Utility of Early Posttreatment PET/CT Evaluation Using FDG or <sup>18</sup>F-FCH to Predict Response to <sup>90</sup>Y Radioembolization in Patients With Hepatocellular Carcinoma

Reizine, Edouard; Chalaye, Julia; Mulé, Sebastien; Regnault, Hélène; Perrin, Clara; Caldéraro, Julien; Laurent, Alexis; Amaddeo, Giuliana; Kobeiter, Hicham; Tacher, Vania; Itti, Emmanuel; Luciani, Alain

doi:10.2214/ajr.21.26485

Cited by 6 publications

(5 citation statements)

References 46 publications

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“…First of all, the limited number of included patients and its retrospective nature may have introduced a selection bias in patient enrollment. However, it has to be underlined that our sample size ( n = 21), although small, is not significantly different with respect to that included in the other cited papers focusing on 18 F-FCH PET/CT on HCC submitted to 90 Y-TARE (i.e., Hartenbach et al, n = 24; Reizine et al, n = 37) [ 13 , 23 ].…”

Section: Discussionmentioning

confidence: 98%

“…Reizine and colleagues applied dual tracer PET/CT with 18 F-FCH and 18 F-FDG in 37 HCC patients submitted to 90 Y-TARE for the assessment of early post-treatment response at 4–8 weeks after procedure [ 13 ]. All of the enrolled subjects were submitted to dual tracer PET/CT before 90 Y-microsphere administration: 28 patients resulted 18 F-FDG-positive; 9 were 18 F-FCH positive.…”

Section: Discussionmentioning

confidence: 99%

“…A recently published paper by Reizine et al showed that the evaluation of response by 18 F-FCH/ 18 F-FDG PET/CT in HCC patients submitted to 90 Y-TARE predicts 6-month response and their final outcome [ 13 ]. However, the impact of dual tracer PET imaging on patient management and, in particular, its potential to identify post 90 Y-TARE metabolically active tumor remnant amenable to further 90 Y-microsphere treatment has yet to be defined.…”

Section: Introductionmentioning

confidence: 99%

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PET/CT with 18F-choline or 18F-FDG in Hepatocellular Carcinoma Submitted to 90Y-TARE: A Real-World Study

et al. 2022

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Our aim was to assess the role of positron emission computed tomography (PET/CT) with 18F-choline (18F-FCH) or 18F-fluorodeoxyglucose (18F-FDG) in hepatocellular carcinoma (HCC) submitted to 90Y-radioembolization (90Y-TARE). We retrospectively analyzed clinical records of 21 HCC patients submitted to PET/CT with 18F-fluorocholine (18F-FCH) or 18F-fluodeoxyglucose (18F-FDG) before and 8 weeks after 90Y-TARE. On pre-treatment PET/CT, 13 subjects (61.9%) were 18F-FCH-positive, while 8 (38.1%) resulted 18F-FCH-negative and 18F-FDG-positive. At 8-weeks post 90Y-TARE PET/CT, 13 subjects showed partial metabolic response and 8 resulted non-responders, with a higher response rate among 18F-FCH-positive with respect to 18F-FDG-positive patients (i.e., 76.9% vs. 37.5%, p = 0.46). Post-treatment PET/CT influenced patients’ clinical management in 10 cases (47.6%); in 8 subjects it provided indication for a second 90Y-TARE targeting metabolically active HCC remnant, while in 2 patients it led to a PET-guided radiotherapy on metastatic nodes. By Kaplan–Meier analysis, patients’ age (≤69 y) and post 90Y-TARE PET/CT’s impact on clinical management significantly correlated with overall survival (OS). In Cox multivariate analysis, PET/CT’s impact on clinical management remained the only predictor of patients’ OS (p < 0.001). In our real-world study, PET/CT with 18F-FCH or 18F-FDG influenced clinical management and affected the final outcome for HCC patients treated with 90Y-TARE.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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PET/CT with 18F-choline or 18F-FDG in Hepatocellular Carcinoma Submitted to 90Y-TARE: A Real-World Study

et al. 2022

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“…Paired [ 18 F]FCH and [ 18 F]FDG PET have been shown to predict a 6-month response to 90 Y-transarterial radioembolisation in hepatocellular carcinoma (HCC) [45]. It also has the potential to identify metabolically active tumour remnants after 90 Y-transarterial radioembolisation in HCC [46].…”

Section: Discussionmentioning

confidence: 99%

Bench to Bedside Development of [18F]Fluoromethyl-(1,2-2H4)choline ([18F]D4-FCH)

