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Pretreatment PET/CT imaging of angiogenesis based on 18F-RGD tracer uptake may predict antiangiogenic response

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To explore the relationship between metabolic uptake of the 18F-ALF-NOTA-PRGD2 (18F-RGD) tracer on positron emission tomography/computerized tomography (PET/CT) and the antiangiogenic effect of apatinib in patients with solid malignancies.

Materials and patients

Patients with measurable lesions scheduled for second- or third-line single-agent therapy with apatinib were eligible for this prospective clinical trial. All patients underwent 18F-RGD PET/CT examination before the start of treatment. Standardized uptake values (SUVs) of contoured tumor lesions were computed and compared using independent sample t-tests or the Mann–Whitney U test. Receiver-operating characteristic (ROC) curve analysis was used to determine accuracy in predicting response. Survival curves were compared using the Kaplan–Meier method.

Results

Of 38 patients who consented to study participation, 25 patients with 42 measurable lesions met the criteria for inclusion in this response assessment analysis. The median follow-up time was 3 months (range, 1–10 months), and the median progression-free survival (PFS) was 3 months (95% confidence interval, 1.04–4.96). The SUVpeak and SUVmean were significantly higher in responding tumors than in non-responding tumors (4.98 ± 2.34 vs 3.59 ± 1.44, p = 0.048; 3.71 ± 1.15 vs 2.95 ± 0.49, P = 0.036). SUVmax did not differ between responding tumors and non-responding tumors (6.58 ± 3.33 vs 4.74 ± 1.83, P = 0.078). An exploratory ROC curve analysis indicated that SUVmean [area under the ROC curve (AUC) = 0.700] was a better parameter than SUVpeak (AUC = 0.689) for predicting response. Using a threshold value of 3.82, high SUVmean at baseline was associated with improved PFS (5.0 vs. 3.4 months, log-rank P = 0.036).

Conclusion

18F-RGD uptake on PET/CT imaging pretreatment may predict the response to antiangiogenic therapy, with higher 18F-RGD uptake in tumors predicting a better response to apatinib therapy.

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Acknowledgments

The authors would like to thank Ms. Laney Weber for excellent assistance.

Funding

This study was partially funded by Shandong Key Research and Development Plan (2017CXGC1209 and 2017GSF18164) and the Outstanding Youth Natural Science Foundation of Shandong Province (JQ201423), Jinan Clinical Medicine Science and Technology Innovation Plan (201704095), NSFC81372413, National Key Research and Development Program of China (2016YFC0904700).

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Authors and Affiliations

  1. School of Medicine and Life Sciences, University of Jinan–Shandong Academy of Medical Sciences, Jinan, Shandong, China

    Li Li

  2. Department of Radiation Oncology, Shandong Cancer Hospital and Institute–Shandong Cancer Hospital Affiliated to Shandong University, No 440 Jiyan Road, Jinan, 250117, Shandong, China

    Li Li, Li Ma, Dongping Shang, Zhiguo Liu, Qingxi Yu, Suzhen Wang, Xuepeng Teng, Xudong Hu, Wei Zhao, Wenhong Hou, Jinming Yu & Shuanghu Yuan

  3. Zibo Forth People’s Hospital, Zibo, Shandong, China

    Qiang Zhang

  4. Shandong Academy of Medical Sciences, Jinan, Shandong, China

    Xudong Hu & Shuanghu Yuan

  5. Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA

    Jianyue Jin

  6. Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA

    Feng-Ming (Spring) Kong

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  1. Li Li
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  2. Li Ma
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  10. Wei Zhao
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  14. Jinming Yu
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Corresponding author

Correspondence to Shuanghu Yuan.

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Conflict of interest

The authors declare no potential conflicts of interest.

Ethical standards

Our investigation was approved by the Shandong Cancer Hospital affiliated to Shandong University Ethical Committee. All persons gave their informed consent prior to their inclusion in the study.

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Li, L., Ma, L., Shang, D. et al. Pretreatment PET/CT imaging of angiogenesis based on 18F-RGD tracer uptake may predict antiangiogenic response. Eur J Nucl Med Mol Imaging 46, 940–947 (2019). https://doi.org/10.1007/s00259-018-4143-8

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  • DOI: https://doi.org/10.1007/s00259-018-4143-8

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