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Heetman JG, Paulino Pereira LJ, Kelder JC, Soeterik TFW, Wever L, Lavalaye J, van der Hoeven EJRJ, Lam MGEH, van Melick HHE, van den Bergh RCN. The additional value of 68Ga-PSMA PET/CT SUVmax in predicting ISUP GG ≥ 2 and ISUP GG ≥ 3 prostate cancer in biopsy. Prostate 2024. [PMID: 38704755 DOI: 10.1002/pros.24716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/25/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Prebiopsy magnetic resonance imaging (MRI) increases the detection rate of clinically significant prostate cancer (csPCa). Prostate-specific membrane antigen-positron emission tomography/computed tomography (PSMA PET/CT) maximum standardized uptake value (SUVmax) of the prostate may offer additional value in predicting the likelihood of csPCa in biopsy. METHODS A single-center cohort study involving patients with biopsy-proven PCa who underwent both MRI and PSMA PET/CT between 2020 and 2021. Logistic regression models were developed for International Society of Urological Pathology (ISUP) Grade Group (GG) ≥ 2 and GG ≥ 3 using noninvasive prebiopsy parameters: age, (log-)prostate-specific antigen (PSA) density, PI-RADS 5 lesion presence, extraprostatic extension (EPE) on MRI, and SUVmax of the prostate. Models with and without SUVmax were compared using Likelihood ratio tests and area under the curve (AUC). DeLong's test was used to compare the AUCs. RESULTS The study included 386 patients, with 262 (68%) having ISUP GG ≥ 2 and 180 (47%) having ISUP GG ≥ 3. Including SUVmax significantly improved both models' goodness of fit (p < 0.001). The GG ≥ 2 model had a higher AUC with SUVmax 89.16% (95% confidence interval [CI]: 86.06%-92.26%) than without 87.34% (95% CI: 83.93%-90.76%) (p = 0.026). Similarly, the GG ≥ 3 model had a higher AUC with SUVmax 82.51% (95% CI: 78.41%-86.6%) than without 79.33% (95% CI: 74.84%-83.83%) (p = 0.003). The SUVmax inclusion improved the GG ≥ 3 model's calibration at higher probabilities. CONCLUSION SUVmax of the prostate on PSMA PET/CT potentially improves diagnostic accuracy in predicting the likelihood of csPCa in prostate biopsy.
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Affiliation(s)
- Joris G Heetman
- Department of Urology, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
| | | | - Johannes C Kelder
- Department of Cardiology, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
| | - Timo F W Soeterik
- Department of Urology, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
| | - Lieke Wever
- Department of Urology, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
| | - Jules Lavalaye
- Department of Nuclear Medicine, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
| | | | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Harm H E van Melick
- Department of Urology, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
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Heetman JG, Lavalaye J, Polm PD, Soeterik TFW, Wever L, Paulino Pereira LJ, van der Hoeven EJRJ, van Melick HHE, van den Bergh RCN. Gallium-68 Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography in Active Surveillance for Prostate Cancer Trial (PASPoRT). Eur Urol Oncol 2024; 7:204-210. [PMID: 37296065 DOI: 10.1016/j.euo.2023.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/24/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND The use of clinical parameters, including prebiopsy magnetic resonance imaging (MRI), to decide between active surveillance (AS) and active therapy for prostate cancer (PCa) leads to imperfect selection. Additional prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) imaging may improve risk stratification. OBJECTIVE To study risk stratification and patient selection for AS with the addition of PSMA PET/CT to standard practice. DESIGN, SETTING, AND PARTICIPANTS A single-centre prospective cohort study (NL69880.100.19) enrolled patients recently diagnosed with PCa who started AS. At diagnosis, all participants had undergone prebiopsy MRI and targeted biopsy for visualised lesions. Patients underwent an additional [68Ga]-PSMA PET/CT and targeted biopsy of all PSMA lesions with a maximum standardised uptake value (SUVmax) of ≥4 not covered by previous biopsies. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was the number needed to scan (NNS) to detect one patient with upgrading. The study was powered to detect an NNS of 10. Regarding secondary outcomes, univariate logistic regressions analyses were performed on all patients and on the patients who received additional PSMA targeted biopsies on the likelihood of upgrading. RESULTS AND LIMITATIONS A total of 141 patients were included. Additional PSMA targeted biopsies were performed in 45 (32%) patients. In 13 (9%) patients, upgrading was detected: nine grade group (GG) 2, two GG 3, one GG 4, and one GG 5. The NNS was 11 (95% confidence interval 6-18). Of all participants, PSMA PET/CT and targeted biopsies yielded upgrading most frequently in patients with negative MRI (Prostate Imaging Reporting and Data System [PI-RADS] 1-2). Of patients who received additional PSMA targeted biopsies, upgrading was most frequently found in those with higher prostate-specific antigen density and negative MRI. Limitations included the lack of comparison with standard repeat biopsy, no central review of MRI, and possibility of biopsy sampling error. CONCLUSIONS PSMA PET/CT can further improve PCa risk stratification and selection for AS patients diagnosed after MRI and targeted biopsies. PATIENT SUMMARY Prostate-specific membrane antigen positron emission tomography/computed tomography and additional targeted prostate biopsies can identify more aggressive prostate cancer cases previously missed in patients recently started with expectant management for favourable-risk prostate cancer.
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Affiliation(s)
- Joris G Heetman
- Department of Urology, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands.
| | - Jules Lavalaye
- Department of Nuclear Medicine, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
| | - Pepijn D Polm
- Department of Urology, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
| | - Timo F W Soeterik
- Department of Urology, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
| | - Lieke Wever
- Department of Urology, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
| | | | | | - Harm H E van Melick
- Department of Urology, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
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Heetman JG, Versteeg R, Wever L, Pereira LJP, Soeterik TFW, Lavalaye J, de Bruin PC, van den Bergh RCN, van Melick HHE. Correction: Is cribriform pattern in prostate biopsy a risk factor for metastatic disease on 68Ga-PSMA-11 PET/CT? World J Urol 2023; 41:2877. [PMID: 37733091 DOI: 10.1007/s00345-023-04615-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Affiliation(s)
- J G Heetman
- Department of Urology, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Utrecht-Nieuwegein, The Netherlands.
| | - R Versteeg
- Department of Urology, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Utrecht-Nieuwegein, The Netherlands
| | - L Wever
- Department of Urology, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Utrecht-Nieuwegein, The Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Prosper Prostate Cancer Clinics, Nijmegen, The Netherlands
| | - L J Paulino Pereira
- Department of Urology, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Utrecht-Nieuwegein, The Netherlands
| | - T F W Soeterik
- Department of Urology, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Utrecht-Nieuwegein, The Netherlands
| | - J Lavalaye
- Department of Pathology, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
| | - P C de Bruin
- Department of Nuclear Medicine, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
| | - R C N van den Bergh
- Department of Urology, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Utrecht-Nieuwegein, The Netherlands
| | - H H E van Melick
- Department of Urology, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Utrecht-Nieuwegein, The Netherlands
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Heetman JG, Versteeg R, Wever L, Paulino Pereira LJ, Soeterik TFW, Lavalaye J, de Bruin PC, van den Bergh RCN, van Melick HHE. Is cribriform pattern in prostate biopsy a risk factor for metastatic disease on 68Ga-PSMA-11 PET/CT? World J Urol 2023; 41:2165-2171. [PMID: 37330440 DOI: 10.1007/s00345-023-04467-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/29/2023] [Indexed: 06/19/2023] Open
Abstract
INTRODUCTION Cribriform growth pattern (CP) in prostate cancer (PCa) has been associated with different unfavourable oncological outcomes. This study addresses if CP in prostate biopsies is an independent risk factor for metastatic disease on PSMA PET/CT. METHODS Treatment-naive patients with ISUP GG ≥ 2 staged with 68Ga-PSMA-11 PET/CT diagnosed from 2020 to 2021 were retrospectively enrolled. To test if CP in biopsies was an independent risk factor for metastatic disease on 68Ga-PSMA PET/CT, regression analyses were performed. Secondary analyses were performed in different subgroups. RESULTS A total of 401 patients were included. CP was reported in 252 (63%) patients. CP in biopsies was not an independent risk factor for metastatic disease on the 68Ga-PSMA PET/CT (p = 0.14). ISUP grade group (GG) 4 (p = 0.006), GG 5 (p = 0.003), higher PSA level groups per 10 ng/ml until > 50 (p-value between 0.02 and > 0.001) and clinical EPE (p > 0.001) were all independent risk factors. In the subgroups with GG 2 (n = 99), GG 3 (n = 110), intermediate-risk group (n = 129) or the high-risk group (n = 272), CP in biopsies was also not an independent risk factor for metastatic disease on 68Ga-PSMA PET/CT. If the EAU guideline recommendation for performing metastatic screening was applied as threshold for PSMA PET/CT imaging, in 9(2%) patients, metastatic disease was missed, and 18% fewer PSMA PET/CT would have been performed. CONCLUSION This retrospective study found that CP in biopsies was not an independent risk factor for metastatic disease on 68Ga-PSMA PET/CT.
