shah
- Department of Nuclear Medicine and Moleular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Ameya Puranik
- Department of Nuclear Medicine and Moleular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Sayak Choudhury
- Department of Nuclear Medicine and Moleular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Varun Shukla
- Department of Nuclear Medicine and Molecular imaging, Mahamana Pandit Madan Mohan Malviya Cancer Center, Tata Memorial Centre, Homi Bhabha National Institute, India
| | - Indraja Dev
- Department of Nuclear Medicine and Moleular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute,
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Moleular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute,
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Emberley E, Pan A, Chen J, Dang R, Gross M, Huang T, Li W, MacKinnon A, Singh D, Sotirovska N, Steggerda SM, Wang T, Parlati F. The glutaminase inhibitor telaglenastat enhances the antitumor activity of signal transduction inhibitors everolimus and cabozantinib in models of renal cell carcinoma. PLoS One 2021; 16:e0259241. [PMID: 34731180 PMCID: PMC8565744 DOI: 10.1371/journal.pone.0259241] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 10/16/2021] [Indexed: 12/26/2022] Open
Abstract
Dysregulated metabolism is a hallmark of cancer that manifests through alterations in bioenergetic and biosynthetic pathways to enable tumor cell proliferation and survival. Tumor cells exhibit high rates of glycolysis, a phenomenon known as the Warburg effect, and an increase in glutamine consumption to support the tricarboxylic acid (TCA) cycle. Renal cell carcinoma (RCC) tumors express high levels of glutaminase (GLS), the enzyme required for the first step in metabolic conversion of glutamine to glutamate and the entry of glutamine into the TCA cycle. We found that RCC cells are highly dependent on glutamine for proliferation, and this dependence strongly correlated with sensitivity to telaglenstat (CB-839), an investigational, first-in-class, selective, orally bioavailable GLS inhibitor. Metabolic profiling of RCC cell lines treated with telaglenastat revealed a decrease in glutamine consumption, which was concomitant with a decrease in the production of glutamate and other glutamine-derived metabolites, consistent with GLS inhibition. Treatment of RCC cells with signal transduction inhibitors everolimus (mTOR inhibitor) or cabozantinib (VEGFR/MET/AXL inhibitor) in combination with telaglenastat resulted in decreased consumption of both glucose and glutamine and synergistic anti-proliferative effects. Treatment of mice bearing Caki-1 RCC xenograft tumors with cabozantinib plus telaglenastat resulted in reduced tumor growth compared to either agent alone. Enhanced anti-tumor activity was also observed with the combination of everolimus plus telaglenastat. Collectively, our results demonstrate potent, synergistic, anti-tumor activity of telaglenastat plus signal transduction inhibitors cabozantinib or everolimus via a mechanism involving dual inhibition of glucose and glutamine consumption.
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Affiliation(s)
- Ethan Emberley
- Calithera Biosciences, Inc., South San Francisco, CA, United States of America
| | - Alison Pan
- Calithera Biosciences, Inc., South San Francisco, CA, United States of America
| | - Jason Chen
- Calithera Biosciences, Inc., South San Francisco, CA, United States of America
| | - Rosalyn Dang
- Calithera Biosciences, Inc., South San Francisco, CA, United States of America
| | - Matt Gross
- Calithera Biosciences, Inc., South San Francisco, CA, United States of America
| | - Tony Huang
- Calithera Biosciences, Inc., South San Francisco, CA, United States of America
| | - Weiqun Li
- Calithera Biosciences, Inc., South San Francisco, CA, United States of America
| | - Andrew MacKinnon
- Calithera Biosciences, Inc., South San Francisco, CA, United States of America
| | - Devansh Singh
- Calithera Biosciences, Inc., South San Francisco, CA, United States of America
| | - Natalija Sotirovska
- Calithera Biosciences, Inc., South San Francisco, CA, United States of America
| | | | - Tracy Wang
- Calithera Biosciences, Inc., South San Francisco, CA, United States of America
| | - Francesco Parlati
- Calithera Biosciences, Inc., South San Francisco, CA, United States of America
- * E-mail:
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3
