Advertisement

Annals of Nuclear Medicine

, Volume 29, Issue 10, pp 877–882 | Cite as

Imaging of metastatic clear cell renal cell carcinoma with PSMA-targeted 18F-DCFPyL PET/CT

  • Steven P. Rowe
  • Michael A. Gorin
  • Hans J. Hammers
  • M. Som Javadi
  • Hazem Hawasli
  • Zsolt Szabo
  • Steve Y. Cho
  • Martin G. Pomper
  • Mohamad E. Allaf
Original Article

Abstract

Objective

Molecular imaging with positron emission tomography (PET) provides a powerful means of identifying and characterizing cancerous processes, as well as providing a quantitative framework within which response to therapy can be ascertained. Unfortunately, the most commonly used PET radiotracer, 18F-fluorodeoxyglucose (FDG), has not demonstrated a definitive role in determining response to therapy in metastatic renal cell carcinoma (RCC). As a result, new radiotracers able to reliably image RCC could be of tremendous value for this purpose.

Methods

Five patients with known metastatic RCC were imaged with the low-molecular weight radiotracer 18F-DCFPyL, an inhibitor of the prostate-specific membrane antigen at 60 min post injection. 18F-DCFPyL PET/CT and conventional images (either contrast-enhanced computed tomography or magnetic resonance imaging) were centrally reviewed for suspected sites of disease.

Results

In all five patients imaged, sites of putative metastatic disease were readily identifiable by abnormal 18F-DCFPyL uptake, with overall more lesions detected than on conventional imaging. These PET-detected sites included lymph nodes, pancreatic parenchymal lesions, lung parenchymal lesions, a brain parenchymal lesion, and other soft tissue sites. 18F-DCFPyL uptake ranged from subtle to intense with maximum standardized uptake values (SUVmax) for the identified lesions of 1.6–19.3. Based upon this small patient series, limited pathology and imaging follow-up of these patients suggests a higher sensitivity for 18F-DCFPyL compared to conventional imaging in the detection of metastatic RCC (94.7 versus 78.9 %).

Conclusions

PSMA expression in the tumor neovasculature of RCC has been previously established and is believed to provide the basis for the imaging findings presented here. PSMA-based PET/CT with radiotracers such as 18F-DCFPyL may allow more accurate staging of patients with RCC and conceivably the ability to predict and follow therapy in patients treated with agents targeting the neovasculature.

Keywords

Prostate-specific membrane antigen (PSMA) Renal cell carcinoma (RCC) Positron emission tomography (PET) DCFPyL 

Notes

Acknowledgments

We acknowledge funding from the Prostate Cancer Foundation Young Investigator Award, EB006351, CA134675, CA184288, CA103175, and CA183031. We thank Akimosa Jeffrey-Kwanisai and Yavette Morton for clinical trial coordination. We thank Takahiro Higuchi, M.D., Ph.D. for critical evaluation of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors report no disclosures relevant to this work.

References

  1. 1.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65:5–29.CrossRefPubMedGoogle Scholar
  2. 2.
    Brufau BP, Cerqueda CS, Villalba LB, Izquierdo RS, González BM, Molina CN. Metastatic renal cell carcinoma: radiologic findings and assessment of response to targeted therapy by using multidetector CT. Radiographics. 2013;33:1691–716.CrossRefPubMedGoogle Scholar
  3. 3.
    Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med. 2009;50(Suppl 1):122S–50S.PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Wang HY, Ding HJ, Chen JH, Chao CH, Lu YY, Lin WY, et al. Meta-analysis of the diagnostic performance of [18F]FDG-PET and PET/CT in renal cell carcinoma. Cancer Imaging. 2012;12:464–74.PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    Calderella C, Muoio B, Isgrò MA, Porfiri E, Treglia G, Giovanella L. The role of fluorine-18-fluorodeoxyglucose positron emission tomography in evaluating the response to tyrosine-kinase inhibitors in patients with metastatic primary renal cell carcinoma. Radiol Oncol. 2014;48:219–27.Google Scholar
  6. 6.
    Chang SS, O’Keefe DS, Bacich DJ, Reuter VE, Heston WD, Gaudin PB. Prostate-specific membrane antigen is produced in tumor-associated neovasculature. Clin Cancer Res. 1999;5:2674–81.PubMedGoogle Scholar
  7. 7.
    Baccala A, Sercia L, Li J, Heston W, Zhou M. Expression of prostate-specific membrane antigen in tumor-associated neovasculature of renal neoplasms. Urology. 2007;70:385–90.CrossRefPubMedGoogle Scholar
  8. 8.
    Demirci E, Ocak M, Kabasakal L, Akyel R, Nematyazar J, Aygun A, et al. 68Ga-PSMA PET/CT imaging of metastatic clear cell renal cell carcinoma. Eur J Nucl Med Mol Imaging. 2014;41:1461–2.CrossRefPubMedGoogle Scholar
  9. 9.
    Chen Y, Pullambhatla M, Foss CA, Byun Y, Nimmagadda S, Senthamizhchelvan S, et al. 2-(3-{1-Carboxy-5-[(6-[18F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid, [18F]DCFPyL, a PSMA-based PET imaging agent for prostate cancer. Clin Cancer Res. 2011;17:7645–53.PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Szabo Z, Mena E, Rowe SP, Plyku D, Nidal R, Eisenberger MA, et al. Initial evaluation of [18F]DCFPyL for prostate-specific membrane antigen (PSMA)-targeted PET imaging of prostate cancer. Mol Imaging Biol. 2015;17:565–74.PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Shuch B, Amin A, Armstrong AJ, Eble JN, Ficarra V, Lopez-Beltran A, et al. Understanding pathologic variants of renal cell carcinoma: distilling therapeutic opportunities from biologic complexity. Eur Urol. 2015;67:85–97.CrossRefPubMedGoogle Scholar
  12. 12.
    Heng DY, Xie W, Regan MM, Warren MA, Golshayan AR, Sahi C, et al. Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large multicenter study. J Clin Oncol. 2009;27:5794–9.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Society of Nuclear Medicine 2015

Authors and Affiliations

  • Steven P. Rowe
    • 1
  • Michael A. Gorin
    • 2
  • Hans J. Hammers
    • 3
  • M. Som Javadi
    • 1
  • Hazem Hawasli
    • 1
  • Zsolt Szabo
    • 1
  • Steve Y. Cho
    • 4
  • Martin G. Pomper
    • 1
    • 3
  • Mohamad E. Allaf
    • 2
  1. 1.The Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.The James Buchanan Brady Urological Institute and Department of UrologyJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.The Department of Medical Oncology at the Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins University School of MedicineBaltimoreUSA
  4. 4.Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA

Personalised recommendations