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Affiliation(s)
- J G Heetman
- Department of Urology, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Utrecht-Nieuwegein, The Netherlands.
| | - R Versteeg
- Department of Urology, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Utrecht-Nieuwegein, The Netherlands
| | - L Wever
- Department of Urology, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Utrecht-Nieuwegein, The Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Prosper Prostate Cancer Clinics, Nijmegen, The Netherlands
| | - L J Paulino Pereira
- Department of Urology, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Utrecht-Nieuwegein, The Netherlands
| | - T F W Soeterik
- Department of Urology, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Utrecht-Nieuwegein, The Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Prosper Prostate Cancer Clinics, Nijmegen, The Netherlands
- Department of Pathology, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
- Department of Nuclear Medicine, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
| | - J Lavalaye
- Department of Pathology, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
| | - P C de Bruin
- Department of Nuclear Medicine, Sint Antonius Hospital, Utrecht-Nieuwegein, The Netherlands
| | - R C N van den Bergh
- Department of Urology, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Utrecht-Nieuwegein, The Netherlands
| | - H H E van Melick
- Department of Urology, Sint Antonius Hospital, Koekoekslaan 1, 3435 CM, Utrecht-Nieuwegein, The Netherlands
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van den Hoven AF, Keijsers RGM, Lam MGEH, Glaudemans AWJM, Verburg FA, Vogel WV, Lavalaye J. Current research topics in FAPI theranostics: a bibliometric analysis. Eur J Nucl Med Mol Imaging 2023; 50:1014-1027. [PMID: 36437424 DOI: 10.1007/s00259-022-06052-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The study aimed to provide a comprehensive bibliometric overview of the current scientific publications on fibroblast activation protein inhibitor (FAPI) positron emission tomography imaging and radionuclide therapy. METHODS A PubMed search was performed to identify all MEDLINE-indexed publications on FAPI imaging and radionuclide therapy. The last update was performed on 31 May 2022. An online database of this literature was created, and hierarchical topic-related tags were subsequently assigned to all relevant studies. Frequency analysis was used to evaluate the distribution of the following characteristics: first author's country of origin, journal of publication, study design, imaging techniques and radiopharmaceutical used, histopathological correlation, the type of cancer, and benign disease/uptake types evaluated. RESULTS A total of 294 relevant publications on original studies were identified, consisting of 209 (71%) case reports/series and 85 cohort studies (29%). The majority of studies focused on imaging topics, predominantly comparing uptake on FAPI-PET/CT with 2-[18F]FDG-PET/CT, anatomical imaging, and/or histopathology results. 68% of studies focused on malignancies, with gastro-intestinal cancer, hepato-pancreato-biliary cancer, mixed cancers/metastases, lung cancer, sarcoma, head and neck cancer, and breast cancer being the most frequently reported. 42% of studies focused on benign disease categories, with cardiovascular, musculoskeletal, HPB, head and neck, and IgG4-related disease as most common categories. 16/294 (5%) studies focused on radionuclide therapy, with preliminary reports of acceptable toxicity profiles, tumour activity retention, and suggestion of disease control. CONCLUSION FAPI research is rapidly expanding from diagnostic studies in malignancies and benign diseases to the first reports of salvage radionuclide therapy. The research activity needs to shift now from low-level-of-evidence case reports and series to prospectively designed studies in homogenous patient groups to provide evidence on how and in which clinical situations FAPI theranostics can be of added value to clinical care. We have provided an overview of current research topics to build upon.
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Affiliation(s)
- Andor F van den Hoven
- Department of Nuclear Medicine, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.
| | - Ruth G M Keijsers
- Department of Nuclear Medicine, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Frederik A Verburg
- Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Wouter V Vogel
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jules Lavalaye
- Department of Nuclear Medicine, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
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Heetman J, Lavalaye J, Polm P, Timo T, Wever L, Paulino Pereira L, Van Der Hoeven E, Van Melick H, Van Den Bergh R. 68Ga-PSMA-PET/CT in patients starting on Active Surveillance for PRostate cancer - Trial (PASPoRT). Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00995-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Bargon C, Huibers A, Young-Afat D, Jansen B, Lavalaye J, Slooten HJV, Verkooijen H, Swol C, Doeksen A. Sentinel Lymph Node Mapping in Breast Cancer Patients through Fluorescent Imaging using Indocyanine Green – the INFLUENCE trial. European Journal of Surgical Oncology 2023. [DOI: 10.1016/j.ejso.2022.11.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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van der Sar ECA, Lavalaye J, Braat AJAT, de Klerk JMH, Lam MGEH, de Keizer B. [PSMA PET, an important addition in prostate cancer diagnostics]. Ned Tijdschr Geneeskd 2023; 167. [PMID: 36633055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PSMA PET/CT is a diagnostic technique for patients with prostate cancer. It makes use of a radioligand that specifically binds to 'prostate specific membrane antigen' (PSMA), expressed by the prostate cancer cells. PSMA PET has proven to be highly effective in prostate cancer diagnostics in both primary staging and re-staging. PSMA PET/CT has a much higher accuracy than traditional CT and skeletal scintigraphy for the detection of metastases, allowing metastases to be detected in an earlier stage. The clinical relevance of the improved detection is now under investigation. Staging with PSMA PET/CT sometimes leads to avoiding surgery because distant metastases are found that were not detected with conventional imaging. In the Netherlands, PSMA PET/CT is now indicated both in primary prostate cancer diagnostics for the detection of metastases and for the detection of biochemical recurrence after prostatectomy or after radiotherapy.
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Affiliation(s)
- Esmée C A van der Sar
- UMC Utrecht, afd. Radiologie en Nucleaire Geneeskunde, Utrecht.,Contact: Esmée C.A. van der Sar
| | - Jules Lavalaye
- St. Antonius Ziekenhuis, afd. Nucleaire Geneeskunde, Nieuwegein
| | | | | | | | - Bart de Keizer
- UMC Utrecht, afd. Radiologie en Nucleaire Geneeskunde, Utrecht
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van der Sar ECA, Keusters WR, van Kalmthout LWM, Braat AJAT, de Keizer B, Frederix GWJ, Kooistra A, Lavalaye J, Lam MGEH, van Melick HHE. Cost-effectiveness of the implementation of [ 68Ga]Ga-PSMA-11 PET/CT at initial prostate cancer staging. Insights Imaging 2022; 13:132. [PMID: 35962838 PMCID: PMC9375809 DOI: 10.1186/s13244-022-01265-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022] Open
Abstract
Background Despite its high specificity, PSMA PET/CT has a moderate to low sensitivity of 40–50% for pelvic lymph node detection, implicating that a negative PSMA PET/CT cannot rule out lymph node metastases. This study investigates a strategy of implementing PSMA PET/CT for initial prostate cancer staging and treatment planning compared to conventional diagnostics. In this PSMA PET/CT strategy, a bilateral extended pelvic lymph node dissection (ePLND) is only performed in case of a negative PSMA PET/CT; in case of a positive scan treatment planning is solely based on PSMA PET/CT results. Method A decision table and lifetime state transition model were created. Quality-adjusted life years and health care costs were modelled over lifetime. Results The PSMA PET/CT strategy of treatment planning based on initial staging with [68Ga]Ga-PSMA-11 PET/CT results in cost-savings of €674 and a small loss in quality of life (QoL), 0.011 QALY per patient. The positive effect of [68Ga]Ga-PSMA-11 PET/CT was caused by abandoning both an ePLND and unnecessary treatment in iM1 patients, saving costs and resulting in higher QoL. The negative effect was caused by lower QoL and high costs in the false palliative state, due to pN1lim patients (≤ 4 pelvic lymph node metastases) being falsely diagnosed as iN1ext (> 4 pelvic lymph node metastases). These patients received subsequently palliative treatment instead of potentially curative therapy. Conclusion Initial staging and treatment planning based on [68Ga]Ga-PSMA-11 PET/CT saves cost but results in small QALY loss due to the rate of false positive findings. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-022-01265-w.