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Klinkhammer BM, Lammers T, Mottaghy FM, Kiessling F, Floege J, Boor P. Non-invasive molecular imaging of kidney diseases. Nat Rev Nephrol 2021; 17:688-703. [PMID: 34188207 PMCID: PMC7612034 DOI: 10.1038/s41581-021-00440-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 02/05/2023]
Abstract
In nephrology, differential diagnosis or assessment of disease activity largely relies on the analysis of glomerular filtration rate, urinary sediment, proteinuria and tissue obtained through invasive kidney biopsies. However, currently available non-invasive functional parameters, and most serum and urine biomarkers, cannot capture intrarenal molecular disease processes specifically. Moreover, although histopathological analyses of kidney biopsy samples enable the visualization of pathological morphological and molecular alterations, they only provide information about a small part of the kidney and do not allow longitudinal monitoring. These limitations not only hinder understanding of the dynamics of specific disease processes in the kidney, but also limit the targeting of treatments to active phases of disease and the development of novel targeted therapies. Molecular imaging enables non-invasive and quantitative assessment of physiological or pathological processes by combining imaging technologies with specific molecular probes. Here, we discuss current preclinical and clinical molecular imaging approaches in nephrology. Non-invasive visualization of the kidneys through molecular imaging can be used to detect and longitudinally monitor disease activity and can therefore provide companion diagnostics to guide clinical trials, as well as the safe and effective use of drugs.
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Affiliation(s)
| | - Twan Lammers
- Institute for Experimental Molecular Imaging, RWTH Aachen University Hospital, Aachen, Germany,Department of Pharmaceutics, Utrecht University, The Netherlands,Department of Targeted Therapeutics, University of Twente, Enschede, The Netherlands
| | - Felix M. Mottaghy
- Department of Nuclear Medicine, University Hospital RWTH Aachen, Germany,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Fabian Kiessling
- Institute for Experimental Molecular Imaging, RWTH Aachen University Hospital, Aachen, Germany,Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Jürgen Floege
- Department of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany,Department of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany,Electron Microscopy Facility, RWTH Aachen University Hospital, Aachen, Germany,
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4
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Fiedorowicz M, Khan MI, Strzemecki D, Orzeł J, Wełniak-Kamińska M, Sobiborowicz A, Wieteska M, Rogulski Z, Cheda L, Wargocka-Matuszewska W, Kilian K, Szczylik C, Czarnecka AM. Renal carcinoma CD105-/CD44- cells display stem-like properties in vitro and form aggressive tumors in vivo. Sci Rep 2020; 10:5379. [PMID: 32214151 PMCID: PMC7096525 DOI: 10.1038/s41598-020-62205-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 03/10/2020] [Indexed: 12/15/2022] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) is the most common kidney cancer. Prognosis for ccRCC is generally poor since it is largely resistant to chemo- and radiotherapy. Many studies suggested that cancer stem cells/tumor initiating cells (CSCs/TICs) are responsible for development of tumor, disease progression, aggressiveness, metastasis and drug resistance. However, tumorigenic potential of CSCs/TICs isolated from established RCC cell lines - basic ccRCC research model - has never been investigated in vivo. CD105+, CD105-, CD44+ and CD44- as well as CD44-/CD105- CD44+/CD105+ and CD44-/CD105+ cells were isolated from Caki-1 RCC cell line, confirming coexistence of multiple subpopulations of stem-related phenotype in stable cell line. Sorted cells were injected subcutaneously into NOD SCID mice and tumor growth was monitored with MRI and PET/CT. Tumor growth was observed after implantation of CD105+, CD44+, CD44-, CD44-/CD105+ and CD44-/CD105- but not CD105- or CD44+/CD105+. Implantation of CD44-/CD105- cells induced tumors that were characterized by longer T1 and distinct metabolic pattern than other tumors. All the tumors were characterized by low uptake of [18F]FDG. CD105+ and CD44- tumors expresses Nanog and Oct-4, while CD44- tumors additionally expressed endothelial cell marker - CD31.
