Burgard Caroline, Engler Jakob, Blickle Arne, Bartholomä Mark, Maus Stephan, Schaefer-Schuler Andrea, Khreish Fadi, Ezziddin Samer, Rosar Florian
Department of Nuclear Medicine, Saarland University-Medical Center, Homburg, Germany.
Front Med (Lausanne). 2024 Jan 17;10:1339160. doi: 10.3389/fmed.2023.1339160. eCollection 2023.
The value of [F]fluorodeoxyglucose ([F]FDG) PET/CT in monitoring prostate-specific membrane antigen (PSMA) targeted radioligand therapy (RLT) is still unclear. The aim of this study was to identify appropriate prognostic dynamic parameters derived from baseline and follow-up [F]FDG and dual [F]FDG/[Ga]Ga-PSMA-11 PET/CT for monitoring early non-responding mCRPC patients undergoing PSMA-RLT.
Twenty-three mCRPC patients of a prospective registry (NCT04833517), who were treated with [Lu]Lu-PSMA-617 RLT and classified as early non-responders were included in this study. All patients received dual PET/CT imaging with [F]FDG and [Ga]Ga-PSMA-11 at baseline and after median two cycles of RLT. We tested potential biomarkers representing the "" and "" composed of established parameters on [F]FDG PET/CT as SUVmax, cumulative SUV of five lesions (SUV5), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) and its corresponding parameters on [Ga]Ga-PSMA-11 PET/CT, respectively, for association with overall survival (OS).
Kaplan-Meier analyses showed no significant association with OS for each tested cGA (cGA = 0.904, cGA, = 0.747 cGA = 0.682 and cGA = 0.700), likewise the dual imaging biomarkers cGAP ( = 0.136), cGAP ( = 0.097), and cGAP ( = 0.113) failed significance. In contrast, cGAP, which is based on TLG and total lesion PSMA (TLP) showed a significant association with OS ( = 0.004). Low cGAP (cut-off 0.7) was associated with significant longer survival (17.6 vs. 12.9 months).
The novel biomarker cGAP, which represents the temporal change of whole-body TLG normalized by TLP, predicts overall survival in the challenging cohort of patients non-responding to PSMA-RLT.
[F]氟脱氧葡萄糖（[F]FDG）PET/CT在监测前列腺特异性膜抗原（PSMA）靶向放射性配体治疗（RLT）中的价值仍不明确。本研究的目的是确定从基线和随访的[F]FDG以及双[F]FDG/[Ga]Ga-PSMA-11 PET/CT中得出的合适的预后动态参数，以监测接受PSMA-RLT的早期无反应的转移性去势抵抗性前列腺癌（mCRPC）患者。
本研究纳入了前瞻性登记研究（NCT04833517）中的23例mCRPC患者，这些患者接受了[Lu]Lu-PSMA-617 RLT治疗并被分类为早期无反应者。所有患者在基线时以及RLT中位两个周期后接受了[F]FDG和[Ga]Ga-PSMA-11的双PET/CT成像。我们测试了潜在的生物标志物，这些标志物分别由[F]FDG PET/CT上的SUVmax、五个病灶的累积SUV（SUV5）、代谢肿瘤体积（MTV）和总病灶糖酵解（TLG）以及[Ga]Ga-PSMA-11 PET/CT上的相应参数组成的“”和“”，以与总生存期（OS）进行关联分析。
Kaplan-Meier分析显示，每个测试的cGA（cGA = 0.904，cGA = 0.747，cGA = 0.682，cGA = 0.700）与OS均无显著关联，同样，双成像生物标志物cGAP（ = 0.136）、cGAP（ = 0.097）和cGAP（ = 0.113）也未达到显著水平。相比之下，基于TLG和总病灶PSMA（TLP）的cGAP与OS显示出显著关联（ = 0.004）。低cGAP（临界值0.7）与显著更长的生存期相关（17.6个月对12.9个月）。
新型生物标志物cGAP代表了经TLP标准化的全身TLG的时间变化，可预测对PSMA-RLT无反应的挑战性患者队列的总生存期。
