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Covington MF, Hoffman JM, Morton KA, Buckway B, Boucher KM, Rosenthal RE, Porretta JM, Brownson KE, Matsen CB, Vaklavas C, Ward JH, Wei M, Buys SS, Chittoria N, Yakish ED, Archibald ZG, Burrell LD, Butterfield RI, Yap JT. Prospective Pilot Study of 18F-Fluoroestradiol PET/CT in Patients With Invasive Lobular Carcinomas. AJR Am J Roentgenol 2023; 221:228-239. [PMID: 36919879 DOI: 10.2214/ajr.22.28809] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Indexed: 03/16/2023]
Abstract
BACKGROUND. PET/CT with 18F-fluoroestradiol (FES) (FDA-approved in 2020) depicts tissues expressing estrogen receptor (ER). Invasive lobular carcinoma (ILC) is commonly ER positive. OBJECTIVE. The primary aim of this study was to assess the frequency with which sites of histologically proven ILC have abnormal uptake on FES PET/CT. METHODS. This prospective single-center pilot study, conducted from December 2020 to August 2021, enrolled patients with histologically confirmed ILC to undergo FES PET/CT; patients optionally underwent FDG PET/CT. Two nuclear radiologists assessed FES PET/CT and FDG PET/CT studies for abnormal uptake corresponding to known ILC sites at enrollment and for additional sites of abnormal uptake, resolving differences by consensus. The primary endpoint was percentage of known ILC sites showing abnormal FES uptake. The alternative to the null hypothesis was that more than 60% of sites would have abnormal FES uptake, exceeding the percentage of ILC with abnormal FDG uptake described in prior literature. A sample size of 24 biopsied lesions was preselected to provide 81% power for the alternative hypothesis (one-sided α = .10). Findings on FES PET/CT and FDG PET/CT were summarized for additional secondary endpoints. RESULTS. The final analysis included 17 patients (mean age, 59.1 ± 13.2 years) with 25 sites of histologically confirmed ILC at enrollment (22 breast lesions, two axillary lymph nodes, one distant metastasis). FES PET/CT showed abnormal uptake in 22 of 25 (88%) lesions, sufficient to reject the null hypothesis (p = .002). Thirteen patients underwent FDG PET/CT. Four of 23 (17%) sites of histologically confirmed ILC, including additional sites detected and confirmed after enrollment, were identified with FES PET/CT only, and 1 of 23 (4%) was identified only with FDG PET/CT (p = .18). FES PET/CT depicted additional lesions not detected with standard-of-care evaluation in 4 of 17 (24%) patients (two contralateral breast cancers and two metastatic axillary lymph nodes, all with subsequent histologic confirmation). Use of FES PET/CT resulted in changes in clinical stage with respect to standard-of-care evaluation in 3 of 17 (18%) patients. CONCLUSION. The primary endpoint of the trial was met. The frequency of abnormal FES uptake among sites of histologically known ILC was found to be to be significantly greater than 60%. CLINICAL IMPACT. This pilot study shows a potential role of FES PET/CT in evaluation of patients with ILC. TRIAL REGISTRATION. ClinicalTrials.gov NCT04252859.
