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Muzi M, Peterson LM, Specht JM, Hippe DS, Novakova-Jiresova A, Lee JH, Kurland BF, Mankoff DA, Obuchowski N, Linden HM, Kinahan PE. Repeatability of 18F-FDG uptake in metastatic bone lesions of breast cancer patients and implications for accrual to clinical trials. EJNMMI Res 2024; 14:32. [PMID: 38536511 PMCID: PMC10973316 DOI: 10.1186/s13550-024-01093-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/06/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Standard measures of response such as Response Evaluation Criteria in Solid Tumors are ineffective for bone lesions, often making breast cancer patients that have bone-dominant metastases ineligible for clinical trials with potentially helpful therapies. In this study we prospectively evaluated the test-retest uptake variability of 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) in a cohort of breast cancer patients with bone-dominant metastases to determine response criteria. The thresholds for 95% specificity of change versus no-change were then applied to a second cohort of breast cancer patients with bone-dominant metastases. METHODS For this study, nine patients with 38 bone lesions were imaged with 18F-FDG in the same calibrated scanner twice within 14 days. Tumor uptake was quantified by the most commonly used PET parameter, the maximum tumor voxel normalized by dose and body weight (SUVmax) and also by the mean of a 1-cc maximal uptake volume normalized by dose and lean-body-mass (SULpeak). The asymmetric repeatability coefficients with confidence intervals for SUVmax and SULpeak were used to determine the limits of 18F-FDG uptake variability. A second cohort of 28 breast cancer patients with bone-dominant metastases that had 146 metastatic bone lesions was imaged with 18F-FDG before and after standard-of-care therapy for response assessment. RESULTS The mean relative difference of SUVmax and SULpeak in 38 bone tumors of the first cohort were 4.3% and 6.7%. The upper and lower asymmetric limits of the repeatability coefficient were 19.4% and - 16.3% for SUVmax, and 21.2% and - 17.5% for SULpeak. 18F-FDG repeatability coefficient confidence intervals resulted in the following patient stratification using SULpeak for the second patient cohort: 11-progressive disease, 5-stable disease, 7-partial response, and 1-complete response with three inevaluable patients. The asymmetric repeatability coefficients response criteria for SULpeak changed the status of 3 patients compared to the standard Positron Emission Tomography Response Criteria in Solid Tumors of ± 30% SULpeak. CONCLUSION In evaluating bone tumor response for breast cancer patients with bone-dominant metastases using 18F-FDG SUVmax, the repeatability coefficients from test-retest studies show that reductions of more than 17% and increases of more than 20% are unlikely to be due to measurement variability. Serial 18F-FDG imaging in clinical trials investigating bone lesions in these patients, such as the ECOG-ACRIN EA1183 trial, benefit from confidence limits that allow interpretation of response.
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Affiliation(s)
- Mark Muzi
- Department of Radiology, University of Washington Medical Center, 1959 NE Pacific Street, UW Box 356465, Seattle, Washington, 98195, USA.
| | - Lanell M Peterson
- Department of Radiology, University of Washington Medical Center, 1959 NE Pacific Street, UW Box 356465, Seattle, Washington, 98195, USA
| | - Jennifer M Specht
- Department of Radiology, University of Washington Medical Center, 1959 NE Pacific Street, UW Box 356465, Seattle, Washington, 98195, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington Medical Center, 1959 NE Pacific Street, UW Box 356465, Seattle, Washington, 98195, USA
| | | | - Jean H Lee
- Department of Radiology, University of Washington Medical Center, 1959 NE Pacific Street, UW Box 356465, Seattle, Washington, 98195, USA
| | - Brenda F Kurland
- Department of Radiology, University of Washington Medical Center, 1959 NE Pacific Street, UW Box 356465, Seattle, Washington, 98195, USA
| | | | | | - Hannah M Linden
- Department of Radiology, University of Washington Medical Center, 1959 NE Pacific Street, UW Box 356465, Seattle, Washington, 98195, USA
| | - Paul E Kinahan
- Department of Radiology, University of Washington Medical Center, 1959 NE Pacific Street, UW Box 356465, Seattle, Washington, 98195, USA
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Muzi M, Peterson LM, Specht JM, Hippe DS, Novakova-Jiresova A, Lee JH, Kurland BF, Mankoff DA, Obuchowski N, Linden HM, Kinahan PE. Repeatability of 18F-FDG uptake in metastatic bone lesions of breast cancer patients and implications for accrual to clinical trials. RESEARCH SQUARE 2024:rs.3.rs-3818932. [PMID: 38313279 PMCID: PMC10836099 DOI: 10.21203/rs.3.rs-3818932/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
BACKGROUND Standard measures of response such as Response Evaluation Criteria in Solid Tumors are ineffective for bone lesions, often making breast cancer patients with bone-dominant metastases ineligible for clinical trials with potentially helpful therapies. In this study we prospectively evaluated the test-retest uptake variability of 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) in a cohort of breast cancer patients with bone-dominant metastases to determine response criteria. The thresholds for 95% specificity of change versus no-change were then applied to a second cohort of breast cancer patients with bone-dominant metastases.In this study, nine patients with 38 bone lesions were imaged with 18F-FDG in the same calibrated scanner twice within 14 days. Tumor uptake was quantified as the maximum tumor voxel normalized by dose and body weight (SUVmax) and the mean of a 1-cc maximal uptake volume normalized by dose and lean-body-mass (SULpeak). The asymmetric repeatability coefficients with confidence intervals of SUVmax and SULpeak were used to determine limits of 18F-FDG uptake variability. A second cohort of 28 breast cancer patients with bone-dominant metastases that had 146 metastatic bone lesions was imaged with 18F-FDG before and after standard-of-care therapy for response assessment. RESULTS The mean relative difference of SUVmax in 38 bone tumors of the first cohort was 4.3%. The upper and lower asymmetric limits of the repeatability coefficient were 19.4% and -16.3%, respectively. The 18F-FDG repeatability coefficient confidence intervals resulted in the following patient stratification for the second patient cohort: 11-progressive disease, 5-stable disease, 7-partial response, and 1-complete response with three inevaluable patients. The asymmetric repeatability coefficients response criteria changed the status of 3 patients compared to standard the standard Positron Emission Tomography Response Criteria in Solid Tumors of ±30% SULpeak. CONCLUSIONS In evaluating bone tumor response for breast cancer patients with bone-dominant metastases using 18F-FDG uptake, the repeatability coefficients from test-retest studies show that reductions of more than 17% and increases of more than 20% are unlikely to be due to measurement variability. Serial 18F-FDG imaging in clinical trials investigating bone lesions from these patients, such as the ECOG-ACRIN EA1183 trial, benefit from confidence limits that allow interpretation of response.
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Affiliation(s)
- Mark Muzi
- University of Washington School of Medicine
| | | | | | | | | | - Jean H Lee
- University of Washington Department of Radiology
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Sunassee ED, Jardim-Perassi BV, Madonna MC, Ordway B, Ramanujam N. Metabolic Imaging as a Tool to Characterize Chemoresistance and Guide Therapy in Triple-Negative Breast Cancer (TNBC). Mol Cancer Res 2023; 21:995-1009. [PMID: 37343066 PMCID: PMC10592445 DOI: 10.1158/1541-7786.mcr-22-1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/07/2023] [Accepted: 06/15/2023] [Indexed: 06/23/2023]
Abstract
After an initial response to chemotherapy, tumor relapse is frequent. This event is reflective of both the spatiotemporal heterogeneities of the tumor microenvironment as well as the evolutionary propensity of cancer cell populations to adapt to variable conditions. Because the cause of this adaptation could be genetic or epigenetic, studying phenotypic properties such as tumor metabolism is useful as it reflects molecular, cellular, and tissue-level dynamics. In triple-negative breast cancer (TNBC), the characteristic metabolic phenotype is a highly fermentative state. However, during treatment, the spatial and temporal dynamics of the metabolic landscape are highly unstable, with surviving populations taking on a variety of metabolic states. Thus, longitudinally imaging tumor metabolism provides a promising approach to inform therapeutic strategies, and to monitor treatment responses to understand and mitigate recurrence. Here we summarize some examples of the metabolic plasticity reported in TNBC following chemotherapy and review the current metabolic imaging techniques available in monitoring chemotherapy responses clinically and preclinically. The ensemble of imaging technologies we describe has distinct attributes that make them uniquely suited for a particular length scale, biological model, and/or features that can be captured. We focus on TNBC to highlight the potential of each of these technological advances in understanding evolution-based therapeutic resistance.
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Affiliation(s)
- Enakshi D. Sunassee
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | | | - Megan C. Madonna
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Bryce Ordway
- Department of Cancer Physiology, Moffitt Cancer Center, Tampa, FL 33612, USA
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Nirmala Ramanujam
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27708, USA
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Automated Optimized Synthesis of [ 18F]FLT Using Non-Basic Phase-Transfer Catalyst with Reduced Precursor Amount. Molecules 2022; 27:molecules27238323. [PMID: 36500417 PMCID: PMC9738687 DOI: 10.3390/molecules27238323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/13/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022] Open
Abstract
3′-deoxy-3′-[18F]fluorothymidine ([18F]FLT) is a positron emission tomography (PET) tracer useful for tumor proliferation assessment for a number of cancers, particularly in the cases of brain, lung, and breast tumors. At present [18F], FLT is commonly prepared by means of the nucleophilic radiofluorination of 3-N-Boc-5′-O-DMT-3′-O-nosyl thymidine precursor in the presence of a phase-transfer catalyst, followed by an acidic hydrolysis. To achieve high radiochemical yield, relatively large amounts of precursor (20−40 mg) are commonly used, leading to difficulties during purification steps, especially if a solid-phase extraction (SPE) approach is attempted. The present study describes an efficient method for [18F]FLT synthesis, employing tetrabutyl ammonium tosylate as a non-basic phase-transfer catalyst, with a greatly reduced amount of precursor employed. With a reduction of the precursor amount contributing to lower amounts of synthesis by-products in the reaction mixture, an SPE purification procedure using only two commercially available cartridges—OASIS HLB 6cc and Sep-Pak Alumina N Plus Light—has been developed for use on the GE TRACERlab FX N Pro synthesis module. [18F]FLT was obtained in radiochemical yield of 16 ± 2% (decay-corrected) and radiochemical purity >99% with synthesis time not exceeding 55 min. The product was formulated in 16 mL of normal saline with 5% ethanol (v/v). The amounts of chemical impurities and residual solvents were within the limits established by European Pharmacopoeia. The procedure described compares favorably with previously reported methods due to simplified automation, cheaper and more accessible consumables, and a significant reduction in the consumption of an expensive precursor.
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Comparison of 18F-fluorothymidine Positron Emission Tomography/Computed Tomography and 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Patients with Breast Cancer. Tomography 2022; 8:2533-2546. [PMID: 36287810 PMCID: PMC9611609 DOI: 10.3390/tomography8050211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/08/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022] Open
Abstract
The uptake of 18F-fluorothymidine (18F-FLT) depends on cells' proliferative rates. We compared the characteristics of 18F-FLT positron emission tomography/computed tomography (PET/CT) with those of 18F-fluorodeoxyglucose (18F-FDG) PET/CT for breast cancer. We prospectively diagnosed patients with breast cancer who underwent 18F-FLT PET/CT and 18F-FDG PET/CT. Subsequently, significant differences and correlation coefficients of the maximum standardized uptake value (SUVmax) in primary breast cancer and axillary lymph nodes were statistically evaluated. We enrolled eight patients with breast cancer. In six treatment-naive patients, the SUVmax for primary lesions showed a significant difference (mean, 2.1 vs. 4.1, p = 0.031) and a strong correlation (r = 0.969) between 18F-FLT and 18F-FDG. Further, although the SUVmax for the axillary lymph nodes did not show a significant difference between 18F-FLT and 18F-FDG (P = 0.246), there was a strong correlation between the two (r = 0.999). In a patient-by-patient study, there were cases in which only 18F-FDG uptake was observed in lymph nodes and normal breasts. Bone metastases demonstrated lower accumulation than bone marrow on the 18F-FLT PET/CT. In conclusion, a strong correlation was observed between the 18F-FLT PET/CT and 18F-FDG PET/CT uptake. Differences in the biochemical characteristics of 18F-FLT and 18F-FDG were reflected in the accumulation differences for breast cancer, metastatic lesions, and normal organs.
