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Sequential ^99mTc-Hydrazinonicotinamide-Annexin V Imaging for Predicting Response to Chemotherapy

¹ Division of Medical Oncology, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium; ² Department of Radiopharmacy, University of Ghent, Ghent, Belgium; and ³ Department of Nuclear Medicine, University Hospital Ghent, Ghent, Belgium

Correspondence: For correspondence or reprints contact: Christophe Van de Wiele, MD, PhD, Department of Nuclear Medicine, University Hospital Ghent, De Pintelaan 185-B, 9000 Ghent, Belgium. E-mail: christophe.vandewiele{at}ugent.be

This study was undertaken to evaluate changes in relative ^99mTc-hydrazinonicotinamide (HYNIC)-annexin V tumor uptake over time in patients undergoing chemotherapeutic treatment at baseline and at 5–7 h and 40–44 h after treatment initiation. Imaging results are related to clinical outcomes, as assessed with response evaluation criteria in solid tumors (RECIST). Methods: We prospectively included 20 patients (11 men and 9 women; mean age, 59.8 y; range, 22–75 y) scheduled for chemotherapy (n = 19) or bisphosphonate treatment (n = 1). Curable disease was present in 5 patients. The other patients had metastatic disease and were treated in a palliative setting. Three of the 20 enrolled patients were excluded from analysis: 1 patient ultimately refused the proposed chemotherapy treatment; because of difficulties with the labeling procedure, 1 patient did not receive a pretreatment scan; and 1 patient presented with an allergic reaction (rash and nausea) to the ^99mTc-HYNIC-annexin V formulation. The remaining 17 patients underwent 3 scintigraphic scans with ^99mTc-HYNIC-annexin V: before treatment and 5–7 h and 40–44 h after treatment initiation. The tumor response was evaluated with RECIST and related to observed changes in the ratios of tumor activity to background activity for the largest known lesion; values exceeding 25% the baseline value on either the 5- to 7-h scan or the 40- to 44-h scan were considered significant. Results: With the proposed sequential imaging protocol and a 25% change threshold, responders to treatment could be separated from nonresponders with a 94% accuracy (16/17 patients). Conclusion: Sequential ^99mTc-HYNIC-annexin V imaging may allow for assessment of the response to chemotherapy within 3 d after treatment initiation.

Key Words: ^99mTc-HYNIC • annexin V • chemotherapy

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