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Nappi AG, Santo G, Jonghi-Lavarini L, Miceli A, Lazzarato A, La Torre F, Dondi F, Gorica J. Emerging Role of [ 18F]FLT PET/CT in Lymphoid Malignancies: A Review of Clinical Results. Hematol Rep 2024; 16:32-41. [PMID: 38247994 PMCID: PMC10801569 DOI: 10.3390/hematolrep16010004] [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: 10/16/2023] [Revised: 12/27/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
Fluorine-18 fluorodeoxyglucose ([18F]FDG) is nowadays the leading positron emission tomography (PET) tracer for routine clinical work-ups in hematological malignancies; however, it is limited by false positive findings. Notably, false positives can occur in inflammatory and infective cases or in necrotic tumors that are infiltrated by macrophages and other inflammatory cells. In this context, 3'-deoxy-3'-[18F]fluorothymidine ([18F]FLT) has been shown to be a promising imaging biomarker of hematological malignant cell proliferation. In this review, a total of 15 papers were reviewed to collect literature data regarding the clinical application of [18F]FLT PET/CT in hematological malignancies. This imaging modality seems to be a suitable tool for noninvasive assessment of tumor grading, also showing a correlation with Ki-67 immunostaining. Moreover, [18F]FLT PET/CT demonstrated high sensitivity in detecting aggressive lymphoma lesions, especially when applying a standardized uptake value (SUV) cutoff of 3. At baseline, the potential of [18F]FLT imaging as a predictive tool is demonstrated by the low tracer uptake in patients with a complete response. However, its use is limited in evaluating bone diseases due to its high physiological uptake in bone marrow. Interim [18F]FLT PET/CT (iFLT) has the potential to identify high-risk patients with greater precision than [18F]FDG PET/CT, optimizing risk-adapted therapy strategies. Moreover, [18F]FLT uptake showed a greater ability to differentiate tumor from inflammation compared to [18F]FDG, allowing the reduction of false-positive findings and making the first one a more selective tracer. Finally, FLT emerges as a superior independent predictor of PFS and OS compared to FDG and ensures a reliable early response assessment with greater accuracy and predictive value.
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Affiliation(s)
- Anna Giulia Nappi
- Section of Nuclear Medicine, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Giulia Santo
- Department of Experimental and Clinical Medicine, “Magna Graecia” University of Catanzaro, 88100 Catanzato, Italy;
| | | | - Alberto Miceli
- Nuclear Medicine Unit, Azienda Ospedaliera SS. Antonio E Biagio E Cesare Arrigo, 15121 Alessandria, Italy;
| | | | - Flavia La Torre
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho Functional Imaging, University of Messina, 98125 Messina, Italy;
| | - Francesco Dondi
- Nuclear Medicine, ASST Spedali Civili Di Brescia and Università degli Studi di Brescia, 25123 Brescia, Italy
| | - Joana Gorica
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza, University of Rome, 00161 Rome, Italy;
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Al Tabaa Y, Bailly C, Kanoun S. FDG-PET/CT in Lymphoma: Where Do We Go Now? Cancers (Basel) 2021; 13:cancers13205222. [PMID: 34680370 PMCID: PMC8533807 DOI: 10.3390/cancers13205222] [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: 09/13/2021] [Revised: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 01/06/2023] Open
Abstract
18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) is an essential part of the management of patients with lymphoma at staging and response evaluation. Efforts to standardize PET acquisition and reporting, including the 5-point Deauville scale, have enabled PET to become a surrogate for treatment success or failure in common lymphoma subtypes. This review summarizes the key clinical-trial evidence that supports PET-directed personalized approaches in lymphoma but also points out the potential place of innovative PET/CT metrics or new radiopharmaceuticals in the future.
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Affiliation(s)
- Yassine Al Tabaa
- Scintidoc Nuclear Medicine Center, 25 rue de Clémentville, 34070 Montpellier, France
- Correspondence:
| | - Clement Bailly
- CRCINA, INSERM, CNRS, Université d’Angers, Université de Nantes, 44093 Nantes, France;
- Nuclear Medicine Department, University Hospital, 44093 Nantes, France
| | - Salim Kanoun
- Nuclear Medicine Department, Institute Claudius Regaud, 31100 Toulouse, France;
- Cancer Research Center of Toulouse (CRCT), Team 9, INSERM UMR 1037, 31400 Toulouse, France
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Abstract
The use of PET imaging agents in oncology, cardiovascular disease, and neurodegenerative disease shows the power of this technique in evaluating the molecular and biological characteristics of numerous diseases. These agents provide crucial information for designing therapeutic strategies for individual patients. Novel PET tracers are in continual development and many have potential use in clinical and research settings. This article discusses the potential applications of tracers in diagnostics, the biological characteristics of diseases, the ability to provide prognostic indicators, and using this information to guide treatment strategies including monitoring treatment efficacy in real time to improve outcomes and survival.
