[177Lu]PSMA全身闪烁扫描与中期PSMA-PET相比，可进行早期治疗反应评估

IF 3.5 2区医学 Q2 ONCOLOGY

Cancer Imaging Pub Date : 2024-09-19 DOI:10.1186/s40644-024-00773-w

David Ventura, Philipp Rassek, Philipp Schindler, Burak Han Akkurt, Linus Bredensteiner, Martin Bögemann, Katrin Schlack, Robert Seifert, Michael Schäfers, Wolfgang Roll, Kambiz Rahbar

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引用次数: 0

摘要

前列腺特异性膜抗原正电子发射断层扫描（PSMA-PET）是放射性配体治疗（RLT）前选择患者的重要工具。在 RLT 期间使用 PSMA-PET 进行中期分期可对治疗进行监测。然而，与治疗后成像相比，PSMA-PET 的附加价值尚未得到充分说明。本研究旨在比较治疗后全身扫描（WBS）评估的早期治疗反应与两个周期后PSMA-PET的中期分期，以预测OS。研究人员对至少接受过两个周期 RLT 治疗的转移性耐药 PC（mCRPC）男性患者和中期 PSMA-PET 进行了回顾性评估。PROMISE V2框架用于对PSMA表达进行分类和评估治疗反应。有反应者的反应定义为疾病控制率（DCR），无反应者的反应定义为疾病进展。共纳入了188名在2015年2月至2021年12月期间接受RLT治疗的男性mCRPC患者。不同成像模式的比较结果显示，与Cramer V检验有很强的显著相关性：例如，与RLT两个周期后的中期PET相比，第二个周期的WBS反应（cφ = 0.888，P < 0.001，n = 188）。中位随访时间为14.7个月（范围：3-63个月；125人死亡）。中位总生存期（OS）为14.5个月（95% CI：11.9-15.9）。就OS分析而言，治疗过程中的早期进展显示死亡的可能性显著增加：例如，第二周期WBS（15个月对25个月，P＜0.001），HR为2.81（P＜0.001）；或在2周期RLT后的PET时间点（11个月对24个月，P＜0.001），HR为3.5（P＜0.001）。就早期生化反应而言，RLT 两个周期后 PSA 下降至少 50%，表明死亡的可能性显著降低（26 个月 vs. 17 个月，P < 0.001），HR 为 0.5（P < 0.001）。WBS 对 RLT 的反应评估与两个周期 RLT 后的中期 PET 具有高度一致性，可以识别有不良预后风险的患者。这表明中期PET可能会被省略用于反应评估，但还需要未来的试验来证实这些发现。

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Early treatment response assessment with [177Lu]PSMA whole-body-scintigraphy compared to interim PSMA-PET

Prostate-specific membrane antigen positron emission tomography (PSMA-PET) is an essential tool for patient selection before radioligand therapy (RLT). Interim-staging with PSMA-PET during RLT allows for therapy monitoring. However, its added value over post-treatment imaging is poorly elucidated. The aim of this study was to compare early treatment response assessed by post-therapeutic whole-body scans (WBS) with interim-staging by PSMA-PET after 2 cycles in order to prognosticate OS. Men with metastasized castration-resistant PC (mCRPC) who had received at least two cycles of RLT, and interim PSMA-PET were evaluated retrospectively. PROMISE V2 framework was used to categorize PSMA expression and assess response to treatment. Response was defined as either disease control rate (DCR) for responders or progression for non-responders. A total of 188 men with mCRPC who underwent RLT between February 2015 and December 2021 were included. The comparison of different imaging modalities revealed a strong and significant correlation with Cramer V test: e.g. response on WBS during second cycle compared to interim PET after two cycles of RLT (cφ = 0.888, P < 0.001, n = 188). The median follow-up time was 14.7 months (range: 3–63 months; 125 deaths occurred). Median overall survival (OS) time was 14.5 months (95% CI: 11.9–15.9). In terms of OS analysis, early progression during therapy revealed a significantly higher likelihood of death: e.g. second cycle WBS (15 vs. 25 months, P < 0.001) with a HR of 2.81 (P < 0.001) or at PET timepoint after 2 cycles of RLT (11 vs. 24 months, P < 0.001) with a HR of 3.5 (P < 0.001). For early biochemical response, a PSA decline of at least 50% after two cycles of RLT indicates a significantly lower likelihood of death (26 vs. 17 months, P < 0.001) with a HR of 0.5 (P < 0.001). Response assessment of RLT by WBS and interim PET after two cycles of RLT have high congruence and can identify patients at risk of poor outcome. This indicates that interim PET might be omitted for response assessment, but future trials corroborating these findings are warranted.

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来源期刊

Cancer Imaging ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

7.00

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Cancer Imaging is an open access, peer-reviewed journal publishing original articles, reviews and editorials written by expert international radiologists working in oncology. The journal encompasses CT, MR, PET, ultrasound, radionuclide and multimodal imaging in all kinds of malignant tumours, plus new developments, techniques and innovations. Topics of interest include: Breast Imaging Chest Complications of treatment Ear, Nose & Throat Gastrointestinal Hepatobiliary & Pancreatic Imaging biomarkers Interventional Lymphoma Measurement of tumour response Molecular functional imaging Musculoskeletal Neuro oncology Nuclear Medicine Paediatric.