Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Urology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey.
Clin Genitourin Cancer. 2021 Oct;19(5):405-416. doi: 10.1016/j.clgc.2021.03.011. Epub 2021 Mar 19.
BACKGROUND: A first-in-human study of [F]-BF3-Cy3-ACUPA, a small-molecule imaging agent that can be unimolecularly both positron emitting and fluorescent, is conducted to determine its safety, biodistribution, radiation dosimetry, feasibility in tumor detection by preoperative positron emission tomography (PET), as well as its intraoperative fluorescence imaging utility in patients with prostate-specific membrane antigen positive (PSMA) tumors. METHODS: Ten patients aged 66 ± 7 years received a 6.5 ± 3.2 mCi intravenous injection of [F]-BF3-Cy3-ACUPA and underwent PET/computed tomography (CT) imaging. Radiation dosimetry of [F]-BF3-Cy3-ACUPA, normal organ biodistribution, and tumor uptakes were examined. Two patients were prescheduled for radical prostatectomy (RP) with extended pelvic lymphadenectomy approximately 24 hours following [F]-BF3-Cy3-ACUPA injection and imaging. Without reinjection, intraoperative fluorescence imaging was performed on freshly excised tissue during RP. Frozen sections of excised tissue during RP were submitted for confirmatory histopathology and multiphoton fluorescence and brightfield microscopy. RESULTS: Absorbed doses by organs including the kidneys and salivary glands were similar to 68Ga-PSMA-11 imaging. [F]-BF3-Cy3-ACUPA physiologic radiotracer accumulation and urinary/biliary excretion closely resembled the distribution of other published PSMA tracers including [F]-JK-PSMA-7, [F]-PSMA-1007, [F]-DCFPyL, and [F]-DCFBC. F-BF3-Cy3-ACUPA was retained in PSMA cancer tissues in patients for at least 24 hours, allowing for intraoperative fluorescence assessment of the prostate and of the embedded prostate cancer without contrast reinjection. After 24 hours, the imaging agent mostly decayed or cleared from the blood pool. Preoperative PET and fluorescence imaging findings were confirmed with final histopathology and multiphoton microscopy. CONCLUSION: Our first-in-human results demonstrate that [F]-BF3-Cy3-ACUPA is safe and feasible in humans. Larger trials with this PET tracer are expected to further define its capabilities and its clinical role in the management of PSMA tumors, especially in prostate cancer.
背景:本研究进行了一种名为 [F]-BF3-Cy3-ACUPA 的小分子成像剂的首次人体研究,该成像剂可以单分子同时发射正电子和荧光,以确定其安全性、生物分布、辐射剂量测定、术前正电子发射断层扫描(PET)检测肿瘤的可行性,以及在前列腺特异性膜抗原阳性(PSMA)肿瘤患者中的术中荧光成像应用。
方法:10 名年龄 66±7 岁的患者接受了 6.5±3.2mCi 的静脉注射 [F]-BF3-Cy3-ACUPA,并进行了 PET/CT 成像。检查了 [F]-BF3-Cy3-ACUPA 的辐射剂量测定、正常器官生物分布和肿瘤摄取情况。两名患者计划在注射 [F]-BF3-Cy3-ACUPA 并进行成像后约 24 小时进行根治性前列腺切除术(RP)和扩大盆腔淋巴结切除术。无需再次注射,在 RP 期间对刚切除的组织进行术中荧光成像。RP 期间切除组织的冷冻切片用于确认组织病理学和多光子荧光和明场显微镜。
结果:包括肾脏和唾液腺在内的器官的吸收剂量与 68Ga-PSMA-11 成像相似。[F]-BF3-Cy3-ACUPA 的生理放射性示踪剂积累和尿液/胆汁排泄与其他已发表的 PSMA 示踪剂(包括[F]-JK-PSMA-7、[F]-PSMA-1007、[F]-DCFPyL 和[F]-DCFBC)的分布非常相似。在患者中,F-BF3-Cy3-ACUPA 在至少 24 小时内保留在 PSMA 癌组织中,允许在没有对比剂再注射的情况下进行前列腺和嵌入前列腺癌的术中荧光评估。24 小时后,造影剂大部分从血池中衰变或清除。术前 PET 和荧光成像结果与最终组织病理学和多光子显微镜检查结果一致。
结论:我们的首次人体研究结果表明,[F]-BF3-Cy3-ACUPA 在人体中是安全可行的。预计更大规模的试验将进一步确定该 PET 示踪剂的能力及其在 PSMA 肿瘤管理中的临床作用,特别是在前列腺癌中。
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