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Molecular imaging with FLT: a case of Cassandra's curse? Eur J Nucl Med Mol Imaging 2021; 48:2687-2689. [PMID: 34081154 DOI: 10.1007/s00259-021-05437-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Butler E, Schwettmann B, Geboers S, Hao G, Kim J, Nham K, Sun X, Laetsch TW, Xu L, Williams NS, Skapek SX. Functional imaging of RAS pathway targeting in malignant peripheral nerve sheath tumor cells and xenografts. Pediatr Blood Cancer 2020; 67:e28639. [PMID: 32975370 DOI: 10.1002/pbc.28639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Malignant peripheral nerve sheath tumor (MPNST) is an aggressive form of soft-tissue sarcoma (STS) in children. Despite intensive therapy, relatively few children with metastatic and unresectable disease survive beyond three years. RAS pathway activation is common in MPNST, suggesting MEK pathway inhibition as a targeted therapy, but the impact on clinical outcome has been small to date. PROCEDURE We conducted preclinical pharmacokinetic (PK) and pharmacodynamic studies of two MEK inhibitors, trametinib and selumetinib, in two MPNST models and analyzed tumors for intratumor drug levels. We then investigated 3'-deoxy-3'-[18 F]fluorothymidine (18 F-FLT) PET imaging followed by 18 F-FDG PET/CT imaging of MPNST xenografts coupled to short-term or longer-term treatment with selumetinib focusing on PET-based imaging as a biomarker of MEK inhibition. RESULTS Trametinib decreased pERK expression in MPNST xenografts but did not prolong survival or decrease Ki67 expression. In contrast, selumetinib prolonged survival of animals bearing MPNST xenografts, and this correlated with decreased pERK and Ki67 staining. PK studies revealed a significantly higher fraction of unbound selumetinib within a responsive MPNST xenograft model. Thymidine uptake, assessed by 18 F-FLT PET/CT, positively correlated with Ki67 expression in different xenograft models and in response to selumetinib. CONCLUSION The ability of MEK inhibitors to control MPNST growth cannot simply be predicted by serum drug levels or drug-induced changes in pERK expression. Tumor cell proliferation assessed by 18 F-FLT PET imaging might be useful as an early response marker to targeted therapies, including MEK inhibition, where a primary effect is cell-cycle arrest.
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Affiliation(s)
- Erin Butler
- Department of Pediatrics Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Blake Schwettmann
- Department of Pediatrics Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sophie Geboers
- Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Guiyang Hao
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jiwoong Kim
- Quantitative Biomedical Research Center, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kien Nham
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Xiankai Sun
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.,The Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Theodore W Laetsch
- Department of Pediatrics Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.,The Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lin Xu
- Department of Pediatrics Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.,Quantitative Biomedical Research Center, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.,The Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Noelle S Williams
- Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Stephen X Skapek
- Department of Pediatrics Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
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Abstract
The major applications for molecular imaging with PET in clinical practice concern cancer imaging. Undoubtedly, 18F-FDG represents the backbone of nuclear oncology as it remains so far the most widely employed positron emitter compound. The acquired knowledge on cancer features, however, allowed the recognition in the last decades of multiple metabolic or pathogenic pathways within the cancer cells, which stimulated the development of novel radiopharmaceuticals. An endless list of PET tracers, substantially covering all hallmarks of cancer, has entered clinical routine or is being investigated in diagnostic trials. Some of them guard significant clinical applications, whereas others mostly bear a huge potential. This chapter summarizes a selected list of non-FDG PET tracers, described based on their introduction into and impact on clinical practice.
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Lu J, Wu Y, Li B, Luo X, Zhang W, Zeng Y, Fu J, Liang A, Xiu B. Predictive value of serological factors, maximal standardized uptake value and ratio of Ki67 in patients diagnosed with non-Hodgkin's lymphoma. Oncol Lett 2020; 20:47. [PMID: 32788936 PMCID: PMC7416380 DOI: 10.3892/ol.2020.11906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/22/2020] [Indexed: 11/24/2022] Open
Abstract
The present study aimed to determine the prognostic value of serological factors, positron emission tomography/computed tomography maximal standardized uptake value (SUVmax) and the immunohistochemical index ratio of Ki67 (Ki67%) for patients diagnosed with non-Hodgkin's lymphoma (NHL). A total of 120 patients with NHL who received regular chemotherapy and underwent serological, radiological and pathological examinations at Shanghai Tongji Hospital between July 2015 and March 2019 were retrospectively analyzed. Spearman's correlation analysis was preformed to describe the associations between different categories of indicators. Kaplan-Meier analysis and log-rank test were used to compare the survival of different subgroups. Receiver operating characteristic curves were generated to assess the predictive value of prominent indicators derived from Cox regression analysis. The results indicated that inflammatory cytokines were strongly associated with tumor burden indicators. The correlation between SUVmax and Ki67% was significant, and SUVmax of the biopsy site exhibited a stronger association with Ki67% (Ρ=0.529, P<0.001) compared with SUVmax of the whole body (Ρ=0.395, P=0.017). C-reactive protein (CRP), lactate dehydrogenase (LDH) and interleukin-6 could differentiate the survival status of patients with NHL, whereas no statistical significance in the estimation of overall survival (OS) was obtained for SUVmax and Ki67%. SUVmax of the biopsy site had only a limited value in the estimation of progression-free survival (PFS), whereas LDH, β2-microglobulin (β2-mg) and CRP were independent predictors of both OS and PFS with high sensitivity and specificity. Among all indicators, CRP and β2-mg could predict both survival status and complete remission of patients with NHL, whereas the prognostic value of SUVmax and Ki67% requires further study and discussion.
