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  • 1
    Online Resource
    Online Resource
    Total Tumor Volume on 18F-PSMA-1007 PET as Additional Imaging Biomarker in mCRPC Patients Undergoing PSMA-Targeted Alpha Therapy with 225Ac-PSMA-I&T
    MDPI AG ; 2022
    In:  Biomedicines Vol. 10, No. 5 ( 2022-04-20), p. 946-
    Details
    In: Biomedicines, MDPI AG, Vol. 10, No. 5 ( 2022-04-20), p. 946-
    Abstract: Background: PSMA-based alpha therapy using 225Ac-PSMA-I & T provides treatment for metastatic castration-resistant prostate cancer (mCRPC), even after the failure of 177Lu-PSMA radioligand therapy (RLT). In clinical routine, the total tumor volume (TTV) on PSMA PET impacts therapy outcomes and plays an increasing role in mCRPC patients. Hence, we aimed to assess TTV and its changes during 225Ac-PSMA-I & T RLT. Methods: mCRPC patients undergoing RLT with 225Ac-PSMA-I & T with available 18F-PSMA-1007 PET/CT prior to therapy initiation were included. TTV was assessed in all patients using established cut-off values. Image derived, clinical and biochemistry parameters (PSA, LDH, AP, pain score) were analyzed prior to and after two cycles of 225Ac-PSMA. Changes in TTV and further parameters were directly compared and then correlated with established response criteria, such as RECIST 1.1 or mPERCIST. Results: 13 mCRPC patients were included. The median overall survival (OS) was 10 months. Prior to 225Ac-PSMA RLT, there was no significant correlation between TTV with other clinical parameters (p 〉 0.05 each). Between short-term survivors (STS, 〈 10 months OS) and long-term survivors (LTS, ≥10 months OS), TTV and PSA were comparable (p = 0.592 & p = 0.286, respectively), whereas AP was significantly lower in the LTS (p = 0.029). A total of 7/13 patients completed two cycles and underwent a follow-up 18F-PSMA-1007 PET/CT. Among these patients, there was a significant decrease in TTV (median 835 vs. 201 mL, p = 0.028) and PSA (median 687 ng/dL vs. 178 ng/dL, p = 0.018) after two cycles of 225Ac-PSMA RLT. Here, percentage changes of TTV after two cycles showed no direct correlation to all other clinical parameters (p 〉 0.05 each). In two patients, new PET-avid lesions were detected on 18F-PSMA-1007 PET/CT. However, TTV and PSA were decreasing or stable. Conclusion: PET-derived assessment of TTV is an easily applicable imaging biomarker independent of other established parameters prior to 225Ac-PSMA RLT in these preliminary follow-up data. Even after the failure of 177Lu-PSMA, patients with extensive TTV seem to profit from RLT. All but one patient who was eligible for ≥2 cycles of 225Ac-PSMA-RLT demonstrated drastic TTV decreases without direct correlation to other biomarkers, such as serum PSA changes. Changes in TTV might hence improve the response assessment compared to standard classifiers by reflecting the current tumor load independent of the occurrence of new lesions.