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Edmonds CE, O'Brien SR, Mankoff DA, Pantel AR. Novel applications of molecular imaging to guide breast cancer therapy. Cancer Imaging 2022; 22:31. [PMID: 35729608 PMCID: PMC9210593 DOI: 10.1186/s40644-022-00468-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
The goals of precision oncology are to provide targeted drug therapy based on each individual’s specific tumor biology, and to enable the prediction and early assessment of treatment response to allow treatment modification when necessary. Thus, precision oncology aims to maximize treatment success while minimizing the side effects of inadequate or suboptimal therapies. Molecular imaging, through noninvasive assessment of clinically relevant tumor biomarkers across the entire disease burden, has the potential to revolutionize clinical oncology, including breast oncology. In this article, we review breast cancer positron emission tomography (PET) imaging biomarkers for providing early response assessment and predicting treatment outcomes. For 2-18fluoro-2-deoxy-D-glucose (FDG), a marker of cellular glucose metabolism that is well established for staging multiple types of malignancies including breast cancer, we highlight novel applications for early response assessment. We then review current and future applications of novel PET biomarkers for imaging the steroid receptors, including the estrogen and progesterone receptors, the HER2 receptor, cellular proliferation, and amino acid metabolism.
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Affiliation(s)
- Christine E Edmonds
- Department of Radiology, Hospital of the University if Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Sophia R O'Brien
- Department of Radiology, Hospital of the University if Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - David A Mankoff
- Department of Radiology, Hospital of the University if Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Austin R Pantel
- Department of Radiology, Hospital of the University if Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
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Su TP, Huang JS, Chang PH, Lui KW, Hsieh JCH, Ng SH, Chan SC. Prospective comparison of early interim 18F-FDG-PET with 18F-FLT-PET for predicting treatment response and survival in metastatic breast cancer. BMC Cancer 2021; 21:908. [PMID: 34376155 PMCID: PMC8353848 DOI: 10.1186/s12885-021-08649-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/23/2021] [Indexed: 11/24/2022] Open
Abstract
Background To compare the value of interim 18F-FLT-PET and 18F-FDG-PET for predicting treatment outcomes in patients with metastatic breast cancer after salvage therapy. Methods Patients with metastatic breast cancer received PET/CT using 18F-FLT and 18F-FDG at baseline, after the 1st and 2nd cycle of systemic chemotherapy. The clinical response was classified according to Response Evaluation Criteria in Solid Tumors 1.1 based on contrast-enhanced CT after 3 months of systemic chemotherapy. The metabolic response on PET was assessed according to European Organization for Research and Treatment of Cancer criteria or PET Response Criteria in Solid Tumors (PERCIST) and was correlated to the clinical response, overall survival (OS), and progression-free survival (PFS). Results Twenty-five patients entered final analysis. On 18F-FDG-PET, clinical responders after 2 chemotherapy cycles (post-2c) had a significantly greater reduction of maximal standardized uptake value (SUV) and the peak SUV corrected for lean body mass (SULpeak) of the tumor than non-responders (P = 0.030 and 0.003). Metabolic response determined by PERCIST on post-2c 18F-FDG-PET showed a high area under the receiver operating characteristics curve of 0.801 in predicting clinical response (P = 0.011). Patients who were metabolic responders by PERCIST on post-2c 18F-FDG-PET had a significantly longer PFS (53.8% vs. 16.7%, P = 0.014) and OS (100% vs. 47.6%, P = 0.046) than non-responders. Survival differences between responders and non-responders in the interim 18F-FLT-PET were not significant. Conclusions 18F-FLT-PET failed to show an advantage over 18F-FDG-PET in predicting the treatment response and survival in patients with metastatic breast cancer. Assessment of treatment outcome by interim 18F-FDG-PET may aid treatment. Trial registration The study was retrospectively registered on 02/06/2020 on Clinicaltrials.gov (identifier NCT04411966).
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Affiliation(s)
- Tzu-Pei Su
- Department of Nuclear Medicine, Keelung Chang Gung Memorial Hospital, 222, Maijin Road, Keelung, 204, Taiwan
| | - Jen-Seng Huang
- Division of Hematology/Oncology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, 222, Maijin Road, Keelung, 204, Taiwan
| | - Pei-Hung Chang
- Division of Hematology/Oncology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, 222, Maijin Road, Keelung, 204, Taiwan
| | - Kar-Wai Lui
- Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 5 Fu-Shin Street, Kueishan, Taoyuan, 333, Taiwan
| | - Jason Chia-Hsun Hsieh
- Division of Hematology/Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 5 Fu-Shin Street, Kueishan, Taoyuan, 333, Taiwan
| | - Shu-Hang Ng
- Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 5 Fu-Shin Street, Kueishan, Taoyuan, 333, Taiwan
| | - Sheng-Chieh Chan
- Department of Nuclear Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707, Section 3, Chung-Yang Road, Hualien, 970, Taiwan. .,School of Medicine, Tzu Chi University, 701 Section 3, Zhong-Yang Road, Hualien, 970, Taiwan.
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Current development of sigma-2 receptor radioligands as potential tumor imaging agents. Bioorg Chem 2021; 115:105163. [PMID: 34289426 DOI: 10.1016/j.bioorg.2021.105163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 12/24/2022]
Abstract
Sigma receptors are transmembrane proteins with two different subtypes: σ1 and σ2. Because of its overexpression in tumors, the σ2 receptor (σ2R) is a well-known biomarker for cancer cells. A large number of small-molecule ligands for the σ2Rs have been identified and tested for imaging the proliferative status of tumors using single photon emission computed tomography (SPECT) and positron emission tomography (PET). These small molecules include derivatives of bicyclic amines, indoles, cyclohexylpiperazines and tetrahydroisoquinolines. This review discusses various aspects of small molecule ligands, such as chemical composition, labeling strategy, affinity for σ2Rs, and in vitro/in vivo investigations. The recent studies described here could be useful for the development of σ2R radioligands as potential tumor imaging agents.
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Romine PE, Peterson LM, Kurland BF, Byrd DW, Novakova-Jiresova A, Muzi M, Specht JM, Doot RK, Link JM, Krohn KA, Kinahan PE, Mankoff DA, Linden HM. 18F-fluorodeoxyglucose (FDG) PET or 18F-fluorothymidine (FLT) PET to assess early response to aromatase inhibitors (AI) in women with ER+ operable breast cancer in a window-of-opportunity study. Breast Cancer Res 2021; 23:88. [PMID: 34425871 PMCID: PMC8381552 DOI: 10.1186/s13058-021-01464-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/10/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE This study evaluated the ability of 18F-Fluorodeoxyglucose (FDG) and 18F-Fluorothymidine (FLT) imaging with positron emission tomography (PET) to measure early response to endocrine therapy from baseline to just prior to surgical resection in estrogen receptor positive (ER+) breast tumors. METHODS In two separate studies, women with early stage ER+ breast cancer underwent either paired FDG-PET (n = 22) or FLT-PET (n = 27) scans prior to endocrine therapy and again in the pre-operative setting. Tissue samples for Ki-67 were taken for all patients both prior to treatment and at the time of surgery. RESULTS FDG maximum standardized uptake value (SUVmax) declined in 19 of 22 lesions (mean 17% (range -45 to 28%)). FLT SUVmax declined in 24 of 27 lesions (mean 26% (range -77 to 7%)). The Ki-67 index declined in both studies, from pre-therapy (mean 23% (range 1 to 73%)) to surgery [mean 8% (range < 1 to 41%)]. Pre- and post-therapy PET measures showed strong rank-order agreement with Ki-67 percentages for both tracers; however, the percent change in FDG or FLT SUVmax did not demonstrate a strong correlation with Ki-67 index change or Ki-67 at time of surgery. CONCLUSIONS A window-of-opportunity approach using PET imaging to assess early response of breast cancer therapy is feasible. FDG and FLT-PET imaging following a short course of neoadjuvant endocrine therapy demonstrated measurable changes in SUVmax in early stage ER+ positive breast cancers. The percentage change in FDG and FLT-PET uptake did not correlate with changes in Ki-67; post-therapy SUVmax for both tracers was significantly associated with post-therapy Ki-67, an established predictor of endocrine therapy response.
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Affiliation(s)
- Perrin E. Romine
- grid.34477.330000000122986657Division of Medical Oncology, University of Washington/Seattle Cancer Care Alliance, 1144 Eastlake (Mail Stop LG-200), Seattle, WA 98109-1023 USA
| | - Lanell M. Peterson
- grid.34477.330000000122986657Division of Medical Oncology, University of Washington/Seattle Cancer Care Alliance, 1144 Eastlake (Mail Stop LG-200), Seattle, WA 98109-1023 USA
| | - Brenda F. Kurland
- grid.21925.3d0000 0004 1936 9000University of Pittsburgh, Pittsburgh, PA USA
| | - Darrin W. Byrd
- grid.34477.330000000122986657Department of Radiology, University of Washington, Seattle, WA USA
| | - Alena Novakova-Jiresova
- grid.4491.80000 0004 1937 116XDepartment of Oncology, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Mark Muzi
- grid.34477.330000000122986657Department of Radiology, University of Washington, Seattle, WA USA
| | - Jennifer M. Specht
- grid.34477.330000000122986657Division of Medical Oncology, University of Washington/Seattle Cancer Care Alliance, 1144 Eastlake (Mail Stop LG-200), Seattle, WA 98109-1023 USA
| | - Robert K. Doot
- grid.25879.310000 0004 1936 8972Department of Radiology, University of Pennsylvania, Philadelphia, PA USA
| | - Jeanne M. Link
- grid.5288.70000 0000 9758 5690Department of Diagnostic Radiology, Oregon Health and Science University, Portland, OR USA
| | - Kenneth A. Krohn
- grid.5288.70000 0000 9758 5690Department of Diagnostic Radiology, Oregon Health and Science University, Portland, OR USA
| | - Paul E. Kinahan
- grid.34477.330000000122986657Department of Radiology, University of Washington, Seattle, WA USA
| | - David A. Mankoff
- grid.25879.310000 0004 1936 8972Department of Radiology, University of Pennsylvania, Philadelphia, PA USA
| | - Hannah M. Linden
- grid.34477.330000000122986657Division of Medical Oncology, University of Washington/Seattle Cancer Care Alliance, 1144 Eastlake (Mail Stop LG-200), Seattle, WA 98109-1023 USA
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Gillman JA, Pantel AR, Mankoff DA, Edmonds CE. Update on Quantitative Imaging for Predicting and Assessing Response in Oncology. Semin Nucl Med 2020; 50:505-517. [PMID: 33059820 PMCID: PMC9788668 DOI: 10.1053/j.semnuclmed.2020.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Molecular imaging has revolutionized clinical oncology by imaging-specific facets of cancer biology. Through noninvasive measurements of tumor physiology, targeted radiotracers can serve as biomarkers for disease characterization, prognosis, response assessment, and predicting long-term response/survival. In turn, these imaging biomarkers can be utilized to tailor therapeutic regimens to tumor biology. In this article, we review biomarker applications for response assessment and predicting long-term outcomes. 18F-fluorodeoxyglucose (FDG), a measure of cellular glucose metabolism, is discussed in the context of lymphoma and breast and lung cancer. FDG has gained widespread clinical acceptance and has been integrated into the routine clinical care of several malignancies, most notably lymphoma. The novel radiotracers 16α-18F-fluoro-17β-estradiol and 18F-fluorothymidine are reviewed in application to the early prediction of response assessment of breast cancer. Through illustrative examples, we explore current and future applications of molecular imaging biomarkers in the advancement of precision medicine.