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Affiliation(s)
- Jinyuan Lu
- Department of Hematology, Shanghai Tongji Hospital, Shanghai Tongji University School of Medicine, Shanghai 200333, P.R. China
| | - You Wu
- Department of Hematology, Shanghai Tongji Hospital, Shanghai Tongji University School of Medicine, Shanghai 200333, P.R. China
| | - Bing Li
- Department of Hematology, Shanghai Tongji Hospital, Shanghai Tongji University School of Medicine, Shanghai 200333, P.R. China
| | - Xiu Luo
- Department of Hematology, Shanghai Tongji Hospital, Shanghai Tongji University School of Medicine, Shanghai 200333, P.R. China
| | - Wenjun Zhang
- Department of Hematology, Shanghai Tongji Hospital, Shanghai Tongji University School of Medicine, Shanghai 200333, P.R. China
| | - Yu Zeng
- Department of Hematology, Shanghai Tongji Hospital, Shanghai Tongji University School of Medicine, Shanghai 200333, P.R. China
| | - Jianfei Fu
- Department of Hematology, Shanghai Tongji Hospital, Shanghai Tongji University School of Medicine, Shanghai 200333, P.R. China
| | - Aibin Liang
- Department of Hematology, Shanghai Tongji Hospital, Shanghai Tongji University School of Medicine, Shanghai 200333, P.R. China
| | - Bing Xiu
- Department of Hematology, Shanghai Tongji Hospital, Shanghai Tongji University School of Medicine, Shanghai 200333, P.R. China
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Zanoni L, Broccoli A, Lambertini A, Pellegrini C, Stefoni V, Lodi F, Fonti C, Nanni C, Zinzani PL, Fanti S. Role of 18F-FLT PET/CT in suspected recurrent or residual lymphoma: final results of a pilot prospective trial. Eur J Nucl Med Mol Imaging 2019; 46:1661-1671. [DOI: 10.1007/s00259-019-04323-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/29/2019] [Indexed: 01/01/2023]
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Wang R, Xu B, Liu C, Guan Z, Zhang J, Li F, Sun L, Zhu H. Prognostic value of interim fluorodeoxyglucose and fluorothymidine PET/CT in diffuse large B-cell lymphoma. Br J Radiol 2018; 91:20180240. [PMID: 30004787 DOI: 10.1259/bjr.20180240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE: To examine the prognostic value of fluorodeoxyglucose (FDG) and fluorothymidine (FLT) interim positron emission tomography/CT (PET/CT) for diffuse large B-cell lymphoma (DLBCL). METHODS: 44 patients with newly diagnosed DLBCL underwent both fluorine 18 FDG (18F-FDG) and 18F-FLT PET/CT scans at baseline and after two cycles of a rituximab-containing chemotherapy regimen. Maximum standard uptake values (SUVmax) and changes in SUV (ΔSUV) were calculated for both tracers for the predominant lesion of each patient, for prediction of progression-free survival (PFS) and overall survival (OS). RESULTS: The median follow-up period was 71 months. Receiver operating characteristic (ROC) analysis indicated that the best ΔSUV cut-off values for FDG (ΔSUVFDG) and FLT (ΔSUVFLT) were 79 and 76%, respectively. A ΔSUVFLT cut-off of 76% had the highest significance for prediction of PFS (p = 0.003) and OS (p = 0009), with sensitivity, specificity, and accuracy of 80.0, 85.7, and 81.8% respectively in response assessment. CONCLUSION: Interim FLT PET/CT had higher specificity and accuracy than standard FDG PET/CT-based interpretation. ADVANCES IN KNOWLEDGE: This study demonstrated that interim FLT PET/CT had higher accuracy than standardized FDG-based interpretation for therapeutic response assessment in DLBCL. FLT had the advantage of potentially reducing false positive of interim FDG PET/CT.
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Affiliation(s)
- Ruimin Wang
- 1 Department of Nuclear Medicine, PLA General Hospital , Beijing , China
| | - Baixuan Xu
- 1 Department of Nuclear Medicine, PLA General Hospital , Beijing , China
| | - Changbin Liu
- 1 Department of Nuclear Medicine, PLA General Hospital , Beijing , China
| | - Zhiwei Guan
- 1 Department of Nuclear Medicine, PLA General Hospital , Beijing , China
| | - Jinming Zhang
- 1 Department of Nuclear Medicine, PLA General Hospital , Beijing , China
| | - Fei Li
- 2 Department of Hematology, PLA General Hospital , Beijing , China
| | - Lu Sun
- 3 Department of Pathology, PLA General Hospital , Beijing , China
| | - Haiyan Zhu
- 2 Department of Hematology, PLA General Hospital , Beijing , China
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Post-therapy lesions in patients with non-Hodgkin's lymphoma characterized by 18F-FDG PET/CT-guided biopsy using automated robotic biopsy arm. Nucl Med Commun 2018; 39:74-82. [PMID: 29189443 DOI: 10.1097/mnm.0000000000000780] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE The aim of this study was to analyse the positive predictive value (PPV) of post-therapy fluorine-18-fluorodeoxyglucose (F-FDG) PET/CT performed for response or recurrence evaluation in patients with non-Hodgkin's lymphoma (NHL) and to appraise the diagnostic utility of F-FDG PET/CT-guided biopsy in this setting. PATIENTS AND METHODS A total of 17 patients with NHL showing F-FDG avid lesions in F-FDG PET/CT performed for response or recurrence assessment underwent F-FDG PET/CT-guided biopsy using automated robotic biopsy arm needle navigation technique. The objectives were analysed in reference to histopathology. RESULTS In all, 15 of the 17 (88.5%) procedures yielded adequate representative tissue samples. Nine out of 15 lesions were positive for residual disease and the remaining revealed benign findings on histopathology. One patient with inconclusive biopsy underwent surgical resection and histopathology confirmed the presence of residual disease. PPV of theF-FDG PET/CT was observed to be 62.5% (10/16). CONCLUSION F-FDG PET/CT for response evaluation in NHL possesses a low PPV and hence warrants histopathological correlation when F-FDG PET/CT findings influence management decision. Diagnostic yield of F-FDG PET/CT-guided biopsy is high and has the potential to reduce sampling errors.