    Type of Medium: Online Resource
    ISSN: 2227-9059
    URL: Article
    DOI: 10.3390/biomedicines10050946
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2720867-9
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  • 2
    Online Resource
    Online Resource
    Cost-Effectiveness Analysis of 177Lu-PSMA-617 Radioligand Therapy in Metastatic Castration-Resistant Prostate Cancer
    Harborside Press, LLC ; 2023
    In:  Journal of the National Comprehensive Cancer Network Vol. 21, No. 1 ( 2023-01), p. 43-50.e2
    Details
    In: Journal of the National Comprehensive Cancer Network, Harborside Press, LLC, Vol. 21, No. 1 ( 2023-01), p. 43-50.e2
    Abstract: Background: Metastatic castration-resistant prostate cancer poses a therapeutic challenge with poor prognosis. The VISION trial showed prolonged progression-free and overall survival in patients treated with lutetium Lu 177 vipivotide tetraxetan ( 177 Lu-PSMA-617) radioligand therapy compared with using the standard of care (SoC) alone. The objective of this study was to determine the cost-effectiveness of 177 Lu-PSMA-617 treatment compared with SoC therapy. Methods: A partitioned survival model was developed using data from the VISION trial, which included overall and progression-free survival and treatment regimens for 177 Lu-PSMA-617 and SoC. Treatment costs, utilities for health states, and adverse events were derived from public databases and the literature. Because 177 Lu-PSMA-617 was only recently approved, costs for treatment were extrapolated from 177 Lu-DOTATATE. Outcome measurements included the incremental cost, effectiveness, and cost-effectiveness ratio. The analysis was performed in a US setting from a healthcare system perspective over the lifetime horizon of 60 months. The willingness-to-pay threshold was set to $50,000, $100,000, and $200,000 per quality-adjusted life years (QALYs). Results: The 177 Lu-PSMA-617 group was estimated to gain 0.42 incremental QALYs. Treatment using 177 Lu-PSMA-617 led to an increase in costs compared with SoC ($169,110 vs $85,398). The incremental cost, effectiveness, and cost-effectiveness ratio for 177 Lu-PSMA-617 therapy was $200,708/QALYs. Sensitivity analysis showed robustness of the model regarding various parameters, which remained cost-effective at all lower and upper parameter bounds. In probabilistic sensitivity analysis using Monte Carlo simulation with 10,000 iterations, therapy using 177 Lu-PSMA-617 was determined as the cost-effective strategy in 37.14% of all iterations at a willingness-to-pay threshold of $200,000/QALYs. Conclusions: Treatment using 177 Lu-PSMA-617 was estimated to add a notable clinical benefit over SoC alone. Based on the model results, radioligand therapy represents a treatment strategy for patients with metastatic castration-resistant prostate cancer with cost-effectiveness in certain scenarios.
    Type of Medium: Online Resource
    ISSN: 1540-1405 , 1540-1413
    URL: Article
    DOI: 10.6004/jnccn.2022.7070
    Language: Unknown
    Publisher: Harborside Press, LLC
    Publication Date: 2023
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  • 3
    Online Resource
    Online Resource
    Correction to: Next‑generation PET/CT imaging in meningioma—first clinical experiences using the novel SSTR‑targeting peptide [18F]SiTATE
    Springer Science and Business Media LLC ; 2023
    In:  European Journal of Nuclear Medicine and Molecular Imaging
    Details
    In: European Journal of Nuclear Medicine and Molecular Imaging, Springer Science and Business Media LLC
    Type of Medium: Online Resource
    ISSN: 1619-7070 , 1619-7089
    URL: Article
    DOI: 10.1007/s00259-023-06409-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2098375-X
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  • 4
    Online Resource
    Online Resource
    Next-generation PET/CT imaging in meningioma—first clinical experiences using the novel SSTR-targeting peptide [18F]SiTATE
    Springer Science and Business Media LLC ; 2023
    In:  European Journal of Nuclear Medicine and Molecular Imaging Vol. 50, No. 11 ( 2023-09), p. 3390-3399
    Details
    In: European Journal of Nuclear Medicine and Molecular Imaging, Springer Science and Business Media LLC, Vol. 50, No. 11 ( 2023-09), p. 3390-3399
    Abstract: Somatostatin-receptor (SSTR)-targeted PET/CT provides important clinical information in addition to standard imaging in meningioma patients. [ 18 F]SiTATE is a novel, 18 F-labeled SSTR-targeting peptide with superior imaging properties according to preliminary data. We provide the first [ 18 F]SiTATE PET/CT data of a large cohort of meningioma patients. Methods Patients with known or suspected meningioma undergoing [ 18 F]SiTATE PET/CT were included. Uptake intensity (SUV) of meningiomas, non-meningioma lesions, and healthy organs were assessed using a 50% isocontour volume of interest (VOI) or a spherical VOI, respectively. Also, trans-osseous extension on PET/CT was assessed. Results A total of 107 patients with 117 [ 18 F]SiTATE PET/CT scans were included. Overall, 231 meningioma lesions and 61 non-meningioma lesions (e.g., post-therapeutic changes) were analyzed. Physiological uptake was lowest in healthy brain tissue, followed by bone marrow, parotid, and pituitary (SUV mean 0.06 ± 0.04 vs. 1.4 ± 0.9 vs. 1.6 ± 1.0 vs. 9.8 ± 4.6; p   〈  0.001). Meningiomas showed significantly higher uptake than non-meningioma lesions (SUV max 11.6 ± 10.6 vs. 4.0 ± 3.3, p   〈  0.001). Meningiomas showed significantly higher uptake than non-meningioma lesions (SUVmax 11.6±10.6 vs. 4.0±3.3, p 〈 0.001). 93/231 (40.3%) meningiomas showed partial trans-osseous extension and 34/231 (14.7%) predominant intra-osseous extension. 59/231 (25.6%) meningioma lesions found on PET/CT had not been reported on previous standard imaging. Conclusion This is the first PET/CT study using an 18 F-labeled SSTR-ligand in meningioma patients: [ 18 F]SiTATE provides extraordinary contrast in meningioma compared to healthy tissue and non-meningioma lesions, which leads to a high detection rate of so far unknown meningioma sites and osseous involvement. Having in mind the advantageous logistic features of 18 F-labeled compared to 68 Ga-labeled compounds (e.g., longer half-life and large-badge production), [ 18 F]SiTATE has the potential to foster a widespread use of SSTR-targeted imaging in neuro-oncology.
