2-[18F]FDG PET in the Management of Radioiodine Refractory Differentiated Thyroid Cancer in the Era of Thyrosin-Kinases Inhibitors: A Real-Life Retrospective Study

Gay, Stefano; Raffa, Stefano; Pietralata, Anna De’Luca di; Bauckneht, Matteo; Vera, Lara; Miceli, Alberto; Albertelli, Manuela; Morbelli, Silvia; Giusti, Massimo; Ferone, Diego

doi:10.3390/diagnostics12020506

Cited by 5 publications

(5 citation statements)

References 35 publications

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“…89 Therefore, a multiparametric approach involving both morphological and metabolic data might be advisable in evaluating the tumour response during MKIs. 23 Real-life data confirmed the clinical benefit observed in clinical trials, but also revealed a reduced efficacy in comparison to the phase 3 studies, which normally include a more selected population. 90 Outside the registrative trials, the initial dosage of MKI is commonly chosen on an individualized basis, sometimes preferring an initial lower dose in case of poor PS and/or presence of several comorbidities.…”

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confidence: 62%

“…Moreover, Tg levels might not reflect the tumour load in aggressive poorly differentiated TCs (PDTCs) that lose the ability to synthesize and/or secrete Tg. 23 Therefore, the isolated increase of Tg should not lead to the start of a MKI in the absence of evident structural disease progression.…”

Section: Characterization and Management Of Rai-r Tc Patients: How To...mentioning

confidence: 99%

“… 89 Therefore, a multiparametric approach involving both morphological and metabolic data might be advisable in evaluating the tumour response during MKIs. 23 …”

Section: Mki Approved For Rai-r Tcmentioning

confidence: 99%

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Management of Progressive Radioiodine-Refractory Thyroid Carcinoma: Current Perspective

Nervo¹,

Retta²,

Ragni³

et al. 2022

CMAR

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Patients with thyroid cancer (TC) usually have an excellent prognosis; however, 5–10% of them develop an advanced disease. The prognosis of this subgroup is still favourable if the lesions respond to radioactive iodine (RAI) treatment. Nearly two-thirds of advanced TC patients become RAI-refractory (RAI-R), and their management is challenging. A multidisciplinary approach in the context of a tumour board is essential to define a personalized strategy. Systemic therapy is not always the best option. In case of slow neoplastic growth and low tumour burden, active surveillance may represent a valuable choice. Local approaches might be considered if the disease progression is limited to a single or few lesions, also in combination and during systemic therapy. Antiresorptive treatment may be started in presence of bone metastases. In case of rapid and/or symptomatic progression involving multiple lesions and/or organs, systemic therapy has to be considered, in absence of contraindications. The multi-kinase inhibitors (MKIs) lenvatinib and sorafenib are currently available as first-line treatment for advanced progressive RAI-R TC. Among second-line options, cabozantinib has been recently approved in RAI-R TC who progressed during MKIs targeting the vascular endothelial growth factor receptor (VEGFR). In the last few years, next-generation sequencing (NGS) assays have been increasingly employed, permitting identification of the genetic alterations harboured by TC, with a significant impact on patients’ management. Novel selective targeted therapies have been introduced for the treatment of RAI-R TC in selected cases: REarranged during Transfection (RET) inhibitors (selpercatinib and pralsetinib) and Tropomyosin Receptor Kinase (TRK) inhibitors (larotrectinib and entrectinib) have recently expanded the panorama of the therapeutic options. Moreover, immune checkpoint inhibitors (ICIs) have shown promising results, and they are still under investigation.

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confidence: 62%

Section: Characterization and Management Of Rai-r Tc Patients: How To...mentioning

confidence: 99%

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Management of Progressive Radioiodine-Refractory Thyroid Carcinoma: Current Perspective

Nervo¹,

Retta²,

Ragni³

et al. 2022

CMAR

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“…Finally, the presence of the BRAF V600E mutation and thyroglobulin doubling time <1 year are poor prognostic factors that we did not include in our analysis. A recent study confirmed that thyroglobulin correlated with overall survival but that MTV was not significantly correlated with thyroglobulin levels [ 56 ]. The retrospective design of our study did not allow for the reliable collection of thyroglobulin levels and BRAFV600E mutation of the included patients because blood samples were often analyzed in external laboratories and surgery was frequently conducted in a care center other than the Henri Becquerel Cancer Centre.…”