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Preclinical Molecular Imaging for Precision Medicine in Breast Cancer Mouse Models. CONTRAST MEDIA & MOLECULAR IMAGING 2019; 2019:8946729. [PMID: 31598114 PMCID: PMC6778915 DOI: 10.1155/2019/8946729] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/28/2019] [Accepted: 07/25/2019] [Indexed: 12/18/2022]
Abstract
Precision and personalized medicine is gaining importance in modern clinical medicine, as it aims to improve diagnostic precision and to reduce consequent therapeutic failures. In this regard, prior to use in human trials, animal models can help evaluate novel imaging approaches and therapeutic strategies and can help discover new biomarkers. Breast cancer is the most common malignancy in women worldwide, accounting for 25% of cases of all cancers and is responsible for approximately 500,000 deaths per year. Thus, it is important to identify accurate biomarkers for precise stratification of affected patients and for early detection of responsiveness to the selected therapeutic protocol. This review aims to summarize the latest advancements in preclinical molecular imaging in breast cancer mouse models. Positron emission tomography (PET) imaging remains one of the most common preclinical techniques used to evaluate biomarker expression in vivo, whereas magnetic resonance imaging (MRI), particularly diffusion-weighted (DW) sequences, has been demonstrated as capable of distinguishing responders from nonresponders for both conventional and innovative chemo- and immune-therapies with high sensitivity and in a noninvasive manner. The ability to customize therapies is desirable, as this will enable early detection of diseases and tailoring of treatments to individual patient profiles. Animal models remain irreplaceable in the effort to understand the molecular mechanisms and patterns of oncologic diseases.
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Mankoff DA, Pantel AR, Viswanath V, Karp JS. Advances in PET Diagnostics for Guiding Targeted Cancer Therapy and Studying In Vivo Cancer Biology. CURRENT PATHOBIOLOGY REPORTS 2019; 7:97-108. [PMID: 37092138 PMCID: PMC10117535 DOI: 10.1007/s40139-019-00202-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose of the Review We present an overview of recent advances in positron emission tomography (PET) diagnostics as applied to the study of cancer, specifically as a tool to study in vivo cancer biology and to direct targeted cancer therapy. The review is directed to translational and clinical cancer investigators who may not be familiar with these applications of PET cancer diagnostics, but whose research might benefit from these advancing tools. Recent Findings We highlight recent advances in 3 areas: (1) the translation of PET imaging cancer biomarkers to clinical trials; (2) methods for measuring cancer metabolism in vivo in patients; and (3) advances in PET instrumentation, including total-body PET, that enable new methodologies. We emphasize approaches that have been translated to human studies. Summary PET imaging methodology enables unique in vivo cancer diagnostics that go beyond cancer detection and staging, providing an improved ability to guide cancer treatment and an increased understanding of in vivo human cancer biology.
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Affiliation(s)
- David A Mankoff
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Austin R Pantel
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Varsha Viswanath
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joel S Karp
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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13
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Elmi A, McDonald ES, Mankoff D. Imaging Tumor Proliferation in Breast Cancer: Current Update on Predictive Imaging Biomarkers. PET Clin 2018; 13:445-457. [PMID: 30100082 DOI: 10.1016/j.cpet.2018.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Uncontrolled growth is a hallmark of cancer; imaging cell proliferation can provides an early indicator of therapeutic response. This capability is especially well-matched to the emerging cell cycle-specific chemotherapeutics with the goal of identifying patients that benefit from these treatments early in the course of treatment to guide personalized therapy. This article focuses on investigational cell proliferation imaging PET radiotracers to evaluate tumor proliferation in the setting of cell cycle-targeted chemotherapy and endocrine therapy for metastatic breast cancer.
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Affiliation(s)
- Azadeh Elmi
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Elizabeth S McDonald
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - David Mankoff
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Zhang J, Liu X, Knopp MI, Ramaswamy B, Knopp MV. How Long of a Dynamic 3'-Deoxy-3'-[ 18F]fluorothymidine ([ 18F]FLT) PET Acquisition Is Needed for Robust Kinetic Analysis in Breast Cancer? Mol Imaging Biol 2018; 21:382-390. [PMID: 29987617 DOI: 10.1007/s11307-018-1231-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To quantitatively evaluate the minimally required scanning time of 3'-deoxy-3'-[18F]fluorothymidine ([18F]FLT) positron emission tomography (PET) dynamic acquisition for accurate kinetic assessment of the proliferation in breast cancer tumors. PROCEDURES Within a therapeutic intervention trial, 26 breast tumors of 8 breast cancer patients were analyzed from 30-min dynamic [18F]FLT-PET acquisitions. PET/CT was acquired on a Gemini TF 64 system (Philips Healthcare) and reconstructed into 26 frames (8 × 15 s, 6 × 30 s, 5 × 1 min, 5 × 2 min, and 2 × 5 min). Maximum activity concentrations (Bq/ml) of volume of interests over tumors and plasma in descending aorta were obtained over time frames. Kinetic parameters were estimated using in-house developed software with the two-tissue three-compartment irreversible model (2TCM) (K1, k2, k3, and Ki; k4 = 0) and Patlak model (Ki) based on different acquisition durations (Td) (10, 12, 14, 16, 20, 25, and 30 min, separately). Different linear regression onset time (T0) points (1, 2, 3, 4, and 5 min) were applied in Patlak analysis. Ki of the 30-min data set was taken as the gold standard for comparison. Pearson product-moment correlation coefficient (R) of 0.9 was chosen as a limit for the correlation. RESULTS The correlation of kinetic parameters between the gold standard and the abbreviated dynamic data series increased with longer Td from 10 to 30 min. k2 and k3 using 2TCM and Ki using Patlak model revealed poor correlations for dynamic PET with Td ≤ 14 min (k2: R = 0.84, 0.85, 0.86; k3: R = 0.67, 0.67, 0.67; Ki: R = 0.72, 0.78, 0.87 at Td = 10, 12, and 14 min, respectively). Excellent correlations were shown for all kinetic parameters when Td ≥ 16 min regardless of the kinetic model and T0 value (R > 0.9). CONCLUSIONS This study indicates that a 16-min dynamic PET acquisition appears to be sufficient to provide accurate [18F]FLT kinetics to quantitatively assess the proliferation in breast cancer lesions.
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Affiliation(s)
- Jun Zhang
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Room 430, Columbus, OH, 43210-1228, USA
| | - Xiaoli Liu
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Room 430, Columbus, OH, 43210-1228, USA
| | - Michelle I Knopp
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Room 430, Columbus, OH, 43210-1228, USA
| | - Bhuvaneswari Ramaswamy
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Michael V Knopp
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Room 430, Columbus, OH, 43210-1228, USA.
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15
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Pharmacodynamic study using FLT PET/CT in advanced solid malignancies treated with a sequential combination of X-82 and docetaxel. Cancer Chemother Pharmacol 2018; 82:211-219. [PMID: 29802443 DOI: 10.1007/s00280-018-3599-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/03/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND A sequential approach, synchronizing cell-cycle specific chemotherapy during VEGFR-TKI treatment breaks, may improve the therapeutic index of this combination therapy. In this study we investigate the safety/tolerability and pharmacodynamic effects of docetaxel used in sequential combination with the novel VEGFR-TKI X-82. METHODS Patients with advanced solid malignancies underwent 21-day treatment cycles with X-82 administered daily on days 1-14, a treatment break on days 15-20, and docetaxel administered on day 21. Randomization was 1:1 to either a low-dose X-82 (200 mg) or high-dose X-82 (400 mg) arm. Patients were scheduled to undergo four 3'-deoxy-3'-18F-fluorothymidine (FLT) PET/CT scans to assess changes in tumor cell proliferation. PET standardized uptake values (SUV) were summarized for tumors and changes were assessed using mixed effects models. RESULTS 14 patients were enrolled and treated with median 3.5 cycles (range 0-12). Three patients in the high-dose cohort (50%) and three patients in the low-dose cohort (38%) experienced at least one grade 3 adverse event during the study (infections, cytopenias, electrolyte abnormalities, and vascular complications). Four patients with 13 metastatic tumors underwent FLT PET/CT scanning. During the cycle 1 X-82 exposure period, tumor SUVmax decreased by - 11% (p = 0.04). After administration of docetaxel and the cycle 2 X-82 exposure period, tumor SUVmax decreased - 44% (p = 0.03). CONCLUSIONS The sequential combination of X-82 and docetaxel was safe and led to diminished FLT uptake. Further, decrease in FLT uptake during cycle 2 (X-82 plus docetaxel) was greater than in cycle 1 (X-82 alone), suggesting sequential chemotherapy enhances the pharmacodynamic effect of therapy.
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16
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Raccagni I, Belloli S, Valtorta S, Stefano A, Presotto L, Pascali C, Bogni A, Tortoreto M, Zaffaroni N, Daidone MG, Russo G, Bombardieri E, Moresco RM. [18F]FDG and [18F]FLT PET for the evaluation of response to neo-adjuvant chemotherapy in a model of triple negative breast cancer. PLoS One 2018; 13:e0197754. [PMID: 29791503 PMCID: PMC5965848 DOI: 10.1371/journal.pone.0197754] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 05/08/2018] [Indexed: 12/31/2022] Open
Abstract
Rationale Pathological response to neo-adjuvant chemotherapy (NAC) represents a commonly used predictor of survival in triple negative breast cancer (TNBC) and the need to identify markers that predict response to NAC is constantly increasing. Aim of this study was to evaluate the potential usefulness of PET imaging with [18F]FDG and [18F]FLT for the discrimination of TNBC responders to Paclitaxel (PTX) therapy compared to the response assessed by an adapted Response Evaluation Criteria In Solid Tumors (RECIST) criteria based on tumor volume (Tumor Volume Response). Methods Nu/nu mice bearing TNBC lesions of different size were evaluated with [18F]FDG and [18F]FLT PET before and after PTX treatment. SUVmax, Metabolic Tumor Volume (MTV) and Total Lesion Glycolysis (TLG) and Proliferation (TLP) were assessed using a graph-based random walk algorithm. Results We found that in our TNBC model the variation of [18F]FDG and [18F]FLT SUVmax similarly defined tumor response to therapy and that SUVmax variation represented the most accurate parameter. Response evaluation using Tumor Volume Response (TVR) showed that the effectiveness of NAC with PTX was completely independent from lesions size at baseline. Conclusions Our study provided interesting results in terms of sensitivity and specificity of PET in TNBC, revealing the similar performances of [18F]FDG and [18F]FLT in the identification of responders to Paclitaxel.
