Abstract
Purpose
We report the effect of antiangiogenic therapy on the biodistribution of 18F-FPPRGD2 (a surrogate biomarker of integrin αvβ3 expression), and the potential of 18F-FPPRGD2 to predict the prognosis in patients with cervical cancer and ovarian cancer in this clinical scenario.
Methods
Data from six women, age range 30 – 59 years (mean ± SD 44.0 ± 12.5 years), who had undergone a 18F-FPPRGD2 PET/CT scan and bevacizumab-containing therapy were prospectively collected and analyzed. We compared baseline 18F-FPPRGD2 and 18F-FDG uptake in the lesions and tumor-to-background (T/B) ratios. The maximum and mean 18F-FPPRGD2 standardized uptake values (SUVmax and SUVmean) were recorded for 13 normal organs, as well as in all the identified malignant lesions on the pretreatment scan and the 1-week post-treatment scan. We also measured changes in 18F-FPPRGD2 uptake from before to 1 week after treatment, and compared them to the changes in 18F-FDG uptake from before to 6 weeks after treatment. Treatment outcomes were correlated with these changes.
Results
The uptake in lesions and T/B ratio of 18F-FPPRGD2 were lower than those of 18F-FDG (SUVmax 3.7 ± 1.3 vs. 6.0 ± 1.8, P < 0.001; SUVmean 2.6 ± 0.7 vs. 4.2 ± 1.3, P < 0.001; T/B ratio based on SUVmax 2.4 ± 1.0 vs. 2.6 ± 1.0, P < 0.04; T/B ratio based on SUVmean 1.9 ± 0.6 vs. 2.4 ± 1.0, P < 0.003). One patient did not return for the follow-up scan and in another patient no lesions were identified on the pretreatment scan. 18F-FPPRGD2 uptake in lesions in the remaining four patients had significantly changed 1 week after treatment (SUVmean 3.3 ± 1.0 vs. 2.7 ± 1.0, P < 0.001), while uptake in all normal tissues analyzed was not affected by treatment. One patient with clinical disease progression had a decrease in lesional 18F-FPPRGD2 SUVmean of 1.6 % and in 18F-FDG SUVmean of 9.4 %. Two patients with a clinical complete response to treatment had decreases in lesional 18F-FPPRGD2 SUVmean of 25.2 % and 25.0 % and in 18F-FDG SUVmean of 6.1 % and 71.8 %. One patient with a clinical partial response had a decrease in lesional 18F-FPPRGD2 SUVmean of 7.9 % and in 18F-FDG SUVmean of 76.4 %.
Conclusion
This pilot study showed that 18F-FPPRGD2 and 18F-FDG provide independent information about the biology of ovarian and cervical cancers. Bevacizumab-containing therapy does not affect 18F-FPPRGD2 uptake in normal organs, but does result in statistically significant changes in lesions. In addition, 18F-FPPRGD2 may have potential for early prediction of response to such treatments. These preliminary findings have to be confirmed in larger studies.
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Acknowledgments
We thank our research coordinators, the radiochemistry staff, and the nuclear medicine technologists. We particularly thank all the patients who agreed to participate in the study and their families.
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Funding
The Mary Lake Polan Endowment supported the research activities of O.D. and this project.
Conflict of interest
S.S.G. Activities related to the present article: none to disclose. Activities not related to the present article: on the board of Endra, Enlight, ImaginAB, MagArray, SiteOne Therapeutics, VisualSonics/Sonosite, and Click Diagnostics; consultant for VisualSonics/Sonosite, Gamma Medica, BMEB, and Bracco; received grants from General Electric and Sanofi-Aventis; received honoraria from Imaging AB; holds stock in Enlight and VisualSonics/Sonosite; received compensation for travel and accommodations from Gamma Camera.
A.I. Activities related to the present article: none to disclose. Activities not related to the present article: received grants from GE Healthcare and Bayer Healthcare.
The other authors declare no conflicts of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Department discretionary funds (O.D.).
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Minamimoto, R., Karam, A., Jamali, M. et al. Pilot prospective evaluation of 18F-FPPRGD2 PET/CT in patients with cervical and ovarian cancer. Eur J Nucl Med Mol Imaging 43, 1047–1055 (2016). https://doi.org/10.1007/s00259-015-3263-7
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DOI: https://doi.org/10.1007/s00259-015-3263-7