Evaluation of PSMA expression changes on PET/CT before and after initiation of novel antiandrogen drugs (enzalutamide or abiraterone) in metastatic castration-resistant prostate cancer patients
Evaluation of PSMA expression changes on PET/CT before and after initiation of novel antiandrogen drugs (enzalutamide or abiraterone) in metastatic castration-resistant prostate cancer patients
复制标题
DOI：
10.1007/s12149-019-01404-2
复制
发表时间：
2019-12-01
影响因子：
2.6
通讯作者：
Flamen, Patrick
中科院分区：
文献类型：
--
作者：
Plouznikoff, Nicolas;Artigas, Carlos;Flamen, Patrick
目的探讨转移性去势抵抗性前列腺癌（mCRPC）患者正电子发射断层扫描-计算机断层扫描（PET/CT）上前列腺特异性膜抗原（PSMA）表达变化与恩杂鲁胺或阿比特龙开始治疗后对治疗的反应之间的关系。回顾性筛选了在我们机构进行的4年多的常规CT扫描。我们纳入了在开始enzalutamide或阿比特龙治疗前2个月内进行基线PSMA PET/CT检查，在开始enzalutamide或阿比特龙治疗后不超过1年内进行随访PSMA PET/CT检查，同时仍在使用这些新型抗雄激素药物（NAD）的mCRPC患者。对相关临床记录进行了审查。如果患者表现出PSA水平降低>50%或基于RECIST 1.1标准的放射学反应，则将其视为治疗应答者。使用每例患者显性反应标准评估随访PET/CT时的PSMA表达变化，将患者分类为PSMA反应者（病理性PSMA摄取完全消失，或大多数病变摄取减少）或PSMA无反应者（新发PSMA表达病变，大多数病变摄取增加，或疾病的稳定PSMA表达）。描述性统计和协会的措施（双侧Fisher精确检验和Phi系数）进行了calculated.ResultsA共11和15例患者被纳入Enzalutamide和阿比特龙组。中位随访时间分别为110（IQR 76-124）天和87（IQR 71-242）天。所有治疗应答者（enzalutamide组3例，阿比特龙组4例）均被视为PSMA应答者，所有治疗非应答者（enzalutamide组8例，阿比特龙组11例）均被视为PSMA非应答者。因此，PSMA PET应答与常规应答标准完全相关（enzalutamide组p=0.006，Phi=1;阿比特龙组p=0.001，Phi=1）。在我们的队列中，在中位随访3个月时，在随访PET/CT扫描中未检测到PSMA表达爆发现象。然而，一个早期和短暂的耀斑不能excluded.ConclusionsThis回顾性研究表明，在Enzalutamide或阿比特龙下的中位随访3个月后，PET/CT上的PSMA表达变化与治疗反应密切相关。需要进行前瞻性研究，以更好地了解Enzalutamide和阿比特龙治疗开始后的PSMA表达动力学，以及沿着PSMA PET/CT在缓解评估中的作用。
ObjectiveTo investigate the association between Prostate-Specific Membrane Antigen (PSMA) expression changes on positron emission tomography-computed tomography (PET/CT) and the response to treatment following the start of enzalutamide or abiraterone in metastatic castration-resistant prostate cancer (mCRPC) patients.MethodsAll consecutive Ga-68-PSMA-11 PET/CT scans routinely performed at our institution during more than 4 years were retrospectively screened for inclusion. We included mCRPC patients with a baseline PSMA PET/CT performed less than 2 months before the start of either enzalutamide or abiraterone, and a follow-up PSMA PET/CT performed no more than a year after, while still under those novel antiandrogen drugs (NAD). The associated clinical records were reviewed. Patients were considered treatment responders if they presented decreasing PSA levels>50% or a radiological response based on RECIST 1.1 criteria. PSMA expression changes on the follow-up PET/CT were assessed using per-patient dominant response criteria to classify patients as PSMA-responders (complete disappearance of pathologic PSMA uptake, or a decreased uptake of the majority of lesions) or PSMA-non-responders (new PSMA-expressing lesions, increased uptake of the majority of lesions, or stable PSMA expression of the disease). Descriptive statistics and measures of associations (two-sided Fisher's exact test and Phi coefficient) were calculated.ResultsA total of 11 and 15 patients were included in the enzalutamide and abiraterone groups. Median follow-up was 110 (IQR 76-124) and 87 (IQR 71-242) days, respectively. All treatment responders (3 enzalutamide and 4 abiraterone) were considered PSMA-responders, and all treatment non-responders (8 enzalutamide, 11 abiraterone) were considered PSMA-non-responders. PSMA PET response was thus perfectly associated with conventional response criteria (p=0.006, Phi=1 for enzalutamide; p=0.001, Phi=1 for abiraterone). In our cohort, no PSMA expression flare phenomenon was detected on follow-up PET/CT scans at a median follow-up of 3 months. However, an early and short-lived flare cannot be excluded.ConclusionsThis retrospective study suggests that, after a median follow-up of 3 months under enzalutamide or abiraterone, PSMA expression changes on PET/CT are strongly associated with response to treatment. Prospective studies are needed to better understand PSMA expression dynamics following the start of enzalutamide and abiraterone, along with the role of PSMA PET/CT in response assessment.