Modifying the Poor Prognosis Associated with <sup>18</sup>F-FDG–Avid NET with Peptide Receptor Chemo-Radionuclide Therapy (PRCRT)

Hofman, Michael S; Michael, Michael; Kashyap, Raghava; Hicks, Rodney J.

doi:10.2967/jnumed.115.154500

Cited by 16 publications

(10 citation statements)

References 9 publications

(5 reference statements)

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“…Although most reports have focussed on patients with lower-grade NET (ENETS grades 1 and 2), provided SSTR expression is adequate, there is emerging evidence that this therapy may be effective in patients with higher-grade NET (grade 2) and NEC (grade 3) who have failed a trial of chemotherapy or who are deemed unsuitable for this therapy. In particular, a recent study confined to patients with FDG-avid disease demonstrated similar response rates to those in other studies and encouraging PFS [51] and OS [60]. FDG avidity has been shown to increase with increasing tumour grade and to be associated with an adverse prognosis with conventional therapy [57,58,59].…”

Section: Prrt Requirementsmentioning

confidence: 52%

“…Indeed, it may be a more powerful prognostic marker than conventional measures including the percentage of cells staining for Ki-67, a proliferation marker [59]. In patients who retain SSTR expression but are FDG-avid, encouraging response rates and survival rates have been reported with PRCRT [51,60]. An ongoing randomized controlled trial in Australia is comparing PRCRT with CAPTEM (capecitabine plus temozolomide) with CAPTEM or PRRT depending on the primary site of origin.…”

Section: Netter-1: the First Randomized Controlled Trial Of Prrtmentioning

confidence: 99%

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ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Neoplasms: Peptide Receptor Radionuclide Therapy with Radiolabelled Somatostatin Analogues

et al. 2017

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The purpose of these guidelines is to assist physicians caring for patients with neuroendocrine neoplasia in considering eligibility criteria for peptide receptor radionuclide therapy (PRRT) and in defining the minimum requirements for PRRT. It is not these guidelines' aim to give recommendations on the use of specific radiolabelled somatostatin analogues for PRRT as different analogues are being used, and their availability is governed by varying international regulations. However, a recent randomized controlled trial, NETTER-1, has provided evidence that may establish ¹⁷⁷Lu-DOTA-octreotate (LutaThera®) as the first widely approved agent. It also makes recommendations on what minimal patient, tumour, and treatment outcome characteristics should be reported for PRRT to facilitate robust comparisons between studies.

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Section: Prrt Requirementsmentioning

confidence: 52%

Section: Netter-1: the First Randomized Controlled Trial Of Prrtmentioning

confidence: 99%

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Neoplasms: Peptide Receptor Radionuclide Therapy with Radiolabelled Somatostatin Analogues

et al. 2017

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“…Emerging data suggest the use of PRRT in combination with chemotherapeutic agents (such as temozolomide/capecitabine) in spatially concordant 18 F-FDG positive disease [32,33], in an attempt to boost the therapeutic efficacy of the former. Hence, Peptide Receptor Chemo-Radionuclide Therapy (PRCRT), can achieve unexpectedly long PFS, modifying the poor prognosis associated with 18 F-FDG-avidity [34].…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of a three-scale grading system based on combining molecular imaging with 68Ga-DOTATATE and 18F-FDG PET/CT in patients with metastatic gastroenteropancreatic neuroendocrine neoplasias

et al. 2020

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We investigated on the added prognostic value of a three-scale combined molecular imaging with 68 Ga-DOTATATE and 18 F-FDG PET/CT, (compared to Ki-67 based histological grading), in gastroenteropancreatic neuroendocrine neoplasia patients. 85 patients with histologically proven metastatic gastroenteropancreatic neuroendocrine neoplasias, who underwent combined PET/CT imaging were retrospectively evaluated. Highest Ki-67 value available at time of 18 F-FDG PET/CT was recorded. Patients were classified according to World Health Organization/European Neuroendocrine Tumor Society histological grades (G1, G2, G3) and into three distinct imaging categories (C1: all lesions are 18 F-FDG negative/ 68 Ga-DOTATATE positive, C2: patients with one or more 18 F-FDG positive lesions, all of them 68 Ga-DOTATATE positive, C3: patients with one or more 18 F-FDG positive lesions, at least one of them 68 Ga-DOTATATE negative). The primary endpoint of the study was Progression-Free Survival, assessed from the date of 18 F-FDG PET/CT to the date of radiological progression according to Response Evaluation Criteria In Solid Tumors version 1.1. Classification according to histological grade did not show significant statistical difference in median Progression-Free Survival between G1 and G2 but was significant between G2 and G3 patients. In contrast, median Progression-Free Survival was significantly higher in C1 compared to C2 and in C2 compared to C3 patients, revealing three distinctive imaging categories, each with highly distinctive prognosis. Our three-scale combined 68 Ga-DOTATATE/ 18 F-FDG PET imaging classification holds high prognostic value in patients with metastatic gastroenteropancreatic neuroendocrine neoplasias. www.oncotarget.com