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Affiliation(s)
- Esmée C A van der Sar
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Willem R Keusters
- Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Arthur J A T Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Geert W J Frederix
- Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anko Kooistra
- Department of Urology, Meander Medical Center, Amersfoort, The Netherlands
| | - Jules Lavalaye
- Department of Nuclear Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Chi KN, Adra N, Garje R, Michalski JM, Lavalaye J, Kempel MM, Brackman M, Perraud K, Holder G, Armstrong AJ. Exposure-adjusted safety analyses of the VISION phase 3 trial of 177Lu-PSMA-617 in patients with metastatic castration-resistant prostate cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
85 Background: In the VISION trial, targeted radioligand therapy with 177Lu-PSMA-617 significantly prolonged radiographic progression free survival (rPFS) and overall survival when added to standard of care (SoC) in patients with advanced prostate-specific membrane antigen (PSMA)-PET-positive metastatic castration-resistant prostate cancer. There was a higher incidence of treatment-emergent adverse events (TEAEs) with 177Lu-PSMA-617 + SoC vs SoC. However, treatment exposure was more than three times longer in the 177Lu-PSMA-617 + SoC arm and thus relative toxicity may have been overestimated. A post hoc analysis of the relationship between exposure and frequency of TEAEs was performed to facilitate comparison of rates between arms. Methods: In this international, open-label study, adult patients previously treated with ≥ 1 androgen receptor pathway inhibitors and 1–2 taxane regimens were randomized 2:1 to 177Lu-PSMA-617 (7.4 GBq Q6W, ≤ 6 cycles) + SoC or SoC. Safety was a secondary endpoint. TEAEs (regardless of causality) were reported from start of randomized treatment for up to 30 days after last treatment administration (including SoC) or 1 day before subsequent anticancer treatment, whichever occurred first. Overall TEAE incidence was adjusted for treatment exposure by calculating incidence per 100 patient treatment-years (PTY). The analysis was performed for the first occurrence of TEAEs. Results: Exposure-adjusted incidence of any grade, grade ≥ 3 and selected TEAEs are listed in the table. There was similar exposure-adjusted incidence of gastrointestinal events and fatigue and higher exposure-adjusted incidence of musculoskeletal and renal events with SoC compared with 177Lu-PSMA-617 + SoC suggesting an association with treatment exposure rather than 177Lu-PSMA-617. Dry mouth, dry eye and acute myelosuppression maintained a higher incidence, confirming relationship with 177Lu-PSMA-617 treatment. Conclusions: The adjusted safety analysis, accounting for a longer safety observation due to longer rPFS in patients receiving 177Lu-PSMA-617, reveals a comparable incidence of TEAEs between arms. This confirms a favorable risk/benefit profile of 177Lu-PSMA-617 added to SoC in this patient population. Clinical trial information: NCT03511664. [Table: see text]
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Affiliation(s)
- Kim N. Chi
- BC Cancer Agency, University of British Columbia, Vancouver, BC, Canada
| | - Nabil Adra
- Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Rohan Garje
- Department of Internal Medicine, Division of Hematology/Oncology, University of Iowa, Iowa City, IA
| | - Jeff M. Michalski
- Department of Radiation Oncology, Washington University, St. Louis, MO
| | - Jules Lavalaye
- Department of Nuclear Medicine, Sint Antonius Ziekenhuis, Nieuwegein, Netherlands
| | - Mette Moe Kempel
- Department of Oncology and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Marcia Brackman
- Advanced Accelerator Applications, a Novartis Company, East Hanover, NJ
| | - Kevin Perraud
- Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
| | - Geoffrey Holder
- Advanced Accelerator Applications, a Novartis Company, Geneva, Switzerland
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Kuppen MCP, Westgeest HM, van den Eertwegh AJM, van Moorselaar RJA, van Oort IM, Tascilar M, Mehra N, Lavalaye J, Somford DM, Aben KKH, Bergman AM, de Wit R, van den Bergh ACMF, de Groot CAU, Gerritsen WR. Symptomatic Skeletal Events and the Use of Bone Health Agents in a Real-World Treated Metastatic Castration Resistant Prostate Cancer Population: Results From the CAPRI-Study in the Netherlands. Clin Genitourin Cancer 2022; 20:43-52. [PMID: 34848157 DOI: 10.1016/j.clgc.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 09/10/2021] [Accepted: 10/28/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patients with metastatic castration resistant prostate cancer (mCRPC) are at risk of symptomatic skeletal events (SSE). Bone health agents (BHA, ie bisphosphonates and denosumab) and new life-prolonging drugs (LPDs) can delay SSEs. The aim of this study is to investigate the use of BHAs in relation to SSEs in treated real-world mCRPC population. PATIENTS AND METHODS We included patients from the CAPRI registry who were treated with at least one LPD and diagnosed with bone metastases prior to the start of first LPD (LPD1). Outcomes were SSEs (external beam radiation therapy (EBRT) to the bone, orthopedic surgery, pathologic fracture or spinal cord compression) and SSE-free survival (SSE-FS) since LPD1. RESULTS One-thousand nine hundred and twenty-three patients were included with a median follow-up from LPD1 of 16.7 months. Fifty-two percent (n = 996) started BHA prior or within 4 weeks after the start of LPD1 (early BHA). In total, 41% experienced at least one SSE. SSE incidence rate was 0.29 per patient year for patients without BHA and 0.27 for patients with early BHA. Median SSE-FS from LPD1 was 12.9 months. SSE-FS was longer in patients who started BHA early versus patients without BHA (13.2 vs. 11.0 months, P = .001). CONCLUSION In a real-world population we observed an undertreatment with BHAs, although patients with early BHA use had lower incidence rates of SSEs and longer SSE-FS. This finding was irrespective of type of SSE and presence of risk factors. In addition to LPD treatment, timely initiation of BHAs is recommended in bone metastatic CRPC-patients with both pain and/or opioid use and prior SSE.
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Affiliation(s)
- Malou C P Kuppen
- Institute for Medical Technology Assessment, Erasmus School of Health Policy and Management, Rotterdam, the Netherlands.
| | - Hans M Westgeest
- Department of Internal Medicine, Amphia Hospital, Breda, the Netherlands
| | - Alfons J M van den Eertwegh
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | | | - Inge M van Oort
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Metin Tascilar
- Department of Internal Medicine, Isala, Zwolle, the Netherlands
| | - Niven Mehra
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jules Lavalaye
- Department of Nuclear Medicine, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Diederik M Somford
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Katja K H Aben
- Department for Health Evidence, Radboud university medical center, Nijmegen, the Netherlands; Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Andre M Bergman
- Division of Medical Oncology, the Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Ronald de Wit
- Department of Medical Oncology, Erasmus MC Daniel den Hoed Cancer Center, Rotterdam
| | - A C M Fons van den Bergh
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Carin A Uyl- de Groot
- Institute for Medical Technology Assessment, Erasmus School of Health Policy and Management, Rotterdam, the Netherlands
| | - Winald R Gerritsen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
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12
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Heetman J, Polm P, Soeterik T, Lavalaye J, Stijns P, Van Melick H, Van Den Bergh R. 68Ga-PSMA-PET/CT in newly diagnosed patients on active surveillance (PASPoRT study). EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)03085-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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13
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Westgeest HM, Kuppen MCP, van den Eertwegh FAJM, van Oort IM, Coenen JLLM, van Moorselaar JRJA, Aben KKH, Bergman AM, Huinink DTB, van den Bosch J, Hendriks MP, Lampe MI, Lavalaye J, Mehra N, Smilde TJ, Somford RDM, Tick L, Weijl NI, van de Wouw YAJ, Gerritsen WR, Groot CAUD. High-Intensity Care in the End-of-Life Phase of Castration-Resistant Prostate Cancer Patients: Results from the Dutch CAPRI-Registry. J Palliat Med 2021; 24:1789-1797. [PMID: 34415798 DOI: 10.1089/jpm.2020.0800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Intensive end-of-life care (i.e., the overuse of treatments and hospital resources in the last months of life), is undesirable since it has a minimal clinical benefit with a substantial financial burden. The aim was to investigate the care in the last three months of life (end-of-life [EOL]) in castration-resistant prostate cancer (CRPC). Methods: Castration-resistant prostate cancer registry (CAPRI) is an investigator-initiated, observational multicenter cohort study in 20 hospitals retrospectively including patients diagnosed with CRPC between 2010 and 2016. High-intensity care was defined as the initiation of life-prolonging drugs (LPDs) in the last month, continuation of LPD in last 14 days, >1 admission, admission duration ≥14 days, and/or intensive care admission in last three months of life. Descriptive and binary logistic regression analyses were performed. Results: High-intensity care was experienced by 41% of 2429 patients in the EOL period. Multivariable analysis showed that age (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.97-0.99), performance status (OR 0.57, 95% CI 0.33-0.97), time from CRPC to EOL (OR 0.98, 95% CI 0.97-0.98), referral to a medical oncologist (OR 1.99, 95% CI 1.55-2.55), prior LPD treatment (>1 line OR 1.72, 95% CI 1.31-2.28), and opioid use (OR 1.45, 95% CI 1.08-1.95) were significantly associated with high-intensity care. Conclusions: High-intensity care in EOL is not easily justifiable due to high economic cost and little effect on life span, but further research is awaited to give insight in the effect on patients' and their caregivers' quality of life.
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Affiliation(s)
- Hans M Westgeest
- Department of Internal Medicine, Amphia Hospital, Breda, the Netherlands
| | - Malou C P Kuppen
- Institute for Medical Technology Assessment, Erasmus School of Health Policy and Management, Rotterdam, the Netherlands
| | - Fons A J M van den Eertwegh
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Inge M van Oort
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - Katja K H Aben
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands.,Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Andre M Bergman
- Division of Medical Oncology, the Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | | | - Joan van den Bosch
- Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | - Mathijs P Hendriks
- Department of Internal Medicine, Northwest Clinics, Alkmaar, the Netherlands
| | - Menuhin I Lampe
- Department of Urology, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Jules Lavalaye
- Department of Nuclear Medicine, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Niven Mehra
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tineke J Smilde
- Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Rik D M Somford
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Lidwine Tick
- Department of Internal Medicine, Maxima Medical Center, Eindhoven, the Netherlands
| | - Nir I Weijl
- Department of Internal Medicine, MCH-Bronovo Hospital, 's-Gravenhage, the Netherlands
| | - Yes A J van de Wouw
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Winald R Gerritsen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Carin A Uyl-de Groot
- Institute for Medical Technology Assessment, Erasmus School of Health Policy and Management, Rotterdam, the Netherlands
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14
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Kuppen MC, Westgeest HM, van der Doelen MJ, van den Eertwegh AJ, Coenen JL, Aben KK, van den Bergh AC, Bergman AM, den Bosch JV, Celik F, Hendriks MP, Lavalaye J, der Meer SV, Polee MB, Somford DM, van Oort IM, Uyl-de Groot CA, Gerritsen WR. Real-world outcomes of radium-223 dichloride for metastatic castration resistant prostate cancer. Future Oncol 2020; 16:1371-1384. [PMID: 32469606 DOI: 10.2217/fon-2020-0039] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Aim: Timing of radium-223 (Ra-223) in metastatic castration-resistant prostate cancer (mCRPC) remains challenging due to alternative options and short window of opportunity. Methods: Ra-223 treated patients in the CAPRI-registry were included. Outcomes were evaluated based on treatment line of Ra-223. Results: Out of 285 patients, 49% received Ra-223 in line ≥3. 51% completed six Ra-223 injections and 34% had a symptomatic skeletal event after first Ra-223 without differences between subgroups. After correction of known prognostic factors Ra-223 in line ≥3 (HR: 3.267; 95% CI: 1.689-6.317; p < 0.01) remained associated with worse OS. Conclusion: In the Netherlands, Ra-223 was mainly started as second or third mCRPC-treatment in 2014-2018. Later timing of Ra-223 did affect OS, but not treatment completion and occurrence of symptomatic skeletal events.