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Affiliation(s)
- Isabella Raccagni
- Institute of Molecular Bioimaging and Physiology (IBFM), CNR, Segrate, Italy
- Tecnomed, Foundation of the University of Milano-Bicocca, Monza, Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Belloli
- Institute of Molecular Bioimaging and Physiology (IBFM), CNR, Segrate, Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Valtorta
- Institute of Molecular Bioimaging and Physiology (IBFM), CNR, Segrate, Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Medicine and Surgery Department, University of Milano-Bicocca, Monza, Italy
| | - Alessandro Stefano
- Institute of Molecular Bioimaging and Physiology (IBFM), CNR, Segrate, Italy
| | - Luca Presotto
- Nuclear Medicine Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Claudio Pascali
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Anna Bogni
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Tortoreto
- Molecular Pharmacology Unit, Experimental Oncology and Molecular Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nadia Zaffaroni
- Molecular Pharmacology Unit, Experimental Oncology and Molecular Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maria Grazia Daidone
- Biomarkers Unit, Experimental Oncology and Molecular Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giorgio Russo
- Institute of Molecular Bioimaging and Physiology (IBFM), CNR, Segrate, Italy
| | | | - Rosa Maria Moresco
- Institute of Molecular Bioimaging and Physiology (IBFM), CNR, Segrate, Italy
- Tecnomed, Foundation of the University of Milano-Bicocca, Monza, Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Medicine and Surgery Department, University of Milano-Bicocca, Monza, Italy
- * E-mail:
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17
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Jaffee EM, Dang CV, Agus DB, Alexander BM, Anderson KC, Ashworth A, Barker AD, Bastani R, Bhatia S, Bluestone JA, Brawley O, Butte AJ, Coit DG, Davidson NE, Davis M, DePinho RA, Diasio RB, Draetta G, Frazier AL, Futreal A, Gambhir SS, Ganz PA, Garraway L, Gerson S, Gupta S, Heath J, Hoffman RI, Hudis C, Hughes-Halbert C, Ibrahim R, Jadvar H, Kavanagh B, Kittles R, Le QT, Lippman SM, Mankoff D, Mardis ER, Mayer DK, McMasters K, Meropol NJ, Mitchell B, Naredi P, Ornish D, Pawlik TM, Peppercorn J, Pomper MG, Raghavan D, Ritchie C, Schwarz SW, Sullivan R, Wahl R, Wolchok JD, Wong SL, Yung A. Future cancer research priorities in the USA: a Lancet Oncology Commission. Lancet Oncol 2017; 18:e653-e706. [PMID: 29208398 PMCID: PMC6178838 DOI: 10.1016/s1470-2045(17)30698-8] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/23/2017] [Accepted: 08/23/2017] [Indexed: 12/12/2022]
Abstract
We are in the midst of a technological revolution that is providing new insights into human biology and cancer. In this era of big data, we are amassing large amounts of information that is transforming how we approach cancer treatment and prevention. Enactment of the Cancer Moonshot within the 21st Century Cures Act in the USA arrived at a propitious moment in the advancement of knowledge, providing nearly US$2 billion of funding for cancer research and precision medicine. In 2016, the Blue Ribbon Panel (BRP) set out a roadmap of recommendations designed to exploit new advances in cancer diagnosis, prevention, and treatment. Those recommendations provided a high-level view of how to accelerate the conversion of new scientific discoveries into effective treatments and prevention for cancer. The US National Cancer Institute is already implementing some of those recommendations. As experts in the priority areas identified by the BRP, we bolster those recommendations to implement this important scientific roadmap. In this Commission, we examine the BRP recommendations in greater detail and expand the discussion to include additional priority areas, including surgical oncology, radiation oncology, imaging, health systems and health disparities, regulation and financing, population science, and oncopolicy. We prioritise areas of research in the USA that we believe would accelerate efforts to benefit patients with cancer. Finally, we hope the recommendations in this report will facilitate new international collaborations to further enhance global efforts in cancer control.
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Affiliation(s)
| | - Chi Van Dang
- Ludwig Institute for Cancer Research New York, NY; Wistar Institute, Philadelphia, PA, USA.
| | - David B Agus
- University of Southern California, Beverly Hills, CA, USA
| | - Brian M Alexander
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | - Alan Ashworth
- University of California San Francisco, San Francisco, CA, USA
| | | | - Roshan Bastani
- Fielding School of Public Health and the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
| | - Sangeeta Bhatia
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jeffrey A Bluestone
- University of California San Francisco, San Francisco, CA, USA; Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | | | - Atul J Butte
- University of California San Francisco, San Francisco, CA, USA
| | - Daniel G Coit
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Nancy E Davidson
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA
| | - Mark Davis
- California Institute for Technology, Pasadena, CA, USA
| | | | | | - Giulio Draetta
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A Lindsay Frazier
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Andrew Futreal
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Patricia A Ganz
- Fielding School of Public Health and the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
| | - Levi Garraway
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; The Broad Institute, Cambridge, MA, USA; Eli Lilly and Company, Boston, MA, USA
| | | | - Sumit Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, Faculty of Medicine and IHPME, University of Toronto, Toronto, Canada
| | - James Heath
- California Institute for Technology, Pasadena, CA, USA
| | - Ruth I Hoffman
- American Childhood Cancer Organization, Beltsville, MD, USA
| | - Cliff Hudis
- Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Chanita Hughes-Halbert
- Medical University of South Carolina and the Hollings Cancer Center, Charleston, SC, USA
| | - Ramy Ibrahim
- Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - Hossein Jadvar
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado, Denver, CO, USA
| | - Rick Kittles
- College of Medicine, University of Arizona, Tucson, AZ, USA; University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | | | - Scott M Lippman
- University of California San Diego Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - David Mankoff
- Department of Radiology and Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elaine R Mardis
- The Institute for Genomic Medicine at Nationwide Children's Hospital Columbus, OH, USA; College of Medicine, Ohio State University, Columbus, OH, USA
| | - Deborah K Mayer
- University of North Carolina Lineberger Cancer Center, Chapel Hill, NC, USA
| | - Kelly McMasters
- The Hiram C Polk Jr MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | | | | | - Peter Naredi
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dean Ornish
- University of California San Francisco, San Francisco, CA, USA
| | - Timothy M Pawlik
- Department of Surgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | | | - Martin G Pomper
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Derek Raghavan
- Levine Cancer Institute, Carolinas HealthCare, Charlotte, NC, USA
| | | | - Sally W Schwarz
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | | | - Richard Wahl
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Jedd D Wolchok
- Ludwig Center for Cancer Immunotherapy, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Parker Institute for Cancer Immunotherapy, San Francisco, CA, USA
| | - Sandra L Wong
- Department of Surgery, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Alfred Yung
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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18
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Advantages of 18F FDG-PET/CT over Conventional Staging for Sarcoma Patients. Pathol Oncol Res 2017; 25:131-136. [DOI: 10.1007/s12253-017-0325-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
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19
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Sharma R, Mapelli P, Hanna GB, Goldin R, Power D, Al-Nahhas A, Merchant S, Ramaswami R, Challapalli A, Barwick T, Aboagye EO. Evaluation of 18F-fluorothymidine positron emission tomography ([ 18F]FLT-PET/CT) methodology in assessing early response to chemotherapy in patients with gastro-oesophageal cancer. EJNMMI Res 2016; 6:81. [PMID: 27854031 PMCID: PMC5112222 DOI: 10.1186/s13550-016-0234-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 10/29/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND 3'-Deoxy-3'-[18F]fluorothymidine ([18F]FLT) PET has limited utility in abdominal imaging due to high physiological hepatic uptake of a tracer. We evaluated [18F]FLT-PET/CT combined with a temporal-intensity information-based voxel-clustering approach termed kinetic spatial filtering (KSF) to improve tumour visualisation in patients with locally advanced and metastatic gastro-oesophageal cancer and as a marker of early response to chemotherapy. Dynamic [18F]FLT-PET/CT data were collected before and 3 weeks post first cycle of chemotherapy. Changes in tumour [18F]FLT-PET/CT variables were determined. Response was determined on contrast-enhanced CT after three cycles of therapy using RECIST 1.1. RESULTS Ten patients were included. Following application of the KSF, visual distinction of all oesophageal and/or gastric tumours was observed in [18F]FLT-PET images. Among the nine patients available for response evaluation (RECIST 1.1), three patients had responded (partial response) and six patients were non-responders (stable disease). There was a significant association between Ki-67 and all baseline [18F]FLT-PET parameters. Area under the curve (AUC) from 0 to 1 min was associated with treatment response. CONCLUSIONS The results of this study indicate that application of the KSF allowed accurate visualisation of both primary and metastatic lesions following imaging with the proliferation marker, [18F]FLT-PET/CT. However, [18F]FLT-PET uptake parameters did not correlate with response. Instead, we observe significant changes in tracer delivery following chemotherapy suggesting that further [18F]FLT-PET/CT studies in this tumour type should be undertaken with caution.
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Affiliation(s)
- R Sharma
- Department of Surgery and Cancer, Imperial College London, London, UK.
- Medical Oncology and Clinical Pharmacology, Imperial College London, Hammersmith Campus, Du Cane Road, W12 0HS, London, UK.
| | - P Mapelli
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - G B Hanna
- Department of Gastro-Oesophageal Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - R Goldin
- Department of Pathology, Imperial College Healthcare NHS Trust, London, UK
| | - D Power
- Department of Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - A Al-Nahhas
- Department of Radiology/Nuclear Medicine, Imperial College Healthcare NHS Trust, London, UK
- Medical Oncology and Clinical Pharmacology, Imperial College London, Hammersmith Campus, Du Cane Road, W12 0HS, London, UK
| | - S Merchant
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - R Ramaswami
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Challapalli
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - T Barwick
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Radiology/Nuclear Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - E O Aboagye
- Department of Surgery and Cancer, Imperial College London, London, UK
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20
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Abstract
Precision medicine, basing treatment approaches on patient traits and specific molecular features of disease processes, has an important role in the management of patients with breast cancer as targeted therapies continue to improve. PET imaging offers noninvasive information that is complementary to traditional tissue biomarkers, including information about tumor burden, tumor metabolism, receptor status, and proliferation. Several PET agents that image breast cancer receptors can visually demonstrate the extent and heterogeneity of receptor-positive disease and help predict which tumors are likely to respond to targeted treatments. This review presents applications of PET imaging in the targeted treatment of breast cancer.
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Affiliation(s)
- Amy V Chudgar
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - David A Mankoff
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, University of Pennsylvania, Donner 116, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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21
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The application of positron emission tomography (PET/CT) in diagnosis of breast cancer. Part II. Diagnosis after treatment initiation, future perspectives. Contemp Oncol (Pozn) 2016; 20:205-9. [PMID: 27647983 PMCID: PMC5013681 DOI: 10.5114/wo.2016.61560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 07/20/2015] [Indexed: 11/17/2022] Open
Abstract
Similarly to the applications described in the first part of this publication, positron emission tomography with computed tomography (PET/CT) is also gaining importance in monitoring a tumour's response to therapy and diagnosing breast cancer recurrences. This is additionally caused by the fact that many new techniques (dual-time point imaging, positron emission tomography with magnetic resonance PET/MR, PET/CT mammography) and radiotracers (16α-18F-fluoro-17β-estradiol, 18F-fluorothymidine) are under investigation. The highest sensitivity and specificity when monitoring response to treatment is achieved when the PET/CT scan is made after one or two chemotherapy courses. Response to anti-hormonal treatment can also be monitored, also when new radiotracers, such as FES, are used. When monitoring breast cancer recurrences during follow-up, PET/CT has higher sensitivity than conventional imaging modalities, making it possible to monitor the whole body simultaneously. New techniques and radiotracers enhance the sensitivity and specificity of PET and this is why, despite relatively high costs, it might become more widespread in monitoring response to treatment and breast cancer recurrences.
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22
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Kenny L. The Use of Novel PET Tracers to Image Breast Cancer Biologic Processes Such as Proliferation, DNA Damage and Repair, and Angiogenesis. J Nucl Med 2016; 57 Suppl 1:89S-95S. [PMID: 26834108 DOI: 10.2967/jnumed.115.157958] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The balance between proliferation and cell death is pivotal to breast tumor growth. Because of a combination of environmental and genetic factors leading to activation of oncogenes or inactivation of tumor suppressor genes, these processes become deregulated in cancer. PET imaging of proliferation, angiogenesis, and DNA damage and repair offers the opportunity to monitor therapeutic efficacy to detect changes in tumor biology that may precede physical size reduction and simultaneously allows the study of intratumoral and intertumoral heterogeneity.This review examines recent developments in breast cancer imaging using novel probes. The probes discussed here are not licensed for routine use and are at various stages of development ranging from preclinical development (e.g., the DNA repair marker γH2AX) to clinical validation in larger studies (such as the proliferation probe 3'-deoxy-3'-(18)F-fluorothymidine [(18)F-FLT]). In breast cancer, most studies have focused on proliferation imaging mainly based on (18)F-labeled thymidine analogs. Initial studies have been promising; however, the results of larger validation studies are necessary before being incorporated into routine clinical use. Although there are distinct advantages in using process-specific probes, properties such as metabolism need careful consideration, because high background uptake in the liver due to glucuronidation in the case of (18)F-FLT may limit utility for imaging of liver metastases.Targeting angiogenesis has had some success in tumors such as renal cell carcinoma; however, angiogenesis inhibitors have not been particularly successful in the clinical treatment of breast cancer. This could be potentially attributed to patient selection due to the lack of validated predictive and responsive biomarkers; the quest for a successful noninvasive biomarker for angiogenesis could solve this challenge. Finally, we look at cell death including apoptosis and DNA damage and repair probes, the most well-studied example being (18)F-annexin V; more recently, probes that target caspase endoproteases have been developed and are undergoing early clinical validation studies.Further clinical studies including analysis of test-retest variability are essential to determine sensitivity and future utility of these probes in breast cancer.