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Everitt S, Ball D, Hicks RJ, Callahan J, Plumridge N, Trinh J, Herschtal A, Kron T, Mac Manus M. Prospective Study of Serial Imaging Comparing Fluorodeoxyglucose Positron Emission Tomography (PET) and Fluorothymidine PET During Radical Chemoradiation for Non-Small Cell Lung Cancer: Reduction of Detectable Proliferation Associated With Worse Survival. Int J Radiat Oncol Biol Phys 2017; 99:947-955. [PMID: 29063854 DOI: 10.1016/j.ijrobp.2017.07.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 07/19/2017] [Accepted: 07/24/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate the associations between interim tumor responses on 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and 18F-fluorothymidine (18F-FLT) PET and patient outcomes, especially progression-free survival (PFS) and overall survival (OS), in non-small cell lung cancer (NSCLC) patients. METHODS AND MATERIALS Patients with FDG-PET/computed tomography stage I-III NSCLC were prescribed concurrent chemotherapy and radiation therapy (60 Gy in 30 fractions). Scans were acquired at baseline (FDG-PET/computed tomography [FDGBL] for radiation therapy planning and FLT-PET [FLTBL]), week 2 (FDGwk2 and FLTwk2), and week 4 (FDGwk4 and FLTwk4) of chemoradiation therapy. Tumor responses were categorized as complete or partial responses or stable or progressive disease (SD, PD) using European Organization for Research and Treatment of Cancer criteria. Associations between response, OS, and PFS were analyzed with univariate Cox regressions and plotted using Kaplan-Meier curves. RESULTS Between 2009 and 2013, 60 patients were recruited. Thirty-seven (62%) were male, and the median age was 66 years (range, 31-86 years). Two-year OS and PFS were 0.51 and 0.26, respectively. Unexpectedly, SD on FLTwk2 compared with complete response/partial response was associated with longer OS (hazard ratio [95% confidence interval] 2.01 [0.87-4.65], P=.082) and PFS (2.01 [0.92-4.36], P=.061). Weeks 2 and 4 FDG PET/CT were not significantly associated with survival. Study scans provided additional information to FDGBL in 21 patients (35%). Distant metastases detected in 3 patients on FLTBL and in 2 patients on FDG/FLTwk2 changed treatment intent from curative to palliative. Locoregional progression during radiation therapy was observed in 5 (8%) patients, prompting larger radiation therapy fields. CONCLUSIONS Stable uptake of 18F-FLT at week 2 was paradoxically associated with longer OS and PFS. This suggests that suppression of tumor cell proliferation may protect against radiation-induced tumor cell killing. Baseline FLT, FLTwk2, and FDGwk2 detected rapid distant and locoregional progression in 10 patients (17%), prompting changes in management.
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Affiliation(s)
- Sarah Everitt
- Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia; Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia.
| | - David Ball
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia; Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Rodney J Hicks
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia; Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jason Callahan
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia; Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Nikki Plumridge
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jenny Trinh
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alan Herschtal
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Tomas Kron
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia; Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia; Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael Mac Manus
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia; Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Drug Discovery by Molecular Imaging and Monitoring Therapy Response in Lymphoma. Int J Mol Sci 2017; 18:ijms18081639. [PMID: 28749424 PMCID: PMC5578029 DOI: 10.3390/ijms18081639] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/23/2017] [Accepted: 07/23/2017] [Indexed: 12/12/2022] Open
Abstract
Molecular imaging allows a noninvasive assessment of biochemical and biological processes in living subjects. Treatment strategies for malignant lymphoma depend on histology and tumor stage. For the last two decades, molecular imaging has been the mainstay diagnostic test for the staging of malignant lymphoma and the assessment of response to treatment. This technology enhances our understanding of disease and drug activity during preclinical and clinical drug development. Here, we review molecular imaging applications in drug development, with an emphasis on oncology. Monitoring and assessing the efficacy of anti-cancer therapies in preclinical or clinical models are essential and the multimodal molecular imaging approach may represent a new stage for pharmacologic development in cancer. Monitoring the progress of lymphoma therapy with imaging modalities will help patients. Identifying and addressing key challenges is essential for successful integration of molecular imaging into the drug development process. In this review, we highlight the general usefulness of molecular imaging in drug development and radionuclide-based reporter genes. Further, we discuss the different molecular imaging modalities for lymphoma therapy and their preclinical and clinical applications.
