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Verhoeff S, van de Donk PP, Aarntzen EH, Miedema IHC, Oosting S, Voortman J, Brouwers AH, Slingerland M, Heskamp S, Van Herpen CM. 89Zr-durvalumab PD-L1 PET in recurrent or metastatic (R/M) squamous cell carcinoma of the head and neck. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.3573] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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
3573 Background: Immune checkpoint inhibitors (ICI) targeting programmed cell death protein-1/ligand-1 (PD-1/PD-L1) have shown activity in R/M squamous cell carcinoma of the head and neck (SCCHN). Positron-emission-tomography (PET) with 89Zr-labeled anti-PD-L1 antibodies could aid in predicting response to ICI. We present the dose-finding results of the first-in-human 89Zr-durvalumab PD-L1 PET-imaging in patients with SCCHN participating in the ongoing phase II PINCH study (NCT03829007). Methods: Following baseline [18F]FDG-PET and CT/MRI imaging, patients with incurable R/M SCCHN received 37 MBq 89Zr-durvalumab and protein dose 2mg, 10mg or 50mg durvalumab. 89Zr-durvalumab PD-L1 PET-scan was acquired day 5 post-injection. Plasma pharmacokinetic analyses were performed at day 0 and 5. Standardized uptake values (SUV, mean ± SD) were measured in [18F]FDG-positive tumor lesion, liver, spleen, bone marrow and bloodpool. PD-L1-expression was assessed on archival tumor tissue using the Ventana PD-L1 (SP263) assay. Results: 14 patients were enrolled and no adverse events were reported. High tracer-retention was observed in liver and spleen, most prominent in patients receiving 2 or 10mg durvalumab. 89Zr-durvalumab accumulation within tumors and between patients was heterogeneous and not all [18F]FDG-positive lesions showed 89Zr-durvalumab uptake. Tumor lesions were visualized best using 10 or 50mg durvalumab (SUVpeak 2mg: 3.86 ± 0.79, 10mg: 7.46 ± 2.18, 50mg: 5.57 ± 1.74). Tumor-to-blood-ratios for 10mg durvalumab were highest (2mg: 2.27 ± 0.33, 10mg: 3.44 ± 0.76, 50mg: 1.73 ± 0.99; p = 0.019). PK-analyses confirmed visual prolonged tracer-retention in bloodpool with increasing protein dose. PD-L1-expression was equally distributed amongst dose-groups. Conclusions: This is the first study to show feasibility of 89Zr-durvalumab PD-L1 PET in SCCHN patients, demonstrating the highest tumor-to-blood radio with a total dose of 10mg durvalumab. So far, no correlation of tumor PD-L1 expression with 89Zr-durvalumab-uptake and PD-L1 expression on archival tissue was found. Next step will be to correlate 89Zr-durvalumab PD-L1 PET tumor uptake with durvalumab treatment response in the phase 2 part of the PINCH study. Clinical trial information: NCT03829007 .
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Affiliation(s)
- Sarah Verhoeff
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Pim P van de Donk
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | - Iris Harriëtte Cornelia Miedema
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Sjoukje Oosting
- Department of Medical Oncology, University Medical Center Groningen, Groningen, Netherlands
| | - Jens Voortman
- Department of Medical Oncology, VU University Medical Center Amsterdam, Amsterdam, Netherlands
| | - Adrienne H. Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, Netherlands
| | | | | | - Carla M.L.- Van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
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Verhoeff S, van Es SC, Elias SG, Gerritse S, Angus L, Oosting S, Heskamp S, Brouwers AH, Arens AI, Menke CW, Hoekstra OS, Zwezerijnen GJ, Van Der Veldt AAM, Mulders P, Van Der Graaf WT, De Vries E, Oyen WJ, Aarntzen EH, Van Herpen CM. Prediction of watchful waiting in newly diagnosed metastatic clear cell renal cell carcinoma patients with a good or intermediate prognosis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.5079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
5079 Background: In metastatic clear cell renal cell carcinoma (mccRCC), the number of International Metastatic Database Consortium (IMDC) risk factors plus metastatic sites may identify patients with rapid or slow disease progression in a period of watchful waiting (WW) (median WW of 8.4 vs 22.2 months; Rini et al. Lancet Oncol. 2016). We aimed to validate this and prospectively assess the added value of baseline PET with [18F]FDG and [89Zr]Zr-DFO-girentuximab to predict the WW-period in the multicenter IMaging PAtients for Cancer drug selecTion (IMPACT)-RCC cohort study. (NCT02228954). Methods: Between February 2015 and March 2018, 40 treatment-naïve mccRCC patients with a good (n=13) or intermediate prognosis (n=25) according to IMDC, were enrolled. Following baseline CT, [18F]FDG and [89Zr]Zr-DFO-girentuximab-PET, CT scans (RECIST1.1) were acquired at 2, 4, 6, 9, 12 months and thereafter every 4 months. Primary endpoint was time to radiological and/or clinical disease progression, requiring systemic treatment. Patients were assigned to a favorable (<2 IMDC risk factors and <3 metastatic sites) or unfavorable for WW-group (all others; Rini et al). Maximum standardized uptake values (SUVmax) were measured in PET-positive lesions measuring ≥10mm, or 15mm in lymph nodes. High and low-uptake groups were defined based on median geometric mean (gm) SUVmax across patients. A one-sided test was used to validate observations by Rini et al; other tests were two-sided. Results: The median WW-period was 9.3 months in the unfavorable WW-group (n=19) vs 20.4 months in the favorable WW-group (n=21) (HR 1.89 95%CI 0.94-3.89; p=0.037), confirming observations of Rini et al. Patients with high [18F]FDG uptake had a median WW-period of 8.5 months compared to 25.2 months in the low-uptake group (HR 4.08 95%CI 1.89-9.28; p=0.0002). Patients with high [89Zr]Zr-DFO-girentuximab uptake had a median WW-period of 10.7 versus 16.4 months in the low-uptake group (HR 1.37; 95%CI 0.69-2.76; p=0.37). [18F]FDG uptake groups improved a Cox-model for WW based on the prognostic groups of Rini et al (p=0.0015); [89Zr]Zr-DFO-girentuximab did not (p=0.98). Conclusions: The IMPACT-RCC study validated the observations by Rini et al. and shows that adding baseline [18F]FDG PET further improves the prediction of the duration of the WW-period in mccRCC patients. Clinical trial information: NCT02228954 .
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Affiliation(s)
- Sarah Verhoeff
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Suzanne C van Es
- Department of Medical Oncology, University Medical Center Groningen, Groningen, Netherlands
| | - Sjoerd G. Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Sophie Gerritse
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Lindsay Angus
- Departments of Medical Oncology and Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Sjoukje Oosting
- Department of Medical Oncology, University Medical Center Groningen, Groningen, Netherlands
| | | | - Adrienne H. Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, Netherlands
| | | | - Catharina Wilhelmina Menke
- Amsterdam UMC Location VUMC, Cancer Center Amsterdam, Amsterdam, the Netherlands, Amsterdam, Netherlands
| | - Otto S. Hoekstra
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location VUMC, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Gerben J.C. Zwezerijnen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam, Netherlands
| | | | - Peter Mulders
- Department of Urology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Elisabeth De Vries
- Department of Medical Oncology, University Medical Center Groningen, Groningen, Netherlands
| | - Wim J.G. Oyen
- The Department of Radiology and Nuclear Medicine, Rijnstate, Arnhem, Netherlands
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