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Recommendations for measurement of tumour vascularity with positron emission tomography in early phase clinical trials

Abstract

The evaluation of drug pharmacodynamics and early tumour response are integral to current clinical trials of novel cancer therapeutics to explain or predict long term clinical benefit or to confirm dose selection. Tumour vascularity assessment by positron emission tomography could be viewed as a generic pharmacodynamic endpoint or tool for monitoring response to treatment. This review discusses methods for semi-quantitative and quantitative assessment of tumour vascularity. The radioligands and radiotracers range from direct physiological functional tracers like [15O]-water to macromolecular probes targeting integrin receptors expressed on neovasculature. Finally we make recommendations on ways to incorporate such measurements of tumour vascularity into early clinical trials of novel therapeutics.

Key Points

[ 15 O]-water is the gold standard for blood flow/tissue perfusion with PET

In some instances dynamic [ 18 F]-FDG uptake may be used to estimate perfusion

Radiopharmaceuticals that target integrins are now being evaluated for measuring tumour vascularity

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Acknowledgements

The authors thank the Society of Nuclear Medicine and Dr Matthew Morrison for allowing permission to reprint the data in Fig. 3. We would also like to acknowledge the Experimental Cancer Medicine Centre Imaging Steering Committee and Secretariat for supporting the workshop on tumour vascularity in May 2010 and coordinating activities, and all of the speakers and delegates who contributed to the meeting. The Experimental Cancer Medicine Centre Initiative is jointly funded by Cancer Research UK, the National Institute for Health Research in England and the Departments of Health for Scotland, Wales and Northern Ireland.

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Correspondence to Eric O. Aboagye.

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L. Clarke represents on behalf of the Experimental Cancer Medicine Centre 13 Imaging Network Group.

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Aboagye, E.O., Gilbert, F.J., Fleming, I.N. et al. Recommendations for measurement of tumour vascularity with positron emission tomography in early phase clinical trials. Eur Radiol 22, 1465–1478 (2012). https://doi.org/10.1007/s00330-011-2311-3

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Keywords

  • Tumour vascularity
  • Positron emission tomography
  • Angiogenesis
  • [15O]-water
  • Integrin receptor ligand