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Windisch P, Zwahlen DR, Giesel FL, Scholz E, Lugenbiel P, Debus J, Haberkorn U, Adeberg S. Clinical results of fibroblast activation protein (FAP) specific PET for non-malignant indications: systematic review. EJNMMI Res 2021; 11:18. [PMID: 33606104 PMCID: PMC7895887 DOI: 10.1186/s13550-021-00761-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/10/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Small molecules targeting fibroblast activation protein (FAP) have emerged as a new group of tracers for positron emission tomography (PET) in 2018. While most of the existing literature has been focussed on the application of FAP-specific PET in various kinds of cancers, some researchers have, both intentionally or unintentionally, used FAP-specific PET in patients with non-cancerous diseases. The purpose of this systematic review is therefore to summarize the available evidence of FAP-specific PET for non-malignant indications. METHODS The MEDLINE database was searched for studies presenting the clinical use of FAP-specific PET, the records were screened according to PRISMA guidelines and articles containing patients suffering from non-malignant diseases were included. RESULTS Sixteen studies with 303 patients were included. FAP-specific PET has been used in cardiac imaging, IgG4-related disease, benign tumors as well as various kinds of inflammation. Two prospective studies on FAP-specific PET for IgG4-related disease show its potential to differentiate inflammatory from fibrotic lesions, which could be used to determine the management of these patients. CONCLUSION While publications on FAP-specific PET for non-malignant indications are mostly limited to case reports and incidental findings, the first retrospective and prospective studies present promising results for IgG4-related as well as cardiovascular disease that warrant further research. Several currently recruiting trials will add to the body evidence in the next few years.
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Affiliation(s)
- Paul Windisch
- Department of Radiation Oncology, Kantonsspital Winterthur, Brauerstrasse 15, 8400, Winterthur, Switzerland.
| | - Daniel R Zwahlen
- Department of Radiation Oncology, Kantonsspital Winterthur, Brauerstrasse 15, 8400, Winterthur, Switzerland
| | - Frederik L Giesel
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Eberhard Scholz
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Patrick Lugenbiel
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Center for Heart Rhythm Disorders (HCR), Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,German Cancer Consortium (DKTK), Partner Site, Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,German Cancer Consortium (DKTK), Partner Site, Heidelberg, Germany
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2
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Iskandar R. Adding noise to Markov cohort state‐transition model in decision modeling and cost‐effectiveness analysis. Stat Med 2020; 39:1529-1540. [DOI: 10.1002/sim.8494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Rowan Iskandar
- Center of Competence for Public ManagementUniversity of Bern Bern Switzerland
- Department of Health Services, Policy, and PracticeBrown University Providence Rhode Island
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Kunst NR, Alarid-Escudero F, Paltiel AD, Wang SY. A Value of Information Analysis of Research on the 21-Gene Assay for Breast Cancer Management. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1102-1110. [PMID: 31563252 PMCID: PMC7343670 DOI: 10.1016/j.jval.2019.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/14/2019] [Accepted: 05/15/2019] [Indexed: 05/02/2023]
Abstract
OBJECTIVES The 21-gene assay Oncotype DX (21-GA) shows promise as a guide in deciding when to initiate adjuvant chemotherapy in women with hormone receptor-positive early-stage breast cancer. Nevertheless, its routine use remains controversial, owing to insufficient evidence of its clinical utility and cost-effectiveness. Accordingly, we aim to quantify the value of conducting further research to reduce decision uncertainty in the use of the 21-GA. METHODS Using value of information methods, we first generated probability distributions of survival and costs for decision making with and without the 21-GA alongside traditional risk prediction. These served as the input to a comparison of 3 alternative study designs: a retrospective observational study to update risk classification from the 21-GA, a prospective observational study to estimate prevalence of chemotherapy use, and a randomized controlled trial (RCT) of the 21-GA predictive value. RESULTS We found that current evidence strongly supports the use of the 21-GA in intermediate- and high-risk women. Further research should focus on low-risk women, among whom the cost-effectiveness findings remained equivocal. For this population, we identified a high value of reducing uncertainty in the 21-GA use for all proposed research studies. The RCT had the greatest potential to efficiently reduce the likelihood of choosing a suboptimal strategy, providing a value between $162 million and $1.1 billion at willingness-to-pay thresholds of $150 000 to $200 000/quality-adjusted life years. CONCLUSION Future research to inform 21-GA decision making is of high value. The RCT of the 21-GA predictive value has the greatest potential to efficiently reduce decision uncertainty around 21-GA use in women with low-risk early-stage breast cancer.