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“…High uptake on SRI compared to FDG would favor PRRT 25, while a high ratio of FDG to SRI uptake would predict resistance to PRRT 25. Some teams have combined PRRT with chemotherapy 36,37, for example in patients with SRI-positive but FDG-avid disease 37.…”

Section: How Dual-imaging With Fdg-pet and Sri-pet Might Influence Mamentioning

confidence: 99%

The NETPET Score: Combining FDG and Somatostatin Receptor Imaging for Optimal Management of Patients with Metastatic Well-Differentiated Neuroendocrine Tumors

Hindié¹

2017

Theranostics

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Neuroendocrine tumors (NET) are often metastatic at the time of diagnosis. Metastatic well-differentiated (G1/G2) NET may display a wide range of behaviors, ranging from indolent to aggressive, even within apparently homogeneous categories. Thus, selecting the optimal treatment strategy is a challenging task. Somatostatin receptor imaging (SRI) is the standard molecular imaging technique for well-differentiated NET. When performed with 68Ga-labeled somatostatin analogs (SRI-PET), it offers exquisite sensitivity for disease staging. SRI is also a prerequisite for using targeted radionuclide therapy (e.g. 177Lu-DOTATATE). 18F-FDG imaging has traditionally been reserved for staging poorly-differentiated G3 neuroendocrine carcinomas. However, recent data showed that FDG imaging has prognostic value in patients with well-differentiated NET: high uptake was associated with an increased risk of early progression while low uptake suggested an indolent tumor.In this issue of the Journal, Chan and colleagues propose a grading system where the results from the combined reading of SRI-PET and FDG-PET are reported as a single parameter, the “NETPET” score. While the scoring system still needs validation, it is clear that time has come to think about FDG and SRI in metastatic NET not as competitors but as complementary imaging modalities. Dual-tracer imaging can be viewed as a way to characterize disease phenotype in the whole-body. Moving from the prognostic value of dual-tracer imaging to a tool that allows for individualized management would require prospective trials. This editorial will argue that dual-tracer FDG-PET and SRI-PET might influence management of patients with well-differentiated metastatic NET and help selecting between different therapy options.

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Modifying the Poor Prognosis Associated with ¹⁸F-FDG–Avid NET with Peptide Receptor Chemo-Radionuclide Therapy (PRCRT)

Cited by 16 publications

References 9 publications

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Neoplasms: Peptide Receptor Radionuclide Therapy with Radiolabelled Somatostatin Analogues

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Neoplasms: Peptide Receptor Radionuclide Therapy with Radiolabelled Somatostatin Analogues

Prognostic value of a three-scale grading system based on combining molecular imaging with 68Ga-DOTATATE and 18F-FDG PET/CT in patients with metastatic gastroenteropancreatic neuroendocrine neoplasias

The NETPET Score: Combining FDG and Somatostatin Receptor Imaging for Optimal Management of Patients with Metastatic Well-Differentiated Neuroendocrine Tumors

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Modifying the Poor Prognosis Associated with 18F-FDG–Avid NET with Peptide Receptor Chemo-Radionuclide Therapy (PRCRT)

Cited by 16 publications

References 9 publications

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Neoplasms: Peptide Receptor Radionuclide Therapy with Radiolabelled Somatostatin Analogues

ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Neoplasms: Peptide Receptor Radionuclide Therapy with Radiolabelled Somatostatin Analogues

Prognostic value of a three-scale grading system based on combining molecular imaging with 68Ga-DOTATATE and 18F-FDG PET/CT in patients with metastatic gastroenteropancreatic neuroendocrine neoplasias

The NETPET Score: Combining FDG and Somatostatin Receptor Imaging for Optimal Management of Patients with Metastatic Well-Differentiated Neuroendocrine Tumors

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Modifying the Poor Prognosis Associated with ¹⁸F-FDG–Avid NET with Peptide Receptor Chemo-Radionuclide Therapy (PRCRT)