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Affiliation(s)
- M Fiedorowicz
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland.
| | - M I Khan
- Department of Oncology with Laboratory of Molecular Oncology, Military Institute of Medicine, Warsaw, Poland
- Department of Otolaryngology - Head & Neck Surgery, Western University, London, ON, N6A 3K7, Canada
| | - D Strzemecki
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - J Orzeł
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
- Faculty of Electronics and Information Technology, Warsaw University of Technology, Warsaw, Poland
| | - M Wełniak-Kamińska
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - A Sobiborowicz
- Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - M Wieteska
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
- Faculty of Electronics and Information Technology, Warsaw University of Technology, Warsaw, Poland
| | - Z Rogulski
- Faculty of Chemistry, Biological and Chemical Research Centre, University of Warsaw, Warsaw, Poland
| | - L Cheda
- Faculty of Chemistry, Biological and Chemical Research Centre, University of Warsaw, Warsaw, Poland
| | - W Wargocka-Matuszewska
- Faculty of Chemistry, Biological and Chemical Research Centre, University of Warsaw, Warsaw, Poland
| | - K Kilian
- Heavy Ion Laboratory, Faculty of Physics, University of Warsaw, Warsaw, Poland
| | - C Szczylik
- Department of Oncology with Laboratory of Molecular Oncology, Military Institute of Medicine, Warsaw, Poland
- Department of Oncology, European Health Centre, Otwock, Poland
- Medical Center for Postgraduate Education, Warsaw, Poland
| | - A M Czarnecka
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
- Department of Oncology with Laboratory of Molecular Oncology, Military Institute of Medicine, Warsaw, Poland
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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5
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Khandani AH, Commander CW, Desai H, Oldan JD, Wong TZ, Benefield T, Ivanovic M. Visual and semiquantitative analysis of 82Rb uptake in malignant tumors on PET/CT: first systematic analysis. Nucl Med Commun 2019; 40:532-538. [PMID: 30920430 DOI: 10.1097/mnm.0000000000001011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The objective of this study was to analyze the uptake of rubidium in malignant tumors. PARTICIPANTS AND METHODS Sixteen malignant lesions were included. Two radiologists compared each lesion to four references (subcutaneous fat, lung, mediastinal blood pool, and liver) at rest and stress and scored as 1-4. Maximum standardized uptake value (SUV) in each lesion and four references, as well as ratios of lesion SUV to SUV of each of the references, were calculated at rest and stress. We assessed an agreement for scores of reader 1 versus reader 2 (inter-reader) at rest and stress, scores at rest versus stress (intrapatient) for reader 1 and reader 2, and lesion SUV and respective ratios at rest and stress using paired t-test and Bland-Altman analyses. RESULTS Fifteen (94%) out of 16 lesions had a score of 3 or 4 at rest or stress or both by at least one reviewer. We did not find evidence of inter-reader bias at rest or stress or intrapatient (rest vs. stress) bias for either reader. SUV ranged from 1.0 to 8.1 at rest and from 0.7 to 6.7 at stress. There was an excellent agreement between ratios of lesion SUV to lung SUV at rest versus stress. On the extreme, there was a poor agreement between ratios of lesion SUV to liver SUV at rest versus stress. Otherwise, the agreement was good for the majority of the results, and moderate for a few others. CONCLUSION Malignant tumors can be readily depicted and quantified on rubidium PET/CT. Further research is needed.