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Affiliation(s)
- Natalia R Kunst
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway; Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; Department of Epidemiology and Biostatistics, Amsterdam UMC, Amsterdam, the Netherlands; LINK Medical Research, Oslo, Norway.
| | - Fernando Alarid-Escudero
- Drug Policy Program, Center for Research and Teaching in Economics (CIDE), Aguascalientes, Mexico; National Council on Science and Technology (CONACyT), Mexico City, Mexico
| | - A David Paltiel
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Shi-Yi Wang
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT, USA; Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA
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4
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Wang W, Lin L, Fei X, Hong J, Gao W, Zhu S, Wu J, Huang O, He J, Li Y, Zhu L, Chen W, Chen X, Shen K. 21-Gene recurrence score influences the chemotherapy decision for patients with breast cancer of different luminal subtypes. Oncol Lett 2019; 18:4346-4356. [PMID: 31579428 DOI: 10.3892/ol.2019.10766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 07/18/2019] [Indexed: 12/20/2022] Open
Abstract
Luminal subtypes and the 21-gene recurrence score (RS) are important factors in the decision-making process for adjuvant chemotherapy in patients with hormonal receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancer. However, their effect on adjuvant chemotherapy decisions in the real world has not been thoroughly investigated, particularly for patients of the luminal A-like subtype with a high RS or the luminal B-like subtype with a low RS. The present study, a total of 772 HR+/HER2- patients who underwent 21-gene testing, were included in a retrospective analysis. The impact of clinicopathological factors and the 21-gene RS on chemotherapy recommendation was analyzed in the whole population and for patients of different luminal subgroups. The results revealed that chemotherapy was highly recommended for patients of younger age, with larger tumor size, node involvement, higher grade, luminal B-like subtype and higher RS. A high RS was identified to be the most important impact factor for chemotherapy recommendation among all patients [odds ratio (OR), 62.54; 95% CI, 25.58-152.92], the luminal A-like group (OR, 435.05; 95% CI, 29.90-6331.06) and the luminal B-like group (OR, 57.20; 95% CI, 22.42-145.96). For patients of the luminal A-like subtype with a high RS or patients of the luminal B-like subtype with low RS, the 21-gene RS was demonstrated to be the most important independent factor for chemotherapy recommendation, with an adjusted OR of 134.52 (95% CI, 10.39-1741.89). In conclusion, luminal subtypes and the 21-gene RS were found to be associated with chemotherapy recommendation for HR+/HER2- patients. For patients with a discordant luminal subtype and 21-gene RS risk, the 21-gene RS score was found to be the most important factor that influences chemotherapy decision, which warrants further clinical evaluation.
