FLT-PET for early response evaluation of colorectal cancer patients with liver metastases: a prospective study

Mogensen, Marie Benzon; Loft, Annika; Aznar, Marianne C.; Axelsen, Thomas; Vainer, Ben; Østerlind, Kell; Kjær, Andreas

doi:10.1186/s13550-017-0302-3

Cited by 7 publications

(8 citation statements)

References 31 publications

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“…Mogensen et al investigated F18-FLT PET/CT's role in patients with at least one measurable (> 1 cm) colorectal cancer liver metastasis and received rst-line chemotherapy. They reported a reduction in F18-FLT uptake in 23 patients (85%), whereas there was no relationship between the early change in measured F18-FLT SUVmax, and RECIST 1.1 based response (p = 0.24) [31]. There was no relationship between ΔSUVmax, ΔSUVmean, and ΔSUVpeak values and RECIST 1.1 and PERCIST based responses in this current study.…”

Section: Discussioncontrasting

confidence: 76%

The Role of F18-FLT PET / CT in Assessing Early Response to TARE and TACE in Patients with Primary and Metastatic Liver Tumors

Nak

Küçük

Çelebioğlu

et al. 2021

Preprint

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ObjectiveThis study aims to identify F18-FLT PET / CT's role in the assessment of early response to intraarterial chemoembolization and radioembolization treatments in patients with unresectable primary and metastatic liver tumors.MethodsThis single-center study included 63 patients who underwent F18-FLT PET / CT for response evaluation after TACE and TARE treatments. After excluding 20 patients due to various reasons, 43 patients were analyzed. The compatibility of change in semi-quantitative values obtained from the F18-FLT PET / CT images with the treatment responses detected in F18-FDG PET / CT, CT, and MR images was evaluated.ResultsThere was no correlation between early metabolic, morphological response, F18-FLT visual change, ΔSUVmax, ΔSUVmean, and ΔSUVpeak values. There was no significant correlation between F18-FLT visual change, ΔSUVmax, ΔSUVmean, ΔSUVpeak, and OS, PFS for the target lobe PFS for the whole-body. The survival distributions for the patients with and without >30% change in ΔSUVmax and ΔSUVpeak values were statistically significantly different (p < .009 and p < .024, respectively).ConclusionIt has not been demonstrated that F18-FLT PET / CT imaging is one of the methodologies that should be applied primarily in monitoring early response to embolization treatment in patients with unresectable primary and metastatic liver tumors.

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Section: Discussioncontrasting

confidence: 76%

The Role of F18-FLT PET / CT in Assessing Early Response to TARE and TACE in Patients with Primary and Metastatic Liver Tumors

Nak

Küçük

Çelebioğlu

et al. 2021

Preprint

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“…Positive findings were published for e.g., differentiation of cerebral radionecrosis from glioma progression ( 169 ), and correlation of mean SUV with OS for resectable pancreatic carcinoma ( 170 ). In contrast, no association was found between early changes in FLT uptake after the first cycle of chemotherapy for CRC and the response evaluated from subsequent CT scans ( 171 ). Its value as a biomarker for ICI in melanoma has only been reported in one case of FLT-PET/MRI; this precludes general conclusions ( 172 ).…”

Section: Imaging Biomarkersmentioning

confidence: 96%

Biomarkers for Clinical Benefit of Immune Checkpoint Inhibitor Treatment—A Review From the Melanoma Perspective and Beyond

2018

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BackgroundImmune checkpoint inhibition (ICI) with anti-CTLA-4 and/or anti-PD-1 antibodies is standard treatment for metastatic melanoma. Anti-PD-1 (pembrolizumab, nivolumab) and anti-PD-L1 antibodies (atezolizumab, durvalumab, and avelumab) have been approved for treatment of several other advanced malignancies, including non-small-cell lung cancer (NSCLC); renal cell, and urothelial carcinoma; head and neck cancer; gastric, hepatocellular, and Merkel-cell carcinoma; and classical Hodgkin lymphoma. In some of these malignancies approval was based on the detection of biomarkers such as PD-L1 expression or high microsatellite instability.MethodsWe review the current status of prognostic and predictive biomarkers used in ICI for melanoma and other malignancies. We include clinical, tissue, blood, and stool biomarkers, as well as imaging biomarkers.ResultsSeveral biomarkers have been studied in ICI for metastatic melanoma. In clinical practice, pre-treatment tumor burden measured by means of imaging and serum lactate dehydrogenase level is already being used to estimate the likelihood of effective ICI treatment. In peripheral blood, the number of different immune cell types, such as lymphocytes, neutrophils, and eosinophils, as well as different soluble factors, have been correlated with clinical outcome. For intra-tumoral biomarkers, expression of the PD-1 ligand PD-L1 has been found to be of some predictive value for anti-PD-1-directed therapy for NSCLC and melanoma. A high mutational load, particularly when accompanied by neoantigens, seems to facilitate immune response and correlates with patient survival for all entities treated by use of ICI. Tumor microenvironment also seems to be of major importance. Interestingly, even the gut microbiome has been found to correlate with response to ICI, most likely through immuno-stimulatory effects of distinct bacteria. New imaging biomarkers, e.g., for PET, and magnetic resonance imaging are also being investigated, and results suggest they will make early prediction of patient response possible.ConclusionSeveral promising results are available regarding possible biomarkers for response to ICI, which need to be validated in large clinical trials. A better understanding of how ICI works will enable the development of biomarkers that can predict the response of individual patients.

