Jager Eline C, McNeil James, Papachristos Alexander J, Sywak Mark, Sidhu Stan B, Siddall Rhonda, Hoang Jeremy, Schembri Geoffrey P, Tsang Venessa H M, Wijewardene Ayanthi, Tacon Lyndal, Robinson Bruce, Clifton-Bligh Roderick J, Bullock Martyn, Brouwers Adrienne H, Links Thera P, Kruijff Schelto, Glover Anthony R, Gild Matti L
Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia.
Department of Internal Medicine, Division of Endocrinology, University Medical Centre Groningen, Groningen, The Netherlands.
Thyroid Res. 2025 Jun 17;18(1):31. doi: 10.1186/s13044-025-00250-x.
Tyrosine kinase inhibitors (TKIs) have significantly improved the prognosis of patients with advanced medullary thyroid cancer (MTC). However, treatment response heterogeneity leads to challenges in predicting individual favourable response. This study evaluated the correlation between PET metrics on Ga-DOTATATE and F-FDG PET/CTs prior to treatment, and TKI response.
This study retrospectively evaluated patients with metastatic MTC who received TKIs at a tertiary care hospital and had prior Ga-DOTATATE and/or F-FDG PET/CT imaging. Patient demographics, treatment and PET/CT data were collected. Standardized Uptake Value (SUV) max, SUVmean, Total Lesion Activity (TLA) and Metabolic Tumor Volume (MTV) were determined per PET/CT.
In the 25 patients, mean age at diagnosis was 48 (±15) years; 11 (44%) were female and 21 tumors harbored RET driver alterations. Thirty-six TKI treatments were administered (11 patients received two TKIs sequentially). RECIST response rates (available in 32/36 treatments) included; stable disease in 8/32 (25%), partial response in 23/32 (72%) and complete response in 1/32 (3%) treatments. In total, 30 pre-TKI PET/CTs (24 Ga-DOTATATE PET/CTs, 6 F-FDG PET/CTs) were performed. Pre-TKI Ga-DOTATATE PET/CTs did not correlate with TKI treatment response. In the F-FDG cohort, high MTV and TLA correlated with a better structural response (p < 0.001) and high SUVmean correlated with a longer time to reach optimal response (p = 0.037).
In a small cohort of MTC patients, MTV and TLA on F-FDG PET/CT were associated with the structural response of TKI treatment, suggesting their potential utility in identifying patients who are likely to respond significantly. In contrast, TKI response showed no correlation with uptake on Ga-DOTATATE PET/CT.
酪氨酸激酶抑制剂（TKIs）显著改善了晚期甲状腺髓样癌（MTC）患者的预后。然而，治疗反应的异质性给预测个体的良好反应带来了挑战。本研究评估了治疗前Ga-DOTATATE和F-FDG PET/CT上的PET指标与TKI反应之间的相关性。
本研究回顾性评估了在一家三级医疗中心接受TKIs治疗且之前有Ga-DOTATATE和/或F-FDG PET/CT成像的转移性MTC患者。收集了患者的人口统计学资料、治疗情况和PET/CT数据。根据PET/CT确定标准化摄取值（SUV）最大值、SUV平均值、总病变活性（TLA）和代谢肿瘤体积（MTV）。
25例患者的诊断时平均年龄为48（±15）岁；11例（44%）为女性，21个肿瘤存在RET驱动改变。共进行了36次TKI治疗（11例患者先后接受了两种TKI治疗）。RECIST反应率（36次治疗中有32次可获得）包括：8/32（25%）为疾病稳定，23/32（72%）为部分缓解，1/32（3%）为完全缓解。总共进行了30次TKI治疗前的PET/CT检查（24次Ga-DOTATATE PET/CT检查，6次F-FDG PET/CT检查）。TKI治疗前的Ga-DOTATATE PET/CT检查结果与TKI治疗反应无关。在F-FDG队列中，高MTV和TLA与更好的结构反应相关（p<0.001），高SUV平均值与达到最佳反应的时间更长相关（p=0.037）。
在一小群MTC患者中，F-FDG PET/CT上的MTV和TLA与TKI治疗的结构反应相关，表明它们在识别可能有显著反应的患者方面具有潜在用途。相比之下，TKI反应与Ga-DOTATATE PET/CT上的摄取无关。
