Pitfalls in Oncology: Osteoblastic Response Mimicking Bone Progression during Ceritinib Treatment in ALK -Rearranged NSCLC

Gelsomino, Francesco; Ambrosini, Valentina; Melotti, Barbara; Sperandi, Francesca; Ardizzoni, Andrea

doi:10.1016/j.jtho.2016.04.002

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…Similar evidence was reported by Ansen S. et al in three patients treated with gefintib or erlotinib for stage IV adenocarcinoma with activating EGFR mutations [13,14]. Osteoblastic response mimicking bone progression during ceritinib treatment was also reported in ALKrearranged NSCLC [15]. Krupitskaya et al reported osteoblastic bone flare on F18-FDG PET in NSCLC patients receiving bevacizumab in addition to standard chemotherapy [16].…”

Section: Discussionsupporting

confidence: 73%

Osteoblastic Flare During Chemo-Immunotherapy in Small Cell Lung Cancer: Do Not Be Misleaded!

2023

Ann Case Report

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Introduction: "Osteoblastic flare" is defined as a temporary increase in bone tracer uptake associated with therapy response in patients without previously detected bone metastases. Hypothetically these apparently "new osteoblastic" lesions are not visible at baseline and are radiologically detected only after a bone sclerotic healing reaction has appeared, for this reason it does not indicate disease progression, but the healing of previously inconspicuous lesions. This phenomenon has been described in several solid tumours as response to antineoplastic treatments; however, it had never been reported in patients with ES-SCLC treated with chemo-immunotherapy. Methods:The Computed Tomography scans (CTs) of five patients with ES-SCLC treated with first-line chemo-immunotherapy with Atezolizumab, Carboplatin and Etoposide, were retrospectively reviewed to analyse the bone response to treatment compared with the response of the visceral tumour.Results: On reassessment CTs the development of new onset osteoblastic lesions was associated with a partial response in the other disease sites. In each case, osteoblastic lesions, developed during therapy, were considered as a response reflecting bone repair and efficacy of the treatment. Therefore, the maintenance therapy was continued obtaining a temporary stability of the disease. In view of the increasing use of chemo-immunotherapy in this setting, it is important not to confuse this phenomenon with disease progression, in order to avoid discontinuation of the maintenance immuno-therapy treatment, which the patient could benefit from.

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Section: Discussionsupporting

confidence: 73%

Osteoblastic Flare During Chemo-Immunotherapy in Small Cell Lung Cancer: Do Not Be Misleaded!

2023

Ann Case Report

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“…Recently, a few cases have been reported in patients with NSCLC undergoing treatment with EGFR TKI [7][8][9]. There has also been one report of osteoblastic flaring in a NSCLC patient harboring an ALK-mutation [10].…”

Section: Discussionmentioning

confidence: 99%

“…Further research is ongoing, and it is expected additional targetable mutations will be identified [16]. As these targeted therapies are increasingly being used, the likelihood of encountering a bone flare phenomenon is growing [7,10].…”

Section: Discussionmentioning

confidence: 99%

A Flare for the Unexpected: Bone Flare as Response to Tyrosine Kinase Inhibitor Treatment in a Lung Cancer Patient

Bondt

Snoeckx

Raskin

2020

Journal of the Belgian Society of Radiology

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We report the case of a 72-year-old female never-smoker with stage IV endothelial growth factor receptor (EGFR) mutated lung adenocarcinoma. This patient was started on first line tyrosine kinase inhibitor (TKI) and seemingly developed new bone metastases under this treatment. As there was a remarkable discrepancy between the partial response seen in the primary tumor and non-osseous metastatic locations, the possibility of a bone flare phenomenon was considered. In this case report, we demonstrate that new bony lesions are not always synonymous with disease progression.

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“…A diffuse UP uptake pattern, coupled with a negative diagnostic CT, is reported as physiologic. This approach based on the correlation between PET/CT and diagnostic CT findings is certainly noteworthy and practical; however, the confidence of the reader is lower when a focal pattern is observed (especially since it is well known and reported in many tumor types that functional changes can precede the evidence of morphological abnormalities) [ 23 ]. Finally, the pre-test probability of disease or co-existing genetic syndromes, characterized by a higher susceptibility to develop NEN lesions, may also contribute to a more defensive PET reporting attitude.…”

Section: Discussionmentioning

confidence: 99%

[68Ga]Ga-DOTANOC Uptake at Pancreatic Head/Uncinate Process: Is It a Persistent Diagnostic Pitfall Over Time?

Tabacchi

Fortunati

Argalia

et al. 2022

Cancers

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Purpose: [68Ga]Ga-DOTA-peptide uptake in the pancreatic head/uncinate process (UP) is a frequent PET/CT finding. Although mostly physiologic, it can represent a pitfall in PET/CT reading, especially when focal. An increased frequency of UP uptake has been reported in patients (pts) affected by diabetes mellitus (DM). The aim of the study is to describe the frequency of [68Ga]Ga-DOTANOC UP uptake to evaluate its variations over time and its possible correlation with DM. Methods: In September 2017, a monocentric prospective observational electronic archive was initiated at our center to collect clinical and imaging data of pts undergoing [68Ga]Ga-DOTANOC PET/CT. Among the pts enrolled in the first 6 months (Sept 2017 to Feb 2018), those presenting [68Ga]Ga-DOTANOC PET/CT uptake at UP level were included. Pts with UP lesions already documented on CT/MRI or those that underwent surgical excision of UP before PET/CT were excluded from the analysis. [68Ga]Ga-DOTANOC UP uptake was classified as diffuse or focal and compared with the pattern observed in previous PET/CT scans performed at our center. An increased frequency of UP uptake was also correlated with the presence of DM. Results: In the first 6 months, 253 pts were enrolled in the archive and 172 out of them were included in the analysis. UP increased uptake was frequently observed (77/172, 44.8%) and was mostly diffuse (62/77). In 75/172 pts (43.6%), previous [68Ga]Ga-DOTANOC PET/CT scans were available (overall 268 scans; number of previous PET per pt range: 1–20) and were retrospectively reviewed. Despite the fact that, in most pts, the uptake pattern was stable over time (54/75 pts, 72%), it changed in approximately one third of cases (21/75, 28%). Among DM pts (29/172), only 10/29 (34.4%) presented increased UP uptake. Conclusions: UP [68Ga]Ga-DOTANOC uptake is a frequent non-malignant finding (slightly higher than previously reported), mostly presenting with a diffuse pattern. However, contrary to previous reports, our data show that the pattern of uptake may vary over time in approximately one third of the cases and it is not more frequently observed in pts with DM.

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Pitfalls in Oncology: Osteoblastic Response Mimicking Bone Progression during Ceritinib Treatment in ALK -Rearranged NSCLC

Cited by 5 publications

References 5 publications

Osteoblastic Flare During Chemo-Immunotherapy in Small Cell Lung Cancer: Do Not Be Misleaded!

Osteoblastic Flare During Chemo-Immunotherapy in Small Cell Lung Cancer: Do Not Be Misleaded!

A Flare for the Unexpected: Bone Flare as Response to Tyrosine Kinase Inhibitor Treatment in a Lung Cancer Patient

[68Ga]Ga-DOTANOC Uptake at Pancreatic Head/Uncinate Process: Is It a Persistent Diagnostic Pitfall Over Time?

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