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13
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Interim PET-driven strategy in de novo diffuse large B-cell lymphoma: do we trust the driver? Blood 2017; 129:3059-3070. [PMID: 28416502 DOI: 10.1182/blood-2016-05-672196] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 04/03/2017] [Indexed: 11/20/2022] Open
Abstract
18F-Fluorodeoxyglucose-positron emission tomography (FDG-PET) has become a central tool for both accurate initial staging and determination of prognosis after treatment of diffuse large B-cell lymphoma (DLBCL). However, the role of PET during treatment (iPET) in daily practice remains a matter of significant debate. This perspective reviews the published studies on iPET in DLBCL, including the methods used to analyze iPET, its timing, and studies of iPET-driven therapy to illuminate where daily practice may benefit from the use of iPET. When performed after 2 and/or 4 courses of immunochemotherapy, iPET has a very good negative predictive value, utilizing both visual (qualitative) and semiquantitative methods. The visual method accurately predicts outcome for patients with limited disease. The semiquantitative method, eg, the change of the difference of maximum standardized uptake value (ΔSUVmax), is for patients with advanced DLBCL, for whom iPET identifies patients with very good outcome with continuation of standard therapy. A low ΔSUVmax also helps identify patients with a risk for relapse averaging 50% and warrants review of their scheduled therapy. To date, no trial has demonstrated the superiority of an iPET-driven strategy in DLBCL. However, the very good negative and good positive predictive values of iPET support its use in daily practice as a better predictive tool than contrast-enhanced computed tomographic scan for therapeutic decision making.
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15
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Valls L, Badve C, Avril S, Herrmann K, Faulhaber P, O'Donnell J, Avril N. FDG-PET imaging in hematological malignancies. Blood Rev 2016; 30:317-31. [PMID: 27090170 PMCID: PMC5298348 DOI: 10.1016/j.blre.2016.02.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 02/12/2016] [Accepted: 02/19/2016] [Indexed: 12/12/2022]
Abstract
The majority of aggressive lymphomas is characterized by an up regulated glycolytic activity, which enables the visualization by F-18 FDG-PET/CT. One-stop hybrid FDG-PET/CT combines the functional and morphologic information, outperforming both, CT and FDG-PET as separate imaging modalities. This has resulted in several recommendations using FDG-PET/CT for staging, restaging, monitoring during therapy, and assessment of treatment response as well as identification of malignant transformation. FDG-PET/CT may obviate the need for a bone marrow biopsy in patients with Hodgkin's lymphoma and diffuse large B cell lymphoma. FDG-PET/CT response assessment is recommended for FDG-avid lymphomas, whereas CT-based response evaluation remains important in lymphomas with low or variable FDG avidity. The treatment induced change in metabolic activity allows for assessment of response after completion of therapy as well as prediction of outcome early during therapy. The five-point scale Deauville Criteria allows the assessment of treatment response based on visual FDG-PET analysis. Although the use of FDG-PET/CT for prediction of therapeutic response is promising it should only be conducted in the context of clinical trials. Surveillance FDG-PET/CT after complete remission is discouraged due to the relative high number of false-positive findings, which in turn may result in further unnecessary investigations. Future directions include the use of new PET tracers such as F-18 fluorothymidine (FLT), a surrogate biomarker of cellular proliferation and Ga-68 CXCR4, a chemokine receptor imaging biomarker as well as innovative digital PET/CT and PET/MRI techniques.
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Affiliation(s)
- L Valls
- Department of Radiology, University Hospitals Case Medical Center, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA
| | - C Badve
- Department of Radiology, University Hospitals Case Medical Center, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA
| | - S Avril
- Department of Pathology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA
| | - K Herrmann
- Department of Nuclear Medicine, University Hospital Würzburg, 97080 Würzburg, Germany; Ahmanson Translational Imaging Division, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-7370, USA
| | - P Faulhaber
- Department of Radiology, University Hospitals Case Medical Center, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA
| | - J O'Donnell
- Department of Radiology, University Hospitals Case Medical Center, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA
| | - N Avril
- Department of Radiology, University Hospitals Case Medical Center, Case Center for Imaging Research, Case Western Reserve University, Cleveland, OH 44106, USA.
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Abstract
With the introduction of hybrid imaging technologies such as PET/CT and recently PET/MRI, staging and therapy-response monitoring have evolved. PET/CT has been shown to be of value for routine staging of FDG-avid lymphomas before as well as at the end of treatment. For interim staging, trials are ongoing to evaluate the use of PET/CT. In melanoma, PET/CT can be recommended for stages III and IV diseases for initial staging and before surgery. Studies investigating the use of PET/CT for early therapy response are promising. The role of PET/MR in lymphoma and melanoma imaging has to be defined because no larger studies exist so far. There may be an application of PET/MR in research especially for tumor characterization and therapy response. Furthermore, the potential role of non-FDG tracers is elucidated regarding the assessment of treatment response in targeted drug regimens.