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Affiliation(s)
- Amir H Khandani
- Department of Radiology, UNC School of Medicine, Division of Nuclear Medicine.,UNC School of Medicine, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Clayton W Commander
- Department of Radiology, UNC School of Medicine, Division of Nuclear Medicine
| | - Hemant Desai
- Department of Radiology, UNC School of Medicine, Division of Nuclear Medicine
| | - Jorge D Oldan
- Department of Radiology, UNC School of Medicine, Division of Nuclear Medicine
| | - Terence Z Wong
- Department of Radiology, UNC School of Medicine, Division of Nuclear Medicine
| | - Thad Benefield
- Department of Radiology, UNC School of Medicine, Division of Nuclear Medicine
| | - Marijana Ivanovic
- Department of Radiology, UNC School of Medicine, Division of Nuclear Medicine
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6
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FDG PET/CT Findings of Polymorphic Posttransplant Lymphoproliferative Disorders in a Transplanted Kidney. Clin Nucl Med 2018; 43:441-444. [DOI: 10.1097/rlu.0000000000002027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Ranieri G, Marech I, Niccoli Asabella A, Di Palo A, Porcelli M, Lavelli V, Rubini G, Ferrari C, Gadaleta CD. Tyrosine-Kinase Inhibitors Therapies with Mainly Anti-Angiogenic Activity in Advanced Renal Cell Carcinoma: Value of PET/CT in Response Evaluation. Int J Mol Sci 2017; 18:ijms18091937. [PMID: 28891933 PMCID: PMC5618586 DOI: 10.3390/ijms18091937] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 02/06/2023] Open
Abstract
Renal cell carcinoma (RCC) is the most frequent renal tumor and the majority of patients are diagnosed with advanced disease. Tumor angiogenesis plays a crucial role in the development and progression of RCC together with hypoxia and glucose metabolism. These three pathways are strictly connected to the cell growth and proliferation, like a loop that is self-feeding. Over the last few years, the ever-deeper knowledge of its contribution in metastatic RCC led to the discovery of numerous tyrosine kinase inhibitors (TKIs) targeting pro-angiogenic receptors at different levels such as sunitinib, sorafenib, pazopanib, axitinib, tivozanib, and dovitinib. As anti-angiogenic agents, TKIs interfere the loop, being able to inhibit tumor proliferation. TKIs are now available treatments for advanced RCC, which demonstrated to improve overall survival and/or progression free survival. Their effects can be detectable early on Positron Emission Tomography/Computed Tomography (PET/CT) by change in 18F-fluoro-2-deoxy-2-d-glucose (18F-FDG) uptake, the main radiotracer used to date, as a strong indicator of biological response. 18F-FDG PET/CT demonstrated an ability to predict and monitor disease progression, allowing an early and reliable identification of responders, and could be used for image-guided optimization and "personalization" of anti-angiogenic regimens. New radiotracers for biometabolic imaging are currently under investigation, which exploit the other pathways involved in the cancer process, including cellular proliferation, aerobic metabolism, cell membrane synthesis, hypoxia and amino acid transport, as well as the angiogenic process, but they require further studies.
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Affiliation(s)
- Girolamo Ranieri
- Interventional Radiology Unit with Integrated Section of Medical Oncology, National Cancer Research Centre, Istituto Tumori "Giovanni Paolo II", Bary 70124, Italy.
| | - Ilaria Marech
- Interventional Radiology Unit with Integrated Section of Medical Oncology, National Cancer Research Centre, Istituto Tumori "Giovanni Paolo II", Bary 70124, Italy.
| | | | - Alessandra Di Palo
- Interventional Radiology Unit with Integrated Section of Medical Oncology, National Cancer Research Centre, Istituto Tumori "Giovanni Paolo II", Bary 70124, Italy.
- Nuclear Medicine Unit, University of Bari "Aldo Moro", Bari 70124, Italy.
| | - Mariangela Porcelli
- Interventional Radiology Unit with Integrated Section of Medical Oncology, National Cancer Research Centre, Istituto Tumori "Giovanni Paolo II", Bary 70124, Italy.
| | - Valentina Lavelli
- Nuclear Medicine Unit, University of Bari "Aldo Moro", Bari 70124, Italy.
| | - Giuseppe Rubini
- Nuclear Medicine Unit, University of Bari "Aldo Moro", Bari 70124, Italy.
| | - Cristina Ferrari
- Interventional Radiology Unit with Integrated Section of Medical Oncology, National Cancer Research Centre, Istituto Tumori "Giovanni Paolo II", Bary 70124, Italy.
- Nuclear Medicine Unit, University of Bari "Aldo Moro", Bari 70124, Italy.
| | - Cosmo Damiano Gadaleta
- Interventional Radiology Unit with Integrated Section of Medical Oncology, National Cancer Research Centre, Istituto Tumori "Giovanni Paolo II", Bary 70124, Italy.