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Affiliation(s)
- Wei Wang
- Department of Breast Surgery, Comprehensive Breast Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Lin Lin
- Department of Clinical Laboratory, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Xiaochun Fei
- Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Jin Hong
- Department of Breast Surgery, Comprehensive Breast Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Weiqi Gao
- Department of Breast Surgery, Comprehensive Breast Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Siji Zhu
- Department of Breast Surgery, Comprehensive Breast Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Jiayi Wu
- Department of Breast Surgery, Comprehensive Breast Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Ou Huang
- Department of Breast Surgery, Comprehensive Breast Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Jianrong He
- Department of Breast Surgery, Comprehensive Breast Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Yafen Li
- Department of Breast Surgery, Comprehensive Breast Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Li Zhu
- Department of Breast Surgery, Comprehensive Breast Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Weiguo Chen
- Department of Breast Surgery, Comprehensive Breast Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Xiaosong Chen
- Department of Breast Surgery, Comprehensive Breast Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
| | - Kunwei Shen
- Department of Breast Surgery, Comprehensive Breast Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200025, P.R. China
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Klein J, Lam WW, Czarnota GJ, Stanisz GJ. Chemical exchange saturation transfer MRI to assess cell death in breast cancer xenografts at 7T. Oncotarget 2018; 9:31490-31501. [PMID: 30140385 PMCID: PMC6101146 DOI: 10.18632/oncotarget.25844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/12/2018] [Indexed: 12/23/2022] Open
Abstract
Purpose Detecting cell death and predicting tumor response early in a course of chemotherapy could help optimize treatment regimens and improve clinical outcomes. Chemical exchange saturation transfer (CEST) MRI was investigated in vivo to study properties that may be able to detect cancer death. Results Using a magnetization transfer ratio (MTR) cutoff of 0.12 at 1.8 ppm was able to differentiate between viable tumor and cell death regions. Comparison of MTR values at this frequency showed significant differences (p < 0.0001) between viable tumor and cell death regions, matching patterns seen on histology. Using this cutoff, the mean increase in cell death index (± standard error of the mean) after chemotherapy was 4 ± 4%, 10% ± 7%, 10 ± 8%, and 4 ± 9% at 4, 8, 12, and 24 h, respectively. Conclusions CEST MRI can detect cell death in MDA-231 xenografts but further work is needed to characterize the clinical applications of this finding. Maximum response to chemotherapy occurred at 8-12 h after chemotherapy injection in this in vivo tumor model. Materials and Methods Breast cancer xenografts (MDA-MB-231) were scanned using 7 T MRI before and after chemotherapy. As a measure of CEST effect at 0.5 µT saturation amplitude, MTR values at frequency offsets of 1.8 and -3.3 ppm were evaluated. CEST signals after chemotherapy treatment were compared to cell-death histopathology of tumors.
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Affiliation(s)
- Jonathan Klein
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Wilfred W Lam
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Gregory J Czarnota
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Greg J Stanisz
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Lublin, Poland
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Patterns of on-treatment cardiac adverse events within three clinical trials of adjuvant anthracycline-based chemotherapy. Breast Cancer 2018; 25:723-728. [PMID: 29882200 DOI: 10.1007/s12282-018-0878-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/05/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aims to assess the patterns of development of on-treatment cardiac side effects among patients with early breast cancer receiving anthracycline-based chemotherapy. METHODS This is a pooled analysis of patient-level data of patients with early-stage breast cancer who were recruited into three clinical trials to receive different adjuvant chemotherapy regimens. Univariable and multivariable analyses of factors predicting the development of on-treatment cardiac adverse events were conducted through logistic regression analysis. The following factors were evaluated in the univariable analysis: age, menopausal status, body mass index, T stage, and type of chemotherapy protocol. RESULTS Among the studied patients, 226 patients (6.7%) experienced 230 incidents of on-treatment cardiac toxicities. Cardiac ischemia was reported among 8 patients, cardiac dysfunction was reported among 19 patients, arrhythmias were reported in 161 patients and other non-specified forms of cardiac adverse events were reported in 42 patients. In univariable logistic regression, the following parameters were predictive of a higher probability of on-treatment cardiac adverse events (P < 0.05): higher age, higher body mass index and FAC chemotherapy protocol. When these factors were included in the multivariable logistic regression analysis, the following factors were predictive of a higher probability of cardiac adverse events: higher body mass index (P = 0.050) and FAC chemotherapy protocol (P = 0.001). CONCLUSION On-treatment cardiac events are not uncommon during adjuvant chemotherapy for early breast cancer. Higher dose of anthracyclines and higher body mass index are associated with a higher risk of on-treatment cardiac events.
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Winning the battle, but losing the war: mechanisms and morphology of cancer-therapy-associated cardiovascular toxicity. Cardiovasc Pathol 2017; 30:55-63. [DOI: 10.1016/j.carpath.2017.06.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/22/2017] [Accepted: 06/27/2017] [Indexed: 01/08/2023] Open
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