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Research ArticleOncology

89Zr-Bevacizumab PET: Potential Early Indicator of Everolimus Efficacy in Patients with Metastatic Renal Cell Carcinoma

Suzanne C. van Es, Adrienne H. Brouwers, Shekar V.K. Mahesh, Annemarie M. Leliveld-Kors, Igle J. de Jong, Marjolijn N. Lub-de Hooge, Elizabeth G.E. de Vries, Jourik A. Gietema and Sjoukje F. Oosting
Journal of Nuclear Medicine June 2017, 58 (6) 905-910; DOI: https://doi.org/10.2967/jnumed.116.183475
Suzanne C. van Es
1Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Adrienne H. Brouwers
2Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Shekar V.K. Mahesh
3Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Annemarie M. Leliveld-Kors
4Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
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Igle J. de Jong
4Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
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Marjolijn N. Lub-de Hooge
5Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Elizabeth G.E. de Vries
1Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Jourik A. Gietema
1Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Sjoukje F. Oosting
1Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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  • FIGURE 1.
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    FIGURE 1.

    Baseline 89Zr-bevacizumab PET images of mRCC patient. (A) Coronal 2-dimensional image through right adrenal gland metastasis, showing additionally 1 local recurrence in left kidney tumor, 1 kidney metastasis, and 1 soft-tissue metastasis near left iliac bone. (B) Sagittal 2-dimensional image through right adrenal gland metastasis, showing additionally 3 kidney metastases and 1 soft-tissue metastasis in abdominal wall.

  • FIGURE 2.
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    FIGURE 2.

    Median tumor tracer uptake with interquartile range per patient at baseline (light shading), after 2 wk of everolimus (medium shading), and after 6 wk of treatment (dark shading). Patients in blue stayed on treatment > 12 mo. n = number of quantified tumor lesions per patient.

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    FIGURE 3.

    (Left) Maximum-intensity projection before treatment showing multiple local recurrences in left kidney tumor and metastases in right kidney, right adrenal gland, and soft-tissue. (Right) Maximum-intensity projection after 6 wk of treatment showing heterogeneous decrease in uptake.

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    FIGURE 4.

    Tumor tracer uptake before and during treatment. (A) Median uptake and interquartile range for all lesions. (B) Mean tumor uptake per patient. *P < 0.0001.

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    FIGURE 5.

    Absolute SUVmax change with median for all lesions per patient after 2 wk (light shading) and 6 wk (dark shading) of everolimus treatment. Patients in blue stayed on treatment > 12 mo.

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    FIGURE 6.

    Plasma VEGF-A concentrations. Each line represents one patient.

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    TABLE 1

    Patient Demographics and Clinical Characteristics

    VariableData
    Sex
     Male9 (69.2)
     Female4 (30.8)
    Age (y)63 (51–71)
    Nephrectomy
     Yes11 (84.6)
     No2 (15.4)
    Histology
     Pure clear cell12 (92.3)
     Mixed1 (7.7)
    World Health Organization performance
     04 (30.8)
     12 (15.4)
     27 (53.8)
    Tumor sites
     Number4 (2–7)
     Kidney6 (46.2)
      Primary2 (15.4)
      Local recurrence2 (15.4)
      Contralateral2 (15.4)
     Lung9 (69.2)
     Lymph node7 (53.8)
     Bone6 (46.2)
     Liver5 (38.5)
     Adrenal4 (30.8)
     Muscle4 (30.8)
     Other10 (76.9)
    Previous treatment
     Tyrosine kinase inhibitor8 (61.5)
     Tyrosine kinase inhibitor and interferon alfa ± bevacizumab2 (15.4)
     Other3 (23.1)
    • Qualitative data are expressed as number followed by percentage in parentheses; continuous data are expressed as median followed by range in parentheses.

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Journal of Nuclear Medicine: 58 (6)
Journal of Nuclear Medicine
Vol. 58, Issue 6
June 1, 2017
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89Zr-Bevacizumab PET: Potential Early Indicator of Everolimus Efficacy in Patients with Metastatic Renal Cell Carcinoma
Suzanne C. van Es, Adrienne H. Brouwers, Shekar V.K. Mahesh, Annemarie M. Leliveld-Kors, Igle J. de Jong, Marjolijn N. Lub-de Hooge, Elizabeth G.E. de Vries, Jourik A. Gietema, Sjoukje F. Oosting
Journal of Nuclear Medicine Jun 2017, 58 (6) 905-910; DOI: 10.2967/jnumed.116.183475

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89Zr-Bevacizumab PET: Potential Early Indicator of Everolimus Efficacy in Patients with Metastatic Renal Cell Carcinoma
Suzanne C. van Es, Adrienne H. Brouwers, Shekar V.K. Mahesh, Annemarie M. Leliveld-Kors, Igle J. de Jong, Marjolijn N. Lub-de Hooge, Elizabeth G.E. de Vries, Jourik A. Gietema, Sjoukje F. Oosting
Journal of Nuclear Medicine Jun 2017, 58 (6) 905-910; DOI: 10.2967/jnumed.116.183475
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Keywords

  • molecular imaging
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