Journal article
Inter- and intra-tumoral heterogeneity on [68Ga]Ga-DOTA-TATE/[68Ga]Ga-DOTA-TOC PET/CT predicts response to [177Lu]Lu-DOTA-TATE PRRT in neuroendocrine tumor patients
EJNMMI reports, Vol.8(1), 39
12/01/2024
DOI: 10.1186/s41824-024-00227-3
PMCID: PMC11607192
PMID: 39613925
Abstract
Background
Indices of tumor heterogeneity on somatostatin receptor PET/CT scans may potentially serve as predictive biomarkers of treatment efficacy in neuroendocrine tumor (NET) patients undergoing [
177
Lu]Lu-DOTA-TATE PRRT.
Methods
NET patients who underwent [
177
Lu]Lu-DOTA-TATE therapy at the University of Iowa from August 2018 to February 2021 were retrospectively evaluated. Radiomic features on the pre-PRRT somatostatin receptor PET/CT were evaluated using a custom MIM Software® LesionID workflow. Conventional PET/CT metrics of tumor burden, such as somatostatin receptor expression and tumor volume, were calculated in addition to the indices of tumor heterogeneity for each lesion (intra-lesional) and then summarized across all lesions throughout the body (inter-lesional). Endpoints included post-PRRT 24-month time to progression (TTP) and overall survival (OS). Cox regression models were used to assess the predictive ability of the imaging factors on post-PRRT 24-month TTP and OS. LASSO-penalized Cox regression was used to build a multivariable model for each outcome.
Results
Eighty patients with a mean age of 65.1 years were included, with most (71.3%) completing 4 cycles of PRRT. Median TTP was 19.1 months, and OS at 60 months was 50%. A large degree of variability between patients was evidenced for imaging features related to somatostatin receptor expression. On multivariable analysis, total receptor expression and mean liver-corrected SUVmean were selected for 24-month TTP. The model was not able to significantly predict progression (C-statistic = 0.58, 95% CI 0.50–0.62). Total receptor expression and mean skewness were selected for OS. The resulting model was able to significantly predict death (C-statistic = 0.62, 95% CI 0.53–0.67), but the predictive ability was limited, as evidenced by the low C-statistic.
Conclusions
Our exploratory analysis provides preliminary results showing that imaging indices of inter- and intra-tumor heterogeneity from pretreatment PET/CT images may potentially predict treatment efficacy in NET patients undergoing [
177
Lu]Lu-DOTA-TATE therapy. However, prospective evaluation in a larger cohort is needed to further assess whether a comprehensive characterization of tumor heterogeneity within a patient can help guide treatment decisions.
Details
- Title: Subtitle
- Inter- and intra-tumoral heterogeneity on [68Ga]Ga-DOTA-TATE/[68Ga]Ga-DOTA-TOC PET/CT predicts response to [177Lu]Lu-DOTA-TATE PRRT in neuroendocrine tumor patients
- Creators
- Camila Gadens Zamboni - Division of Nuclear Medicine, Department of Radiology-Room 3820-AJPP, University of Iowa Carver College of MedicineAyca Dundar - University of IowaSanchay Jain - University of IowaMarc Kruzer - RHAMM TechnologiesBradley T. Loeffler - University of Iowa Holden Comprehensive Cancer CenterStephen A. Graves - University of IowaJanet H. Pollard - University of IowaSarah L. Mott - University of Iowa Holden Comprehensive Cancer CenterJoseph S. Dillon - University of Iowa, Endocrinology and MetabolismMichael M. Graham - University of IowaYusuf Menda - University of IowaAhmad Shariftabrizi - University of Iowa
- Resource Type
- Journal article
- Publication Details
- EJNMMI reports, Vol.8(1), 39
- DOI
- 10.1186/s41824-024-00227-3
- PMID
- 39613925
- PMCID
- PMC11607192
- NLM abbreviation
- EJNMMI Rep
- eISSN
- 3005-074X
- Publisher
- Springer International Publishing
- Language
- English
- Date published
- 12/01/2024
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Radiology; Radiation Oncology; Fraternal Order of Eagles Diabetes Research Center; Endocrinology and Metabolism; Internal Medicine
- Record Identifier
- 9984751759002771
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