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Affiliation(s)
- Nina F Schwenzer
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Anna Christina Pfannenberg
- Department of Radiology, Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
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17
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Minamimoto R, Fayad L, Advani R, Vose J, Macapinlac H, Meza J, Hankins J, Mottaghy F, Juweid M, Quon A. Diffuse Large B-Cell Lymphoma: Prospective Multicenter Comparison of Early Interim FLT PET/CT versus FDG PET/CT with IHP, EORTC, Deauville, and PERCIST Criteria for Early Therapeutic Monitoring. Radiology 2016; 280:220-9. [PMID: 26854705 DOI: 10.1148/radiol.2015150689] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To compare the performance characteristics of interim fluorine 18 ((18)F) fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) (after two cycles of chemotherapy) by using the most prominent standardized interpretive criteria (including International Harmonization Project [IHP] criteria, European Organization for Research and Treatment of Cancer [EORTC] criteria, and PET Response Criteria in Solid Tumors (PERCIST) versus those of interim (18)F fluorothymidine (FLT) PET/CT and simple visual interpretation. Materials and Methods This HIPAA-compliant prospective study was approved by the institutional review boards, and written informed consent was obtained. Patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL) underwent both FLT and FDG PET/CT 18-24 days after two cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone or rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin. For FDG PET/CT interpretation, IHP criteria, EORTC criteria, PERCIST, Deauville criteria, standardized uptake value, total lesion glycolysis, and metabolic tumor volume were used. FLT PET/CT images were interpreted with visual assessment by two reviewers in consensus. The interim (after cycle 2) FDG and FLT PET/CT studies were then compared with the end-of-treatment FDG PET/CT studies to determine which interim examination and/or criteria best predicted the result after six cycles of chemotherapy. Results From November 2011 to May 2014, there were 60 potential patients for inclusion, of whom 46 patients (24 men [mean age, 60.9 years ± 13.7; range, 28-78 years] and 22 women [mean age, 57.2 years ± 13.4; range, 25-76 years]) fulfilled the criteria. Thirty-four patients had complete response, and 12 had residual disease at the end of treatment. FLT PET/CT had a significantly higher positive predictive value (PPV) (91%) in predicting residual disease than did any FDG PET/CT interpretation method (42%-46%). No difference in negative predictive value (NPV) was found between FLT PET/CT (94%) and FDG PET/CT (82%-95%), regardless of the interpretive criteria used. FLT PET/CT showed statistically higher (P < .001-.008) or similar NPVs than did FDG PET/CT. Conclusion Early interim FLT PET/CT had a significantly higher PPV than standardized FDG PET/CT-based interpretation for therapeutic response assessment in DLBCL. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Ryogo Minamimoto
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, and Department of Medical Oncology (R.A.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5281 (R.M., A.Q.); Department of Radiology, Molecular Imaging Program, Stanford University, Stanford, Calif (R.M.); Departments of Lymphoma/Myeloma (L.F.) and Nuclear Medicine (H.M.), the University of Texas, MD Anderson Cancer Center, Houston, Tex; Oncology/Hematology Section (J.V.) and Department of Radiology (J.H.), University of Nebraska Medical Center, Omaha, Neb; Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Neb (J.M.); Department of Nuclear Medicine, University Hospital of Aachen, Aachen, Germany (F.M.); and Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan (M.J.)
| | - Luis Fayad
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, and Department of Medical Oncology (R.A.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5281 (R.M., A.Q.); Department of Radiology, Molecular Imaging Program, Stanford University, Stanford, Calif (R.M.); Departments of Lymphoma/Myeloma (L.F.) and Nuclear Medicine (H.M.), the University of Texas, MD Anderson Cancer Center, Houston, Tex; Oncology/Hematology Section (J.V.) and Department of Radiology (J.H.), University of Nebraska Medical Center, Omaha, Neb; Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Neb (J.M.); Department of Nuclear Medicine, University Hospital of Aachen, Aachen, Germany (F.M.); and Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan (M.J.)
| | - Ranjana Advani
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, and Department of Medical Oncology (R.A.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5281 (R.M., A.Q.); Department of Radiology, Molecular Imaging Program, Stanford University, Stanford, Calif (R.M.); Departments of Lymphoma/Myeloma (L.F.) and Nuclear Medicine (H.M.), the University of Texas, MD Anderson Cancer Center, Houston, Tex; Oncology/Hematology Section (J.V.) and Department of Radiology (J.H.), University of Nebraska Medical Center, Omaha, Neb; Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Neb (J.M.); Department of Nuclear Medicine, University Hospital of Aachen, Aachen, Germany (F.M.); and Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan (M.J.)
| | - Julie Vose
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, and Department of Medical Oncology (R.A.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5281 (R.M., A.Q.); Department of Radiology, Molecular Imaging Program, Stanford University, Stanford, Calif (R.M.); Departments of Lymphoma/Myeloma (L.F.) and Nuclear Medicine (H.M.), the University of Texas, MD Anderson Cancer Center, Houston, Tex; Oncology/Hematology Section (J.V.) and Department of Radiology (J.H.), University of Nebraska Medical Center, Omaha, Neb; Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Neb (J.M.); Department of Nuclear Medicine, University Hospital of Aachen, Aachen, Germany (F.M.); and Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan (M.J.)