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Affiliation(s)
- Malou Cp Kuppen
- Institute for Medical Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Hans M Westgeest
- Department of Internal Medicine, Amphia Hospital, Breda, The Netherlands
| | | | - Alphonsus Jm van den Eertwegh
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | | | - Katja Kh Aben
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.,Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Alphons Cm van den Bergh
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Andries M Bergman
- Division of Internal Medicine (MOD) & Oncogenomics, the Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Joan van den Bosch
- Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands
| | - Filiz Celik
- Department of Nuclear Medicine, Deventer Hospital, Deventer, The Netherlands
| | - Mathijs P Hendriks
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - Jules Lavalaye
- Department of Nuclear Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Saskia van der Meer
- Department of Urology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Marco B Polee
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Diederik M Somford
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Inge M van Oort
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carin A Uyl-de Groot
- Institute for Medical Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Winald R Gerritsen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
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15
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Heetman JG, Lavalaye J, van Selm S, van der Hoeven EJ, van Melick HH, van den Bergh RC. Is there any additional value to 68Ga-PSMA PET/CT in patients with suspicion of prostate cancer despite negative MRI and systematic biopsy? MINERVA UROL NEFROL 2020; 72:511-513. [PMID: 32284529 DOI: 10.23736/s0393-2249.20.03722-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Joris G Heetman
- Department of Urology, St. Antonius Hospital, Nieuwegein, the Netherlands -
| | - Jules Lavalaye
- Department of Nuclear Medicine, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Sandrine van Selm
- Department of Urology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | | | - Harm H van Melick
- Department of Urology, St. Antonius Hospital, Nieuwegein, the Netherlands
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16
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Aluwini SS, Mehra N, Lolkema MP, Oprea-Lager DE, Yakar D, Stoevelaar H, van der Poel H, Busstra M, de Jong IJ, de Reijke T, de Vries K, Heijmink S, Jenster G, Klaver S, Kneppers J, Lavalaye J, Leyten G, Moonen L, Nagaraj J, Noordzij W, Osanto S, Oving I, Schaake E, Scheenen T, Schoots I, Sedelaar M, Somford D, van den Berkmortel F, van der Hulle T, van der Voort van Zyp J, van Leeuwen P, van Moorselaar J, van Oort I, Vogel W, Westgeest H. Oligometastatic Prostate Cancer: Results of a Dutch Multidisciplinary Consensus Meeting. Eur Urol Oncol 2020; 3:231-238. [DOI: 10.1016/j.euo.2019.07.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 06/20/2019] [Accepted: 07/12/2019] [Indexed: 12/27/2022]
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17
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Kuppen M, Westgeest H, van den Eertwegh A, Van Moorselaar J, Mehra N, Coenen J, van Oort I, van den Bergh A, Lavalaye J, Aben K, Somford D, de Wit R, Bergman A, Uyl-de Groot C, Gerritsen W. Real-world use of radium-223 for treatment of metastatic castration resistant-prostate cancer (mCRPC): Results from the Dutch CAPRI registry. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz248.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Jansen BHE, Kramer GM, Cysouw MCF, Yaqub MM, de Keizer B, Lavalaye J, Booij J, Vargas HA, Morris MJ, Vis AN, van Moorselaar RJA, Hoekstra OS, Boellaard R, Oprea-Lager DE. Healthy Tissue Uptake of 68Ga-Prostate-Specific Membrane Antigen, 18F-DCFPyL, 18F-Fluoromethylcholine, and 18F-Dihydrotestosterone. J Nucl Med 2019; 60:1111-1117. [PMID: 30630941 DOI: 10.2967/jnumed.118.222505] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/17/2018] [Indexed: 02/07/2023] Open
Abstract
PET is increasingly used for prostate cancer (PCa) diagnostics. Important PCa radiotracers include 68Ga-prostate-specific membrane antigen HBED-CC (68Ga-PSMA), 18F-DCFPyL, 18F-fluoromethylcholine (18F-FCH), and 18F-dihydrotestosterone (18F-FDHT). Knowledge on the variability of tracer uptake in healthy tissues is important for accurate PET interpretation, because malignancy is suspected only if the uptake of a lesion contrasts with its background. Therefore, the aim of this study was to quantify uptake variability of PCa tracers in healthy tissues and identify stable reference regions for PET interpretation. Methods: A total of 232 PCa PET/CT scans from multiple hospitals was analyzed, including 87 68Ga-PSMA scans, 50 18F-DCFPyL scans, 68 18F-FCH scans, and 27 18F-FDHT scans. Tracer uptake was assessed in the blood pool, lung, liver, bone marrow, and muscle using several SUVs (SUVmax, SUVmean, SUVpeak). Variability in uptake between patients was analyzed using the coefficient of variation (COV%). For all tracers, SUV reference ranges (95th percentiles) were calculated, which could be applicable as image-based quality control for future PET acquisitions. Results: For 68Ga-PSMA, the lowest uptake variability was observed in the blood pool (COV, 19.9%), which was significantly more stable than all other tissues (COV, 29.8%-35.2%; P = 0.001-0.024). For 18F-DCFPyL, the lowest variability was observed in the blood pool and liver (COV, 14.4% and 21.7%, respectively; P = 0.001-0.003). The least variable 18F-FCH uptake was observed in the liver, blood pool, and bone marrow (COV, 16.8%-24.2%; P = 0.001-0.012). For 18F-FDHT, low uptake variability was observed in all tissues, except the lung (COV, 14.6%-23.6%; P = 0.001-0.040). The different SUV types had limited effect on variability (COVs within 3 percentage points). Conclusion: In this multicenter analysis, healthy tissues with limited uptake variability were identified, which may serve as reference regions for PCa PET interpretation. These reference regions include the blood pool for 68Ga-PSMA and 18F-DCFPyL and the liver for 18F-FCH and 18F-FDHT. Healthy tissue SUV reference ranges are presented and applicable as image-based quality control.
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Affiliation(s)
- Bernard H E Jansen
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, VU University Medical Center, Amsterdam, The Netherlands.,Department of Urology, Amsterdam University Medical Centers, VU University Medical Center, Amsterdam, The Netherlands
| | - Gem M Kramer
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, VU University Medical Center, Amsterdam, The Netherlands
| | - Matthijs C F Cysouw
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, VU University Medical Center, Amsterdam, The Netherlands
| | - Maqsood M Yaqub
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, VU University Medical Center, Amsterdam, The Netherlands
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jules Lavalaye
- Department of Nuclear Medicine, St-Antonius Hospital, Nieuwegein, The Netherlands
| | - Jan Booij
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands; and
| | | | - Michael J Morris
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - André N Vis
- Department of Urology, Amsterdam University Medical Centers, VU University Medical Center, Amsterdam, The Netherlands
| | - Reindert J A van Moorselaar
- Department of Urology, Amsterdam University Medical Centers, VU University Medical Center, Amsterdam, The Netherlands
| | - Otto S Hoekstra
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, VU University Medical Center, Amsterdam, The Netherlands
| | - Ronald Boellaard
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, VU University Medical Center, Amsterdam, The Netherlands
| | - Daniela E Oprea-Lager
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, VU University Medical Center, Amsterdam, The Netherlands
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19
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Westgeest H, Kuppen M, van den Eertwegh A, Van Moorselaar J, Mehra N, van Oort I, van den Bergh A, Coenen J, Aben K, Somford R, de Wit R, Bergman A, Lavalaye J, Uyl-de Groot C, Gerritsen W. Cabazitaxel treatment in metastatic castration-resistant prostate cancer (mCRPC) clinical trials compared to usual care in CAPRI: An observational study in the Netherlands. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy284.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Kuppen M, Westgeest H, van den Eertwegh A, Van Moorselaar J, Mehra N, van Oort I, van den Bergh A, Coenen J, Aben K, Somford R, Lavalaye J, Bergman A, Uyl-de Groot C, Gerritsen W. Symptomatic skeletal related events (SSE) and SSE-free-survival in real world castration-resistant prostate cancer (CRPC) patients: Results from CAPRI. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy284.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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van Gils K, Brinks P, Lavalaye J, Verberne HJ, Habraken JBA. A method to measure the absorbed dose of the thyroid during I-131 therapy, using a collar detector system and a SPECT acquisition. Med Phys 2017; 44:5450-5456. [DOI: 10.1002/mp.12472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/07/2017] [Accepted: 07/10/2017] [Indexed: 11/06/2022] Open
Affiliation(s)
- Koen van Gils
- Department of Medical Physics; St Antonius Hospital; Utrecht/Nieuwegein The Netherlands
| | - Peter Brinks
- Department of Medical Physics; St Antonius Hospital; Utrecht/Nieuwegein The Netherlands
| | - Jules Lavalaye
- Department of Nuclear Medicine; St Antonius Hospital; Utrecht/Nieuwegein The Netherlands
| | - Hein J. Verberne
- Department of Nuclear Medicine; Academic Medical Center; Amsterdam The Netherlands
| | - Jan B. A. Habraken
- Department of Medical Physics; St Antonius Hospital; Utrecht/Nieuwegein The Netherlands
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22
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Brinks P, Van Gils K, Kranenborg E, Lavalaye J, Dieckens D, Habraken JBA. Measuring the actual I-131 thyroid uptake curve with a collar detector system: a feasibility study. Eur J Nucl Med Mol Imaging 2016; 44:935-940. [PMID: 27988801 DOI: 10.1007/s00259-016-3595-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/06/2016] [Indexed: 11/25/2022]
Abstract
Radionuclide therapy using I-131 is commonly used for the treatment of benign thyroid diseases. The therapeutic dose to be administered is calculated based on the type of disease, the volume of the thyroid, and the measured uptake percentage. This methodology assumes a similar biological half-life of iodine, whereas in reality a large variation in biological half-life is observed. More knowledge about the actual biological half-life of iodine for individual patients will improve the quantification of the delivered radiation dose during radioiodine therapy and could aid the evaluation of the success of the therapy. In this feasibility study we used a novel measurement device [Collar Therapy Indicator (CoTI)] to measure the uptake curve of patients undergoing I-131 radioiodine therapy. The CoTI device is a light-weight wearable device that contains two independent gamma radiation detectors that are placed in a collar. By comparing results of thyroid uptake measurements with results obtained with a gamma camera, the precision of the system is demonstrated. Additionally, for three patients the uptake curve is measured during 48 h of admission in the hospital. The presented results demonstrate the feasibility of the new measurement device to measure the uptake curve during radioiodine therapy.
