A prospective study on the early evaluation of response to androgen receptor-targeted agents with C-Choline, Ga-PSMA, and F-FACBC PET in metastatic castration-resistant prostate cancer: a single-center experience.

C Nanni, S Fanti, F Massari, A Marchetti, V Mollica, N Fraccascia, E Tabacchi, C Malizia, G Argalia, M Rosellini, E Tassinari, A Paccapelo

Journal: ESMO open 2024;9(5):103448

PMID: 38718704

Free Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

The early identification of responsive and resistant patients to androgen receptor-targeting agents (ARTA) in metastatic castration-resistant prostate cancer (mCRPC) is not completely possible with prostate-specific antigen (PSA) assessment and conventional imaging. Considering its ability to determine metabolic activity of lesions, positron emission tomography (PET) assessment might be a promising tool.

PATIENTS AND METHODS

We carried out a monocentric prospective study in patients with mCRPC treated with ARTA to evaluate the role of different PET radiotracers: 49 patients were randomized to receive C-Choline, Fluorine 18 fluciclovine (anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid - FACBC) (F-FACBC), or Gallium-68-prostate-specific-membrane-antigen (Ga-PSMA) PET, one scan before therapy and one 2 months later. The primary aim was to investigate the performance of three novel PET radiotracers for the early evaluation of response to ARTA in metastatic CRPC patients; the outcome evaluated was biochemical response (PSA reduction ≥50%). The secondary aim was to investigate the prognostic role of several semiquantitative PET parameters and their variations with the different radiotracers in terms of biochemical progression-free survival (bPFS) and overall survival (OS). The study was promoted by the Italian Department of Health (code RF-2016-02364809).

RESULTS

Regarding the primary endpoint, at log-rank test a statistically significant correlation was found between metabolic tumor volume (MTV) (P = 0.018) and total lesion activity (TLA) (P = 0.025) percentage variation among the two scans with Ga-PSMA PET and biochemical response. As for the secondary endpoints, significant correlations with bPFS were found for Ga-PSMA total MTV and TLA at the first scan (P = 0.001 and P = 0.025, respectively), and MTV percentage variation (P = 0.031). For OS, statistically significant correlations were found for different Ga-PSMA and F-FACBC parameters and for major maximum standardized uptake value at the first C-Choline PET scan.

CONCLUSIONS

Our study highlighted that C-Choline, Ga-PSMA, and F-FACBC semiquantitative PET parameters and their variations present a prognostic value in terms of OS and bPFS, and MTV and TLA variations with Ga-PSMA PET a correlation with biochemical response, which could help to assess the response to ARTA.

Address: Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna. Electronic address: [email protected].; Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna.; UOC Medicina Nucleare-Centro PET/TC, Ente Ecclesiastico Ospedale Generale Regionale 'F. Miulli', Acquaviva delle Fonti, Bari.; Division of Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna.; Nuclear Medicine, Department of Radiological Sciences, University Hospital of Marche, Ancona.; Research and Innovation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.

DOI: 10.1016/j.esmoop.2024.103448