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8
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Brooks SA, Khandani AH, Fielding JR, Lin W, Sills T, Lee Y, Arreola A, Milowsky MI, Wallen EM, Woods ME, Smith AB, Nielsen ME, Parker JS, Lalush DS, Rathmell WK. Alternate Metabolic Programs Define Regional Variation of Relevant Biological Features in Renal Cell Carcinoma Progression. Clin Cancer Res 2016; 22:2950-9. [PMID: 26787754 DOI: 10.1158/1078-0432.ccr-15-2115] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/13/2015] [Indexed: 01/18/2023]
Abstract
PURPOSE Clear cell renal cell carcinoma (ccRCC) has recently been redefined as a highly heterogeneous disease. In addition to genetic heterogeneity, the tumor displays risk variability for developing metastatic disease, therefore underscoring the urgent need for tissue-based prognostic strategies applicable to the clinical setting. We have recently employed the novel PET/magnetic resonance (MR) image modality to enrich our understanding of how tumor heterogeneity can relate to gene expression and tumor biology to assist in defining individualized treatment plans. EXPERIMENTAL DESIGN ccRCC patients underwent PET/MR imaging, and these images subsequently used to identify areas of varied intensity for sampling. Samples from 8 patients were subjected to histologic, immunohistochemical, and microarray analysis. RESULTS Tumor subsamples displayed a range of heterogeneity for common features of hypoxia-inducible factor expression and microvessel density, as well as for features closely linked to metabolic processes, such as GLUT1 and FBP1. In addition, gene signatures linked with disease risk (ccA and ccB) also demonstrated variable heterogeneity, with most tumors displaying a dominant panel of features across the sampled regions. Intriguingly, the ccA- and ccB-classified samples corresponded with metabolic features and functional imaging levels. These correlations further linked a variety of metabolic pathways (i.e., the pentose phosphate and mTOR pathways) with the more aggressive, and glucose avid ccB subtype. CONCLUSIONS Higher tumor dependency on exogenous glucose accompanies the development of features associated with the poor risk ccB subgroup. Linking these panels of features may provide the opportunity to create functional maps to enable enhanced visualization of the heterogeneous biologic processes of an individual's disease. Clin Cancer Res; 22(12); 2950-9. ©2016 AACR.
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Affiliation(s)
- Samira A Brooks
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina. Curriculum in Toxicology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Amir H Khandani
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina. Department of Radiology, Nuclear Medicine, University of North Carolina at Chapel Hill, North Carolina.
| | - Julia R Fielding
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
| | - Weili Lin
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
| | - Tiffany Sills
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yueh Lee
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
| | - Alexandra Arreola
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Mathew I Milowsky
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina. Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Eric M Wallen
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina. Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael E Woods
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
| | - Angie B Smith
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mathew E Nielsen
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joel S Parker
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina. Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - David S Lalush
- Department of Radiology, Nuclear Medicine, University of North Carolina at Chapel Hill, North Carolina. Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, Raleigh, North Carolina
| | - W Kimryn Rathmell
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina. Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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9
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Luo J, Mao Y, Cai S, Shen X, Chen S, Xie L. Post-nephrectomy foreign-body granuloma in the retroperitoneum mimicking lymph node metastasis of renal cell cancer. Onco Targets Ther 2014; 7:2137-41. [PMID: 25429231 PMCID: PMC4242698 DOI: 10.2147/ott.s70705] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Recently, iatrogenic foreign-body granuloma has been increasingly reported. The asymptomatic presentation and confusing appearance of granuloma can lead to misdiagnosis of a secondary malignancy, especially for a patient with a corresponding past medical history. Sometimes, surgical treatment is unavoidable, and the diagnosis relies upon the pathologic result. Herein, we report an unusual case of a 43-year-old man who underwent a nephrectomy for renal cell carcinoma (clear cell type) 5 years ago. A secondary granuloma was identified behind the inferior vena cava in the retroperitoneum 6 months after the surgery, but the radiologists had failed to identify it throughout the 4 years of routine examination. Later on, the lesion was identified by positron emission tomography, which classified it as a highly 18F-fluorodeoxyglucose-avid lesion. Considering no visible foreign-bodies identified on images, the lesion was arguably diagnosed as a lymph node metastasis of renal cancer. Finally, it was confirmed as a foreign-body granuloma encasing surgical suture and adipose tissue by the pathological analysis.