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Affiliation(s)
- Peter Brinks
- Department of Medical Physics, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - Koen Van Gils
- Department of Medical Physics, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Ellen Kranenborg
- Department of Nuclear Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jules Lavalaye
- Department of Nuclear Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Dennis Dieckens
- Department of Medical Physics, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jan B A Habraken
- Department of Medical Physics, St. Antonius Hospital, Nieuwegein, The Netherlands
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23
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Vis R, Lavalaye J, van de Garde EM. GMP-compliant (68)Ga radiolabelling in a conventional small-scale radiopharmacy: a feasible approach for routine clinical use. EJNMMI Res 2015; 5:27. [PMID: 25932354 PMCID: PMC4412871 DOI: 10.1186/s13550-015-0105-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 04/14/2015] [Indexed: 12/19/2022] Open
Abstract
Background The number of routine care patient examinations with 68Ga radiopharmaceuticals is still relatively limited, probably caused by the presumed need for large investments in hot cells, automated synthesis modules, laboratory equipment and validation efforts. Our aim was to set up the preparation of 68Ga-DOTA-NOC in compliance with all current European Union-Good Manufacturing Practices (EU-GMP), current Good Radiopharmacy Practice (cGRPP) and European Pharmacopoeia (Ph. Eur.) guidance but without the availability of a hot cell and gas chromatography (GC), high-performance liquid chromatography (HPLC) and atomic absorption spectrometry (AAS) equipment. Methods A risk-based approach was applied to align preparation conditions with applicable regulations, together with a validation of a thin-layer chromatography (ITLC) method to replace HPLC as modality for examining radiochemical purity. Results Using an internally shielded labelling module for manual operation, a 68Ga-DOTA-NOC labelling procedure was set up that meets all applicable Ph. Eur. specifications. The applied ITLC method showed very good correlation with HPLC results (r = 0.961) and was able to detect relevant deviations in radiolabelling procedures. All identified quality assurance aspects were made compliant with EU-GMP and cGRPP guidance. Conclusions We consider the described configuration and validation approach feasible for many conventional small-scale radiopharmacies, something that could help to increase the availability of 68Ga radiopharmaceuticals to a large number of patients.
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Affiliation(s)
- Roeland Vis
- Department of Clinical Pharmacy, St Antonius Hospital, Koekoekslaan 1, 3430EM Nieuwegein, The Netherlands
| | - Jules Lavalaye
- Department of Nuclear Medicine, St Antonius Hospital, Koekoekslaan 1, 3430EM Nieuwegein, The Netherlands
| | - Ewoudt Mw van de Garde
- Department of Clinical Pharmacy, St Antonius Hospital, Koekoekslaan 1, 3430EM Nieuwegein, The Netherlands
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Lavalaye J, Lam MGEH, Verzijlbergen JFF, Krijger GC, Vis R, de Keizer B. [Not Available]. Ned Tijdschr Geneeskd 2015; 160:A9780. [PMID: 27142500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
(68)Gallium (Ga)-PSMA PET/CT (PSMA stands for "prostate-specific membrane antigen") is a new diagnostic tool for patients with prostate cancer or with prostate cancer metastases. PET/CT is a combination scan which uses the physiological information of the PET scan and the anatomic information of the CT scan. The radioligand (68)Ga-PSMA is a radioactively labelled peptide that binds to the membrane protein PSMA. Prostate cancer cells in the primary tumour and in metastases express increased levels of PSMA in the plasma membrane. A number of studies have shown that (68)Ga-PSMA PET/CT is sensitive in detecting primary prostate cancer and metastases in lymph nodes and bone. In the same patient, (68)Ga-PSMA PET/CT detects more metastases in an earlier phase, i.e. at a lower PSA level, than fluorine-18 choline PET/CT. Furthermore, the (68)Ga-PSMA can be produced in the investigating hospital with a gallium generator. The expectation is that the use of (68)Ga-PSMA PET/CT will increase to a major extent over the coming years in patients with prostate cancer.
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Affiliation(s)
- Jules Lavalaye
- Namens de Nederlandse werkgroep 68Ga-PSMA-PET-diagnostiek bij prostaatcarcinoom
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Dieckens D, Lavalaye J, Romijn L, Habraken J. Contrast-noise-ratio (CNR) analysis and optimisation of breast-specific gamma imaging (BSGI) acquisition protocols. EJNMMI Res 2013; 3:21. [PMID: 23531207 PMCID: PMC3648494 DOI: 10.1186/2191-219x-3-21] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 02/24/2013] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Breast cancer is one of the most prevalent forms of cancer in women. Breast-specific gamma imaging (BSGI) is a diagnostic imaging method that uses sestamibi-labelled 99Tc and a dedicated gamma camera to localize malignant lesions in breast tissue. The aim of this study is to investigate if the current acquisition protocol for BSGI at our hospital is optimized for the detection of lesions in our patients. METHODS We analyzed patient data and performed a phantom study with a Dilon 6800 gamma camera. The patient data were collected from a group of 13 patients (740 MBq 99mTc-sestamibi, four views per patient were dynamically acquired with a frame duration of 30 s per frame and a total acquisition time of 8 min per view). Reduced-time static images were created, and contrast-to-noise ratios of identified hotspots were determined for different acquisition times. For the phantom study, we used a contrast detail phantom to investigate the contrast and resolution properties, within the range of relevant clinical acquisition parameters. The phantom was filled with a concentration of 80 MBq in 500 ml of water, and we dynamically acquired frames for a total acquisition time of 60 min using a general purpose (GP) collimator. To compare the GP collimator with the high-resolution collimator, a second acquisition was made for both collimators with a total acquisition time of 16 min. RESULTS The initial analysis of BSGI scans of the 13 patients showed that a dose reduction by a factor of 3 would not have reduced the number of observable hotspots in each of the acquired views. However, a subsequent systematic analysis of our protocol with a contrast-detail phantom showed that dose reduction results in a lower observability of hotspots, whereas increased doses resulted in a higher observability. CONCLUSION We believe that the results of our phantom study are relevant for clinical practice and that further dose reduction cannot be recommended for the BSGI exams at our hospital and that an increase of the administered activity should be considered.
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Affiliation(s)
- Dennis Dieckens
- Department of Medical Physics, St, Antonius Hospital, , Nieuwegein, 3435, CM, The Netherlands.
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Keijsers RG, Grutters JC, Thomeer M, Du Bois RM, Van Buul MM, Lavalaye J, Van Den Bosch JM, Verzijlbergen FJ. Imaging the inflammatory activity of sarcoidosis: sensitivity and inter observer agreement of (67)Ga imaging and (18)F-FDG PET. Q J Nucl Med Mol Imaging 2011; 55:66-71. [PMID: 21242947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM The aim of this study was to investigate sensitivity of 67Ga imaging and 18F-FDG PET for sarcoidosis activity and their inter observer variability. METHODS Thirty-four newly diagnosed, histologically proven sarcoidosis patients were analyzed prospectively. (67)Ga imaging and (18)F-FDG PET were performed, the presence of pulmonary and extra pulmonary lesions was evaluated and inter observer variability of both techniques was assessed. RESULTS Overall sensitivity to detect active sarcoidosis was 88% for (67)Ga imaging and 97% for (18)F-FDG PET. Although these results were not significantly different, 18F-FDG PET detected more lesions in the mediastinum (P<0.05), hila (P<0.05), lymph nodes (P<0.001) and extra pulmonary regions in general (P<0.001). Inter observer agreement was poor to moderate for (67)Ga imaging (kappa 0.19-0.59) and good to very good for (18)F-FDG PET (kappa 0.65-1.00). CONCLUSION (18)F-FDG PET is more sensitive than (67)Ga imaging in the assessment of sarcoidosis activity with regard to the mediastinum, hila, lymph nodes and extra pulmonary lesions in general. Furthermore, (18)F-FDG PET demonstrates a very good inter observer agreement in contrast with (67)Ga imaging and (18)F-FDG PET is therefore the nuclear imaging technique of choice in sarcoidosis assessment.
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Affiliation(s)
- R G Keijsers
- Department of Nuclear Medicine, St Antonius Hospital, Nieuwegein, the Netherlands.
