Abstract
Evolution and survival instinct have been the principal forces behind the existence of any biological system in nature. Homo sapiens are no exception to it. Cancer cells, evolving from the “normal cells” of Homo sapiens are thus governed by the same rules. This is one of the reasons why, despite the advances in modern oncology, cure is not achievable in several cancers. Driven by the challenges posed by cancerous tissue, several new multipronged strategies have been envisaged. At the center of the new strategical development in oncology is the understanding that we need to outsmart cancer cells by evolving much powerful diagnostic tools and highly specific targeted therapy. Nuclear medicine, at the forefront of precision theranostics, has realized the challenges and offered appropriate and well-timed diagnostic and therapeutic options to improve and optimize patient management. This chapter will highlight the pitfalls of classical evidence-based medicine and show the way forward to more individualized/personalized approach, i.e., by amalgamating radiomolecular oncology with specific molecular profiling and gene panels, texture analyses, and better understanding of the cancer phenome.
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References
Ahmadzadehfar H (2016) Targeted therapy for metastatic prostate cancer with radionuclides. In: Mohan R (ed) Prostate cancer – leading-edge diagnostic procedures and treatments
Ahmadzadehfar H, Rahbar K, Kurpig S, Bogemann M, Claesener M, Eppard E et al (2015) Early side effects and first results of radio ligand therapy with (177)Lu-DKFZ-617 PSMA of castrate-resistant metastatic prostate cancer: a two-centre study. EJNMMI Res 5:114. https://doi.org/10.1186/s13550-015-0114-2
Ahmadzadehfar H, Eppard E, Kürpig S, Fimmers R, Yordanova A, Schlenkhoff CD, Gärtner F, Rogenhofer S, Essler M (2016) Therapeutic response and side effects of repeated radioligand therapy with 177Lu-PSMA-DKFZ-617 of castrate-resistant metastatic prostate cancer. Oncotarget 7(11):12477
Ahmadzadehfar H, Rahbar K, Essler M, Biersack HJ (2020) PSMA-based theranostics: a step-by-step practical approach to diagnosis and therapy for mCRPC patients. Semin Nucl Med 50:98–109. https://doi.org/10.1053/j.semnuclmed.2019.07.003
Alzahrani AS, AlShaikh O, Tuli M, Al-Sugair A, Alamawi R, Al-Rasheed MM (2012) Diagnostic value of recombinant human thyrotropin–stimulated 123I whole-body scintigraphy in the follow-up of patients with differentiated thyroid cancer. Clin Nucl Med 37(3):229–234
Are C, Rajaram S, Are M, Raj H, Anderson BO, Chaluvarya Swamy R, Vijayakumar M, Song T, Pandey M, Edney JA, Cazap EL (2013) A review of global cancer burden: trends, challenges, strategies, and a role for surgeons. J Surg Oncol 107(2):221–226
Ashwathanarayana AG, Biswal CK, Sood A, Parihar AS, Kapoor R, Mittal BR (2017) Imaging-guided use of combined 177Lu-DOTATATE and capecitabine therapy in metastatic mediastinal paraganglioma. J Nucl Med Technol 45(4):314–316
Baum RP, Kulkarni HR (2012) THERANOSTICS: from molecular imaging using Ga-68 labeled tracers and PET/CT to personalized radionuclide therapy-the Bad Berka experience. Theranostics 2(5):437
Baum RP, Prasad V, Hommann M, Hörsch D (2008) Receptor PET/CT imaging of neuroendocrine tumors. In: PET in oncology. Springer, Berlin, Heidelberg, pp 225–242
Baum RP, Prasad V, Müller D, Schuchardt C, Orlova A, Wennborg A, Tolmachev V, Feldwisch J (2010) Molecular imaging of HER2-expressing malignant tumors in breast cancer patients using synthetic 111In-or 68Ga-labeled affibody molecules. J Nucl Med 51(6):892–897
