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18F-FDG and 18F-Fluciclovine Uptake in Poorly Differentiated Lung Adenocarcinoma in the Setting of Biochemically Recurrent Prostatic Adenocarcinoma. Clin Nucl Med 2022; 47:1077-1078. [PMID: 36342794 DOI: 10.1097/rlu.0000000000004387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
ABSTRACT A 64-year-old man with a history of Gleason 7 (3 + 4) pT2cN0 prostatic adenocarcinoma status post prostatectomy underwent a fluciclovine PET/CT that showed a tracer-avid right upper lobe spiculated solitary pulmonary nodule. Follow-up FDG PET/CT showed a hypermetabolic right upper lobe spiculated solitary pulmonary nodule. Fine-needle aspiration was consistent with primary lung adenocarcinoma. Subsequently, right upper lobectomy was performed, and poorly differentiated lung adenocarcinoma was confirmed.
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van Genugten EAJ, Weijers JAM, Heskamp S, Kneilling M, van den Heuvel MM, Piet B, Bussink J, Hendriks LEL, Aarntzen EHJG. Imaging the Rewired Metabolism in Lung Cancer in Relation to Immune Therapy. Front Oncol 2022; 11:786089. [PMID: 35070990 PMCID: PMC8779734 DOI: 10.3389/fonc.2021.786089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/10/2021] [Indexed: 12/14/2022] Open
Abstract
Metabolic reprogramming is recognized as one of the hallmarks of cancer. Alterations in the micro-environmental metabolic characteristics are recognized as important tools for cancer cells to interact with the resident and infiltrating T-cells within this tumor microenvironment. Cancer-induced metabolic changes in the micro-environment also affect treatment outcomes. In particular, immune therapy efficacy might be blunted because of somatic mutation-driven metabolic determinants of lung cancer such as acidity and oxygenation status. Based on these observations, new onco-immunological treatment strategies increasingly include drugs that interfere with metabolic pathways that consequently affect the composition of the lung cancer tumor microenvironment (TME). Positron emission tomography (PET) imaging has developed a wide array of tracers targeting metabolic pathways, originally intended to improve cancer detection and staging. Paralleling the developments in understanding metabolic reprogramming in cancer cells, as well as its effects on stromal, immune, and endothelial cells, a wave of studies with additional imaging tracers has been published. These tracers are yet underexploited in the perspective of immune therapy. In this review, we provide an overview of currently available PET tracers for clinical studies and discuss their potential roles in the development of effective immune therapeutic strategies, with a focus on lung cancer. We report on ongoing efforts that include PET/CT to understand the outcomes of interactions between cancer cells and T-cells in the lung cancer microenvironment, and we identify areas of research which are yet unchartered. Thereby, we aim to provide a starting point for molecular imaging driven studies to understand and exploit metabolic features of lung cancer to optimize immune therapy.
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Affiliation(s)
- Evelien A J van Genugten
- Department of Medical Imaging, Radboud University Medical Centre (Radboudumc), Nijmegen, Netherlands
| | - Jetty A M Weijers
- Department of Medical Imaging, Radboud University Medical Centre (Radboudumc), Nijmegen, Netherlands
| | - Sandra Heskamp
- Department of Medical Imaging, Radboud University Medical Centre (Radboudumc), Nijmegen, Netherlands
| | - Manfred Kneilling
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University, Tuebingen, Germany.,Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | | | - Berber Piet
- Department of Respiratory Diseases, Radboudumc, Nijmegen, Netherlands
| | - Johan Bussink
- Radiotherapy and OncoImmunology Laboratory, Department of Radiation Oncology, Radboudumc, Netherlands
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre (UMC), Maastricht, Netherlands
| | - Erik H J G Aarntzen
- Department of Medical Imaging, Radboud University Medical Centre (Radboudumc), Nijmegen, Netherlands
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Romagnolo C, Cottignoli C, Palucci A, Biscontini G, Fringuelli FM, Burroni L. Pictorial essay: incidental findings on 18F-Fluciclovine PET/CT scan. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00412-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Abstract
Introduction
Fluorine-18 (18F) Fluciclovine (anti-1-amino-3-18F-fluorocyclobutane- 1-carboxylic acid [FACBC]) is a synthetic amino acid labeled with 18F, currently used as PET radiopharmaceutical to investigating prostate cancer, namely in the recurrent setting.