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Lavalaye J, Grutters JC, van de Garde EMW, van Buul MMC, van den Bosch JMM, Windhorst AD, Verzijlbergen FJ. Imaging of fibrogenesis in patients with idiopathic pulmonary fibrosis with cis-4-[(18)F]-Fluoro-L: -proline PET. Mol Imaging Biol 2008; 11:123-7. [PMID: 18665424 DOI: 10.1007/s11307-008-0164-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Revised: 03/20/2008] [Accepted: 05/19/2008] [Indexed: 12/31/2022]
Abstract
PURPOSE Idiopathic pulmonary fibrosis (IPF) is a lethal lung disease for which no single diagnostic modality is able to evaluate the activity of the disease process. Cis-4-(18)F-fluoro-L: -proline ((18)F-proline) was shown in animal studies to be a reliable marker for fibrosis formation. We tested this candidate radioligand for imaging of fibrogenesis in patients with IPF. METHODS Five patients with IPF proven by lung biopsy and computed tomography were included. Furthermore, we also included one patient with non-specific interstitial pneumonia (NSIP) and scleroderma and one with NSIP and organising pneumonia. Positron emission tomography (PET) acquisition was performed 1, 2 and 3h after injection of 400MBq (18)F-proline. We scored (18)F-proline activity visually and quantitatively by calculating the activity in the regions of interest over lung, liver and mediastinum. RESULTS We found low uptake of (18)F-proline in the lungs of all patients with IPF. The highest uptake was seen at 2h post-injection, with a decline at 3h past injection. The differences in lung uptake between patients were small, except for one patient with NSIP and organising pneumonia who had a slightly higher (18)F-proline uptake. No significant correlations between (18)F-proline uptake and clinical parameters were found. CONCLUSIONS Due to the low pulmonary uptake of (18)F-proline in patients with IPF, (18)F-proline does not seem to be a suitable radioligand to evaluate the activity of fibrosis formation in patients with IPF. The low uptake in the lungs of patients with interstitial fibrosis may be explained by the slow nature of fibrogenesis or to the relatively low dose of proline that can be used.
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Affiliation(s)
- Jules Lavalaye
- Department of Nuclear Medicine, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands.
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Keijsers R, van Buul M, Lavalaye J, Verzijlbergen F. [Clinical reasoning and decision-making in practice. A man with swelling of both corners of the jaw]. Ned Tijdschr Geneeskd 2008; 152:1700-1701. [PMID: 18714526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Tiel-van BMMC, Lavalaye J, Keijsers RGM, Verzijlbergen JF. [Three previously healthy persons with a stress fracture]. Ned Tijdschr Geneeskd 2007; 151:1154-5; author reply 1155. [PMID: 17557673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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de Haan L, Booij J, Lavalaye J, van Amelsvoort T, Linszen D. Occupancy of dopamine D2 receptors by antipsychotic drugs is related to nicotine addiction in young patients with schizophrenia. Psychopharmacology (Berl) 2006; 183:500-5. [PMID: 16292589 DOI: 10.1007/s00213-005-0218-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Accepted: 09/23/2005] [Indexed: 01/11/2023]
Abstract
RATIONALE Occupancy of dopamine D2 receptors by antipsychotic drugs depends on the individual availability of D2 receptors and on the dose and type of antipsychotic medication. It has been suggested that a low availability of these receptors may increase the risk for addictive behavior. OBJECTIVE This study aims to show that patients with relatively high occupancy of D2 receptors by antipsychotic drugs are more prone to nicotine consumption. METHODS Striatal D2 receptor occupancy by equivalent doses of olanzapine or risperidone was assessed with [123I]iodobenzamide single-photon emission computed tomography (SPECT) in 36 patients with schizophrenia. Smoking status at the time of SPECT imaging was assessed. The number of cigarettes used in the following three consecutive years was estimated with the Life Chart Schedule (LCS). RESULTS There was a positive and significant relation between D2 receptor occupancy following treatment with olanzapine (n=19) or risperidone (n=12) and the number of cigarettes smoked in three consecutive years (r=0.60, p<0.001) in patients who smoked. There was a significant difference in the percentage of D2 occupancy for smokers (mean 74.3%, SD 12.8, n=31) and nonsmokers (mean 49.8%, SD 9.1, n=5). CONCLUSION Frequency of cigarette smoking in schizophrenic patients treated with antipsychotic medication is significantly and negatively related to the availability of striatal D2 receptors.
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Affiliation(s)
- Lieuwe de Haan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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de Haan L, Lavalaye J, van Bruggen M, van Nimwegen L, Booij J, van Amelsvoort T, Linszen D. Subjective experience and dopamine D2 receptor occupancy in patients treated with antipsychotics: clinical implications. Can J Psychiatry 2004; 49:290-6. [PMID: 15198464 DOI: 10.1177/070674370404900503] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES This paper gives an overview of studies on the association between dopaminergic neurotransmission and the subjective experience of patients with schizophrenia. METHODS We undertook a review of the literature. RESULTS Dopaminergic neurotransmission may be relevant for subjective experience. Higher striatal D2 receptor occupancy by typical and atypical antipsychotics is related to worse subjective experience, more severe negative symptoms, and depression. Individuals with lower baseline dopamine function are at an increased risk for dysphoric responses during antipsychotic therapy with dopaminergic-blocking drugs. There is preliminary evidence that a window of striatal D2 receptor occupancy between 60% and 70% is optimal for the subjective experience of patients. These occupancies are often reached even with low dosages of antipsychotic drugs. CONCLUSIONS Reaching an optimal dopamine D2 receptor occupancy is clinically relevant, since subjective experience associated with antipsychotic medication is related to medication compliance. Antipsychotic drug dosages often need to be lower than levels in common use.
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Affiliation(s)
- Lieuwe de Haan
- Adolescent Clinic, Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands.
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de Haan L, van Bruggen M, Lavalaye J, Booij J, Dingemans PMAJ, Linszen D. Subjective experience and D2 receptor occupancy in patients with recent-onset schizophrenia treated with low-dose olanzapine or haloperidol: a randomized, double-blind study. Am J Psychiatry 2003; 160:303-9. [PMID: 12562577 DOI: 10.1176/appi.ajp.160.2.303] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors tested the hypothesis that a dopamine D(2) receptor occupancy level between 60% and 70% in patients with recent-onset schizophrenia would result in optimal subjective experience. In addition, they sought preliminary evidence on whether subjective experience is better with low-dose olanzapine than with low-dose haloperidol. METHOD Subjects (N=24) who met DSM-IV criteria for schizophrenia were randomly assigned to 6 weeks of double-blind treatment with either olanzapine, 7.5 mg/day, or haloperidol, 2.5 mg/day. Subjective experience, psychopathology, and extrapyramidal symptoms were assessed at baseline and at endpoint. After 6 weeks, D(2) receptor occupancy was assessed with [(123)I]iodobenzamide single photon emission computed tomography. RESULTS The two study groups were similar at baseline. After 6 weeks, patients receiving olanzapine had a significantly lower mean dopamine D(2) receptor occupancy (51.0%, range=36%-67%) than those given haloperidol (65.5%, range=45%-75%). Receptor occupancy between 60% and 70% was associated with optimal subjective experience, and subjective experience improved significantly in the haloperidol group. CONCLUSIONS A level of D(2) receptor occupancy between 60% and 70% is optimal for subjective experience of patients with recent-onset schizophrenia. Substantial interindividual variation in D(2) receptor occupancy was seen at fixed low-dose levels of olanzapine and haloperidol. Olanzapine, 7.5 mg/day, showed no superior subjective response over haloperidol, 2.5 mg/day. Olanzapine may need to be dosed higher than 7.5 mg/day for most patients with recent-onset schizophrenia, and haloperidol needs to be individually titrated in the very low dose range to reach optimal occupancy.
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Affiliation(s)
- Lieuwe de Haan
- Academic Medical Center, University of Amsterdam Department of Psychiatry, The Netherlands.
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Reneman L, Endert E, de Bruin K, Lavalaye J, Feenstra MG, de Wolff FA, Booij J. The acute and chronic effects of MDMA ("ecstasy") on cortical 5-HT2A receptors in rat and human brain. Neuropsychopharmacology 2002; 26:387-96. [PMID: 11850153 DOI: 10.1016/s0893-133x(01)00366-9] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
While the pre-synaptic effects of 3,4-methylenedioxymethamphetamine (MDMA) on serotonin (5-HT) neurons have been studied extensively, little is known about its effects on post-synaptic 5-HT(2) receptors. Therefore, cortical 5-HT(2A) receptor densities and 5-HT concentration were studied in MDMA treated rats (10 mg/kg s.c.). Furthermore, 5-HT(2A) post-synaptic receptor densities in the cerebral cortex of recent as well as ex-MDMA users were studied using [123I]R91150 SPECT. In rats we observed a decrease followed by a time-dependent recovery of cortical 5-HT(2A) receptor densities, which was strongly and positively associated with the degree of 5-HT depletion. In recent MDMA users, post-synaptic 5-HT(2A) receptor densities were significantly lower in all cortical areas studied, while 5-HT(2A) receptor densities were significantly higher in the occipital cortex of ex-MDMA users. The combined results of this study suggest a compensatory upregulation of post-synaptic 5-HT(2A) receptors in the occipital cortex of ex-MDMA users due to low synaptic 5-HT levels.
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Affiliation(s)
- Liesbeth Reneman
- Graduate School of Neurosciences, Department of Nuclear Medicine Academic Medical Center, 1105 AZ Amsterdam, The Netherlands.
