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Improved identification of patients with oligometastatic clear cell renal cell carcinoma with PSMA-targeted 18F-DCFPyL PET/CT

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Abstract

Objective

Complete surgical resection of metastatic sites has been shown to prolong survival in select patients with oligometastatic RCC. This treatment strategy is dependent upon the accurate characterization of a patient’s extent of disease. The objective of this study was to explore the utility of PSMA-targeted 18F-DCFPyL PET/CT in patients with presumed oligometastatic clear cell RCC.

Methods

This is a subset analysis of a prospective study in which patients with RCC were imaged with 18F-DCFPyL PET/CT (ClinicalTrials.gov identifier NCT02687139). In the present analysis, patients with oligometastatic clear cell RCC, defined as ≤ 3 metastatic lesions on conventional imaging, were evaluated. 18F-DCFPyL PET/CT scans were reviewed for sites of disease and compared to conventional imaging.

Results

The final cohort included 14 patients with oligometastatic clear cell RCC. Conventional imaging revealed 21 metastatic lesions and 3 primary tumors. 18F-DCFPyL PET/CT detected 29 sites of metastatic disease and 3 primary tumors. Of the 21 metastatic lesions detected on conventional imaging, 17 (81.0%) had radiotracer uptake. Additionally, all 3 primary tumors had radiotracer uptake. In 4 (28.6%) patients a total of 12 more lesions were identified on 18F-DCFPyL PET/CT than conventional imaging. Notably, 3 (21.4%) patients were no longer considered oligometastatic. The detection rates of conventional imaging and 18F-DCFPyL PET/CT for identifying sites of disease were 66.7% and 88.9%, respectively.

Conclusions

PSMA-targeted PET/CT appears to aid in the identification of patients with oligometastatic clear cell RCC. If borne out in future studies, this suggests that PSMA-targeted imaging has the potential to help select candidates for metastasis-directed therapy.

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Authors and Affiliations

  1. The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Park 213, Baltimore, MD, 21287, USA

    Alexa R. Meyer, Michael A. Carducci, Samuel R. Denmeade, Martin G. Pomper, Philip M. Pierorazio, Mohamad E. Allaf, Steven P. Rowe & Michael A. Gorin

  2. Department of Oncology, Sydney Kimmel Comprehensive Cancer Center, Johns Hopkins University of Medicine, Baltimore, MD, USA

    Michael A. Carducci, Samuel R. Denmeade, Mark C. Markowski, Martin G. Pomper, Philip M. Pierorazio, Mohamad E. Allaf & Michael A. Gorin

  3. The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Martin G. Pomper, Steven P. Rowe & Michael A. Gorin

Authors
  1. Alexa R. Meyer
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  2. Michael A. Carducci
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  3. Samuel R. Denmeade
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  4. Mark C. Markowski
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  5. Martin G. Pomper
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  6. Philip M. Pierorazio
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  7. Mohamad E. Allaf
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  8. Steven P. Rowe
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  9. Michael A. Gorin
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Corresponding author

Correspondence to Michael A. Gorin.

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Conflict of interest

MGP is a co-inventor on a US Patent covering 18F-DCFPyL and as such is entitled to a portion of any licensing fees and royalties generated by this technology. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict-of-interest policies. MAG has served as a consultant to Progenics Pharmaceuticals, the licensee of 18F-DCFPyL. SPR, MAG, and MGP have received research support from Progenics Pharmaceuticals.

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Meyer, A.R., Carducci, M.A., Denmeade, S.R. et al. Improved identification of patients with oligometastatic clear cell renal cell carcinoma with PSMA-targeted 18F-DCFPyL PET/CT. Ann Nucl Med 33, 617–623 (2019). https://doi.org/10.1007/s12149-019-01371-8

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  • DOI: https://doi.org/10.1007/s12149-019-01371-8

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