Fluciclovine is transported to cell membranes by amino acid transporters, such as LAT1 and ASCT2. The upregulation of LAT-1 and ASCT2 activities is typical of prostate cancer but is also present in other pathological conditions such as non-prostatic neoplasms (e.g., lung cancer) and in benign inflammatory process (e.g., benign prostatic hyperplasia, chronic prostatitis, high-grade prostatic hyperplasia intraepithelial).
Methods
In this short essay we present a retrospective FACBC PET/CT analysis consisting of a selection of the five most relevant cases of patients referred in our centre to FACBC PET/CT for prostate cancer, with concomitant FACBC uptake in sites atyipical for prostate cancer.
Results
These five selected cases demonstrate FACBC uptake at the level of the pancreatic head, adrenal incidentalomas, pulmonary nodules, mediastinal lymph nodes and neoformative tissue of the rectal wall.
Discussion
Clinical cases selected in this pictorial essay have demonstrated that Fluciclovine is not an exclusive and specific radiotracer for prostate cancer and, therefore, can induce misdiagnosis. In fact, incidental benign and malignant uptake might occur and should be further evaluated with clinical correlation or other imaging.
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Incidental Detection of Lung Adenocarcinoma Presenting as an Anterior Mediastinal Mass on 18F-Fluciclovine PET/CT in a Patient With Primary Prostate Cancer. Clin Nucl Med 2020; 45:e525-e527. [PMID: 32701811 DOI: 10.1097/rlu.0000000000003207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
F-fluciclovine is a PET radiotracer approved for detection of recurrent prostate cancer, with utility in other malignancies being investigated. We present the case of a 71-year-old man with high-risk primary prostate cancer (Gleason score 9, prostate-specific antigen 34 ng/mL) and newly diagnosed lung adenocarcinoma. As part of a clinical trial (NCT03081884), preoperative F-fluciclovine PET/CT showed localized abnormal uptake in the prostate gland with extracapsular extension. Additionally, an incidental anterior mediastinal mass measuring 2.2 × 1.8 cm demonstrated abnormal radiotracer uptake. Biopsy of the mediastinal mass confirmed invasive lung adenocarcinoma with solid and acinar patterns and high programmed death 1 ligand expression.
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Hoyle JM, Lenzie A, Galgano SJ, McConathy JE, Rais-Bahrami S, Nix JW, McDonald AM. Synchronous Malignancies Identified by 18F-fluciclovine Positron Emission Tomography for Prostate Cancer: Case Series and Mini-Review. Clin Genitourin Cancer 2020; 19:e37-e40. [PMID: 32771333 DOI: 10.1016/j.clgc.2020.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/29/2020] [Accepted: 07/12/2020] [Indexed: 11/17/2022]
Abstract
Positron emission tomography using the fluorine-18 (18F) fluciclovine radiotracer has been approved for use in recurrent prostate cancer and is a useful tool for clinical decision making. However, 18F-fluciclovine is not specific for prostate cancer tumor cells, and false-positive results have been reported. In the present study, we have reported our experience with synchronous malignancies identified using 18F-fluciclovine and reviewed other reported cases, with a special emphasis on highlighting the clinical decisions that led to the correct diagnosis.
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Affiliation(s)
- John M Hoyle
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Andrew Lenzie
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Samuel J Galgano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Jonathan E McConathy
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Soroush Rais-Bahrami
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL; Department of Urology, University of Alabama at Birmingham, Birmingham, AL
| | - Jeffrey W Nix
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL; Department of Urology, University of Alabama at Birmingham, Birmingham, AL
| | - Andrew M McDonald
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL; Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL; Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
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