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Affiliation(s)
- Laura Kenny
- Department of Surgery and Cancer, Comprehensive Cancer Imaging Center, Imperial College London, London, United Kingdom
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23
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van Es SC, Venema CM, Glaudemans AWJM, Lub-de Hooge MN, Elias SG, Boellaard R, Hospers GAP, Schröder CP, de Vries EGE. Translation of New Molecular Imaging Approaches to the Clinical Setting: Bridging the Gap to Implementation. J Nucl Med 2016; 57 Suppl 1:96S-104S. [PMID: 26834109 DOI: 10.2967/jnumed.115.157974] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Molecular imaging with PET is a rapidly emerging technique. In breast cancer patients, more than 45 different PET tracers have been or are presently being tested. With a good rationale, after development of the tracer and proven feasibility, it is of interest to evaluate whether there is a potential meaningful role for the tracer in the clinical setting-such as in staging, in the (early) prediction of a treatment response, or in supporting drug choices. So far, only (18)F-FDG PET has been incorporated into breast cancer guidelines. For proof of the clinical relevance of tracers, especially for analysis in a multicenter setting, standardization of the technology and access to the novel PET tracer are required. However, resources for PET implementation research are limited. Therefore, next to randomized studies, novel approaches are required for proving the clinical value of PET tracers with the smallest possible number of patients. The aim of this review is to describe the process of the development of PET tracers and the level of evidence needed for the use of these tracers in breast cancer. Several breast cancer trials have been performed with the PET tracers (18)F-FDG, 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT), and (18)F-fluoroestradiol ((18)F-FES). We studied them to learn lessons for the implementation of novel tracers. After defining the gap between a good rationale for a tracer and implementation in the clinical setting, we propose solutions to fill the gap to try to bring more PET tracers to daily clinical practice.
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Affiliation(s)
- Suzanne C van Es
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Clasina M Venema
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marjolijn N Lub-de Hooge
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ronald Boellaard
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Carolina P Schröder
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;
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A systematic review on [(18)F]FLT-PET uptake as a measure of treatment response in cancer patients. Eur J Cancer 2016; 55:81-97. [PMID: 26820682 DOI: 10.1016/j.ejca.2015.11.018] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 11/15/2015] [Indexed: 12/19/2022]
Abstract
Imaging biomarkers have a potential to depict the hallmarks of cancers that characterise cancer cells as compared to normal cells. One pertinent example is 3'-deoxy-3'-(18)F-fluorothymidine positron emission tomography ([(18)F]FLT-PET), which allows non-invasive in vivo assessment of tumour proliferation. Most importantly, [(18)F]FLT does not seem to be accumulating in inflammatory processes, as seen in [(18)F]-fludeoxyglucose, the most commonly used PET tracer for assessment of cell metabolism. [(18)F]FLT could therefore provide additional information about the tumour biology before, during and after treatment. This systematic review focuses on the use of [(18)F]FLT-PET tumour uptake values as a measure of tumour response to therapeutic interventions. The clinical studies which evaluated the role of [(18)F]FLT-PET as a measure of tumour response to treatment are summarised and the evidence linking [(18)F]FLT-PET tumour uptake values with clinical outcome is evaluated.
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Abstract
Breast cancer is the most common malignancy in females. Imaging plays a critical role in diagnosis, staging and surveillance, and management of disease. Fluorodeoxyglucose (FDG) PET the imaging is indicated in specific clinical setting. Sensitivity of detection depends on tumor histology and size. Whole body FDG PET can change staging and management. In recurrent disease, distant metastasis can be detected. FDG PET imaging has prognostic and predictive value. PET/MR is evolving rapidly and may play a role management, assessment of metastatic lesions, and treatment monitoring. This review discusses current PET modalities, focusing on of FDG PET imaging and novel tracers.
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Affiliation(s)
- Lizza Lebron
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Daniel Greenspan
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Neeta Pandit-Taskar
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Tran LBA, Bol A, Labar D, Karroum O, Mignion L, Bol V, Jordan BF, Grégoire V, Gallez B. DW-MRI and18F-FLT PET for early assessment of response to radiation therapy associated with hypoxia-driven interventions. Preclinical studies using manipulation of oxygenation and/or dose escalation. CONTRAST MEDIA & MOLECULAR IMAGING 2015; 11:115-21. [DOI: 10.1002/cmmi.1670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 07/17/2015] [Accepted: 09/03/2015] [Indexed: 01/17/2023]
Affiliation(s)
- Ly-Binh-An Tran
- Louvain Drug Research Institute, Biomedical Magnetic Resonance Research Group; Université catholique de Louvain; Brussels Belgium
| | - Anne Bol
- Institut de Recherche Expérimentale et Clinique, Center for Molecular Imaging, Radiotherapy and Oncology; Université catholique de Louvain; Brussels Belgium
| | - Daniel Labar
- Institut de Recherche Expérimentale et Clinique, Center for Molecular Imaging, Radiotherapy and Oncology; Université catholique de Louvain; Brussels Belgium
| | - Oussama Karroum
- Louvain Drug Research Institute, Biomedical Magnetic Resonance Research Group; Université catholique de Louvain; Brussels Belgium
| | - Lionel Mignion
- Louvain Drug Research Institute, Biomedical Magnetic Resonance Research Group; Université catholique de Louvain; Brussels Belgium
| | - Vanesa Bol
- Institut de Recherche Expérimentale et Clinique, Center for Molecular Imaging, Radiotherapy and Oncology; Université catholique de Louvain; Brussels Belgium
| | - Bénédicte F. Jordan
- Louvain Drug Research Institute, Biomedical Magnetic Resonance Research Group; Université catholique de Louvain; Brussels Belgium
| | - Vincent Grégoire
- Institut de Recherche Expérimentale et Clinique, Center for Molecular Imaging, Radiotherapy and Oncology; Université catholique de Louvain; Brussels Belgium
| | - Bernard Gallez
- Louvain Drug Research Institute, Biomedical Magnetic Resonance Research Group; Université catholique de Louvain; Brussels Belgium
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Integration of imaging into clinical practice to assess the delivery and performance of macromolecular and nanotechnology-based oncology therapies. J Control Release 2015; 219:295-312. [PMID: 26403800 DOI: 10.1016/j.jconrel.2015.09.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/19/2015] [Accepted: 09/19/2015] [Indexed: 01/02/2023]
Abstract
Functional and molecular imaging has become increasingly used to evaluate interpatient and intrapatient tumor heterogeneity. Imaging allows for assessment of microenvironment parameters including tumor hypoxia, perfusion and proliferation, as well as tumor metabolism and the intratumoral distribution of specific molecular markers. Imaging information may be used to stratify patients for targeted therapies, and to define patient populations that may benefit from alternative therapeutic approaches. It also provides a method for non-invasive monitoring of treatment response at earlier time-points than traditional cues, such as tumor shrinkage. Further, companion diagnostic imaging techniques are becoming progressively more important for development and clinical implementation of targeted therapies. Imaging-based companion diagnostics are likely to be essential for the validation and FDA approval of targeted nanotherapies and macromolecular medicines. This review describes recent clinical advances in the use of functional and molecular imaging to evaluate the tumor microenvironment. Additionally, this article focuses on image-based assessment of distribution and anti-tumor effect of nano- and macromolecular systems.
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Kostakoglu L, Duan F, Idowu MO, Jolles PR, Bear HD, Muzi M, Cormack J, Muzi JP, Pryma DA, Specht JM, Hovanessian-Larsen L, Miliziano J, Mallett S, Shields AF, Mankoff DA. A Phase II Study of 3'-Deoxy-3'-18F-Fluorothymidine PET in the Assessment of Early Response of Breast Cancer to Neoadjuvant Chemotherapy: Results from ACRIN 6688. J Nucl Med 2015; 56:1681-9. [PMID: 26359256 DOI: 10.2967/jnumed.115.160663] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/18/2015] [Indexed: 12/24/2022] Open
Abstract
UNLABELLED Our objective was to determine whether early change in standardized uptake values (SUVs) of 3'deoxy-3'-(18)F-fluorothymidine ((18)F-FLT) using PET with CT could predict pathologic complete response (pCR) of primary breast cancer to neoadjuvant chemotherapy (NAC). The key secondary objective was to correlate SUV with the proliferation marker Ki-67 at baseline and after NAC. METHODS This prospective, multicenter phase II study did not specify the therapeutic regimen, thus, NAC varied among centers. All evaluable patients underwent (18)F-FLT PET/CT at baseline (FLT1) and after 1 cycle of NAC (FLT2); 43 patients were imaged at FLT1, FLT2, and after NAC completion (FLT3). The percentage change in maximum SUV (%ΔSUVmax) between FLT1 and FLT2 and FLT3 was calculated for the primary tumors. The predictive value of ΔSUVmax for pCR was determined using receiver-operating-characteristic curve analysis. The correlation between SUVmax and Ki-67 was also assessed. RESULTS Fifty-one of 90 recruited patients (median age, 54 y; stage IIA-IIIC) met the eligibility criteria for the primary objective analysis, with an additional 22 patients totaling 73 patients for secondary analyses. A pCR in the primary breast cancer was achieved in 9 of 51 patients. NAC resulted in a significant reduction in %SUVmax (mean Δ, 39%; 95% confidence interval, 31-46). There was a marginal difference in %ΔSUVmax_FLT1-FLT2 between pCR and no-pCR patient groups (Wilcoxon 1-sided P = 0.050). The area under the curve for ΔSUVmax in the prediction of pCR was 0.68 (90% confidence interval, 0.50-0.83; Delong 1-sided P = 0.05), with slightly better predictive value for percentage mean SUV (P = 0.02) and similar prediction for peak SUV (P = 0.04). There was a weak correlation with pretherapy SUVmax and Ki-67 (r = 0.29, P = 0.04), but the correlation between SUVmax and Ki-67 after completion of NAC was stronger (r = 0.68, P < 0.0001). CONCLUSION (18)F-FLT PET imaging of breast cancer after 1 cycle of NAC weakly predicted pCR in the setting of variable NAC regimens. Posttherapy (18)F-FLT uptake correlated with Ki-67 on surgical specimens. These results suggest some efficacy of (18)F-FLT as an indicator of early therapeutic response of breast cancer to NAC and support future multicenter studies to test (18)F-FLT PET in a more uniformly treated patient population.
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Affiliation(s)
- Lale Kostakoglu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Fenghai Duan
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | | | - Paul R Jolles
- Virginia Commonwealth University, Richmond, Virginia
| | - Harry D Bear
- Virginia Commonwealth University, Richmond, Virginia Massey Cancer Center of Virginia Commonwealth University, Richmond, Virginia
| | - Mark Muzi
- University of Washington, Seattle, Washington
| | - Jean Cormack
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - John P Muzi
- University of Washington, Seattle, Washington
| | - Daniel A Pryma
- Abramson Cancer Center and Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | - Sharon Mallett
- American College of Radiology Imaging Network (ACRIN), Philadelphia, Pennsylvania; and
| | - Anthony F Shields
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
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Challapalli A, Barwick T, Pearson RA, Merchant S, Mauri F, Howell EC, Sumpter K, Maxwell RJ, Aboagye EO, Sharma R. 3'-Deoxy-3'-¹⁸F-fluorothymidine positron emission tomography as an early predictor of disease progression in patients with advanced and metastatic pancreatic cancer. Eur J Nucl Med Mol Imaging 2015; 42:831-40. [PMID: 25673055 DOI: 10.1007/s00259-015-3000-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 01/16/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE 3'-Deoxy-3'-(18)F-fluorothymidine (FLT) positron emission tomography (PET) has limited utility in abdominal imaging due to high physiological hepatic uptake of tracer. We evaluated FLT PET/CT combined with a temporal-intensity information-based voxel-clustering approach termed kinetic spatial filtering (FLT PET/CTKSF) for early prediction of response and survival outcomes in locally advanced and metastatic pancreatic cancer patients receiving gemcitabine-based chemotherapy. METHODS Dynamic FLT PET/CT data were collected before and 3 weeks after the first cycle of chemotherapy. Changes in tumour FLT PET/CT variables were determined. The primary end point was RECIST 1.1 response on contrast-enhanced CT after 3 months of therapy. RESULTS Twenty patients were included. Visual distinction between tumours and normal pancreas was seen in FLT PETKSF images. All target lesions (>2 cm), including all primary pancreatic tumours, were visualised. Of the 11 liver metastases, 3 (<2 cm) were not visible after kinetic filtering. Of the 20 patients, 7 progressed (35%). Maximum standardised uptake value at 60 min post-injection (SUV60,max) significantly increased in patients with disease progression (p = 0.04). Receiver-operating characteristic curve analysis indicated that a threshold of SUV60,max increase of ≥ 12% resulted in sensitivity, specificity and positive predictive value (PPV) of 71, 100 and 100%, respectively [area under the curve (AUC) 0.90, p = 0.0001], to predict patients with disease progression. Changes in SUV60,max were not predictive of survival. CONCLUSION FLT PET/CT detected changes in proliferation, with early increase in SUV60,max predicting progressive disease with a high specificity and PPV. Therefore, FLT PET/CT could be used as an early response biomarker for gemcitabine-based chemotherapy, to select a poor prognostic group who may benefit from novel therapeutic agents in advanced and metastatic pancreatic cancer.