Bombardieri E, Giammarile F, Aktolun C, Baum RP, Delaloye AB, Maffioli L, Moncayo R, Mortelmans L, Pepe G, Reske SN, Castellani MR (2010) 131 I/123 I-Metaiodobenzylguanidine (mIBG) scintigraphy: procedure guidelines for tumour imaging. Eur J Nucl Med Mol Imaging 37(12):2436–2446
Deb N, Goris M, Trisler K et al (1996) Treatment of hormone-refractory prostate cancer with 90Y-CYT-356 monoclonal antibody. Clin Cancer Res 2:1289–1297
Decarolis B, Schneider C, Hero B, Simon T, Volland R, Roels F, Dietlein M, Berthold F, Schmidt M (2013) Iodine-123 metaiodobenzylguanidine scintigraphy scoring allows prediction of outcome in patients with stage 4 neuroblastoma: results of the Cologne interscore comparison study. J Clin Oncol 31(7):944–951
French S, DuBois SG, Horn B, Granger M, Hawkins R, Pass A, Plummer E, Matthay K (2013) 131I-MIBG followed by consolidation with busulfan, melphalan and autologous stem cell transplantation for refractory neuroblastoma. Pediatr Blood Cancer 60(5):879–884
Gabriel M, Decristoforo C, Kendler D, Dobrozemsky G, Heute D, Uprimny C, Kovacs P, Von Guggenberg E, Bale R, Virgolini IJ (2007) 68Ga-DOTA-Tyr3-octreotide PET in neuroendocrine tumors: comparison with somatostatin receptor scintigraphy and CT. J Nucl Med 48(4):508–518
Haberkorn U, Giesel F, Morgenstern A et al (2017) The future of radioligand therapy: α, β, or both? J Nucl Med 58:1017–1018
Haug A, Auernhammer CJ, Wängler B, Tiling R, Schmidt G, Göke B, Bartenstein P, Pöpperl G (2009) Intraindividual comparison of 68 Ga-DOTA-TATE and 18 F-DOPA PET in patients with well-differentiated metastatic neuroendocrine tumours. Eur J Nucl Med Mol Imaging 36(5):765–770
Heck MM, Tauber R, Schwaiger S, Retz M, D’Alessandria C, Maurer T et al (2019) Treatment outcome, toxicity, and predictive factors for Radioligand therapy with (177)Lu-PSMA-I&T in metastatic castration-resistant prostate cancer. Eur Urol 75:920–926. https://doi.org/10.1016/j.eururo.2018.11.016
Hofman MS, Emmett L, Sandhu S, Iravani A et al (2021) [177Lu]Lu-PSMA-617 versus cabazitaxel in patients with metastatic castration-resistant prostate cancer (TheraP): a randomised, open-label, phase 2 trial. Lancet 397(10276):797–804
Jain TK, Parihar AS, Sood A, Basher RK, Bollampally N, Shekhawat AS, Mittal BR (2018) Orbital metastasis: rare initial presentation of an occult gall bladder carcinoma. Clin Nucl Med 43(3):188–189
Kolstad A, Illidge T, Bolstad N et al (2020) Phase 1/2a study of 177Lu-lilotomab satetraxetan in relapsed/refractory indolent non-Hodgkin lymphoma. Blood Adv 4(17):4091–4101
Kraeber-Bodéré F, Barbet J, Chatal J (2016) Radioimmunotherapy: from current clinical success to future industrial breakthrough? J Nucl Med 57(3):329–331
Kratochwil C, Giesel FL, Bruchertseifer F et al (2014) 213Bi-DOTATOC receptor-targeted alpha-radionuclide therapy induces remission in neuroendocrine tumours refractory to beta radiation: a first-inhuman experience. Eur J Nucl Med Mol Imaging 41:2106–2119
Kratochwil C, Giesel FL, Eder M, Afshar-Oromieh A, Benesova M, Mier W et al (2015) [(1)(7)(7)Lu]Lutetium-labelled PSMA ligand induced remission in a patient with metastatic prostate cancer. Eur J Nucl Med Mol Imaging 42:987–988. https://doi.org/10.1007/s00259-014-2978-1
Kratochwil C, Flechsig P, Lindner T et al (2019) 68Ga-FAPI PET/CT: tracer uptake in 28 different kinds of cancer. J Nucl Med 60(6):801–805
Kwekkeboom DJ, de Herder WW, Kam BL, van Eijck CH, van Essen M, Kooij PP, Feelders RA, van Aken MO, Krenning EP (2008) Treatment with the radiolabeled somatostatin analog [177Lu-DOTA0, Tyr3] octreotate: toxicity, efficacy, and survival. J Clin Oncol 26(13):2124–2130
Lamberts SW, Bakker WH, Reubi JC, Krenning EP (1990a) Treatment with Sandostatin and in vivo localization of tumors with radiolabeled somatostatin analogs. Metabolism 39(9):152–155