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Affiliation(s)
- Matthew F Covington
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT
| | - John M Hoffman
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT
| | - Kathryn A Morton
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT
- Present affiliation: Summit Physician Specialists, Murray, UT
| | - Brandon Buckway
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT
| | | | | | - Jane M Porretta
- Department of Surgery, University of Utah, Salt Lake City, UT
| | | | - Cindy B Matsen
- Department of Surgery, University of Utah, Salt Lake City, UT
| | - Christos Vaklavas
- Department of Internal Medicine, Oncology Division, University of Utah, Salt Lake City, UT
| | - John H Ward
- Department of Internal Medicine, Oncology Division, University of Utah, Salt Lake City, UT
| | - Mei Wei
- Department of Internal Medicine, Oncology Division, University of Utah, Salt Lake City, UT
| | - Saundra S Buys
- Department of Internal Medicine, Oncology Division, University of Utah, Salt Lake City, UT
| | - Namita Chittoria
- Department of Internal Medicine, Oncology Division, University of Utah, Salt Lake City, UT
| | - Ellen D Yakish
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112
| | - Zane G Archibald
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112
| | - Lance D Burrell
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112
- Present affiliation: Society of Nuclear Medicine and Molecular Imaging, Reston, VA
| | - Regan I Butterfield
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112
| | - Jeffrey T Yap
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT
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Jeffers CD, Lawhn-Heath C, Butterfield RI, Hoffman JM, Scott PJH. SNMMI Clinical Trials Network Research Series for Technologists: Clinical Research Primer- Use of Imaging Agents in Therapeutic Drug Development and Approval. J Nucl Med Technol 2022; 50:jnmt.122.264372. [PMID: 35701219 DOI: 10.2967/jnmt.122.264372] [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: 05/04/2022] [Accepted: 06/11/2022] [Indexed: 11/16/2022] Open
Abstract
The process of bringing a new drug to market is complex and has recently necessitated a new drug discovery paradigm for the pharmaceutical industry that is both more efficient and more economical. Key to this has been the increasing use of nuclear medicine and molecular imaging to support drug discovery efforts by answering critical questions on the pathway for development and approval of a new therapeutic drug. Some of these questions include: (i) Does the new drug reach its intended target in the body at sufficient levels to effectively treat or diagnose disease without unacceptable toxicity? (ii) How is the drug absorbed, metabolized, and excreted? (iii) What is the effective dose in humans? To conduct the appropriate imaging studies to answer such questions, pharmaceutical companies are increasingly partnering with molecular imaging departments. Nuclear medicine technologists are critical to this process as they perform scans to collect the qualitative and quantitative imaging data used to measure study endpoints. This article describes preclinical and clinical research trials and provides an overview of the different ways that radiopharmaceuticals are used to answer critical questions during therapeutic drug development.
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Zürcher NR, Loggia ML, Mullett JE, Tseng C, Bhanot A, Richey L, Hightower BG, Wu C, Parmar AJ, Butterfield RI, Dubois JM, Chonde DB, Izquierdo-Garcia D, Wey HY, Catana C, Hadjikhani N, McDougle CJ, Hooker JM. [ 11C]PBR28 MR-PET imaging reveals lower regional brain expression of translocator protein (TSPO) in young adult males with autism spectrum disorder. Mol Psychiatry 2021; 26:1659-1669. [PMID: 32076115 PMCID: PMC8159742 DOI: 10.1038/s41380-020-0682-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 01/12/2020] [Accepted: 02/06/2020] [Indexed: 12/19/2022]
Abstract
Mechanisms of neuroimmune and mitochondrial dysfunction have been repeatedly implicated in autism spectrum disorder (ASD). To examine these mechanisms in ASD individuals, we measured the in vivo expression of the 18 kDa translocator protein (TSPO), an activated glial marker expressed on mitochondrial membranes. Participants underwent scanning on a simultaneous magnetic resonance-positron emission tomography (MR-PET) scanner with the second-generation TSPO radiotracer [11C]PBR28. By comparing TSPO in 15 young adult males with ASD with 18 age- and sex-matched controls, we showed that individuals with ASD exhibited lower regional TSPO expression in several brain regions, including the bilateral insular cortex, bilateral precuneus/posterior cingulate cortex, and bilateral temporal, angular, and supramarginal gyri, which have previously been implicated in autism in functional MR imaging studies. No brain region exhibited higher regional TSPO expression in the ASD group compared with the control group. A subset of participants underwent a second MR-PET scan after a median interscan interval of 3.6 months, and we determined that TSPO expression over this period of time was stable and replicable. Furthermore, voxelwise analysis confirmed lower regional TSPO expression in ASD at this later time point. Lower TSPO expression in ASD could reflect abnormalities in neuroimmune processes or mitochondrial dysfunction.
