METHODS: We retrospectively reviewed the medical records of 123 patients with mCRPC treated with SGA (Abiraterone or Enzalutamide) after docetaxel between 2016 and 2019. Patients underwent PSA testing, and C[11] choline PET/CT scan at baseline level before starting treatment with SGA, then every 3-6 months as part of their follow up evaluation. Loss of response to SGA was defined by increase in corrected maximum standardized uptake value (SUVmax) of pretreatment lesions on C-11 Choline PET/CT, and/or development of new lesions. Suspicious new lesions were confirmed by biopsy and/or conventional imaging.
RESULTS: We identified 123 mCRPC patients who received SGA (Abiraterone, n = 106; Enzalutamide, n = 17) after docetaxel. Median duration of therapy was 13.9 months (interquartile range: 8.75-21.14). Approximately 43% (n = 53) of subjects in this study exhibited an increase in choline avidity while on SGA. Of this group, 60.4% of patients experienced a parallel rise in PSA (Group-A), whereas 39.6% displayed a paradoxical response (PR) (Group-B), defined as increased choline avidity combined with stable or down-trending PSA. Median PSA at time of increase in choline avidity was 3.1 ng/ml for Group-A, and 1.3 ng/ml for Group-B (p = 0.0176). Median SUVmax was similar in both groups (4.9 for Group-A, 4.6 for Group-B; p = 0.6072). The median time for increase in choline avidity was 9.5 versus 3.9 months for Group-A versus Group-B, respectively (Log-Rank = 0.0063).
CONCLUSIONS: Nearly 40% of mCRPC patients placed on SGA post docetaxel chemotherapy will exhibit paradoxical responses to therapy, therefore, warranting close follow up with imaging. C-11 choline PET/CT imaging is a useful tool that can help in early predication of disease progression or treatment failure.
方法:我们回顾性回顾了2016年至2019年间多西他赛后接受SGA(阿比特龙或恩扎鲁他胺)治疗的123例mCRPC患者的病历。患者接受了PSA检测,和C[11]胆碱PET/CT扫描在基线水平开始用SGA治疗前,然后每3-6个月作为他们后续评估的一部分。通过C-11胆碱PET/CT上预处理病变的校正最大标准化摄取值(SUVmax)的增加来定义对SGA的反应丧失。和/或新病变的发展。通过活检和/或常规成像证实可疑的新病变。
结果:我们确定了123名接受SGA的mCRPC患者(阿比特龙,n=106;恩扎鲁胺,n=17)后多西他赛。治疗的中位持续时间为13.9个月(四分位距:8.75-21.14)。该研究中大约43%(n=53)的受试者在SGA上表现出胆碱亲和力增加。在这个群体中,60.4%的患者经历了PSA的平行升高(A组),而39.6%表现出矛盾反应(PR)(B组),定义为胆碱亲和力增加,PSA稳定或下降。A组胆碱亲和力增加时的PSA中位数为3.1ng/ml,和1.3ng/ml的B组(p=0.0176)。两组的SUVmax中位数相似(A组为4.9,B组的4.6;p=0.6072)。A组与B组的胆碱亲和力增加的中位时间分别为9.5个月和3.9个月,分别(Log-Rank=0.0063)。
结论:在多西他赛化疗后接受SGA治疗的mCRPC患者中,近40%会表现出对治疗的矛盾反应,因此,保证密切随访成像。C-11胆碱PET/CT成像是一种有用的工具,可以帮助早期预测疾病进展或治疗失败。