Lamberts SW, Reubi JC, Bakker WH, Krenning EP (1990b) Somatostatin receptor imaging with 123I-Tyr3-octreotide. Zeitschrift fur Gastroenterologie 28:20
Matthay KK, Yanik G, Messina J, Quach A, Huberty J, Cheng SC, Veatch J, Goldsby R, Brophy P, Kersun LS, Hawkins RA (2007) Phase II study on the effect of disease sites, age, and prior therapy on response to iodine-131-metaiodobenzylguanidine therapy in refractory neuroblastoma. J Clin Oncol 25(9):1054–1060
Miao Y, Quinn TP (2008) Peptide-targeted radionuclide therapy for melanoma. Crit Rev Oncol Hematol 67:213–228
Moadel RM, Nguyen AV, Lin EY, Lu P, Mani J, Blaufox MD, Pollard JW, Dadachova E (2003) Positron emission tomography agent 2-deoxy-2-[18 F] fluoro-D-glucose has a therapeutic potential in breast cancer. Breast Cancer Res 5(6):1–7
Morgenstern A, Apostolidis C, Kratochwil C et al (2018) An overview of targeted alpha therapy with 225Actinium and 213Bismuth. Curr Radiopharm 11:200–208
Nuhn P, DeBono JS, Fizazi K, Freedland SJ, Grilli M, Kantoff PW et al (2019) Update on systemic prostate cancer therapies: management of metastatic castration-resistant prostate cancer in the era of precision oncology. Eur Urol 75:88–99. https://doi.org/10.1016/j.eururo.2018.03.028
Parihar AS, Basher RK, Rana N et al (2018a) Incidental meningioma on 68Ga-DOTANOC positron-emission tomography. Indian. J Nucl Med 33(2):182
Parihar AS, Ga A, Sood K et al (2018b) Incidental detection of synchronous lung melanoma on 18F-FDG PET/CT in a patient with parotid gland myoepithelial carcinoma. Clin Nucl Med 43(4):e127–e129
Parihar AS, Mittal BR, Sood A, et al (2018c) 68Ga-prostate-specific membrane antigen PET/CT and 18F-FDG PET/CT of primary signet ring cell breast adenocarcinoma. Clin Nucl Med 43(11):e414–e416
Parihar AS, Mittal BR, Vadi SK et al (2018d) (18)F-FDG PET/CT detects metastatic renal cell carcinoma masquerading as primary breast malignancy. Nucl Med Mol Imaging 52(6):475–478. https://doi.org/10.1007/s13139-018-0553-6
Parihar AS, Mittal BR, Vadi SK et al (2018e) 18F-FDG PET/CT in isolated primary extraskeletal osteosarcoma. Clin Nucl Med 43(12):e463–e464
Parihar AS, Mittal BR, Vadi SK et al (2018f) Ectopic Cushing syndrome (ECS): 68Ga-DOTANOC PET/CT localizes the site of ectopic adrenocorticotropic hormone production. Clin Nucl Med 43(10):769–770. https://doi.org/10.1097/RLU.0000000000002217
Parihar AS, Mittal BR, Vadi SK et al (2018g) Groove pancreatitis masquerading as pancreatic carcinoma-detected on (18)F-FDG PET/CT. Nucl Med Mol Imaging 52(6):473–474. https://doi.org/10.1007/s13139-018-0552-7
Parihar AS, Singh H, Kumar R et al (2018h) Pancreatic malignancy or not?: role of 18F-FDG PET/CT in solving the diagnostic dilemma and evaluating treatment response. Clin Nucl Med 43(4):e115–e117. https://doi.org/10.1097/RLU.0000000000001989
Parihar AS, Sood A, Kumar R et al (2018i) Novel use of 177Lu-DOTA-RGD2 in treatment of 68Ga-DOTA-RGD2-avid lesions in papillary thyroid cancer with TENIS. Eur J Nucl Med Mol Imaging 45(10):1836–1837
Parihar AS, Vadi SK, Kumar R et al (2018j) 68Ga-DOTA-Exendin PET/CT for detection of Insulinoma in a patient with persistent hyperinsulinemic hypoglycemia. Clin Nucl Med 43(8):e285–e286
Parihar AS, Vadi SK, Mittal BR et al (2018k) 68Ga-PSMA-HBED-CC-avid synchronous urinary bladder paraganglioma in a patient with metastatic prostate carcinoma. Clin Nucl Med 43(9):e329–e330
Parihar AS, Mittal BR, Kumar R et al (2020a) 68Ga-DOTA-RGD2 PET/CT in radioiodine (131I) refractory thyroid cancer – prospective comparison of diagnostic accuracy with 18F-FDG PET/CT and evaluation towards potential theranostics. Thyroid 30(4):557–67
Parihar AS, Mittal BR, Sood A et al (2020b) 68Ga-PSMA-HBED-CC PET/CT and 18F-FDG PET/CT in Ewing sarcoma. Clin Nucl Med 45(1):e57–e58