    Type of Medium: Online Resource
    ISSN: 1619-7070 , 1619-7089
    URL: Article
    DOI: 10.1007/s00259-023-06315-z
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2098375-X
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  • 5
    Online Resource
    Online Resource
    Table_1.docx
    Frontiers Media SA ; 2021
    In:  Frontiers in Oncology Vol. 11 ( 2021-5-21)
    Details
    In: Frontiers in Oncology, Frontiers Media SA, Vol. 11 ( 2021-5-21)
    Abstract: Delineation of PSMA-positive tumor volume on PET using PSMA-ligands is of highest clinical interest as changes of PSMA-PET/CT-derived whole tumor volume (WTV) have shown to correlate with treatment response in metastatic prostate cancer patients. So far, WTV estimation was performed on PET using 68 Ga-labeled ligands; nonetheless, 18 F-labeled PET ligands are gaining increasing importance due to advantages over 68 Ga-labeled compounds. However, standardized tumor delineation methods for 18 F-labeled PET ligands have not been established so far. As correlation of PET-based information and morphological extent in osseous and visceral metastases is hampered by morphological delineation, low contrast in liver tissue and movement artefacts, we correlated CT-based volume of lymph node metastases (LNM) and different PET-based delineation approaches for thresholding on 18 F-PSMA-1007 PET. Methods Fifty patients with metastatic prostate cancer, 18 F-PSMA-1007 PET/CT and non-bulky LNM (short-axis diameter ≥10mm) were included. Fifty LNM were volumetrically assessed on contrast-enhanced CT (volumetric reference standard). Different approaches for tumor volume delineation were applied and correlated with the reference standard: I) fixed SUV threshold, II) isocontour thresholding relative to SUV max (SUV%), and thresholds relative to III) liver (SUV liver ), IV) parotis (SUV parotis ) and V) spleen (SUV spleen ). Results A fixed SUV of 4.0 (r=0.807, r 2 = 0.651, p & lt;0.001) showed the best overall association with the volumetric reference. 55% SUV max (r=0.627, r 2 = 0.393, p & lt;0.001) showed highest association using an isocontour-based threshold. Best background-based approaches were 60% SUV liver (r=0.715, r 2 = 0.511, p & lt;0.001), 80% SUV parotis (r=0.762, r 2 = 0.581, p & lt;0.001) and 60% SUV spleen (r=0.645, r 2 = 0.416, p & lt;0.001). Background tissues SUV liver, SUV parotis & amp; SUV spleen did not correlate (p & gt;0.05 each). Recently reported cut-offs for intraprostatic tumor delineation (isocontour 44% SUV max , 42% SUV max and 20% SUV max ) revealed inferior association for LNM delineation. Conclusions A threshold of SUV 4.0 for tumor delineation showed highest association with volumetric reference standard irrespective of potential changes in PSMA-avidity of background tissues (e. g. parotis). This approach is easily applicable in clinical routine without specific software requirements. Further studies applying this approach for total tumor volume delineation are initiated.
    Type of Medium: Online Resource
    ISSN: 2234-943X
    URL: Article
    URL: Article
    DOI: 10.3389/fonc.2021.663631
    DOI: 10.3389/fonc.2021.663631.s001
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2021
    detail.hit.zdb_id: 2649216-7
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