| | - Homer Macapinlac
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, and Department of Medical Oncology (R.A.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5281 (R.M., A.Q.); Department of Radiology, Molecular Imaging Program, Stanford University, Stanford, Calif (R.M.); Departments of Lymphoma/Myeloma (L.F.) and Nuclear Medicine (H.M.), the University of Texas, MD Anderson Cancer Center, Houston, Tex; Oncology/Hematology Section (J.V.) and Department of Radiology (J.H.), University of Nebraska Medical Center, Omaha, Neb; Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Neb (J.M.); Department of Nuclear Medicine, University Hospital of Aachen, Aachen, Germany (F.M.); and Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan (M.J.)
| | - Jane Meza
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, and Department of Medical Oncology (R.A.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5281 (R.M., A.Q.); Department of Radiology, Molecular Imaging Program, Stanford University, Stanford, Calif (R.M.); Departments of Lymphoma/Myeloma (L.F.) and Nuclear Medicine (H.M.), the University of Texas, MD Anderson Cancer Center, Houston, Tex; Oncology/Hematology Section (J.V.) and Department of Radiology (J.H.), University of Nebraska Medical Center, Omaha, Neb; Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Neb (J.M.); Department of Nuclear Medicine, University Hospital of Aachen, Aachen, Germany (F.M.); and Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan (M.J.)
| | - Jordan Hankins
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, and Department of Medical Oncology (R.A.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5281 (R.M., A.Q.); Department of Radiology, Molecular Imaging Program, Stanford University, Stanford, Calif (R.M.); Departments of Lymphoma/Myeloma (L.F.) and Nuclear Medicine (H.M.), the University of Texas, MD Anderson Cancer Center, Houston, Tex; Oncology/Hematology Section (J.V.) and Department of Radiology (J.H.), University of Nebraska Medical Center, Omaha, Neb; Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Neb (J.M.); Department of Nuclear Medicine, University Hospital of Aachen, Aachen, Germany (F.M.); and Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan (M.J.)
| | - Felix Mottaghy
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, and Department of Medical Oncology (R.A.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5281 (R.M., A.Q.); Department of Radiology, Molecular Imaging Program, Stanford University, Stanford, Calif (R.M.); Departments of Lymphoma/Myeloma (L.F.) and Nuclear Medicine (H.M.), the University of Texas, MD Anderson Cancer Center, Houston, Tex; Oncology/Hematology Section (J.V.) and Department of Radiology (J.H.), University of Nebraska Medical Center, Omaha, Neb; Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Neb (J.M.); Department of Nuclear Medicine, University Hospital of Aachen, Aachen, Germany (F.M.); and Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan (M.J.)
| | - Malik Juweid
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, and Department of Medical Oncology (R.A.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5281 (R.M., A.Q.); Department of Radiology, Molecular Imaging Program, Stanford University, Stanford, Calif (R.M.); Departments of Lymphoma/Myeloma (L.F.) and Nuclear Medicine (H.M.), the University of Texas, MD Anderson Cancer Center, Houston, Tex; Oncology/Hematology Section (J.V.) and Department of Radiology (J.H.), University of Nebraska Medical Center, Omaha, Neb; Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Neb (J.M.); Department of Nuclear Medicine, University Hospital of Aachen, Aachen, Germany (F.M.); and Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan (M.J.)
| | - Andrew Quon
- From the Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, and Department of Medical Oncology (R.A.), Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5281 (R.M., A.Q.); Department of Radiology, Molecular Imaging Program, Stanford University, Stanford, Calif (R.M.); Departments of Lymphoma/Myeloma (L.F.) and Nuclear Medicine (H.M.), the University of Texas, MD Anderson Cancer Center, Houston, Tex; Oncology/Hematology Section (J.V.) and Department of Radiology (J.H.), University of Nebraska Medical Center, Omaha, Neb; Department of Biostatistics, University of Nebraska Medical Center College of Public Health, Omaha, Neb (J.M.); Department of Nuclear Medicine, University Hospital of Aachen, Aachen, Germany (F.M.); and Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan (M.J.)
