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European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-05-2015 | Original Article

3′-Deoxy-3′-¹⁸F-fluorothymidine positron emission tomography as an early predictor of disease progression in patients with advanced and metastatic pancreatic cancer

Authors: Amarnath Challapalli, Tara Barwick, Rachel A. Pearson, Shairoz Merchant, Francesco Mauri, Elizabeth C. Howell, Katherine Sumpter, Ross J. Maxwell, Eric O. Aboagye, Rohini Sharma

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 6/2015

Abstract

Purpose

3′-Deoxy-3′-¹⁸F-fluorothymidine (FLT) positron emission tomography (PET) has limited utility in abdominal imaging due to high physiological hepatic uptake of tracer. We evaluated FLT PET/CT combined with a temporal-intensity information-based voxel-clustering approach termed kinetic spatial filtering (FLT PET/CT_KSF) for early prediction of response and survival outcomes in locally advanced and metastatic pancreatic cancer patients receiving gemcitabine-based chemotherapy.

Methods

Dynamic FLT PET/CT data were collected before and 3 weeks after the first cycle of chemotherapy. Changes in tumour FLT PET/CT variables were determined. The primary end point was RECIST 1.1 response on contrast-enhanced CT after 3 months of therapy.

Results

Twenty patients were included. Visual distinction between tumours and normal pancreas was seen in FLT PET_KSF images. All target lesions (>2 cm), including all primary pancreatic tumours, were visualised. Of the 11 liver metastases, 3 (<2 cm) were not visible after kinetic filtering. Of the 20 patients, 7 progressed (35 %). Maximum standardised uptake value at 60 min post-injection (SUV_60,max) significantly increased in patients with disease progression (p = 0.04). Receiver-operating characteristic curve analysis indicated that a threshold of SUV_60,max increase of ≥ 12 % resulted in sensitivity, specificity and positive predictive value (PPV) of 71, 100 and 100 %, respectively [area under the curve (AUC) 0.90, p = 0.0001], to predict patients with disease progression. Changes in SUV_60,max were not predictive of survival.

Conclusion

FLT PET/CT detected changes in proliferation, with early increase in SUV_60,max predicting progressive disease with a high specificity and PPV. Therefore, FLT PET/CT could be used as an early response biomarker for gemcitabine-based chemotherapy, to select a poor prognostic group who may benefit from novel therapeutic agents in advanced and metastatic pancreatic cancer.

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Title: 3′-Deoxy-3′-18F-fluorothymidine positron emission tomography as an early predictor of disease progression in patients with advanced and metastatic pancreatic cancer
Authors: Amarnath Challapalli
Tara Barwick
Rachel A. Pearson
Shairoz Merchant
Francesco Mauri
Elizabeth C. Howell
Katherine Sumpter
Ross J. Maxwell
Eric O. Aboagye
Rohini Sharma
Publication date: 01-05-2015
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 6/2015
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-015-3000-2

At a glance: The ONWARDS insulin icodec trials

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3′-Deoxy-3′-¹⁸F-fluorothymidine positron emission tomography as an early predictor of disease progression in patients with advanced and metastatic pancreatic cancer

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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