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Affiliation(s)
- N R Zürcher
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - M L Loggia
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - J E Mullett
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA, USA
| | - C Tseng
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - A Bhanot
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - L Richey
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - B G Hightower
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - C Wu
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - A J Parmar
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - R I Butterfield
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - J M Dubois
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - D B Chonde
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - D Izquierdo-Garcia
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - H Y Wey
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - C Catana
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - N Hadjikhani
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Harvard Medical School, Boston, MA, USA
- Gillberg Neuropsychiatry Center, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - C J McDougle
- Harvard Medical School, Boston, MA, USA
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA, USA
| | - J M Hooker
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Horn KP, Yap JT, Agarwal N, Morton KA, Kadrmas DJ, Beardmore B, Butterfield RI, Boucher K, Hoffman JM. FDG and FLT-PET for Early measurement of response to 37.5 mg daily sunitinib therapy in metastatic renal cell carcinoma. Cancer Imaging 2015; 15:15. [PMID: 26335224 PMCID: PMC4558962 DOI: 10.1186/s40644-015-0049-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 08/11/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Metastatic renal cell carcinoma has a poor prognosis and an intrinsic resistance to standard treatment. Sunitinib is an oral receptor tyrosine kinase inhibitor that has been used as a first-line targeted therapy in metastatic renal cell carcinoma. While computed tomography (CT) is currently the gold standard for response assessment in oncological trials, numerous studies have shown that positron emission tomography (PET) imaging can provide information predictive of tumor response to treatment earlier than the typical interval for standard of care follow-up CT imaging. In this exploratory study we sought to characterize early tumor response in patients with metastatic renal cell carcinoma treated with continuous daily 37.5 mg sunitinib therapy. METHODS Twenty patients underwent dynamic acquisition positron emission tomography (PET) imaging using (18) F-fluorodeoxyglucose (FDG) and (18) F-fluorothymidine (FLT) at baseline and early in treatment (after 1, 2, 3 or 4 weeks) with 37.5 mg continuous daily dosing of sunitinib. Semi-quantitative analyses were performed to characterize the tumor metabolic (FDG) and proliferative (FLT) responses to treatment. RESULTS Proliferative responses were observed in 9/19 patients and occurred in 2 patients at one week (the earliest interval evaluated) after the initiation of therapy. A metabolic response was observed in 5/19 patients, however this was not observed until after two weeks of therapy were completed. Metabolic progression was observed in 2/19 patients and proliferative progression was observed in 1/19 patients. Baseline FDG-PET tumor maximum standardized uptake values correlated inversely with overall survival (p = 0.0036). Conversely, baseline (18) F-fluorothymidine PET imaging did not have prognostic value (p = 0.56) but showed a greater early response rate at 1-2 weeks after initiating therapy. CONCLUSIONS While preliminary in nature, these results show an immediate and sustained proliferative response followed by a delayed metabolic response beginning after two weeks in metastatic renal cell carcinoma treated with a continuous daily dose of 37.5 mg sunitinib. The results provide evidence of tumor response to lower-dose sunitinib while also supporting the inclusion of PET imaging as a tool for early assessment in oncological clinical trials. TRIAL REGISTRATION ID: NCT00694096.
