Role of textural heterogeneity parameters in patient selection for 177Lu-PSMA therapy via response prediction

Khurshid, Zain; Ahmadzadehfar, Hojjat; Gaertner, Florian; Papp, László; Zsótér, Norbert; Essler, Markus; Bundschuh, Ralph A.

doi:10.18632/oncotarget.26051

Cited by 38 publications

(37 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This observation of MX response underlines the well-known development of heterogeneity of PC lesions over time. Textural heterogeneity parameters may also play an important role explaining these findings [14]. In fact, all our patients with MX response also showed increasing PSA values over time und thus disease progression.…”

Section: Discussionmentioning

confidence: 58%

See 1 more Smart Citation

The 68Ga/177Lu-theragnostic concept in PSMA-targeting of metastatic castration–resistant prostate cancer: impact of post-therapeutic whole-body scintigraphy in the follow-up

Maffey-Steffan

Scarpa

Svirydenka³

et al. 2019

Eur J Nucl Med Mol Imaging

View full text Add to dashboard Cite

Introduction A new therapeutic option for metastatic castration-resistant prostate cancer (mCRPC) of heavily pre-treated patients lies in 177 Lu-PSMA-617 radioligand therapy. Methods On the basis of PSMA-targeted 68 Ga-PSMA-11 PET/CT, 32 consecutive mCRPC patients were selected for 177 Lu-PSMA-617 therapy (6 GBq/cycle, 2 to 6 cycles, 6-10 weeks apart) and followed until death. Post-therapy whole-body (WB) dosimetry and 68 Ga-PSMA-11 PET/CT data were compared and related to progression free and overall survival. Results 177 Lu-PSMA-617 dosimetry after the first cycle indicated high tumor doses for skeletal (4.01 ± 2.64; range 1.10-13.00 Gy/GBq), lymph node (3.12 ± 2.07; range 0.70-8.70 Gy/GBq), and liver (2.97 ± 1.38; range 0.76-5.00 Gy/GBq) metastases whereas the dose for tissues/organs was acceptable in all patients for an intention-to-treat activity of 24 GBq. Any PSA decrease after the first cycle was found in 23/32 (72%), after the second cycle in 22/32 (69%), after the third cycle in 16/28 (57%), and after the fourth cycle in 8/18 (44%) patients. Post-therapy 24 h WB scintigraphy showed decreased tumor-to-background ratios in 24/ 32 (75%) after the first therapy cycle, after the second cycle in 17/29 (59%), and after the third cycle in 13/21 (62%) patients. The median PFS was 7 months and the median OS 12 months. In the group of PSA responders (n = 22) the median OS was 17 months versus 11 months in the group of non-responders (n = 10), p < 0.05. Decreasing SUV max values were found for parotid (15.93 ± 6.23 versus 12.33 ± 4.07) and submandibular glands (17.65 ± 7.34 versus 13.12 ± 4.62) following treatment, along with transient (n = 6) or permanent (n = 2) xerostomia in 8/32 (25%) patients. In 3/32 patients, nephrotoxicity changed from Grade 2 to 3, whereas neither Grade 4 nephrotoxicity nor hematotoxicity was found. In most patients a good agreement was observed for the visual interpretation of the tracer accumulation between 24 h WB and PET/CT scans. However, no significance could be calculated for baseline-absorbed tumor doses and SUV max values of tumor lesions. 5/32 (16%) patients showed a mixed response pattern, which resulted in disease progression over time. Conclusion Serial PSA measurements and post-therapy 24 h WB scintigraphy seems to allow a sufficiently accurate follow-up of 177 Lu-PSMA-617-treated mCRPC patients whereas 68 Ga-PSMA-11 PET/CT should be performed for patient selection and final response assessment.

show abstract

Section: Discussionmentioning

confidence: 58%

“…In 8 patients (nos. 1,3,6,7,8,14,20,32), bone-targeted therapy was continued after 177 Lu-PSMA-617 therapy had commenced. and could be discharged 48 h post-injection.…”

Section: Patient Selectionmentioning

confidence: 99%

The 68Ga/177Lu-theragnostic concept in PSMA-targeting of metastatic castration–resistant prostate cancer: impact of post-therapeutic whole-body scintigraphy in the follow-up

Maffey-Steffan

Scarpa

Svirydenka³

et al. 2019

Eur J Nucl Med Mol Imaging

View full text Add to dashboard Cite

show abstract

“…In several previous studies the ability of textural parameters assessed in PET/CT examination as surrogate marker for tumor heterogeneity to predict treatment outcome was shown [12,[19][20][21]. Especially higher-order textural features correlate well with the human perception of texture and shape of s structure and reflect therefore the impression of the physician [22].…”