Parihar AS, Sood A, Sood A et al (2020c) Demonstration of focal physiologic in-vivo somatostatin receptor expression in the caput epididymis of the testes on 68Ga-DOTANOC PET/CT and 177Lu-DOTATATE post-therapy whole body scintigraphy. Asia Ocean J Nucl Med Biol 8(2):132–135
Parihar AS, Chandekar K, Singh H et al (2021) Orbital and brain metastases on 68Ga-PSMA PET/CT in a patient with prostate carcinoma refractory to 177Lu-PSMA and 225Ac-PSMA therapy. Asia Ocean J Nucl Med Biol 9(1):67–70
Parker C, Nilsson S, Heinrich D et al (2013) Alpha emitter radium-223 and survival in metastatic prostate cancer. N Engl J Med 369:213–223
Prasad V, Baum RP (2010) Biodistribution of the Ga-68 labeled somatostatin analogue DOTA-NOC in patients with neuroendocrine tumors: characterization of uptake in normal organs and tumor lesions. QJ Nucl Med Mol Imaging 54(1):61–67
Prasad V, Ambrosini V, Hommann M, Hoersch D, Fanti S, Baum RP (2010) Detection of unknown primary neuroendocrine tumours (CUP-NET) using 68 Ga-DOTA-NOC receptor PET/CT. Eur J Nucl Med Mol Imaging 37(1):67
Prasad V, Steffen IG, Diederichs G, Makowski MR, Wust P, Brenner W (2016a) Biodistribution of [68 Ga] PSMA-HBED-CC in patients with prostate cancer: characterization of uptake in normal organs and tumour lesions. Mol Imaging Biol 18(3):428–436
Prasad V, Sainz-Esteban A, Arsenic R, Plöckinger U, Denecke T, Pape UF, Pascher A, Kühnen P, Pavel M, Blankenstein O (2016b) Role of 68 Ga somatostatin receptor PET/CT in the detection of endogenous hyperinsulinaemic focus: an explorative study. Eur J Nucl Med Mol Imaging 43(9):1593–1600
Santoni M, Scarpelli M, Mazzucchelli R, Lopez-Beltran A, Cheng L, Cascinu S, Montironi R (2014) Targeting prostate-specific membrane antigen for personalized therapies in prostate cancer: morphologic and molecular backgrounds and future promises. J Biol Regul Homeost Agents 28(4):555–563
Satapathy S, Das CK, Parihar AS, Sood A, Mittal BR (2021) Response to concomitant enzalutamide and 177Lu-PSMA-617 radioligand therapy in ATM-mutated metastatic castration resistant prostate cancer. Clin Nucl Med. https://doi.org/10.1097/RLU.0000000000003541
Sathekge M, Bruchertseifer F, Knoesen O et al (2019) 225Ac-PSMA-617 in chemotherapy-naive patients with advanced prostate cancer: a pilot study. Eur J Nucl Med Mol Imaging 46:129–138
Schmidt M, Simon T, Hero B, Schicha H, Berthold F (2008) The prognostic impact of functional imaging with 123I-mIBG in patients with stage 4 neuroblastoma >1 year of age on a high-risk treatment protocol: results of the German Neuroblastoma Trial NB97. Eur J Cancer 44(11):1552–1558
Seidlin SM, Rossman I, Oshry E, Siegel E (1949) Radioiodine therapy of metastases from carcinoma of the thyroid: a six-year progress report. J Clin Endocrinol 9(11):1122–1137
Sharma S, Singh B, Mishra AK, Rathod D, Hazari PP, Chuttani K, Chopra S, Singh PM, Abrar ML, Mittal BR, Singh G (2014) Lat-1 based primary breast cancer detection by [99m] tc-labeled dtpa-bis-methionine scintimammography: first results using indigenously developed single vial kit preparation. Cancer Biother Radiopharm 29(7):283–288
Singh B, Prasad V, Schuchardt C, Kulkarni H, Baum RP (2013) Can the standardized uptake values derived from diagnostic 68Ga-DOTATATEPET/CT imaging predict the radiation dose delivered to the metastatic liver NET lesions on 177Lu-DOTATATE peptide receptor radionuclide therapy. J Postgrad Med Educ Res 47:7–13
Singh B, Sharma S, Bansal P, Hooda M, Singh H, Parihar AS, Kumar A, Watts A, Mohan R, Singh SK (2021) Comparison of the diagnostic utility of 99mTc-PSMA scintigraphy versus 68Ga-PSMA-11 PET/CT in the detection of metastatic prostate cancer and dosimetry analysis: a gamma-camera-based alternate prostate-specific membrane antigen imaging modality. Nucl Med Commun 42(5):482–489
