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18F-FDG PET predicts survival after pretargeted radioimmunotherapy in patients with progressive metastatic medullary thyroid carcinoma

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

PET is a powerful tool for assessing targeted therapy. Since 18F-FDG shows a potential prognostic value in medullary thyroid carcinoma (MTC), this study evaluated 18F-FDG PET alone and combined with morphological and biomarker evaluations as a surrogate marker of overall survival (OS) in patients with progressive metastatic MTC treated with pretargeted anti-CEA radioimmunotherapy (pRAIT) in a phase II clinical trial.

Methods

Patients underwent PET associated with morphological imaging (CT and MRI) and biomarker evaluations, before and 3 and 6 months, and then every 6 months, after pRAIT for 36 months. A combined evaluation was performed using anatomic, metabolic and biomarker methods. The prognostic value of the PET response was compared with demographic parameters at inclusion including age, sex, RET mutation, time from initial diagnosis, calcitonin and CEA concentrations and doubling times (DT), SUVmax, location of disease and bone marrow involvement, and with response using RECIST, biomarker concentration variation, impact on DT, and combined methods.

Results

Enrolled in the study were 25 men and 17 women with disease progression. The median OS from pRAIT was 3.7 years (0.2 to 6.5 years) and from MTC diagnosis 10.9 years (1.7 to 31.5 years). After pRAIT, PET/CT showed 1 patient with a complete response, 4 with a partial response and 24 with disease stabilization. The combined evaluation showed 20 responses. For OS from pRAIT, univariate analysis showed the prognostic value of biomarker DT (P = 0.011) and SUVmax (P = 0.038) calculated before pRAIT and impact on DT (P = 0.034), RECIST (P = 0.009), PET (P = 0.009), and combined response (P = 0.004) measured after pRAIT. PET had the highest predictive value with the lowest Akaike information criterion (AIC 74.26) as compared to RECIST (AIC 78.06), biomarker variation (AIC 81.94) and impact on DT (AIC 79.22). No benefit was obtained by combining the methods (AIC 78.75). This result was confirmed by the analysis of OS from MTC diagnosis.

Conclusion

18F-FDG PET appeared as the most potent and simplest prognostic method to predict survival in patients with progressive MTC treated with pRAIT. Biomarker DT before pRAIT also appeared as an independent prognostic factor, but no benefit was found by adding morphological and biomarker evaluation to PET assessment.

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Acknowledgments

This work was supported in part by a grant from French Programme Hospitalier de Recherche 2002, the French National Agency for Research (“Investissements d’Avenir”, no. ANR-11-LABX-0018-01), and by a grant from the Pays de la Loire Regional Council (“NucSan”).

Disclosure statement

David M. Goldenberg has a leadership position at Immunomedics, Inc., and IBC Pharmaceuticals, Inc. (Morris Plains, NJ).

Author information

Authors and Affiliations

  1. Nuclear Medicine Department, University Hospital, Brest, France

    Pierre-Yves Salaun & Philippe Robin

  2. Statistical Department, ICO-Gauducheau Cancer Institute, Nantes, France

    Loïc Campion

  3. Nuclear Medicine Department, University Hospital, Nantes, France

    Catherine Ansquer, Cédric Mathieu & Françoise Kraeber-Bodéré

  4. Radiology Department, University Hospital, Nantes, France

    Eric Frampas

  5. Nantes-Angers Cancer Research Center, Inserm, U 892, CNRS, UMR 6299, Université de Nantes, Nantes, France

    Eric Frampas, Caroline Rousseau, Jacques Barbet & Françoise Kraeber-Bodéré

  6. Nuclear Medicine Department, University Hospital, Lyon, France

    Claire Bournaud

  7. Nuclear Medicine Department, University Hospital, Grenoble, France

    Jean-Philippe Vuillez

  8. Nuclear Medicine Department, University Hospital, Marseille, France

    David Taieb

  9. Nuclear Medicine Department, ICO-René Gauducheau, Nantes, France

    Caroline Rousseau & Françoise Kraeber-Bodéré

  10. Endocrinology Department, University Hospital, Nantes, France

    Delphine Drui

  11. Surgery Department, University Hospital, Nantes, France

    Eric Mirallié

  12. Endocrinology Department, University Hospital, Lyon, France

    Françoise Borson-Chazot

  13. IBC Pharmaceuticals, Inc., and Immunomedics, Inc., Morris Plains, NJ, USA

    David M. Goldenberg

  14. Garden State Cancer Center, Center for Molecular Medicine and Immunology, Morris Plains, NJ, USA

    David M. Goldenberg

  15. GIP ARRONAX, Saint-Herblain, France

    Jean-François Chatal & Jacques Barbet

  16. Nuclear Medicine Department, Hôtel Dieu University Hospital, 1 place Ricordeau, 44093, Nantes, France

    Françoise Kraeber-Bodéré

Authors
  1. Pierre-Yves Salaun
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Correspondence to Françoise Kraeber-Bodéré.

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Salaun, PY., Campion, L., Ansquer, C. et al. 18F-FDG PET predicts survival after pretargeted radioimmunotherapy in patients with progressive metastatic medullary thyroid carcinoma. Eur J Nucl Med Mol Imaging 41, 1501–1510 (2014). https://doi.org/10.1007/s00259-014-2772-0

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  • DOI: https://doi.org/10.1007/s00259-014-2772-0

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