Section: Discussionmentioning

confidence: 92%

Textural features in FDG-PET/CT can predict outcome in melanoma patients to treatment with Vemurafenib and Ipililumab

et al. 2020

Self Cite

View full text Add to dashboard Cite

Aim Recently, textural parameters assessed in FDG-PET/CT as surrogate marker for tumor heterogeneity have been shown to provide prognostic power. Therefore, we investigated the use of such parameters in FDG-PET/CT examinations before the start of immunotherapy with vemurafenib or ipilimumab in patients with malignant melanoma. Methods In this retrospective analysis 26 patients with histologically proven advanced melanoma were included. FGD-PET/CT was performed before the start of treatment either with vemurafenib (n = 9) or ipilimumab (n = 17) and tumors were analyzed for textural parameters as well as conventional PET features. Lesions were classified as responding or not responding following PERCIST criteria. ROC analysis was performed to analyze the predictive power and cut-off values. In addition, the change of maximum SUV of the lesions between pretherapeutic PET/CT and another PET/CT performed about 12 weeks after start of treatment was evaluated and correlated with the pretreatment parameters. Results In both groups, six textural parameters showed statistically significant predictive power as well as the metabolic tumor volume. In the group treated with vemurafenib eight additional textural parameters as well as the maximum and mean SUV and the TLG showed significance. A statistically significant correlation between the change of maximum SUV in the course of treatment and the pretherapeutic parameters was found in both treatment groups for three textural features. Conclusion In patients with malignant melanoma textural parameters in pretherapeutic FDG-PET/CT examinations seem to have prognostic power for treatment response of immunotherapy with vemurafenib and ipilimumab. This can be an important step towards personalized tumor therapy.

show abstract

“…As a result, it would be possible to exclude non-responders from this treatment to avoid undesirable side effects and cost-intensive treatments without benefit for the individual patient. In this context, Khurshid et al reported a significant correlation between some textural parameters such as the mean homogeneity and entropy in 68 Ga-PSMA-PET scans and response to 177 Lu-PSMA therapy as determined by the reduction of prostate-specific antigen (PSA) levels [ 24 ]. Development of an ML algorithm for therapy decision would be of high interest for general oncology and for the selection of patients for clinical trials and could be an important further step towards individualized tumor therapy.…”

Section: Discussionmentioning

confidence: 99%

Machine Learning Facilitates Hotspot Classification in PSMA-PET/CT with Nuclear Medicine Specialist Accuracy

Moazemi

Khurshid²,

Erle

et al. 2020

Diagnostics

Self Cite

View full text Add to dashboard Cite

Gallium-68 prostate-specific membrane antigen positron emission tomography (68Ga-PSMA-PET) is a highly sensitive method to detect prostate cancer (PC) metastases. Visual discrimination between malignant and physiologic/unspecific tracer accumulation by a nuclear medicine (NM) specialist is essential for image interpretation. In the future, automated machine learning (ML)-based tools will assist physicians in image analysis. The aim of this work was to develop a tool for analysis of 68Ga-PSMA-PET images and to compare its efficacy to that of human readers. Five different ML methods were compared and tested on multiple positron emission tomography/computed tomography (PET/CT) data-sets. Forty textural features extracted from both PET- and low-dose CT data were analyzed. In total, 2419 hotspots from 72 patients were included. Comparing results from human readers to those of ML-based analyses, up to 98% area under the curve (AUC), 94% sensitivity (SE), and 89% specificity (SP) were achieved. Interestingly, textural features assessed in native low-dose CT increased the accuracy significantly. Thus, ML based on 68Ga-PSMA-PET/CT radiomics features can classify hotspots with high precision, comparable to that of experienced NM physicians. Additionally, the superiority of multimodal ML-based analysis considering all PET and low-dose CT features was shown. Morphological features seemed to be of special additional importance even though they were extracted from native low-dose CTs.

show abstract

Role of textural heterogeneity parameters in patient selection for 177Lu-PSMA therapy via response prediction

Cited by 38 publications

References 29 publications

The 68Ga/177Lu-theragnostic concept in PSMA-targeting of metastatic castration–resistant prostate cancer: impact of post-therapeutic whole-body scintigraphy in the follow-up

The 68Ga/177Lu-theragnostic concept in PSMA-targeting of metastatic castration–resistant prostate cancer: impact of post-therapeutic whole-body scintigraphy in the follow-up

Textural features in FDG-PET/CT can predict outcome in melanoma patients to treatment with Vemurafenib and Ipililumab

Machine Learning Facilitates Hotspot Classification in PSMA-PET/CT with Nuclear Medicine Specialist Accuracy

Contact Info

Product

Resources

About