Evaluation of 18F-FMISO PET and 18F-FDG PET Scans in Assessing the Therapeutic Response of Patients With Metastatic Colorectal Cancer Treated With Anti-Angiogenic Therapy

Sze Ting Lee; Sze Ting Lee; Sze Ting Lee; Sze Ting Lee; Sze Ting Lee; Niall Tebbutt; Niall Tebbutt; Niall Tebbutt; Hui Kong Gan; Hui Kong Gan; Hui Kong Gan; Zhanqi Liu; John Sachinidis; Kunthi Pathmaraj; Andrew Mark Scott; Andrew Mark Scott; Andrew Mark Scott; Andrew Mark Scott

doi:10.3389/fonc.2021.606210

Frontiers in Oncology (Mar 2021)

Evaluation of 18F-FMISO PET and 18F-FDG PET Scans in Assessing the Therapeutic Response of Patients With Metastatic Colorectal Cancer Treated With Anti-Angiogenic Therapy

Sze Ting Lee,
Sze Ting Lee,
Sze Ting Lee,
Sze Ting Lee,
Sze Ting Lee,
Niall Tebbutt,
Niall Tebbutt,
Niall Tebbutt,
Hui Kong Gan,
Hui Kong Gan,
Hui Kong Gan,
Zhanqi Liu,
John Sachinidis,
Kunthi Pathmaraj,
Andrew Mark Scott,
Andrew Mark Scott,
Andrew Mark Scott,
Andrew Mark Scott

Affiliations

Sze Ting Lee: Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia
Sze Ting Lee: Tumor Targeting Laboratory, Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, VIC, Australia
Sze Ting Lee: School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia
Sze Ting Lee: Department of Surgery, The University of Melbourne, Austin Health, Melbourne, VIC, Australia
Sze Ting Lee: Department of Medicine, The University of Melbourne, Austin Health, Melbourne, VIC, Australia
Niall Tebbutt: School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia
Niall Tebbutt: Department of Surgery, The University of Melbourne, Austin Health, Melbourne, VIC, Australia
Niall Tebbutt: Department of Medical Oncology, Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia
Hui Kong Gan: Tumor Targeting Laboratory, Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, VIC, Australia
Hui Kong Gan: School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia
Hui Kong Gan: Department of Medical Oncology, Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia
Zhanqi Liu: Tumor Targeting Laboratory, Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, VIC, Australia
John Sachinidis: Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia
Kunthi Pathmaraj: Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia
Andrew Mark Scott: Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia
Andrew Mark Scott: Tumor Targeting Laboratory, Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, VIC, Australia
Andrew Mark Scott: School of Cancer Medicine, La Trobe University, Melbourne, VIC, Australia
Andrew Mark Scott: Department of Medicine, The University of Melbourne, Austin Health, Melbourne, VIC, Australia

DOI: https://doi.org/10.3389/fonc.2021.606210
Journal volume & issue: Vol. 11

Abstract

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IntroductionTumor hypoxia and angiogenesis are implicated in tumor growth and metastases, and anti-angiogenic therapies have an important role in treating patients with metastatic colorectal cancer. However, the prevalence of hypoxia has not been fully evaluated in colorectal liver metastases, and hypoxic response to anti-angiogenic therapy has not been clearly established. The aims of the study were to evaluate the changes seen on 18F-FMISO and 18F-FDG PET scans in patients treated with anti-angiogenic therapy, and to correlate these measures of hypoxia and metabolism with clinical outcomes, and blood biomarkers of angiogenesis.MethodsPatients with metastatic colorectal carcinoma planned for treatment with bevacizumab and chemotherapy received routine staging investigations prior to any treatment, including a FDG PET scan. A FMISO PET scan was performed within 4 weeks of staging tests, with blood specimens collected at that time for serum VEGF and osteopontin measurement. Follow-up FDG and FMISO scans were performed after 1 cycle of treatment. Results were compared to response (RECIST), progression free survival (PFS), and overall survival (OS).ResultsA total of 15 patients were recruited into this prospective trial, of which 13 patients were evaluable for assessment of treatment follow-up. Baseline FDG uptake was higher than FMISO uptake, and there was a significant decrease in FDG uptake (SUVmax and TGV) but not FMISO uptake (SUVmax and TNR) after treatment. There was a positive correlation between FDG and FMISO SUVmax on both baseline and post-treatment PET scans. Blood biomarkers of serum VEGF and osteopontin were significantly correlated with the FDG and FMISO PET parameters.ConclusionsThis study shows that hypoxia in metastatic colorectal cancer, assessed by FMISO PET, shows minor changes following initial treatment with anti-angiogenic therapy, but is associated with therapeutic response. FDG PET uptake changes (SUVmax, TLG) are also associated with response to anti-angiogenic therapy. These findings demonstrate the interplay between tumor metabolism and hypoxic regulation following anti-angiogenic treatment of metastatic colorectal cancer.

Published in Frontiers in Oncology

ISSN: 2234-943X (Online)
Publisher: Frontiers Media S.A.
Country of publisher: Switzerland
LCC subjects: Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.frontiersin.org/journals/oncology/

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