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Groheux D, Majdoub M, Sanna A, de Cremoux P, Hindié E, Giacchetti S, Martineau A, de Roquancourt A, Merlet P, Visvikis D, Resche-Rigon M, Hatt M, Espié M. Early Metabolic Response to Neoadjuvant Treatment: FDG PET/CT Criteria according to Breast Cancer Subtype. Radiology 2015; 277:358-71. [PMID: 25915099 DOI: 10.1148/radiol.2015141638] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To investigate parameters based on fluorine 18 fluorodeoxyglucose (FDG) positron emission tomographic (PET) imaging that are best correlated with pathologic complete response (PCR) in human epidermal growth factor receptor type 2 (HER2)-positive cancer and triple-negative breast cancer (TNBC) and with partial or complete response in ER-positive/HER2-negative breast cancer. MATERIALS AND METHODS This study was approved by institutional review board with waivers of informed written consent and included consecutive patients treated by neoadjuvant chemotherapy. Five PET examination-derived parameters were tested: standard uptake value (SUV) maximum (SUV(max)), peak (SUV(peak)), and mean (SUV(mean)), metabolically active tumor volume, and total lesion glycolysis (TLG). Absolute values at baseline PET, at PET imaging after two cycles of chemotherapy, and variation (ie, change) were measured. Correlations with pathologic response (Wilcoxon rank-sum test) and predictive power assessed (area under the curve [AUC] on the basis of receiver operating characteristic analysis) were examined. RESULTS Included were 169 consecutive patients (mean age, 50 years). PCR was more frequent in HER2-positive tumors (16 of 33 patients [48.5%]) and TNBCs (20 of 54 patients [37%]) than in ER positive/HER2-negative tumors (four of 82 [4.9%]) (P < .001). Among patients with ER-positive/HER2-negative cancers, 33 patients had partial response. In TNBC, best association with PCR was obtained with change in SUV(max) (AUC, 0.86) or change in TLG (AUC, 0.88). In HER2-positive phenotype, absolute SUV(max) (or SUV(peak)) values at PET imaging after two cycles of chemotherapy (AUC for each cycle, 0.93) were better correlated with PCR than change in SUV(max) (AUC, 0.78; P = .11) or change in TLG (AUC, 0.62; P = .005). Regarding ER-positive/HER2-negative cancers, change in SUV(max) or change in TLG (AUC, 0.75) were parameters best correlated with partial or complete response. Baseline SUV(max) was higher in lymph nodes than in primary tumor in 31 patients. Findings were similar considering the site with highest FDG uptake. CONCLUSION Quantitative indexes of tumor glucose use that are best correlated with pathologic response vary by phenotype: change in SUV(max) or TLG are most adequate for TNBCs and ER-positive/ HER2-negative cancers and absolute SUV(max) after two cycles of chemotherapy for HER2-positive breast cancers.
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Affiliation(s)
- David Groheux
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Mohamed Majdoub
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Alice Sanna
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Patricia de Cremoux
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Elif Hindié
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Sylvie Giacchetti
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Antoine Martineau
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Anne de Roquancourt
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Pascal Merlet
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Dimitris Visvikis
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Matthieu Resche-Rigon
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Mathieu Hatt
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
| | - Marc Espié
- From the Department of Nuclear Medicine (D.G., A.M., P.M.), Department of Statistical Sciences (A.S., M.R.R.), Department of Biochemistry (P.d.C.), Breast Diseases Unit and Department of Medical Oncology (S.G., M.E.), and Department of Pathology (A.d.R.), Saint-Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France; INSERM, UMR 1101 LaTIM, Brest, France (M.M., D.V., M.H.); Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, Bordeaux, France (E.H.); and B2T, Doctoral School, IUH, University of Paris VII, Paris, France (D.G., P.M.)
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Dubash SR, Idowu OA, Sharma R. The emerging role of positron emission tomography in hepatocellular carcinoma. Hepat Oncol 2015; 2:191-200. [PMID: 30190998 DOI: 10.2217/hep.15.6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer mortality worldwide. HCC a heterogeneous disease occurring on the background of cirrhosis. The presence of cirrhosis limits the sensitivity of conventional imaging modalities in differentiating HCC from surrounding cirrhotic parenchyma. Positron emission tomography (PET) using 18F-fluorodeoxyglucose (18F-FDG) is widely used for assessing a variety of malignancies, however, has poor sensitivity in the evaluation of HCC. This has led to the investigation of other radiotracers such as 11C-acetate and 11C-choline, with improved sensitivity in terms of detection and therapeutic response. In this review, we discuss the emerging field of PET imaging for the detection, staging and assessment of treatment response in HCC. In particular we discuss the role of 18F-FDG-PET in imaging hepatocellular cancer, the limitations of this PET tracer and emerging novel PET tracers being investigated that exploit key metabolic processes including fatty acid and lipid synthesis, choline kinase activity and gene expression.
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Affiliation(s)
- Suraiya R Dubash
- Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, UK.,Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, UK
| | - Oluwagbemiga A Idowu
- Department of Medical Oncology, Hammersmith Hospital, London, UK.,Department of Medical Oncology, Hammersmith Hospital, London, UK
| | - Rohini Sharma
- Division of Translational & Experimental Medicine, Imperial College London, Hammersmith Campus, Du Cane Road, London, UK.,Medical Oncology & Clinical Pharmacology, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK.,Division of Translational & Experimental Medicine, Imperial College London, Hammersmith Campus, Du Cane Road, London, UK.,Medical Oncology & Clinical Pharmacology, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK
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Hoyng LL, Frings V, Hoekstra OS, Kenny LM, Aboagye EO, Boellaard R. Metabolically active tumour volume segmentation from dynamic [(18)F]FLT PET studies in non-small cell lung cancer. EJNMMI Res 2015; 5:26. [PMID: 25932353 PMCID: PMC4409618 DOI: 10.1186/s13550-015-0102-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 12/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Positron emission tomography (PET) with (18)F-3'-deoxy-3'-fluorothymidine ([(18)F]FLT) can be used to assess tumour proliferation. A kinetic-filtering (KF) classification algorithm has been suggested for segmentation of tumours in dynamic [(18)F]FLT PET data. The aim of the present study was to evaluate KF segmentation and its test-retest performance in [(18)F]FLT PET in non-small cell lung cancer (NSCLC) patients. METHODS Nine NSCLC patients underwent two 60-min dynamic [(18)F]FLT PET scans within 7 days prior to treatment. Dynamic scans were reconstructed with filtered back projection (FBP) as well as with ordered subsets expectation maximisation (OSEM). Twenty-eight lesions were identified by an experienced physician. Segmentation was performed using KF applied to the dynamic data set and a source-to-background corrected 50% threshold (A50%) was applied to the sum image of the last three frames (45- to 60-min p.i.). Furthermore, several adaptations of KF were tested. Both for KF and A50% test-retest (TRT) variability of metabolically active tumour volume and standard uptake value (SUV) were evaluated. RESULTS KF performed better on OSEM- than on FBP-reconstructed PET images. The original KF implementation segmented 15 out of 28 lesions, whereas A50% segmented each lesion. Adapted KF versions, however, were able to segment 26 out of 28 lesions. In the best performing adapted versions, metabolically active tumour volume and SUV TRT variability was similar to those of A50%. KF misclassified certain tumour areas as vertebrae or liver tissue, which was shown to be related to heterogeneous [(18)F]FLT uptake areas within the tumour. CONCLUSIONS For [(18)F]FLT PET studies in NSCLC patients, KF and A50% show comparable tumour volume segmentation performance. The KF method needs, however, a site-specific optimisation. The A50% is therefore a good alternative for tumour segmentation in NSCLC [(18)F]FLT PET studies in multicentre studies. Yet, it was observed that KF has the potential to subsegment lesions in high and low proliferative areas.
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Affiliation(s)
- Lieke L Hoyng
- />Department of Radiology & Nuclear Medicine, VU University Medical Center (VUmc), P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Virginie Frings
- />Department of Radiology & Nuclear Medicine, VU University Medical Center (VUmc), P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Otto S Hoekstra
- />Department of Radiology & Nuclear Medicine, VU University Medical Center (VUmc), P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Laura M Kenny
- />Comprehensive Cancer Imaging Centre, Imperial College London, Hammersmith Hospital, W12 0NN London, UK
| | - Eric O Aboagye
- />Comprehensive Cancer Imaging Centre, Imperial College London, Hammersmith Hospital, W12 0NN London, UK
| | - Ronald Boellaard
- />Department of Radiology & Nuclear Medicine, VU University Medical Center (VUmc), P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
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Vercher-Conejero JL, Pelegrí-Martinez L, Lopez-Aznar D, Cózar-Santiago MDP. Positron Emission Tomography in Breast Cancer. Diagnostics (Basel) 2015; 5:61-83. [PMID: 26854143 PMCID: PMC4665546 DOI: 10.3390/diagnostics5010061] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 12/26/2022] Open
Abstract
Gradually, FDG-PET/CT has been strengthening within the diagnostic algorithms of oncological diseases. In many of these, PET/CT has shown to be useful at different stages of the disease: diagnosis, staging or re-staging, treatment response assessment, and recurrence. Some of the advantages of this imaging modality versus CT, MRI, bone scan, mammography, or ultrasound, are based on its great diagnostic capacity since, according to the radiopharmaceutical used, it reflects metabolic changes that often occur before morphological changes and therefore allows us to stage at diagnosis. Moreover, another advantage of this technique is that it allows us to evaluate the whole body so it can be very useful for the detection of distant disease. With regard to breast cancer, FDG-PET/CT has proven to be important when recurrence is suspected or in the evaluation of treatment response. The technological advancement of PET equipment through the development of new detectors and equipment designed specifically for breast imaging, and the development of more specific radiopharmaceuticals for the study of the different biological processes of breast cancer, will allow progress not only in making the diagnosis of the disease at an early stage but also in enabling personalized therapy for patients with breast cancer.
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Affiliation(s)
- Jose Luis Vercher-Conejero
- Clinical Area of Medical Imaging, Department of Nuclear Medicine, GIBI230, Polytechnic and University Hospital La Fe, Valencia 46026, Spain.
| | - Laura Pelegrí-Martinez
- Diagnostic Imaging, Sant Joan Despí Moisès Broggi Hospital, Sant Joan Despí, Barcelona 08970, Spain.
| | - Diego Lopez-Aznar
- Department of Nuclear Medicine, Provincial Hospital Consortium, Castellón de la Plana 12002, Spain.
