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C-X-C motif chemokine receptor 4 (CXCR4) plays a major role in tumor growth and the process of metastasis and is thus a highly attractive target in oncology [1]. Non-invasive chemokine receptor imaging using positron emission tomography (PET) has demonstrated promising results, especially in hematologic malignancies including multiple myeloma or lymphoma [2]. Tumor detection in solid cancers is more heterogeneous (as compared to [18F]-fluorodeoxyglucose ([18F]FDG)) with many entities showing only low to moderate in vivo CXCR4 expression [3, 4].
A 73-year-old male with a history of Binet Stage B chronic lymphatic leukemia (CLL), and lentigo maligna melanoma (UICC IA) presented for re-staging with a rapidly enlarging cervical mass as well as new liver lesions (detected by previous ultrasound). [18F]FDG-PET/computed tomography (CT) displayed high uptake in the cervical mass and liver lesions. In addition, pulmonary and osteolytic bone lesions with intense [18F]FDG accumulation could be detected (A). In contrast, CT showed various additional enlarged lymph nodes and splenomegaly with only minimal [18F]FDG uptake (A). Thus, CXCR-directed imaging was added. Contrary to [18F]FDG, [68Ga]Ga-PentixaFor displayed intense tracer uptake -consistent with CLL- in the enlarged lymph nodes, bone marrow and spleen, and minimal uptake in the aforementioned [18F]FDG-avid sites, suggestive of melanoma metastases (B). Immunohistochemical staining confirmed these findings showing high GLUT1 (C) and low CXCR4 expression (D) in an osteolytic melanoma lesion (arrows; SUVmax 14.0 vs. 2.2) as opposed to intense CXCR4 expression (E) in a site with osseous CLL infiltration (dotted arrows; SUVmax 2.6 vs. 9.1). Our case highlights the ability of molecular imaging to non-invasively phenotype disease and visualize tumor biology.
References
Domanska UM, Kruizinga RC, Nagengast WB, Timmer-Bosscha H, Huls G, de Vries EG, et al. A review on CXCR4/CXCL12 axis in oncology: no place to hide. Eur J Cancer. 2013;49:219–30. https://doi.org/10.1016/j.ejca.2012.05.005.
Buck AK, Haug A, Dreher N, Lambertini A, Higuchi T, Lapa C, et al. Imaging of C-X-C motif chemokine receptor 4 expression in 690 patients with solid or hematologic neoplasms using (68)Ga-Pentixafor PET. J Nucl Med. 2022;63:1687–92. https://doi.org/10.2967/jnumed.121.263693.
Werner RA, Kircher S, Higuchi T, Kircher M, Schirbel A, Wester HJ, et al. CXCR4-directed imaging in solid tumors. Front Oncol. 2019;9:770. https://doi.org/10.3389/fonc.2019.00770.
Vag T, Gerngross C, Herhaus P, Eiber M, Philipp-Abbrederis K, Graner FP, et al. First experience with chemokine receptor CXCR4-Targeted PET imaging of patients with solid cancers. J Nucl Med. 2016;57:741–6. https://doi.org/10.2967/jnumed.115.161034.
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CL reports prior consulting activities for Blue Earth Diagnostics Ltd. (Oxford, UK) and Novartis. RAB is consultant for and has received speaker´s honoraria from Bayer Healthcare (Leverkusen, Germany), Novartis Pharma (Nürnberg, Germany) and Eisai GmbH (Frankfurt, Germany). All other authors do not report relevant conflicts of interest regarding this article.
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Gäble, A., Enke, J.S., Hügle, M.J. et al. Disclosing tumor biology by means of molecular imaging in a patient with malignant melanoma and chronic lymphatic leukemia. Eur J Nucl Med Mol Imaging (2024). https://doi.org/10.1007/s00259-024-06834-3
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DOI: https://doi.org/10.1007/s00259-024-06834-3