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Reneman L, Booij J, Lavalaye J, de Bruin K, Reitsma JB, Gunning B, den Heeten GJ, van Den Brink W. Use of amphetamine by recreational users of ecstasy (MDMA) is associated with reduced striatal dopamine transporter densities: a [123I]beta-CIT SPECT study--preliminary report. Psychopharmacology (Berl) 2002; 159:335-40. [PMID: 11862367 DOI: 10.1007/s00213-001-0930-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2001] [Accepted: 09/25/2001] [Indexed: 10/27/2022]
Abstract
RATIONALE Tablets sold as ecstasy often contain not only 3,4-methylenedioxymethamphetamine (MDMA) but other compounds well known to cause dopaminergic neurotoxicity, such as (meth)amphetamine. Furthermore, the use of ecstasy in the Netherlands is often combined with the use of amphetamine. However, little is known about the effects of ecstasy use or the combination of ecstasy and amphetamine use on dopamine (DA) neurones in the human brain. OBJECTIVES This study was designed to investigate the effects of ecstasy as well as the combined use of ecstasy and amphetamine on the density of nigrostriatal DA neurones. METHODS [123I]beta-CIT SPECT was used to quantify striatal DA transporters. Striatal [123I]beta-CIT binding ratios of control subjects ( n=15) were compared with binding ratios of ecstasy users ( n=29) and individuals with a history of combined ecstasy and amphetamine use ( n=9) after adjustment for age. RESULTS Striatal [123I]beta-CIT binding ratios were significantly lower in combined ecstasy and amphetamine users compared to sole ecstasy users (6.75 versus 8.46, respectively: -20.2%, P=0.007). Binding ratios were significantly higher in ecstasy users when compared to controls (8.46 versus 7.47, respectively: +13.2%, P=0.045). CONCLUSIONS These initial observations suggest that the sole use of ecstasy is not related to dopaminergic neurotoxicity in humans. In contrast, the reported use of amphetamine by regular users of ecstasy seems to be associated with a reduction in nigrostriatal DA neurones.
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Affiliation(s)
- Liesbeth Reneman
- Department of Nuclear Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Reneman L, Lavalaye J, Schmand B, de Wolff FA, van den Brink W, den Heeten GJ, Booij J. Cortical serotonin transporter density and verbal memory in individuals who stopped using 3,4-methylenedioxymethamphetamine (MDMA or "ecstasy"): preliminary findings. Arch Gen Psychiatry 2001; 58:901-6. [PMID: 11576026 DOI: 10.1001/archpsyc.58.10.901] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Although the popular drug 3,4-methylenedioxymethamphetamine (MDMA or "ecstasy") has been shown to damage brain serotonin (5-HT) neurons in animals, the fate and functional consequences of 5-HT neurons after MDMA injury are not known in humans. We investigated the long-term effects of MDMA use on cortical 5-HT neurons in humans and memory function, because brain 5-HT has been implicated in memory function. METHODS Twenty-two recent MDMA users, 16 ex-MDMA users who had stopped using MDMA for more than 1 year, and 13 control subjects. The effects of MDMA use on cortical 5-HT neurons was studied by means of single-photon emission computed tomography with iodine 123-labeled 2beta-carbomethoxy-3beta-(4-iodophenyl) tropane ([(123)I]beta-CIT) by quantification of brain 5-HT transporter densities. Verbal memory performance was assessed with the Rey Auditory Verbal Learning Test. RESULTS Mean cortical [(123)I]beta-CIT-labeled 5-HT transporter density was significantly lower in recent MDMA users than in controls (1.17 vs. 1.28 [-9%]) but not in ex-MDMA users (1.24 vs. 1.28 [-3%]). Recent and ex-MDMA users recalled significantly fewer words than did controls on the immediate recall (47.0 and 48.0 vs 60.0, respectively; P =.001) as well as the delayed recall (9.8 and 10.1 vs. 13.1, respectively; P =.003). Greater use of MDMA was associated with greater impairment in immediate verbal memory. However, memory performance was not associated with [(123)I]beta-CIT binding to cortical 5-HT transporters or duration of abstinence from MDMA. CONCLUSION The present study suggests that, while the neurotoxic effects of MDMA on 5-HT neurons in the human cortex may be reversible, the effects of MDMA on memory function may be long-lasting.
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Affiliation(s)
- L Reneman
- Department of Nuclear Medicine, F2-210, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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Lavalaye J, Booij J, Linszen DH, Reneman L, van Royen EA. Higher occupancy of muscarinic receptors by olanzapine than risperidone in patients with schizophrenia. A[123I]-IDEX SPECT study. Psychopharmacology (Berl) 2001; 156:53-7. [PMID: 11465633 DOI: 10.1007/s002130000679] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
RATIONALE In vitro data have shown anticholinergic properties of the atypical antipsychotic drug olanzapine. Substantial occupancy of muscarinic receptors may be an explanation for the low incidence of extrapyramidal side effects induced by olanzapine. OBJECTIVES To obtain an in vivo measurement of muscarinic receptor occupancy by olanzapine compared with risperidone in patients with schizophrenia stabilised on medication. METHODS Five patients with schizophrenia treated with olanzapine and five patients treated with risperidone were studied. Muscarinic receptor occupancy in the striatum and cortex was studied in vivo with SPECT using [123I]-IDEX as a radioligand. SPECT data were compared with those of six healthy subjects. RESULTS Patients stabilised on olanzapine showed significantly lower mean (+/-SD) striatal and cortical (1.50+/-0.21 and 1.51+/-0.22, respectively) muscarinic receptor binding ratios of [123I]-IDEX (reflecting higher levels of muscarinic receptor occupancy) than controls (3.91+/-0.61 and 3.65+/-0.70, respectively). Furthermore, [123I]-IDEX binding ratios in patients treated with risperidone were slightly lower than controls, reaching significance only in the striatum (2.99+/-0.27 versus 3.91+/-0.61, for risperidone and controls). CONCLUSIONS The substantial occupancy of muscarinic receptors in the striatum and cortex by olanzapine may be an explanation for the low incidence and severity of extrapyramidal side effects of this antipsychotic drug. Furthermore, it may also explain the anticholinergic side effects of olanzapine.
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Affiliation(s)
- J Lavalaye
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands.
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Lavalaye J, Sarlet A, Booij J, Linszen DH, Reneman L, Gersons BP, van Royen EA. Dopamine transporter density in patients with tardive dyskinesia: a single photon emission computed tomography study. Psychopharmacology (Berl) 2001; 155:107-9. [PMID: 11374328 DOI: 10.1007/s002130000670] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
RATIONALE Tardive dyskinesia occurs frequently in schizophrenic patients chronically treated with classical antipsychotic medication. It may be caused by loss of dopaminergic cells, due to free radicals as a product of high synaptic dopamine levels. OBJECTIVE To evaluate dopamine transporter density in the striatum in patients with tardive dyskinesia. METHODS Striatal [123I]FP-CIT binding was measured with SPECT in seven schizophrenic patients with tardive dyskinesia and eight healthy controls. RESULTS No significant difference was found between striatal [123I]FP-CIT binding ratios in patients with tardive dyskinesia and controls. CONCLUSIONS This preliminary study indicates no change in striatal dopamine transporter density in schizophrenic patients with tardive dyskinesia. This finding does not support the hypothesis that tardive dyskinesia is caused by dopaminergic cell loss.
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Affiliation(s)
- J Lavalaye
- Department of Nuclear Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Reneman L, De Bruin K, Lavalaye J, Gunning WB, Booij J. Addition of a 5-HT receptor agonist to methylphenidate potentiates the reduction of [123I]FP-CIT binding to dopamine transporters in rat frontal cortex and hippocampus. Synapse 2001; 39:193-200. [PMID: 11169768 DOI: 10.1002/1098-2396(20010301)39:3<193::aid-syn1000>3.0.co;2-f] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The neurotoxic potential of amphetamine and related drugs is well documented. However, methylphenidate, an amphetamine derivative used in the treatment of attention deficit hyperactivity disorder, and known to increase synaptic dopamine (DA) levels, seems to lack neurotoxic potential. It is hypothesized that both dopaminergic and serotonergic systems are involved in the neurotoxicity of amphetamine derivatives. The purpose of the present study was to evaluate the neurotoxic potential of methylphenidate and to test whether stimulation of the serotonergic system may confer neurotoxic properties to methylphenidate for DA or serotonin (5-HT) neurons. In addition, the present study was undertaken to evaluate the necessity to perform future SPECT studies in individuals using both methylphenidate and 5-HT-acting agents. We therefore measured monoaminergic transporters in rat brain using radioligands suitable for SPECT imaging ([123I]beta-CIT and [123I]FP-CIT). Groups of rats were treated with methylphenidate or saline for 4 days. Additional groups were treated with the selective 5-HT(2) receptor agonist quipazine or the selective 5-HT reuptake blocker fluoxetine, alone or in combination with methylphenidate. Binding studies were performed 5 days after the last treatment. In a second experiment, methylphenidate in combination with quipazine, along with a control group, was retested. In this experiment, monoaminergic terminal density was estimated 2 weeks (rather than 5 days) after drug treatment. Five days, but not 2 weeks, after treatment a significant reduction in specific [123I]FP-CIT binding was observed in the frontal cortex and hippocampus of rats treated with methylphenidate in combination with quipazine. These changes probably do not reflect neurotoxic changes of frontal cortex and hippocampal DA terminal markers, but a compensatory downregulation of DA transporters. These findings suggest potential harmful effects of concomitant use of drugs directly activating 5-HT2 receptors in patients using methylphenidate.
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Affiliation(s)
- L Reneman
- Graduate School of Neurosciences, Department of Nuclear Medicine, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands.