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Affiliation(s)
- Jindan Luo
- Department of Urology, The First Affiliated Hospital of College of Medicine, Zhejiang University, Zhejiang, People's Republic of China
| | - Yeqing Mao
- Department of Urology, The First Affiliated Hospital of College of Medicine, Zhejiang University, Zhejiang, People's Republic of China
| | - Songliang Cai
- Department of Urology, The First Affiliated Hospital of College of Medicine, Zhejiang University, Zhejiang, People's Republic of China
| | - Xiaoyong Shen
- Department of Radiology, The First Affiliated Hospital of College of Medicine, Zhejiang University, Zhejiang, People's Republic of China
| | - Shanwen Chen
- Department of Urology, The First Affiliated Hospital of College of Medicine, Zhejiang University, Zhejiang, People's Republic of China
| | - Liping Xie
- Department of Urology, The First Affiliated Hospital of College of Medicine, Zhejiang University, Zhejiang, People's Republic of China
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10
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Polat EC, Otunctemur A, Ozbek E, Besiroglu H, Dursun M, Ozer K, Horsanali MO. Standardized uptake values highly correlate with tumor size and Fuhrman grade in patients with clear cell renal cell carcinoma. Asian Pac J Cancer Prev 2014; 15:7821-4. [PMID: 25292070 DOI: 10.7314/apjcp.2014.15.18.7821] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We investigated the correlation between standardized uptake value (SUVmax), tumor size and Fuhrman grade in patients with renal cell carcinoma (RC). MATERIALS AND METHODS We retrospectively analyzed the data of 54 patients with clear cell renal cell carcinoma histopathologically diagnosed who underwent fluorine-18 fluoro-2 deoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) between January 2005 and March 2014. RESULTS Avarage tumor sizes were 5.64±1.85, 6.85±2.24 and 7.98±2.45 in low, medium and high SUVmax groups, respectively. The Spearman's correlation coefficient between the tumor size and SUVmax was 0.385 (p=0.004) and between the Fuhrman grade and SUVmax was 0.578 (p<0.001). CONCLUSIONS SUVmax appears highly correlated with tumor size and Fuhrman grade in patients with histopathologically confirmed clear cell RC. Multicenter studies are needed to provide larger series for more accurate results.
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Affiliation(s)
- Emre Can Polat
- Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey E-mail
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Takayama T, Takehara Y, Sugiyama M, Sugiyama T, Ishii Y, Johnson KE, Wieben O, Wakayama T, Sakahara H, Ozono S. Use of three-dimensional time-resolved phase-contrast magnetic resonance imaging with vastly undersampled isotropic projection reconstruction to assess renal blood flow in a renal cell carcinoma patient treated with sunitinib: a case report. BMC Res Notes 2014; 7:527. [PMID: 25125076 PMCID: PMC4138367 DOI: 10.1186/1756-0500-7-527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 08/11/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND New imaging modalities to assess the efficacy of drugs that have molecular targets remain under development. Here, we describe for the first time the use of time-resolved three-dimensional phase-contrast magnetic resonance imaging to monitor changes in blood supply to a tumor during sunitinib treatment in a patient with localized renal cell carcinoma. CASE PRESENTATION A 43-year-old Japanese woman with a tumor-bearing but functional single kidney presented at our hospital in July 2012. Computed tomography and magnetic resonance imaging revealed a cT1aN0M0 renal cell carcinoma embedded in the upper central region of the left kidney. She was prescribed sunitinib as neoadjuvant therapy for 8 months, and then underwent partial nephrectomy. Tumor monitoring during this time was done using time-resolved three-dimensional phase-contrast magnetic resonance imaging, a recent technique which specifically measures blood flow in the various vessels of the kidney. This imaging allowed visualization of the redistribution of renal blood flow during treatment, and showed that flow to the tumor was decreased and flows to other areas increased. Of note, this change occurred in the absence of any change in tumor size. CONCLUSION The ability of time-resolved three-dimensional phase-contrast magnetic resonance imaging to provide quantitative information on blood supply to tumors may be useful in monitoring the efficacy of sunitinib treatment.