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18F-FLT PET/CT as an imaging tool for early prediction of pathological response in patients with locally advanced breast cancer treated with neoadjuvant chemotherapy: a pilot study. Eur J Nucl Med Mol Imaging 2015; 42:818-30. [DOI: 10.1007/s00259-015-2995-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 01/14/2015] [Indexed: 02/07/2023]
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Humbert O, Cochet A, Coudert B, Berriolo-Riedinger A, Kanoun S, Brunotte F, Fumoleau P. Role of positron emission tomography for the monitoring of response to therapy in breast cancer. Oncologist 2015; 20:94-104. [PMID: 25561512 DOI: 10.1634/theoncologist.2014-0342] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
This review considers the potential utility of positron emission tomography (PET) tracers in the setting of response monitoring in breast cancer, with a special emphasis on glucose metabolic changes assessed with (18)F-fluorodeoxyglucose (FDG). In the neoadjuvant setting of breast cancer, the metabolic response can predict the final complete pathologic response after the first cycles of chemotherapy. Because tumor metabolic behavior highly depends on cancer subtype, studies are ongoing to define the optimal metabolic criteria of tumor response in each subtype. The recent multicentric randomized AVATAXHER trial has suggested, in the human epidermal growth factor 2-positive subtype, a clinical benefit of early tailoring the neoadjuvant treatment in women with poor metabolic response after the first course of treatment. In the bone-dominant metastatic setting, there is increasing clinical evidence that FDG-PET/computed tomography (CT) is the most accurate imaging modality for assessment of the tumor response to treatment when both metabolic information and morphologic information are considered. Nevertheless, there is a need to define standardized metabolic criteria of response, including the heterogeneity of response among metastases, and to evaluate the costs and health outcome of FDG-PET/CT compared with conventional imaging. New non-FDG radiotracers highlighting specific molecular hallmarks of breast cancer cells have recently emerged in preclinical and clinical studies. These biomarkers can take into account the heterogeneity of tumor biology in metastatic lesions. They may provide valuable clinical information for physicians to select and monitor the effectiveness of novel therapeutics targeting the same molecular pathways of breast tumor.
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Affiliation(s)
- Olivier Humbert
- Departments of Nuclear Medicine and Medical Oncology, Centre G.F. Leclerc, Dijon, France; Imaging Department, Centre Hospitalo-Universitaire Le Bocage, Dijon, France; Université de Bourgogne, UMR CNRS 6306, Dijon, France
| | - Alexandre Cochet
- Departments of Nuclear Medicine and Medical Oncology, Centre G.F. Leclerc, Dijon, France; Imaging Department, Centre Hospitalo-Universitaire Le Bocage, Dijon, France; Université de Bourgogne, UMR CNRS 6306, Dijon, France
| | - Bruno Coudert
- Departments of Nuclear Medicine and Medical Oncology, Centre G.F. Leclerc, Dijon, France; Imaging Department, Centre Hospitalo-Universitaire Le Bocage, Dijon, France; Université de Bourgogne, UMR CNRS 6306, Dijon, France
| | - Alina Berriolo-Riedinger
- Departments of Nuclear Medicine and Medical Oncology, Centre G.F. Leclerc, Dijon, France; Imaging Department, Centre Hospitalo-Universitaire Le Bocage, Dijon, France; Université de Bourgogne, UMR CNRS 6306, Dijon, France
| | - Salim Kanoun
- Departments of Nuclear Medicine and Medical Oncology, Centre G.F. Leclerc, Dijon, France; Imaging Department, Centre Hospitalo-Universitaire Le Bocage, Dijon, France; Université de Bourgogne, UMR CNRS 6306, Dijon, France
| | - François Brunotte
- Departments of Nuclear Medicine and Medical Oncology, Centre G.F. Leclerc, Dijon, France; Imaging Department, Centre Hospitalo-Universitaire Le Bocage, Dijon, France; Université de Bourgogne, UMR CNRS 6306, Dijon, France
| | - Pierre Fumoleau
- Departments of Nuclear Medicine and Medical Oncology, Centre G.F. Leclerc, Dijon, France; Imaging Department, Centre Hospitalo-Universitaire Le Bocage, Dijon, France; Université de Bourgogne, UMR CNRS 6306, Dijon, France
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Jhaveri K, Linden H. Measuring Tumor Metabolism by 18F-FDG PET Predicts Outcome in a Multicenter Study: A Step Off in the Right Direction. J Nucl Med 2014; 56:1-2. [DOI: 10.2967/jnumed.114.151175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lee CI, Gold LS, Nelson HD, Chou R, Ramsey SD, Sullivan SD. Comparative effectiveness of imaging modalities to determine metastatic breast cancer treatment response. Breast 2014; 24:3-11. [PMID: 25479913 DOI: 10.1016/j.breast.2014.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 11/07/2014] [Accepted: 11/16/2014] [Indexed: 11/26/2022] Open
Abstract
We performed a systematic review to address the comparative effectiveness of different imaging modalities in evaluating treatment response among metastatic breast cancer patients. We searched seven multidisciplinary electronic databases for relevant publications (January 2003-December 2013) and performed dual abstraction of details and results for all clinical studies that involved stage IV breast cancer patients and evaluated imaging for detecting treatment response. Among 159 citations reviewed, 17 single-institution, non-randomized, observational studies met our inclusion criteria. Several studies demonstrate that changes in PET/CT standard uptake values are associated with changes in tumor volume as determined by bone scan, MRI, and/or CT. However, no studies evaluated comparative test performance between modalities or determined relationships between imaging findings and subsequent clinical decisions. Evidence for imaging's effectiveness in determining treatment response among metastatic breast cancer patients is limited. More rigorous research is needed to address imaging's value in this patient population.
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Affiliation(s)
- Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Avenue East, Seattle, WA 98109, USA; Department of Health Services, University of Washington School of Public Health, Box 357660, Seattle, WA 98195, USA; Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Seattle, WA 98109, USA; Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Laura S Gold
- Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Pharmaceutical Outcomes Research & Policy Program, School of Pharmacy, University of Washington, Box 257630, Seattle, WA 98195, USA.
| | - Heidi D Nelson
- Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Departments of Medical Informatics and Clinical Epidemiology and Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Providence Cancer Center, Providence Health & Services, 4805 NE Glisan Street, Portland, OR 97213, USA.
| | - Roger Chou
- Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Departments of Medical Informatics and Clinical Epidemiology and Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Scott D Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Seattle, WA 98109, USA; Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Pharmaceutical Outcomes Research & Policy Program, School of Pharmacy, University of Washington, Box 257630, Seattle, WA 98195, USA; Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA.
| | - Sean D Sullivan
- Department of Health Services, University of Washington School of Public Health, Box 357660, Seattle, WA 98195, USA; Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Seattle, WA 98109, USA; Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Pharmaceutical Outcomes Research & Policy Program, School of Pharmacy, University of Washington, Box 257630, Seattle, WA 98195, USA.
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Deng SM, Zhang W, Zhang B, Wu YW. Assessment of tumor response to chemotherapy in patients with breast cancer using (18)F-FLT: a meta-analysis. Chin J Cancer Res 2014; 26:517-24. [PMID: 25400416 DOI: 10.3978/j.issn.1000-9604.2014.08.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 08/05/2014] [Indexed: 11/14/2022] Open
Abstract
PURPOSE To determine the diagnostic performance of 3'-deoxy-3'-(18)F-fluorothymidine positron emission tomography/computed tomography (FLT PET/CT) and FLT PET for evaluating response to chemotherapy in patients with breast cancer. METHODS Databases such as PubMed (MEDLINE included) and excerpta medica database (EMBASE), were searched for relevant original articles. The included studies were assessed for methodological quality with quality assessment of diagnosis accuracy studies (QUADAS) score tool. Histopathological analysis and/or clinical and/or radiological follow-up for at least 6 months were used as the reference standard. The data were extracted by two reviewers independently to analyze the sensitivity, specificity, summary receiver operating characteristic (SROC) curve, area under the curve (AUC), and heterogeneity. RESULTS The present study analyzed a total of 4 selected articles. The pool sensitivity was 0.773 [95% confidence interval (CI): 0.594-0.900]. The pooled specificity was 0.685 (95% CI: 0.479-0.849) on basis of FEM. The pooled LR+, LR-, and DOR were 2.874 (1.492-5.538), 0.293 (0.146-0.589), and 14.891 (3.238-68.475), respectively. The AUC was 0.8636 (±0.0655), and the Q* index was 0.7942 (±0.0636). CONCLUSIONS Our results indicate that (18)F-FLT PET/CT or PET is useful to predict chemotherapy response in breast cancer with reasonable sensitivity, specificity and DOR. However, future larger scale clinical trials will be needed to assess the regimen of (18)F-FLT PET/CT or PET in monitoring the response to chemotherapy in breast cancer patients.
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Affiliation(s)
- Sheng-Ming Deng
- 1 Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215000, China ; 2 School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou 215000, China ; 3 Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi 214000, China
| | - Wei Zhang
- 1 Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215000, China ; 2 School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou 215000, China ; 3 Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi 214000, China
| | - Bin Zhang
- 1 Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215000, China ; 2 School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou 215000, China ; 3 Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi 214000, China
| | - Yi-Wei Wu
- 1 Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215000, China ; 2 School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou 215000, China ; 3 Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi 214000, China
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Lin NU, Amiri-Kordestani L, Palmieri D, Liewehr DJ, Steeg PS. CNS metastases in breast cancer: old challenge, new frontiers. Clin Cancer Res 2014; 19:6404-18. [PMID: 24298071 DOI: 10.1158/1078-0432.ccr-13-0790] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Despite major therapeutic advances in the management of patients with breast cancer, central nervous system (CNS) metastases remain an intractable problem, particularly in patients with metastatic HER2-positive and triple-negative breast cancer. As systemic therapies to treat extracranial disease improve, some patients are surviving longer, and the frequency of CNS involvement seems to be increasing. Furthermore, in the early-stage setting, the CNS remains a potential sanctuary site for relapse. This review highlights advances in the development of biologically relevant preclinical models, including the development of brain-tropic cell lines for testing of agents to prevent and treat brain metastases, and summarizes our current understanding of the biology of CNS relapse. From a clinical perspective, a variety of therapeutic approaches are discussed, including methods to improve drug delivery, novel cytotoxic agents, and targeted therapies. Challenges in current trial design and endpoints are reviewed. Finally, we discuss promising new directions, including novel trial designs, correlative imaging techniques, and enhanced translational opportunities.
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Affiliation(s)
- Nancy U Lin
- Authors' Affiliations: Dana-Farber Cancer Institute, Boston, Massachusetts; Medical Oncology Branch, Center for Cancer Research, National Cancer Institute; Women's Cancers Section, Laboratory of Molecular Pharmacology; and Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
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Sala R, Nguyen QD, Patel CBK, Mann D, Steinke JHG, Vilar R, Aboagye EO. Phosphorylation status of thymidine kinase 1 following antiproliferative drug treatment mediates 3'-deoxy-3'-[18F]-fluorothymidine cellular retention. PLoS One 2014; 9:e101366. [PMID: 25003822 PMCID: PMC4086825 DOI: 10.1371/journal.pone.0101366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 06/05/2014] [Indexed: 12/29/2022] Open
Abstract
Background 3′-Deoxy-3′-[18F]-fluorothymidine ([18F]FLT) is being investigated as a Positron Emission Tomography (PET) proliferation biomarker. The mechanism of cellular [18F]FLT retention has been assigned primarily to alteration of the strict transcriptionally regulated S-phase expression of thymidine kinase 1 (TK1). This, however, does not explain how anticancer agents acting primarily through G2/M arrest affect [18F]FLT uptake. We investigated alternative mechanisms of [18F]FLT cellular retention involving post-translational modification of TK1 during mitosis. Methods [18F]FLT cellular retention was assessed in cell lines having different TK1 expression. Drug-induced phosphorylation of TK1 protein was evaluated by MnCl2-phos-tag gel electrophoresis and correlated with [18F]FLT cellular retention. We further elaborated the amino acid residues involved in TK1 phosphorylation by transient transfection of FLAG-pCMV2 plasmids encoding wild type or mutant variants of TK1 into TK1 negative cells. Results Baseline [18F]FLT cellular retention and TK1 protein expression were associated. S-phase and G2/M phase arrest caused greater than two-fold reduction in [18F]FLT cellular retention in colon cancer HCT116 cells (p<0.001). G2/M cell cycle arrest increased TK1 phosphorylation as measured by induction of at least one phosphorylated form of the protein on MnCl2-phos-tag gels. Changes in [18F]FLT cellular retention reflected TK1 phosphorylation and not expression of total protein, in keeping with the impact of phosphorylation on enzyme catalytic activity. Both Ser13 and Ser231 were shown to be involved in the TK1 phosphorylation-modulated [18F]FLT cellular retention; although the data suggested involvement of other amino-acid residues. Conclusion We have defined a regulatory role of TK1 phosphorylation in mediating [18F]FLT cellular retention and hence reporting of antiproliferative activity, with implications especially for drugs that induce a G2/M cell cycle arrest.