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Lavalaye J, Linszen DH, Booij J, Dingemans PM, Reneman L, Habraken JB, Gersons BP, van Royen EA. Dopamine transporter density in young patients with schizophrenia assessed with [123]FP-CIT SPECT. Schizophr Res 2001; 47:59-67. [PMID: 11163545 DOI: 10.1016/s0920-9964(00)00023-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Disturbances in the dopamine (DA) system are thought to play a major role in schizophrenia. Amphetamine-induced release of endogenous DA is shown to be enhanced in schizophrenia, as is striatal [18F]FDOPA uptake in the striatum. It is not clear if the density of DA neurons is altered in schizophrenia. By studying the DA transporter with [123I]FP-CIT single photon emission computed tomography (SPECT), the density of nigrostriatal dopaminergic cells can be studied. Using [123I]FP-CIT SPECT, DA transporter density in the striatum was studied in 36 young patients with schizophrenia. Ten patients were antipsychotic (AP)-naive, 15 were treated with olanzapine, eight with risperidone and three were AP-free. A control group of 10 age-matched volunteers was included. Striatal [123I]FP-CIT binding was not significantly different between AP-naive patients (2.87), patients treated with olanzapine (2.76), patients treated with risperidone (2.76), AP-free patients (2.68) and controls (2.82) (F=0.07,p=0.98). Unexpectedly, striatal [123I]FP-CIT binding in females was significantly higher than in males (3.29 and 2.70, respectively; t=-2.56, p=0.014).Concluding, functional changes in the dopaminergic system in schizophrenia are not likely to be reflected in a change in DA transporter density. Moreover, DA transporter density does not seem to be altered by AP medication.
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Affiliation(s)
- J Lavalaye
- Department of Psychiatry, Academic Medical Center, Tafelbergweg 25, 1105 BC Amsterdam, The Netherlands.
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Booji J, Reneman L, Lavalaye J, Knol R, De Bruin K, Speelman J, Janssen A. Dopamine transporter imaging as an in vivo marker of dopaminergic neurons. DRUG FUTURE 2001. [DOI: 10.1358/dof.2001.026.03.858707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lavalaye J, Booij J, Reneman L, Habraken JB, van Royen EA. Effect of age and gender on dopamine transporter imaging with [123I]FP-CIT SPET in healthy volunteers. Eur J Nucl Med 2000; 27:867-9. [PMID: 10952500 DOI: 10.1007/s002590000279] [Citation(s) in RCA: 220] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Dopamine transporter imaging is a valuable tool to investigate the integrity of the dopaminergic neurons. To date, several reports have shown an age-associated decline in dopamine transporters in healthy volunteers. Although animal studies suggest an effect of gender on dopamine transporter density, this gender effect has not yet been confirmed in human studies. To study the influence of age and gender on dopamine transporter imaging in healthy volunteers, we performed single-photon emission tomography imaging with [123I]FP-CIT to quantify dopamine transporters. Forty-five healthy volunteers (23 males and 22 females) were included, ranging in age from 18 to 83 years. SPET imaging was performed 3 h after injection of +/-110 MBq [123I]FP-CIT. An operator-independent volume of interest analysis was used for quantification of [123I]FP-CIT binding in the striatum. The ratio of specific striatal to non-specific [123I]FP-CIT binding was found to decrease significantly with age. Moreover, we found a high variance in [123I]FP-CIT binding in young adults. Finally, females were found to have significantly higher [123I]FP-CIT binding ratios than males. This effect of gender on [123I]FP-CIT binding ratios was not related to age. The results of this study are consistent with findings from previous studies, which showed that dopamine transporter density declines with age. The intriguing finding of a higher dopamine transporter density in females than in males is in line with findings from animal studies.
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Affiliation(s)
- J Lavalaye
- Graduate School of Neurosciences Amsterdam, Department of Nuclear Medicine, Academic Medical Center, The Netherlands.
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de Haan L, Lavalaye J, Linszen D, Dingemans PM, Booij J. Subjective experience and striatal dopamine D(2) receptor occupancy in patients with schizophrenia stabilized by olanzapine or risperidone. Am J Psychiatry 2000; 157:1019-20. [PMID: 10831489 DOI: 10.1176/appi.ajp.157.6.1019] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors' goal was to study the relationship between subjective experience during treatment with olanzapine or risperidone and dopamine D(2) receptor occupancy in stabilized patients with schizophrenia. METHOD Subjective experience, psychopathology, and extrapyramidal symptoms were assessed, and D(2) receptor occupancy was determined with [(123)I]iodobenzamide single photon emission computed tomography, in 22 patients whose schizophrenia was stabilized by olanzapine or risperidone. RESULTS Subjective experience, depression, and negative symptoms were related to dopamine D(2) receptor occupancy, but extrapyramidal symptoms were not. CONCLUSIONS These results provide preliminary evidence that negative subjective experience is related to high D(2) receptor occupancy. Longitudinal study is required because this relationship may have implications for dosing strategies.
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Affiliation(s)
- L de Haan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands.
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Lavalaye J, Knol RJ, de Bruin K, Reneman L, Janssen AG, Booij J. [123I]FP-CIT binding in rat brain after acute and sub-chronic administration of dopaminergic medication. Eur J Nucl Med 2000; 27:346-9. [PMID: 10774889 DOI: 10.1007/s002590050044] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The recently developed radioligand [123I]FP-CIT is suitable for clinical single-photon emission tomography (SPET) imaging of the dopamine (DA) transporter in vivo. To date it has remained unclear whether dopaminergic medication influences the striatal [123I]FP-CIT binding. The purpose of this study was to investigate the influence of this medication on [123I]FP-CIT binding in the brain. We used an animal model in which we administered dopaminomimetics, antipsychotics and an antidepressant. In vivo [123I]FP-CIT binding to the DA and serotonin transporters was evaluated after subchronic and acute administration of the drugs. The administered medication induced small changes in striatal [123I]FP-CIT binding which were not statistically significant. As expected, the DA reuptake blocker GBR 12,909 induced a significant decrease in [123I]FP-CIT binding. [123I]FP-CIT binding in the serotonin-rich hypothalamus was decreased only after acute administration of fluvoxamine. The results of this study suggest that dopaminergic medication will not affect the results of DA transporter SPET imaging with [123I]FP-CIT.
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Affiliation(s)
- J Lavalaye
- Graduate School of Neurosciences Amsterdam, Department of Nuclear Medicine, Academic Medical Center, The Netherlands
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Abstract
A crucial characteristic of antipsychotic medication is the occupancy of the dopamine (DA) D2 receptor. We assessed striatal DA D2 receptor occupancy by olanzapine and risperidone in 36 young patients [31 males, 5 females; mean age 21.1 years (16-28)] with first episode schizophrenia, using [123I]iodobenzamide (IBZM) SPECT. The occupancy of DA D2 receptors was not significantly different between olanzapine and risperidone. However, in subgroups of most prescribed doses, DA D2 occupancy was higher in the risperidone 4-mg group (79%) compared to the olanzapine 15-mg group (62%). [123I]IBZM binding ratios decreased with olanzapine dose (r = -0.551; P < 0.01), indicating higher DA D2 receptor occupancy with higher olanzapine dose. Akathisia and positive symptoms were correlated with [123I]IBZM binding ratio (r = -0.442; P < 0.01; and r = -0.360; P < 0.05, respectively). Prolactin (PRL) levels were elevated in the risperidone, but not in the olanzapine group, at comparable D2 receptor occupancy levels. In the olanzapine group, PRL levels were correlated with [123I]IBZM binding ratio (r = -0.551; P < 0.01). In conclusion, both olanzapine and risperidone induce a high striatal D2 receptor occupancy, dependent on dose and group formation. The lower incidence of prolactin elevation with olanzapine, compared to risperidone, may not be attributed to a lower D2 receptor occupancy.
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Affiliation(s)
- J Lavalaye
- Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands.
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Reneman L, Booij J, Lavalaye J, De Bruin K, De Wolff FA, Koopmans RP, Stoof JC, Den Heeten GJ. Comparative in vivo study of iodine-123-labeled beta-CIT and nor-beta-CIT binding to serotonin transporters in rat brain. Synapse 1999; 34:77-80. [PMID: 10459174 DOI: 10.1002/(sici)1098-2396(199910)34:1<77::aid-syn9>3.0.co;2-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Both iodine-123-labeled beta-CIT (2beta-carbomethoxy-3beta-(4-iodophenyl)tropane) and nor-beta-CIT (2beta-carbomethoxy-3beta-(4-iodophenyl)nortropane) have shown to be suitable radioligands for imaging serotonin (5-HT) transporters. [(123)I]nor-beta-CIT has the highest in vitro affinity for 5-HT transporters among beta-CIT analogs reported so far. However, no direct comparison-studies of these two radiotracers as to their in vivo binding to 5-HT transporters have been reported so far. Therefore, it is still unclear which of the two radiotracers is more suitable for single photon emission computed tomography (SPECT) imaging of 5-HT transporters. The purpose of this study was to compare directly in a controlled design the in vivo [(123)I]beta-CIT and [(123)I]nor-beta-CIT binding to 5-HT transporters under the same conditions in rats with the focus on brain kinetic characteristics by means of a two-compartment analysis. We observed that [(123)I]beta-CIT has a higher binding potential and faster kinetics for 5-HT transporters than [(123)I]nor-beta-CIT, suggesting that [(123)I]beta-CIT may be a more suitable radioligand than [(123)I]nor-beta-CIT for imaging 5-HT transporters with SPECT.
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Affiliation(s)
- L Reneman
- Graduate School of Neurosciences, Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands.
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