Strosberg J, El-Haddad G, Wolin E, Hendifar A, Yao J, Chasen B, Mittra E, Kunz PL, Kulke MH, Jacene H, Bushnell D (2017) Phase 3 trial of 177Lu-Dotatate for midgut neuroendocrine tumors. N Engl J Med 376(2):125–135
Targeted Alpha Therapy Working Group (2018) Targeted alpha therapy, an emerging class of cancer agents: a review. JAMA Oncol 4(12):1765–1772
Ulaner GA, Jacene HA, Parihar AS, Groheux D (2021) Evidence based best practices: 18F-FDG PET staging of newly diagnosed breast cancer. Clin Nucl Med 46(7):569–570. https://journals.lww.com/nuclearmed/Fulltext/2021/07000/Evidence_Based_Best_Practices__18F_FDG_PET_Staging.7.aspx. Ahead of Print
Vadi SK, Mittal BR, Sood A, Singh G, Bal A, Parihar AS, Bhattacharya A, Basher RK, Kapoor R (2019) Diagnostic and prognostic value of 18F-FDG PET/CT imaging in suspected recurrence of male breast cancer. Nucl Med Commun 40(1):63–72
Vahidfar N, Fallahpoor M, Farzanehfar S, Divband G, Ahmadzadehfar H (2019) Historical review of pharmacological development and dosimetry of PSMA-based theranostics for prostate cancer. J Radioanal Nucl Chem 322:237–248. https://doi.org/10.1007/s10967-019-06800-6
Vander Heiden MG, DeBerardinis RJ (2017) Understanding the intersections between metabolism and cancer biology. Cell 168(4):657–669
Watts A, Singh B, Basher R, Singh H, Bal A, Kapoor R, Arora SK, Wester HJ, Mittal BR, Behera D (2017) 68Ga-Pentixafor PET/CT demonstrating higher CXCR4 density in small cell lung carcinoma than in non-small cell variant. Eur J Nucl Med Mol Imaging (44):909–910
Yanik GA, Villablanca JG, Maris JM, Weiss B, Groshen S, Marachelian A, Park JR, Tsao-Wei D, Hawkins R, Shulkin BL, Jackson H (2015) 131I-metaiodobenzylguanidine with intensive chemotherapy and autologous stem cell transplantation for high-risk neuroblastoma. A new approaches to neuroblastoma therapy (NANT) phase II study. Biol Blood Marrow Transplant 21(4):673–681
Yordanova A, Ahmadzadehfar H, Gonzalez-Carmona M, Strassburg C, Mayer K, Feldmann G, Schmidt-Wolf I, Lingohr P, Fischer S, Kristiansen G, Essler M (2017a) A step-by-step clinical approach for the management of neuroendocrine tumours. Horm Metab Res 49(2):77–85
Yordanova A, Becker A, Eppard E, Kürpig S, Fisang C, Feldmann G, Essler M, Ahmadzadehfar H (2017b) The impact of repeated cycles of radioligand therapy using [177 Lu] Lu-PSMA-617 on renal function in patients with hormone refractory metastatic prostate cancer. Eur J Nucl Med Mol Imaging 44(9):1473–1479
Yordanova A, Mayer K, Brossart P, Gonzalez-Carmona MA, Strassburg CP, Essler M, Ahmadzadehfar H (2017c) Safety of multiple repeated cycles of 177 Lu-octreotate in patients with recurrent neuroendocrine tumour. Eur J Nucl Med Mol Imaging 44(7):1207–1214
Zhang J, Li D, Niu G, Baum R, Zhu Z, Chen X (2020) First-in-human study of a64Cu-labeled long-acting integrin αvβ3 targeting molecule64Cu-NOTA-EB-RGD in healthy volunteers and GBM patients. J Nucl Med 61(Suppl 1):349
Zhou MJ, Doral MY, DuBois SG, Villablanca JG, Yanik GA, Matthay KK (2015) Different outcomes for relapsed versus refractory neuroblastoma after therapy with 131I-metaiodobenzylguanidine (131I-MIBG). Eur J Cancer 51(16):2465–2472
Zlotnik A, Burkhardt AM, Homey B (2011) Homeostatic chemokine receptors and organ-specific metastasis. Nat Rev Immunol 11(9):597–606
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Singh, B., Kaur, H., Parihar, A.S., Watts, A., Prasad, V. (2022). Precision Radiomolecular Oncology: Challenging the Classical Statistical Evidence-Based Medicine. In: Sobti, R., Dhalla, N.S. (eds) Biomedical Translational Research. Springer, Singapore. https://doi.org/10.1007/978-981-16-9232-1_7
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