Section: Discussionmentioning

confidence: 97%

Using 18F-FDG-PET/CT Metrics to Predict Survival in Ra-Dio-Iodine Refractory Thyroid Cancers

et al. 2022

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Radio-iodine refractory (RAI-R) differentiated thyroid cancer (DTC) is a rare disease with a poor prognosis and limited therapeutic resources. Therefore, identifying prognostic factors is essential in order to select patients who could benefit from an early start of treatment. The aim of this study is to identify positron emission tomography with 18F-fluorodeoxyglucose with integrated computed tomography (18F-FDG-PET/CT) parameters to predict overall survival (OS) in patients with RAI-R DTC. In this single-center retrospective study, we analyze the 18F-FDG-PET/CT parameters of 34 patients with RAI-R DTC between April 2007 and December 2019. The parameters collected are MTV, SUVmax and progression for each site of metastasis (neck, mediastinum, lungs, liver, bone) and total sites. ROC curves, Kaplan–Meier survival analysis curves, univariate and multivariate Cox analyses determine prognostic factors for 1-year and 5-year OS. The parameters for mediastinum, liver and total sites are significantly associated with worse 1-year and 5-year OS by both ROC curve analysis and Kaplan–Meier survival analysis. Univariate Cox analysis confirms significance of mediastinum SUVmax (HR 1.08; 95% CI [1.02–1.15]; p = 0.014) and total SUVmax (HR 1.06; 95% CI [1–1.12]; p = 0.042) for worse 1-year OS; of mediastinum SUVmax (HR 1.06; 95% CI [1.02–1.10]; p = 0.003), liver SUVmax (HR 1.04; 95% CI [1.01–1.08]; p = 0.02), liver MTV (HR 2.56; 95% CI [1.13–5.82]; p = 0.025), overall SUVmax (HR 1.05; 95% CI [1.02–1.08]; p = 0.001) and total MTV (HR 1.41; 95% CI [1.07–1.86]; p = 0.016) for worse 5-year OS. Multivariate Cox analysis confirms a significant association between liver MTV (HR 1.02; 95% CI [1–1.04]; p = 0.042) and decrease 1-year OS. In this study, we demonstrate that in RAI-R DTC, 18F-FDG-PET/CT parameters of the mediastinum, liver and overall tumor burden were prognostic factors of poor 1-year and 5-year OS. Identifying these criteria could allow early therapeutic intervention in order to improve patients’ survival.

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“…FDG PET/CT is particularly important for recurrence evaluation in differentiated thyroid cancer (DTC) patients having thyroglobulin elevation with negative iodine scintigraphy (TENIS) [ 95 ]. FDG PET/CT is also widely used to assess disease extent in patients with radioiodine-refractory DTC (RR-DTC) [ 96 ]. Given limited systemic therapeutic options, multiple tracers, including radiolabeled FAPIs have been tried in progressive RR-DTC with the ultimate aim of potential theranostics [ 97 ].…”

Section: Fapi Pet/ct—oncological Indicationsmentioning

confidence: 99%

FAPI PET/CT Imaging—An Updated Review

et al. 2023

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Despite revolutionizing the field of oncological imaging, Positron Emission Tomography (PET) with [18F]Fluorodeoxyglucose (FDG) as its workhorse is limited by a lack of specificity and low sensitivity in certain tumor subtypes. Fibroblast activation protein (FAP), a type II transmembrane glycoprotein, is expressed by cancer-associated fibroblasts (CAFs) that form a major component of the tumor stroma. FAP holds the promise to be a pan-cancer target, owing to its selective over-expression in a vast majority of neoplasms, particularly epithelial cancers. Several radiolabeled FAP inhibitors (FAPI) have been developed for molecular imaging and potential theranostic applications. Preliminary data on FAPI PET/CT remains encouraging, with extensive multi-disciplinary clinical research currently underway. This review summarizes the existing literature on FAPI PET/CT imaging with an emphasis on diagnostic applications, comparison with FDG, pitfalls, and future directions.

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2-[18F]FDG PET in the Management of Radioiodine Refractory Differentiated Thyroid Cancer in the Era of Thyrosin-Kinases Inhibitors: A Real-Life Retrospective Study

Cited by 5 publications

References 35 publications

Management of Progressive Radioiodine-Refractory Thyroid Carcinoma: Current Perspective

Management of Progressive Radioiodine-Refractory Thyroid Carcinoma: Current Perspective

Using 18F-FDG-PET/CT Metrics to Predict Survival in Ra-Dio-Iodine Refractory Thyroid Cancers

FAPI PET/CT Imaging—An Updated Review

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