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Affiliation(s)
- Kevin P Horn
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah, 1950 Circle of Hope Dr, Suite 6810, Salt Lake City, UT, 84112-5560, USA. .,Department of Radiology, University of Utah, 30 North 1900 East #1A071, Salt Lake City, UT, 84132-2140, USA.
| | - Jeffrey T Yap
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah, 1950 Circle of Hope Dr, Suite 6810, Salt Lake City, UT, 84112-5560, USA. .,Department of Radiology, University of Utah, 30 North 1900 East #1A071, Salt Lake City, UT, 84132-2140, USA.
| | - Neeraj Agarwal
- Department of Medicine, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112-5550, USA.
| | - Kathryn A Morton
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah, 1950 Circle of Hope Dr, Suite 6810, Salt Lake City, UT, 84112-5560, USA. .,Department of Radiology, University of Utah, 30 North 1900 East #1A071, Salt Lake City, UT, 84132-2140, USA.
| | - Dan J Kadrmas
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah, 1950 Circle of Hope Dr, Suite 6810, Salt Lake City, UT, 84112-5560, USA. .,Department of Radiology, University of Utah, 30 North 1900 East #1A071, Salt Lake City, UT, 84132-2140, USA.
| | - Britney Beardmore
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah, 1950 Circle of Hope Dr, Suite 6810, Salt Lake City, UT, 84112-5560, USA.
| | - Regan I Butterfield
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 Thirteenth Street, Suite 2301, Charlestown, MA, 02129, USA.
| | - Kenneth Boucher
- Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112-5550, USA.
| | - John M Hoffman
- Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah, 1950 Circle of Hope Dr, Suite 6810, Salt Lake City, UT, 84112-5560, USA. .,Department of Radiology, University of Utah, 30 North 1900 East #1A071, Salt Lake City, UT, 84132-2140, USA.
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Duff K, Foster NL, Dennett K, Hammers DB, Zollinger LV, Christian PE, Butterfield RI, Beardmore BE, Wang AY, Morton KA, Hoffman JM. Amyloid deposition and cognition in older adults: the effects of premorbid intellect. Arch Clin Neuropsychol 2013; 28:665-71. [PMID: 23817438 PMCID: PMC3807831 DOI: 10.1093/arclin/act047] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2013] [Indexed: 11/13/2022] Open
Abstract
Although amyloid deposition remains a marker of the development of Alzheimer's disease, results linking amyloid and cognition have been equivocal. Twenty-five community-dwelling non-demented older adults were examined with (18)F-flutemetamol, an amyloid imaging agent, and a cognitive battery, including an estimate of premorbid intellect and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). In the first model, (18)F-flutemetamol uptake significantly correlated with the Delayed Memory Index of the RBANS (r = -.51, p = .02) and premorbid intellect (r = .43, p = .03). In the second model, the relationship between (18)F-flutemetamol and cognition was notably stronger when controlling for premorbid intellect (e.g., three of the five RBANS Indexes and its Total score significantly correlated with (18)F-flutemetamol, r's = -.41 to -.58). Associations were found between amyloid-binding (18)F-flutemetamol and cognitive functioning in non-demented older adults. These associations were greatest with delayed memory and stronger when premorbid intellect was considered, suggesting that cognitive reserve partly compensates for the symptomatic expression of amyloid pathology in community-dwelling elderly.
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Affiliation(s)
- Kevin Duff
- Center for Alzheimer's Care, Imaging, and Research, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Norman L. Foster
- Center for Alzheimer's Care, Imaging, and Research, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kathryn Dennett
- Center for Alzheimer's Care, Imaging, and Research, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Dustin B. Hammers
- Center for Alzheimer's Care, Imaging, and Research, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | | | | | | | - Angela Y. Wang
- Center for Alzheimer's Care, Imaging, and Research, Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA
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Rodrigues RS, Bozza FA, Christian PE, Hoffman JM, Butterfield RI, Christensen CR, Heilbrun M, Wiggins RH, Hunt JP, Bentz BG, Hitchcock YJ, Morton KA. Comparison of Whole-Body PET/CT, Dedicated High-Resolution Head and Neck PET/CT, and Contrast-Enhanced CT in Preoperative Staging of Clinically M0 Squamous Cell Carcinoma of the Head and Neck. J Nucl Med 2009; 50:1205-13. [DOI: 10.2967/jnumed.109.062075] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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