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18
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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: 80] [Impact Index Per Article: 10.0] [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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19
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Schöder H, Zelenetz AD, Hamlin P, Gavane S, Horwitz S, Matasar M, Moskowitz A, Noy A, Palomba L, Portlock C, Straus D, Grewal R, Migliacci JC, Larson SM, Moskowitz CH. Prospective Study of 3'-Deoxy-3'-18F-Fluorothymidine PET for Early Interim Response Assessment in Advanced-Stage B-Cell Lymphoma. J Nucl Med 2015; 57:728-34. [PMID: 26719374 DOI: 10.2967/jnumed.115.166769] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/04/2015] [Indexed: 01/17/2023] Open
Abstract
UNLABELLED Current clinical and imaging tools remain suboptimal for early assessment of prognosis and treatment response in aggressive lymphomas. PET with 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT) can be used to measure tumor cell proliferation and treatment response. In a prospective study in patients with advanced-stage B-cell lymphoma, we investigated the prognostic and predictive value of (18)F-FLT PET in comparison to standard imaging with (18)F-FDG PET and clinical outcome. METHODS Sixty-five patients were treated with an induction/consolidation regimen consisting of 4 cycles of R-CHOP-14 (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) followed by 3 cycles of ICE (ifosfamide, carboplatin, etoposide). (18)F-FLT PET was performed at baseline and at interim (iPET) after 1-2 cycles of therapy. (18)F-FDG PET was performed at baseline, after cycle 4, and at the end of therapy. The relationship between PET findings, progression-free survival (PFS) and overall survival (OS) was investigated. RESULTS With a median follow-up of 51 mo, PFS and OS were 71% and 86%, respectively. (18)F-FLT iPET, analyzed visually (using a 5-point score) or semiquantitatively (using SUV and ΔSUV) predicted both PFS and OS (P < 0.01 for all parameters). Residual (18)F-FLT SUVmax on iPET was associated with an inferior PFS (hazard ratio, 1.26, P = 0.001) and OS (hazard ratio, 1.27, P = 0.002). When (18)F-FDG PET was used, findings in the end of treatment scan were better predictors of PFS and OS than findings on the interim scan. Baseline PET imaging parameters, including SUV, proliferative volume, or metabolic tumor volume, did not correlate with outcome. CONCLUSION (18)F-FLT PET after 1-2 cycles of chemotherapy predicts PFS and OS, and a negative (18)F-FLT iPET result may potentially help design risk-adapted therapies in patients with aggressive lymphomas. In contrast, the positive predictive value of (18)F-FLT iPET remains too low to justify changes in patient management.
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Affiliation(s)
- Heiko Schöder
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew D Zelenetz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Paul Hamlin
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Somali Gavane
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Steven Horwitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Matthew Matasar
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Alison Moskowitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Ariela Noy
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Lia Palomba
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Carol Portlock
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - David Straus
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Ravinder Grewal
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Steven M Larson
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Craig H Moskowitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; and
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20
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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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21
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Herrmann K, Buck AK, Schuster T, Abbrederis K, Blümel C, Santi I, Rudelius M, Wester HJ, Peschel C, Schwaiger M, Dechow T, Keller U. Week one FLT-PET response predicts complete remission to R-CHOP and survival in DLBCL. Oncotarget 2015; 5:4050-9. [PMID: 24979177 PMCID: PMC4147305 DOI: 10.18632/oncotarget.1990] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Despite improved survival in the Rituximab (R) era, a considerable number of patients with diffuse large B-cell lymphoma (DLBCL) ultimately die from the disease. Functional imaging using [18F]fluorodeoxyglucose-PET is suggested for assessment of residual viable tumor very early during treatment but is compromised by non-specific tracer retention in inflammatory lesions. The PET tracer [18F]fluorodeoxythymidine (FLT) as surrogate marker of tumor proliferation may overcome this limitation. We present results of a prospective clinical study testing FLT-PET as superior and early predictor of response to chemotherapy and outcome in DLBCL. 54 patients underwent FLT-PET prior to and one week after the start of R-CHOP chemotherapy. Repetitive FLT-PET imaging was readily implemented into the diagnostic work-up. Our data demonstrate that the reduction of FLT standard uptake valuemean (SUVmean) and SUVmax one week after chemotherapy was significantly higher in patients achieving complete response (CR, n=48; non-CR, n=6; p<0.006). Martingale-residual and Cox proportional hazard analyses showed a significant monotonous decrease of mortality risk with increasing change in SUV. Consistent with these results, early FLT-PET response showed relevant discriminative ability in predicting CR. In conclusion, very early FLT-PET in the course of R-CHOP chemotherapy is feasible and enables identification of patients at risk for treatment failure.
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Affiliation(s)
- Ken Herrmann
- Department of Nuclear Medicine, Technische Universität München, Munich, Germany. Department of Nuclear Medicine, Universitätsklinikum Würzburg, Würzburg, Germany. These Authors contributed equally to this work
| | - Andreas K Buck
- Department of Nuclear Medicine, Technische Universität München, Munich, Germany. Department of Nuclear Medicine, Universitätsklinikum Würzburg, Würzburg, Germany. These Authors contributed equally to this work
| | - Tibor Schuster
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Kathrin Abbrederis
- III. Medical Department, Technische Universität München, Munich, Germany
| | - Christina Blümel
- Department of Nuclear Medicine, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Ivan Santi
- Department of Nuclear Medicine, Technische Universität München, Munich, Germany
| | - Martina Rudelius
- Institute of Pathology, Technische Universität München, Munich, Germany. Institute of Pathology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Hans-Jürgen Wester
- Department of Nuclear Medicine, Technische Universität München, Munich, Germany
| | - Christian Peschel
- III. Medical Department, Technische Universität München, Munich, Germany
| | - Markus Schwaiger
- Department of Nuclear Medicine, Technische Universität München, Munich, Germany
| | - Tobias Dechow
- III. Medical Department, Technische Universität München, Munich, Germany. Oncology Ravensburg, Ravensburg, Germany
| | - Ulrich Keller
- III. Medical Department, Technische Universität München, Munich, Germany
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22
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3’-Deoxy-3’-[18F]-fluorothymidine PET/CT in early determination of prognosis in patients with esophageal squamous cell cancer. Strahlenther Onkol 2014; 191:141-52. [DOI: 10.1007/s00066-014-0744-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 07/16/2014] [Indexed: 12/13/2022]
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23
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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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