Abstract
Nintedanib is an oral angiokinase inhibitor used as a second-line treatment for non-small-cell lung cancer (NSCLC). New radiotracers, such as 68Ga-DOTA-E-[c(RGDfK)]2, that target αvβ3 integrin might impact the clinical practice as a non-invasive method for assessing angiogenesis inhibitors. Methods: From July 2014 through October 2015, 38 patients received second-line nintedanib plus docetaxel. All the patients underwent PET/CT with 68Ga-DOTA-E-[c(RGDfK)]2 radiotracer and blood-sample tests to quantify angiogenesis factors (FGF, VEGF and PDGF-AB) prior to and after completing 2 therapy cycles. Results: Of the 38 patients, 31 had available baseline and follow-up PET/CT. Baseline lung tumoral volume addressed with 68Ga-DOTA-E-[c(RGDfK)]2 PET/CT correlated with VEGF serum levels, while the baseline Lung/Liver SUVmax-Index correlated with PDGF-AB. After treatment, the overall response rate (ORR) and disease control rate (DCR) were 7.9% and 47.3%, respectively. A greater decrease in the lung tumoral volume (-37.2% vs. -27.6%) was associated with a better DCR in patients (P = 0.005). Median progression-free survival (PFS) was 3.7 months. Non-smokers and patients with a higher baseline lung tumoral volume were more likely to have a higher PFS (6.4 vs. 3.74; P = 0.023 and 6.4 vs. 2.1; P = 0.003; respectively). Overall survival (OS) was non-reached (NR). Patients with a greater decrease in Lung SUVmax (NR vs. 7.1 months; P = 0.016) and a greater decrease in the Lung/Spleen SUVmax Index (NR vs. 7.1; P = 0.043) were more likely to have a longer OS. Conclusion: 68Ga-DOTA-E-[c(RGDfK)]2 PET/CT is a potentially useful imaging tool to assess responses related to angiogenesis inhibitors. Further analysis and novel studies with 68Ga-DOTA-E-[c(RGDfK)]2 are warranted to identify patients who might benefit from this therapy.
- Oncology: Lung
- PET/CT
- Vascular
- αvβ3 integrin
- 68Ga-DOTA-E-[c(RGDfK)]2
- angiogenesis
- lung cancer
- nuclear medicine
- Copyright © 2017 by the Society of Nuclear Medicine and Molecular Imaging, Inc.