The early identification of responsive and resistant patients to androgen receptor-targeting agents (ARTA) in metastatic castration-resistant prostate cancer (mCRPC) is not completely possible with ...prostate-specific antigen (PSA) assessment and conventional imaging. Considering its ability to determine metabolic activity of lesions, positron emission tomography (PET) assessment might be a promising tool.
We carried out a monocentric prospective study in patients with mCRPC treated with ARTA to evaluate the role of different PET radiotracers: 49 patients were randomized to receive 11C-Choline, Fluorine 18 fluciclovine (anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid - FACBC) (18F-FACBC), or Gallium-68-prostate-specific-membrane-antigen (68Ga-PSMA) PET, one scan before therapy and one 2 months later.
The primary aim was to investigate the performance of three novel PET radiotracers for the early evaluation of response to ARTA in metastatic CRPC patients; the outcome evaluated was biochemical response (PSA reduction ≥50%). The secondary aim was to investigate the prognostic role of several semiquantitative PET parameters and their variations with the different radiotracers in terms of biochemical progression-free survival (bPFS) and overall survival (OS).
The study was promoted by the Italian Department of Health (code RF-2016-02364809).
Regarding the primary endpoint, at log-rank test a statistically significant correlation was found between metabolic tumor volume (MTV) (P = 0.018) and total lesion activity (TLA) (P = 0.025) percentage variation among the two scans with 68Ga-PSMA PET and biochemical response. As for the secondary endpoints, significant correlations with bPFS were found for 68Ga-PSMA total MTV and TLA at the first scan (P = 0.001 and P = 0.025, respectively), and MTV percentage variation (P = 0.031). For OS, statistically significant correlations were found for different 68Ga-PSMA and 18F-FACBC parameters and for major maximum standardized uptake value at the first 11C-Choline PET scan.
Our study highlighted that 11C-Choline, 68Ga-PSMA, and 18F-FACBC semiquantitative PET parameters and their variations present a prognostic value in terms of OS and bPFS, and MTV and TLA variations with 68Ga-PSMA PET a correlation with biochemical response, which could help to assess the response to ARTA.
•An unmet need in mCRPC is the early evaluation of response to ARTA.•We evaluated ARTA response with three different PET radiotracers, before therapy onset and after 2 months.•We analyzed PET-derived parameters to explore their prognostic value in terms of bPFS and OS.•68Ga-PSMA is the most reliable tracers to evaluate ARTA response, in view of the correlation with biochemical response.•Several PET-derived parameters could represent an effective prognostic factor.
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
FDG-PET/CT clinical use for cardiovascular implantable electronic device (CIED) infection is of relevant importance, since ...it provides information about presence and extension of the infection. However, asymptomatic patients with incidental FDG uptake on CIED are challenging.
Purpose
The primary objective of this observational study was to assess the diagnostic role of FDG PET/CT in patients without a suspicious of CIED infection. The secondary objective was to identify qualitative and semiquantitative predictors of CIED infection.
Methods
From 2017 to 2019 all FDG-PET/CT scans of CIED patients were analysed, the indications were a suspicious of CIED or non-cardiovascular infection, or oncological follow up. Four expert nuclear medicine physicians blindly reviewed all scans, focusing on FDG uptake in pocket and/or in extracardiac lead parts. They reported standardized uptake values (SUV), liver and blood pool target-to-background ratios, metabolic tumour volume (MTV). 6 months follow up after PET/CT scan was performed for eventual CIED extraction because of infection.
Results
320 FDG-PET/CT scans were considered. Median age was 74 33-94 years, 219/320 (68%) males. 122/320 (38%) scans presented FDG uptake around pocket and/or extracardiac lead parts; and 65/320 (20%) scans reported suspicious uptake. We identified these cut-off criteria as predictors of CIED extraction: TARGET SUV max >2.6 (sensitivity 71%, specificity 89%), LIVER-TARGET SUV max >1.3 (sensitivity 68%, specificity 89%). Both these values also demonstrated to be good predictors of CIED infection after 6 months follow up (p<0,001).
Conclusion
FDG-PET/CT uptake in asymptomatic CIED patients is underestimated and may be related to subtle CIED infection. By introducing high-specific SUV cut-off values, a considerable impact on patient management is expected.
Despite the effectiveness of the currently available antiviral drugs in treating cytomegalovirus (CMV) infection, high rates of adverse effects are associated with their use. Moreover, a problem of ...increasing importance is the emergence of drug-resistant CMV infection. Here, we describe the first case of off-label use of letermovir (LMV) as preemptive antiviral therapy, in a pediatric allogeneic peripheral blood stem cell transplant recipient with ganciclovir-resistant CMV infection who was intolerant to foscarnet and unable to achieve viral clearance after seven doses of cidofovir. After the administration of LMV, a gradual reduction in viral load was observed and within 6 weeks of LMV treatment, after more than 6 months of positive CMV-DNAemia, the patient cleared the infection. No adverse effects associated with LMV were observed during treatment. In this pediatric study case, the off-label use of LMV for the treatment of CMV infection has been well tolerated and proved to be effective in leading to the suppression of viral replication.
The early identification of responsive and resistant patients to androgen receptor-targeting agents (ARTA) in metastatic castration-resistant prostate cancer (mCRPC) is not completely possible with ...prostate-specific antigen (PSA) assessment and conventional imaging. Considering its ability to determine metabolic activity of lesions, positron emission tomography (PET) assessment might be a promising tool.
We carried out a monocentric prospective study in patients with mCRPC treated with ARTA to evaluate the role of different PET radiotracers: 49 patients were randomized to receive
C-Choline, Fluorine 18 fluciclovine (anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid - FACBC) (
F-FACBC), or Gallium-68-prostate-specific-membrane-antigen (
Ga-PSMA) PET, one scan before therapy and one 2 months later. The primary aim was to investigate the performance of three novel PET radiotracers for the early evaluation of response to ARTA in metastatic CRPC patients; the outcome evaluated was biochemical response (PSA reduction ≥50%). The secondary aim was to investigate the prognostic role of several semiquantitative PET parameters and their variations with the different radiotracers in terms of biochemical progression-free survival (bPFS) and overall survival (OS). The study was promoted by the Italian Department of Health (code RF-2016-02364809).
Regarding the primary endpoint, at log-rank test a statistically significant correlation was found between metabolic tumor volume (MTV) (P = 0.018) and total lesion activity (TLA) (P = 0.025) percentage variation among the two scans with
Ga-PSMA PET and biochemical response. As for the secondary endpoints, significant correlations with bPFS were found for
Ga-PSMA total MTV and TLA at the first scan (P = 0.001 and P = 0.025, respectively), and MTV percentage variation (P = 0.031). For OS, statistically significant correlations were found for different
Ga-PSMA and
F-FACBC parameters and for major maximum standardized uptake value at the first
C-Choline PET scan.
Our study highlighted that
C-Choline,
Ga-PSMA, and
F-FACBC semiquantitative PET parameters and their variations present a prognostic value in terms of OS and bPFS, and MTV and TLA variations with
Ga-PSMA PET a correlation with biochemical response, which could help to assess the response to ARTA.
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