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Affiliation(s)
- Roberta Sala
- Comprehensive Cancer Imaging Centre, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Quang-Dé Nguyen
- Comprehensive Cancer Imaging Centre, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Chirag B. K. Patel
- Institute of Chemical Biology, Department of Chemistry, Imperial College London, London, United Kingdom
| | - David Mann
- Department of Life Sciences, Imperial College London, London, United Kingdom
| | - Joachim H. G. Steinke
- Institute of Chemical Biology, Department of Chemistry, Imperial College London, London, United Kingdom
| | - Ramon Vilar
- Institute of Chemical Biology, Department of Chemistry, Imperial College London, London, United Kingdom
| | - Eric O. Aboagye
- Comprehensive Cancer Imaging Centre, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- * E-mail:
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Sanghera B, Wong WL, Sonoda LI, Beynon G, Makris A, Woolf D, Ardeshna K. FLT PET-CT in evaluation of treatment response. Indian J Nucl Med 2014; 29:65-73. [PMID: 24761056 PMCID: PMC3996774 DOI: 10.4103/0972-3919.130274] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Review published studies to investigate the value of clinical 3-deoxy-3-(18)F-fluorothymidine (FLT) positron emission tomography (PET) in predicting response to treatment. MATERIALS AND METHODS Interrogate databases to identify suitable publications between 2007 and 2013 with a minimum of five patients. Articles within the inclusion criteria were reviewed with major findings reported leading to a descriptive analysis of FLT PET in therapy response. RESULTS Lesions investigated included glioma, head and neck, esophageal, lung, breast, gastric, renal, rectal, sarcomas, germ cell, lymphomas, leukemia, and melanoma resulting in a total of 34 studies analyzed. A variety of therapies were applied and dissimilar PET protocols were widespread making direct comparison between studies challenging. Though baseline, early and late therapy scans were popular particularly in chemotherapy regimes. Most studies investigated showed significantly reduced FLT uptake during or after therapy compared with pretreatment scans. CONCLUSION Current evidence suggests FLT PET has a positive role to play in predicting therapy response especially in brain, lung, and breast cancers where good correlation with Ki-67 is observed. However, careful attention must be placed in undertaking larger clinical trials where harmonization of scanning and analysis protocols are strictly adhered to fully assess the true potential of FLT PET in predicting response to treatment.
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Affiliation(s)
- Bal Sanghera
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England
| | - Wai Lup Wong
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England
| | - Luke I Sonoda
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England
| | - Gwen Beynon
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England
| | - Andreas Makris
- Cancer Centre, Mount Vernon Hospital, Northwood, England
| | - David Woolf
- Cancer Centre, Mount Vernon Hospital, Northwood, England
| | - Kirit Ardeshna
- Cancer Centre, Mount Vernon Hospital, Northwood, England ; Department of Haematology, University College London Cancer Institute and University College Hospital, London, England
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Groheux D, Hindié E, Giacchetti S, Hamy AS, Berger F, Merlet P, de Roquancourt A, de Cremoux P, Marty M, Hatt M, Espié M. Early assessment with 18F-fluorodeoxyglucose positron emission tomography/computed tomography can help predict the outcome of neoadjuvant chemotherapy in triple negative breast cancer. Eur J Cancer 2014; 50:1864-71. [PMID: 24841218 DOI: 10.1016/j.ejca.2014.04.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 03/06/2014] [Accepted: 04/21/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND In patients with triple-negative breast cancer (TNBC), pathology complete response (pCR) to neoadjuvant chemotherapy (NAC) is associated with improved prognosis. This prospective study was designed and powered to investigate the ability of interim (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)FDG-PET/CT) to predict pathology outcomes to NAC early during treatment. PATIENTS AND METHODS Consecutive TNBC women underwent (18)FDG-PET/CT at baseline and after two courses of NAC. Maximum standardised uptake value (SUV(max)) in the primary tumour and lymph nodes at each examination and the evolution (ΔSUV(max)) between the two scans were measured. NAC was continued irrespective of PET results. Correlations between PET parameters and pathology response, and between PET parameters and event-free survival (EFS), were examined. RESULTS Fifty patients without distant metastases were enroled. At completion of NAC, surgery showed pCR in 19 patients, while 31 had residual tumour. Mean follow-up was 30.3 months. Thirteen patients, all with residual tumour, experienced relapse. Of all assessed clinical, biological and PET parameters, ΔSUV(max) in the primary tumour was the most predictive of pathology results (p<0.0001; Mann-Whitney-U test) and EFS (p=0.02; log rank test). A threshold of 42% decrease in SUV was identified because it offered the best accuracy in predicting EFS. There were 32 metabolic responders (⩾ 42% decrease in SUV(max)) and 18 non-responders. Within responders, the pCR rate was 59% and the 3-year EFS 77.5%. In non-responders, the pCR rate was 0% and the 3-year EFS 47.1%. CONCLUSION Interim (18)FDG can early predict the inefficacy of NAC in TNBC patients. It shows promise as a potential contributory biomarker in these patients.
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Affiliation(s)
- David Groheux
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; B2T, Doctoral School, IUH, University of Paris VII, France.
| | - Elif Hindié
- Department of Nuclear Medicine, CHU Bordeaux, University of Bordeaux, France
| | - Sylvie Giacchetti
- Breast Diseases Unit and Department of Medical Oncology, Saint-Louis Hospital, Paris, France
| | - Anne-Sophie Hamy
- Breast Diseases Unit and Department of Medical Oncology, Saint-Louis Hospital, Paris, France; Department of Biostatistics, Institut Curie, Paris, France
| | | | - Pascal Merlet
- Department of Nuclear Medicine, Saint-Louis Hospital, Paris, France; B2T, Doctoral School, IUH, University of Paris VII, France
| | | | | | - Michel Marty
- Breast Diseases Unit and Department of Medical Oncology, Saint-Louis Hospital, Paris, France; Centre for Therapeutic Innovation, Saint Louis Hospital, Paris, France
| | | | - Marc Espié
- Breast Diseases Unit and Department of Medical Oncology, Saint-Louis Hospital, Paris, France
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Herrmann K, Buck AK. Proliferation imaging with ¹⁸F-fluorothymidine PET/computed tomography: physiologic uptake, variants, and pitfalls. PET Clin 2014; 9:331-8. [PMID: 25030396 DOI: 10.1016/j.cpet.2014.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
For noninvasive in vivo imaging of proliferation, 18F-FLT PET/CT remains a promising tool, owing to its correlation with proliferation indexes in many tumor entities. Future clinical applications will focus on monitoring response to cancer therapy, whereas tumor detection will be limited to organs with high physiologic 18F-FDG uptake. Use and interpretation of 18F-FLT requires knowledge of the physiologic tracer distribution and how it will be affected by anticancer treatment. Further studies are needed to determine the optimal timing of 18F-FLT PET/CT imaging in the course of cancer therapies or at the conclusion of therapy.
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Affiliation(s)
- Ken Herrmann
- Department of Nuclear Medicine, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, Würzburg 97080, Germany.
| | - Andreas K Buck
- Department of Nuclear Medicine, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, Würzburg 97080, Germany
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45
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Abstract
Biomarkers can be used to characterize disease status or predict disease behavior. Cancer biomarkers have typically relied on assays of blood or tissue; however, molecular imaging has a promising and complementary role as a cancer biomarker. This "Focus on Molecular Imaging" article reviews the current role of biomarkers to direct cancer clinical trials and clinical practice, along with current and future cancer biomarker applications of molecular imaging.
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Affiliation(s)
- David A Mankoff
- Radiology/Nuclear Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
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46
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Cullinane C, Solomon B, Hicks RJ. Imaging of molecular target modulation in oncology: challenges of early clinical trials. Clin Transl Imaging 2014. [DOI: 10.1007/s40336-013-0047-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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47
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Abstract
Over recent years, there has been a rapid expansion in our knowledge of the factors that regulate tumor growth; this has resulted in the identification of new therapeutic targets and improvements in the long-term survival of cancer patients. New noninvasive biomarkers of drug targets and pathway modulation in vivo are needed to guide therapy selection and detect drug resistance early so that alternative, more effective treatments can be offered. The translation of new therapeutics into the clinic is disappointingly slow, expensive, and subject to high rates of attrition often occurring at late stages (phase 3) of development. In an attempt to mitigate these delays and failures, there has been resurgence in the development of new molecular imaging probes for studies with positron emission tomography (PET) to characterize tumor biology. In the assessment of therapeutic effects, PET allows imaging of entire tumor burden in a noninvasive repeatable manner. This chapter focuses on the clinical translation of PET imaging agents from bench to bedside. New probes are being used to study a diverse range of processes such as angiogenesis, apoptosis, fatty acid metabolism, and growth factor receptor expression. In the future, validation of these novel imaging probes could allow more innovative therapies to be adapted earlier in the clinic leading to improved patient outcomes.
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Affiliation(s)
- Laura M Kenny
- Comprehensive Cancer Imaging Centre, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Eric O Aboagye
- Comprehensive Cancer Imaging Centre, Department of Surgery & Cancer, Imperial College London, London, United Kingdom.
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48
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Lee H, Kim SK, Kim YI, Kim TS, Kang SH, Park WS, Yun T, Eom HS. Early Determination of Prognosis by Interim 3′-Deoxy-3′-18F-Fluorothymidine PET in Patients with Non-Hodgkin Lymphoma. J Nucl Med 2013; 55:216-22. [DOI: 10.2967/jnumed.113.124172] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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49
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Abstract
Response prediction is an important emerging concept in oncologic imaging, with tailored, individualized treatment regimens increasingly becoming the standard of care. This review aims to define tumour response and illustrate the ways in which imaging techniques can demonstrate tumour biological characteristics that provide information on the likely benefit to be received by treatment. Two imaging approaches are described: identification of therapeutic targets and depiction of the treatment-resistant phenotype. The former approach is exemplified by the use of radionuclide imaging to confirm target expression before radionuclide therapy but with angiogenesis imaging and imaging correlates for genetic response predictors also demonstrating potential utility. Techniques to assess the treatment-resistant phenotype include demonstration of hypoperfusion with dynamic contrast-enhanced computed tomography and magnetic resonance imaging (MRI), depiction of necrosis with diffusion-weighted MRI, imaging of hypoxia and tumour adaption to hypoxia, and 99mTc-MIBI imaging of P-glycoprotein mediated drug resistance. To date, introduction of these techniques into clinical practice has often been constrained by inadequate cross-validation of predictive criteria and lack of verification against appropriate response end points such as survival. With further refinement, imaging predictors of response could play an important role in oncology, contributing to individualization of therapy based on the specific tumour phenotype. This ability to predict tumour response will have implications for improving efficacy of treatment, cost-effectiveness and omission of futile therapy.
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Affiliation(s)
- Samuel D Kyle
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Southern Clinical School, Brisbane, Australia
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50
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Abstract
Imaging techniques afford the opportunity to personalize chemotherapy delivery by prospectively determining how much of an agent is delivered to which tumor site. Drug distribution can be prescribed by altering the properties of the drug (nontechnology) or the physiology of the host (induction of alterations of blood flow).
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Affiliation(s)
- Raymond J Hohl
- Department of Internal Medicine and Pharmacology, University of Iowa, Iowa City, Iowa, USA.
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