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Affiliation(s)
- Tatsuya Takayama
- Departments of Urology, Hamamatsu University School of Medicine, 1-20-1 Higashi-ku, Handayama, Hamamatsu, Shizuoka 431-3192, Japan.
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The role of fluorine-18-fluorodeoxyglucose positron emission tomography in evaluating the response to tyrosine-kinase inhibitors in patients with metastatic primary renal cell carcinoma. Radiol Oncol 2014; 48:219-27. [PMID: 25177235 PMCID: PMC4110077 DOI: 10.2478/raon-2013-0067] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 08/21/2013] [Indexed: 01/03/2023] Open
Abstract
Background Positron emission tomography-computed tomography (PET-CT) using fluorodeoxyglucose (FDG) is increasingly used in the evaluation of patients with advanced renal cell carcinoma (RCC), primarily for staging purposes. The aim of this paper is to perform a systematic review about the usefulness of PET-CT using FDG in response assessment after treatment with tyrosine-kinase inhibitors (TKIs) in patients with advanced RCC. Materials and methods. The scientific literature about the role of PET-CT using FDG in the assessment of response to treatment with TKIs in patients affected by advanced RCC was systematically reviewed. Results Seven studies about the role of PET-CT using FDG in the response assessment after treatment with TKIs (essentially sunitinib and sorafenib) in advanced RCC were retrieved in full-text and analysed, to determine the predictive role of this morpho-functional imaging method on patient outcome. Conclusions To date, the role of PET-CT using FDG in evaluating the response to TKIs in metastatic RCC patients is still not well defined, partly due to heterogeneity of available studies; however, PET-CT reveals potential role for the selection of patients undergoing therapy with TKIs. The use of contrast-enhanced PET-CT appears to be promising for a “multi-dimensional” evaluation of treatment response in these patients.
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Assessing the Response to Targeted Therapies in Renal Cell Carcinoma: Technical Insights and Practical Considerations. Eur Urol 2014; 65:766-77. [DOI: 10.1016/j.eururo.2013.11.031] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 11/18/2013] [Indexed: 12/21/2022]
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Bhatt VR, Ganti AK, Schwarz JK, Wang J. Safety and efficacy of preoperative sorafenib therapy in facilitating cytoreductive surgery in renal cell carcinoma. Future Oncol 2014; 10:703-6. [DOI: 10.2217/fon.14.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Vijaya R Bhatt
- Department of Internal Medicine, Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Apar Kishor Ganti
- Department of Internal Medicine, Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Internal Medicine, Division of Hematology & Oncology, VA Nebraska Western Iowa Health Care System, Omaha, NE, USA
| | - James K Schwarz
- Department of Internal Medicine, Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jue Wang
- Department of Internal Medicine, Division of Hematology & Oncology, University of Nebraska Medical Center, Omaha, NE, USA
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Lee H, Hwang KH, Kim SG, Koh G, Kim JH. Can Initial (18)F-FDG PET-CT Imaging Give Information on Metastasis in Patients with Primary Renal Cell Carcinoma? Nucl Med Mol Imaging 2013; 48:144-52. [PMID: 24900155 PMCID: PMC4028476 DOI: 10.1007/s13139-013-0245-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 10/10/2013] [Accepted: 10/15/2013] [Indexed: 12/22/2022] Open
Abstract
Purpose The aim of this study was to investigate the relationship between the maximum standardized uptake values (SUVmax) of primary renal cancers with and without metastatic lesions, if any. We also studied the relationship between the size of primary renal cancers and their SUVmax, and tried to find a clinical value of 18F-FDG PET-CT for the initial evaluation of renal cell carcinoma (RCC). Methods The cases of 23 patients, 16 men and 7 women, who underwent PET-CT examination before operation were retrospectively reviewed. We measured the SUVmax of the primary renal cancers and those of any existing metastatic lesions, and the size of the primary renal cancers. We compared the SUVmax of primary RCCs with metastases and those without metastases, SUVmax of primary RCC and those of metastases, and studied the correlation between the size and SUVmax of primary RCCs. Results The SUVmax of primary RCC of the 16 patients without metastasis ranged from 1.1 to 5.6 with a median value of 2.6. Those of the patients with metastasis ranged from 2.9 to 7.6 with a median of 5.0. The size of the all 23 primary renal cancers ranged from 1.7 cm to 13.5 cm, with a median of 4.5 cm, and their SUVmax ranged from 1.1 to 7.6, with a median of 2.9. There was a statistically significant difference between the SUVmax of the primary RCC with metastasis (5.3 ± 1.7) and those without metastasis (2.9 ± 1.0). There was a moderate positive correlation between the sizes and SUVmax of all 23 primary RCCs. However, there was no statistically significant correlation between the sizes and SUVmax of primary RCCs with metastatic lesions and the same for RCCs without metastasis. The cutoff value of SUVmax for predicting extra-renal lesion was 4.4 and that for size was 5.8 cm according to the receiver operating characteristic curves. Conclusions Those who have primary RCC with high SUVmax are suggested to have a likelihood of metastasis. Also, there was a moderate trend of increasing value of SUVmax of primary RCC as their size increases. Physicians should beware of missing extra-renal lesions elsewhere.