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“…FLT was synthesized in-house according to standard procedures ( 25 ). After administration of 3.4-9.3 mCi 18 F-FLT intravenously, the whole-body PET/CT imaging was performed starting 60 min after injection ( 26 , 27 , 28 , 29 , 30 ). Following CT for attenuation correction, and anatomical correlation, whole-body PET images were obtained, in the supine position, from the vertex to the middle thigh, and 3 min per bed.…”

Section: Methodsmentioning

confidence: 99%

“…Since the reference (non-tumoral) liver parenchymal SUV values of the patients showed a significant difference both between the patients and the baseline and post-treatment images of the same patient, the target background ratio (TBR) of the target lesions were calculated by proportioning the SUV values of the target lesion to reference values and were evaluated separately. Reference SUV values were calculated by manually placing a 2 cm region of interest in the liver in a tumor-free area to measure background liver activity ( 26 , 28 , 29 , 30 ). Patients were divided into groups with and without the change of SUV values calculated from the difference between the target lesion’s post-treatment and pre-treatment SUV values, which were calculated and referred to as delta (Δ) SUV values.…”

Section: Methodsmentioning

confidence: 99%

The Role of <sup>18</sup>F-FLT PET/CT in Assessing Early Response to Transarterial Radioembolization and Chemoembolization in Patients with Primary and Metastatic Liver Tumors

Nak¹,

Küçük²,

Çelebioğlu³

et al. 2022

Mirt

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Objectives: Metastases and primary malignancies are common in the liver. Local ablative applications such as transarterial chemoembolization (TACE), and transarterial radioembolization (TARE) provide minimally invasive and safe treatment in unresectable liver tumors. Early detection of response to treatment prevents unnecessary toxicity and cost in non-responder patients and provides an earlier use of other options that may be effective. This study aimed to identify the role of 18 F-fluorothymidine (FLT) positron emission tomography/computed tomography (PET/CT) in the assessment of early response to TACE and TARE treatments in patients with unresectable primary and metastatic liver tumors Methods: This single-center study included 63 patients who underwent 18 F-FLT PET/CT for response evaluation after TACE and TARE. After excluding 20 patients whose data were missing 43 TARE-receiving patients were analyzed. The compatibility of change in semi-quantitative values obtained from the 18 F-FLT PET/CT images with the treatment responses detected in 18 F-fluorodeoxyglucose PET/CT, CT, and MR images and survival was evaluated. Results: There was no correlation between early metabolic, morphological response, and 18 F-FLT uptake pattern, and change in standardized uptake values (SUV) which were ΔSUV max , ΔSUV mean , ΔSUV peak ., ΔSUV mean , Δ SUV peak values. There was no significant correlation between 18 F-FLT uptake pattern, ΔSUV max , ΔSUV mean , ΔSUV peak , and overall survival, progression-free survival (PFS) for the target lobe PFS for the whole-body. The survival distributions for the patients with >30% change in Δ SUV max and ΔSUV peak values were statistically significantly longer than the patients with <30% change (p<0.009 and p<0.024, respectively). Conclusion: There was significant longer PFS for target liver lobe in patients with more than 30% decrease in 18 F-FLT SUV max and SUV peak of the liver lesion in primary and metastatic unresectable liver tumors undergoing TARE.

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FLT-PET for early response evaluation of colorectal cancer patients with liver metastases: a prospective study

Cited by 7 publications

References 31 publications

The Role of F18-FLT PET / CT in Assessing Early Response to TARE and TACE in Patients with Primary and Metastatic Liver Tumors

The Role of F18-FLT PET / CT in Assessing Early Response to TARE and TACE in Patients with Primary and Metastatic Liver Tumors

Biomarkers for Clinical Benefit of Immune Checkpoint Inhibitor Treatment—A Review From the Melanoma Perspective and Beyond

The Role of <sup>18</sup>F-FLT PET/CT in Assessing Early Response to Transarterial Radioembolization and Chemoembolization in Patients with Primary and Metastatic Liver Tumors

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