Prospective, single-arm trial evaluating changes in uptake patterns on prostate-specific membrane antigen (PSMA)-targeted 18F-DCFPyL PET/CT in patients with castration-resistant prostate cancer starting abiraterone or enzalutamide

Katherine A. Zukotynski, Urban Emmenneger, Sebastien Hotte, Anil Kapoor, Wei Fu, Amanda L. Blackford, John Valliant, François Bénard, Chun K. Kim, Mark C. Markowski, Mario A. Eisenberger, Emmanuel S. Antonarakis, Kenneth J. Pienta, Michael A. Gorin, Matthew Lubanovic, Jihyun Kim, Martin G. Pomper, Steve Y. Cho, Steven P. Rowe

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Purpose: Positron emission tomography (PET) with small molecules targeting prostate-specific membrane antigen (PSMA) is being adopted as a clinical standard for prostate cancer (PCa) imaging. In this study, we evaluated changes in uptake on PSMA-targeted PET in men starting abiraterone or enzalutamide. Methods: This prospective, single-arm, two-center, exploratory clinical trial enrolled men with metastatic castration-resistant prostate cancer (CRPC) initiating abiraterone or enzalutamide. Each patient was imaged with 18F-DCFPyL at baseline and within 2-4 months after starting therapy. Patients were followed for up to 48 months from enrollment. A central review evaluated baseline and follow-up PET scans recording change in maximum standardized uptake value (SUVmax) at all disease sites and classifying the pattern of change. Two parameters: the delta percent SUVmax (DPSM) of all lesions and the delta absolute SUVmax (DASM) of all lesions were derived. Kaplan-Meier curves were used to estimate time to therapy change (TTTC) and overall survival (OS). Results: Sixteen evaluable patients were accrued to the study. Median TTTC was 9.6 months (95% confidence interval (CI), 6.9-14.2) and median OS was 28.6 months (95% CI 18.3-not available (N/A)). Patients with a mixed-but-predominantly-increased pattern of radiotracer uptake had shorter TTTC and OS. Men with low DPSM had median TTTC 12.2 months (95% CI 11.3-N/A) and median OS 37.2 months (95% CI 28.9-N/A), while those with high DPSM had median TTTC 6.5 months (95% CI 4.6-N/A, P = 0.0001) and median OS 17.8 months (95% CI 13.9-N/A, P = 0.02). Men with low DASM had median TTTC 12.2 months (95% CI 11.3-N/A) and median OS N/A (95% CI 37.2 months-N/A), while those with high DASM had median TTTC 6.9 months (95% CI 6.1-N/A, P = 0.003) and median OS 17.8 months (95% CI 13.9-N/A, P = 0.002). Conclusions: Findings on PSMA-targeted PET 2-4 months after initiation of abiraterone or enzalutamide are associated with TTTC and OS. Development of new lesions and/or increasing intensity of radiotracer uptake at sites of baseline disease are poor prognostic findings suggesting shorter TTTC and OS.

Original languageEnglish (US)
JournalJournal of Nuclear Medicine
Volume62
Issue number10
DOIs
StatePublished - Oct 1 2021
Externally publishedYes

Bibliographical note

Funding Information:
research funding from Progenics Pharmaceuticals, Inc. Funding for this study was

Funding Information:
Investigator Award and National Institutes of Health grants CA134675, CA184228,

Publisher Copyright:
© 2021 Society of Nuclear Medicine Inc.. All rights reserved.

Keywords

  • Anti-androgen
  • CRPC
  • Prognosis
  • Radiopharmaceutical
  • Response assessment

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

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