Challapalli,

Barwick,

Dubash

et al. 2023

Molecules

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Malignant transformation is characterised by aberrant phospholipid metabolism of cancers, associated with the upregulation of choline kinase alpha (CHKα). Due to the metabolic instability of choline radiotracers and the increasing use of late-imaging protocols, we developed a more stable choline radiotracer, [18F]fluoromethyl-[1,2-2H4]choline ([18F]D4-FCH). [18F]D4-FCH has improved protection against choline oxidase, the key choline catabolic enzyme, via a 1H/2D isotope effect, together with fluorine substitution. Due to the promising mechanistic and safety profiles of [18F]D4-FCH in vitro and preclinically, the radiotracer has transitioned to clinical development. [18F]D4-FCH is a safe positron emission tomography (PET) tracer, with a favourable radiation dosimetry profile for clinical imaging. [18F]D4-FCH PET/CT in lung and prostate cancers has shown highly heterogeneous intratumoral distribution and large lesion variability. Treatment with abiraterone or enzalutamide in metastatic castrate-resistant prostate cancer patients elicited mixed responses on PET at 12–16 weeks despite predominantly stable radiological appearances. The sum of the weighted tumour-to-background ratios (TBRs-wsum) was associated with the duration of survival.

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“…Reizine and coworkers evaluated 37 HCC patients submitted to both FDG and 18 F choline PET/CT scans before Y-90 therapy: 28 subjects exhibited FDG-positive lesions, while nine patients were 18F-choline positive. The authors found early metabolic response, assessed by 18 F choline or FDG PET/CT PET/CT at 4–8 weeks post-treatment, to be 100% sensitive and 100% specific for the prediction of 6-month radiological response evaluated according to mRECIST [ 86 ]. Very recently, a retrospective real-world study including 21 HCC patients submitted to SIRT with Y-90 microspheres highlighted the clinical usefulness of response assessment performed with 18 F choline or FDG PET/CT at 8 weeks after SIRT: PET/CT influenced clinical management in 10 cases (47.6%), providing indications for a second Y-90 administration targeting metabolically active HCC remnants or leading to PET-guided radiotherapy of metastatic nodes [ 87 ].…”

Section: Pet/ct Imaging Of Hccmentioning

confidence: 99%

Update on PET Radiopharmaceuticals for Imaging Hepatocellular Carcinoma

Nyakale

Filippi

Aldous

et al. 2023

Cancers

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Numerous positron emission tomography (PET) targets for detection and staging of hepatocellular cancer have been developed in recent years. Hepatocellular carcinomas (HCCs) are clinically and pathologically heterogeneous tumours with a high tendency to be aggressive and unresponsive to chemotherapy. Early detection is essential, and the need for an adequate imaging biomarker, which can overcome some of the limitations of conventional radiological imaging, is persistent. Flourine-18 (18F) flourodeoxyglucose (FDG), the most widely used PET radiopharmaceutical, has proven disappointing as a possible staple in the evaluation of HCC. This disappointment had led to experimentation with carious radiotracers, such as the choline derivatives, acetate, and prostate-specific membrane antigen, which appear to complement and/or enhance the role of FDG. In this study, we look at the various PET radiopharmaceuticals that have been used for imaging HCC and the particular pathways that they target in HCC and liver cancers.

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Utility of Early Posttreatment PET/CT Evaluation Using FDG or ¹⁸F-FCH to Predict Response to ⁹⁰Y Radioembolization in Patients With Hepatocellular Carcinoma

Cited by 6 publications

References 46 publications

PET/CT with 18F-choline or 18F-FDG in Hepatocellular Carcinoma Submitted to 90Y-TARE: A Real-World Study

PET/CT with 18F-choline or 18F-FDG in Hepatocellular Carcinoma Submitted to 90Y-TARE: A Real-World Study

Bench to Bedside Development of [18F]Fluoromethyl-(1,2-2H4)choline ([18F]D4-FCH)

Update on PET Radiopharmaceuticals for Imaging Hepatocellular Carcinoma

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Utility of Early Posttreatment PET/CT Evaluation Using FDG or 18F-FCH to Predict Response to 90Y Radioembolization in Patients With Hepatocellular Carcinoma

Cited by 6 publications

References 46 publications

PET/CT with 18F-choline or 18F-FDG in Hepatocellular Carcinoma Submitted to 90Y-TARE: A Real-World Study

PET/CT with 18F-choline or 18F-FDG in Hepatocellular Carcinoma Submitted to 90Y-TARE: A Real-World Study

Bench to Bedside Development of [18F]Fluoromethyl-(1,2-2H4)choline ([18F]D4-FCH)

Update on PET Radiopharmaceuticals for Imaging Hepatocellular Carcinoma

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Product

Resources

About

Utility of Early Posttreatment PET/CT Evaluation Using FDG or ¹⁸F-FCH to Predict Response to ⁹⁰Y Radioembolization in Patients With Hepatocellular Carcinoma