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Research ArticleClinical Investigation

68Ga-PSMA PET/CT for Response Assessment and Outcome Prediction in Metastatic Prostate Cancer Patients Treated with Taxane-Based Chemotherapy

Qaid Ahmed Shagera, Carlos Artigas, Ioannis Karfis, Gabriela Critchi, Nieves Martinez Chanza, Spyridon Sideris, Alexandre Peltier, Marianne Paesmans, Thierry Gil and Patrick Flamen
Journal of Nuclear Medicine August 2022, 63 (8) 1191-1198; DOI: https://doi.org/10.2967/jnumed.121.263006
Qaid Ahmed Shagera
1Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium;
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Carlos Artigas
1Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium;
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Ioannis Karfis
1Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium;
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Gabriela Critchi
1Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium;
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Nieves Martinez Chanza
2Department of Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium;
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Spyridon Sideris
2Department of Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium;
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Alexandre Peltier
3Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; and
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Marianne Paesmans
4Biostatistics Unit Data Centre, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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Thierry Gil
2Department of Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium;
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Patrick Flamen
1Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium;
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Abstract

We aimed to evaluate the role of PET targeting the prostate-specific membrane antigen (PSMA) for response assessment in metastatic prostate cancer (PCa) patients treated with taxane-based chemotherapy (docetaxel or cabazitaxel) and its predictive value on patient outcome. Methods: We retrospectively evaluated 37 patients with metastatic hormone-sensitive PCa or metastatic castration-resistant PCa (mCRPC) who underwent 68Ga-PSMA-11 PET/CT at baseline and after the last cycle of taxane-based chemotherapy (docetaxel or cabazitaxel) without treatment modification between scans. Biochemical response (BR) was defined as an undetectable or at least 50% decreased level of prostate-specific antigen, compared with baseline. Associations between BR and different PET parameters were tested. A cutoff of at least a 30% decrease in PSMA total tumor volume (PSMA-TV) was used to define a PSMA response (PSMA-R) versus a PSMA nonresponse (PSMA-NR). Correlations between PSMA PET/CT response and BR were evaluated using the ϕ-coefficient. Associations between PET response and overall survival (OS) was tested using Cox regression and the Kaplan–Meier method. Results: Our cohort comprised 8 (22%) metastatic hormone-sensitive PCa and 29 (78%) mCRPC patients. Twenty-one patients received docetaxel treatment, and 16 received cabazitaxel (median, 6 cycles; interquartile range, 5–8 cycles). BR was found in 18 of 37 patients. Using PSMA total tumor volume, PSMA PET/CT response was concordant with BR in 35 of 37 patients (ϕ = 0.89, P < 0.0001). Eighteen of 37 patients had PSMA-R (6, complete response; 12, partial response), and 19 had PSMA-NR (17, progressive disease; 2, stable disease). After a median follow-up of 23 mo, there was a statistically significant longer OS for PSMA-R than for PSMA-NR (median OS not reached vs. 12 mo, respectively; hazard ratio, 0.10; 95% CI, 0.03–0.39; P = 0.001) for the entire population. Among the mCRPC subgroup, differences in OS were also observed (median, 22 vs. 12 mo, respectively; hazard ratio, 0.22; 95% CI, 0.06–0.82; P = 0.023), with a 12-mo OS rate of 100% for PSMA-R and 52% for PSMA-NR (P = 0.011). Conclusion: This retrospective analysis suggests that 68Ga-PSMA-11 PET/CT is a promising imaging modality for assessing response to taxane-based chemotherapy in metastatic PCa. Changes in PSMA expression might be used as a predictive biomarker for OS to help tailor individual therapy and select eligible patients for clinical trials.

  • PSMA
  • PET/CT
  • prostate cancer
  • response
  • chemotherapy

Footnotes

  • Published online Nov. 12, 2021.

  • © 2022 by the Society of Nuclear Medicine and Molecular Imaging.
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Journal of Nuclear Medicine: 63 (8)
Journal of Nuclear Medicine
Vol. 63, Issue 8
August 1, 2022
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68Ga-PSMA PET/CT for Response Assessment and Outcome Prediction in Metastatic Prostate Cancer Patients Treated with Taxane-Based Chemotherapy
Qaid Ahmed Shagera, Carlos Artigas, Ioannis Karfis, Gabriela Critchi, Nieves Martinez Chanza, Spyridon Sideris, Alexandre Peltier, Marianne Paesmans, Thierry Gil, Patrick Flamen
Journal of Nuclear Medicine Aug 2022, 63 (8) 1191-1198; DOI: 10.2967/jnumed.121.263006

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68Ga-PSMA PET/CT for Response Assessment and Outcome Prediction in Metastatic Prostate Cancer Patients Treated with Taxane-Based Chemotherapy
Qaid Ahmed Shagera, Carlos Artigas, Ioannis Karfis, Gabriela Critchi, Nieves Martinez Chanza, Spyridon Sideris, Alexandre Peltier, Marianne Paesmans, Thierry Gil, Patrick Flamen
Journal of Nuclear Medicine Aug 2022, 63 (8) 1191-1198; DOI: 10.2967/jnumed.121.263006
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Keywords

  • PSMA
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  • response
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