Abstract
BackgroundOur aim was to measure the impact of two cycles of standard chemotherapy on tumoural neoangiogenesis by [18F] fluorine arginine-glycine-aspartic (RGD-K5) positron emission tomography–computed tomography (PET) on patients presenting with lymphoma. Nineteen patients at Rouen’s Henri Becquerel Cancer Centre were prospectively included. Fluorodeoxyglucose (FDG) and RGD-K5 PET were performed before (C0) and after (C2) two cycles of chemotherapy. End-of-treatment FDG PET was performed for final evaluation. Maximum standardised uptake value (SUVmax), SUVmean, Metabolic Tumour Volume (MTV) and Angiogenic Tumour Volume (ATV) were measured for all lesions. RGD SUVmax and SUVmean were also analysed in 13 normal organs at C0 and C2. The patient’s treatment response was considered using the Deauville score (DS) at the end of FDG PET treatment (DS 1–3 were considered responders, and 4 and 5 non-responders).ResultsEighteen patients had both C0 FDG and RGD PET. Twelve patients had both C2 FDG and RGD, completed the treatment protocol and were included in end-of-treatment analysis. No statistical difference was found in RGD uptake of normal organs before and after chemotherapy for SUVmax and SUVmean. On C0 RGD, apart from classical Hodgkin lymphoma (cHL; n = 5) and grey zone lymphoma (GZL; n = 1), other lymphoma sub-types (n = 12) had low RGD uptake (p < 0.001). Regarding FDG, there was no significant difference for SUVmax, SUVmean and MTV at C0 and C2 between patients with cHL and non-Hodgkin lymphoma (NHL). At C2 RGD, non-responders had higher SUVmax and SUVmean compared to responders (p < 0.001). There was no significant difference in RGD ATV between responders and non-responders.ConclusionsOur study showed significant higher initial RGD uptake in patients presenting with cHL and GZL compared to NHL. Non-responder also had higher post-chemotherapy RGD uptake compared to responders. Issues raised by RGD uptake, particularly in cHL, are yet to be explored and need to be confirmed in a larger population.
Highlights
Our aim was to measure the impact of two cycles of standard chemotherapy on tumoural neoangiogenesis by [18F] fluorine arginine-glycine-aspartic (RGD-K5) positron emission tomography–computed tomography (PET) on patients presenting with lymphoma
Positron emission tomography–computed tomography (PET) using tracers for the assessment of glucose metabolism by [18F] fluorodeoxyglucose (FDG) is well established, and it plays a crucial role in initial staging and treatment response assessment, especially in patients with lymphoma [2]
Li et al recently showed that high RGD uptake on pre-treatment PET predicted antiangiogenic response in refractory patients presenting with solid cancer [5]
Summary
Our aim was to measure the impact of two cycles of standard chemotherapy on tumoural neoangiogenesis by [18F] fluorine arginine-glycine-aspartic (RGD-K5) positron emission tomography–computed tomography (PET) on patients presenting with lymphoma. Tonnelet et al EJNMMI Res (2021) 11:37 cancer progression by suppressing the tumour’s blood supply, and more than 20 angiogenic growth factors have been studied, including their receptors and signal transduction pathways This increasing use of targeted therapies has led to a growing demand for imaging the tumour response to these treatments. It has been found that several ECM proteins, like vitronectin, fibrinogen and fibronectin, interact with integrins via the amino acid sequence arginine–glycine–aspartic acid (RGD in the single letter code) [3] Based on these findings, monomeric, multimeric and cyclic peptides, including the RGD sequence have been introduced to allow integrin αvβ imaging and picture pathological angiogenesis. Li et al recently showed that high RGD uptake on pre-treatment PET predicted antiangiogenic response in refractory patients presenting with solid cancer [5]. RGD imaging could be used for response assessment of antiangiogenic therapies
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