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Affiliation(s)
- Haejun Lee
- Department of Nuclear Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Kyung Hoon Hwang
- Department of Nuclear Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Seog Gyun Kim
- Department of Nuclear Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Geon Koh
- Department of Nuclear Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Ji Hyun Kim
- Department of Nuclear Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
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Chen JL, Appelbaum DE, Kocherginsky M, Cowey CL, Rathmell WK, McDermott DF, Stadler WM. FDG-PET as a predictive biomarker for therapy with everolimus in metastatic renal cell cancer. Cancer Med 2013; 2:545-52. [PMID: 24156027 PMCID: PMC3799289 DOI: 10.1002/cam4.102] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 05/28/2013] [Accepted: 05/29/2013] [Indexed: 01/20/2023] Open
Abstract
The mTOR (mammalian target of rapamycin) inhibitor, everolimus, affects tumor growth by targeting cellular metabolic proliferation pathways and delays renal cell carcinoma (RCC) progression. Preclinical evidence suggests that baseline elevated tumor glucose metabolism as quantified by FDG-PET ([18F] fluorodeoxy-glucose positron emission tomography) may predict antitumor activity. Metastatic RCC (mRCC) patients refractory to vascular endothelial growth factor (VEGF) pathway inhibition were treated with standard dose everolimus. FDG-PET scans were obtained at baseline and 2 weeks; serial computed tomography (CT) scans were obtained at baseline and every 8 weeks. Maximum standardized uptake value (SUVmax) of the most FDG avid lesion, average SUVmax of all measured lesions and their corresponding 2-week relative changes were examined for association with 8-week change in tumor size. A total of 63 patients were enrolled; 50 were evaluable for the primary endpoint of which 48 had both PET scans. Patient characteristics included the following: 36 (72%) clear cell histology and median age 59 (range: 37–80). Median pre- and 2-week treatment average SUVmax were 6.6 (1–17.9) and 4.2 (1–13.9), respectively. Response evaluation criteria in solid tumors (RECIST)-based measurements demonstrated an average change in tumor burden of 0.2% (−32.7% to 35.9%) at 8 weeks. Relative change in average SUVmax was the best predictor of change in tumor burden (all evaluable P = 0.01; clear cell subtype P = 0.02), with modest correlation. Baseline average SUVmax was correlated with overall survival and progression-free survival (PFS) (P = 0.023; 0.020), but not with change in tumor burden. Everolimus therapy decreased SUVs on follow-up PET scans in mRCC patients, but changes were only modestly correlated with changes in tumor size. Thus, clinical use of FDG-PET-based biomarkers is challenged by high variability. In this phase II trial, FDG-PET was explored as a predictive biomarker for response to everolimus (mTOR inhibition) in metastatic renal cell carcinoma. Everolimus therapy decreased SUVs on follow-up FDG-PET scans in these patients. SUV changes were modestly correlated with changes in tumor size and baseline average SUVmax values were correlated with overall survival.
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Affiliation(s)
- James L Chen
- Departments of Biomedical Informatics and Internal Medicine, The Ohio State University Columbus, Ohio
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