Abstract
PurposeThe main objective of this preliminary analysis of the IMaging PAtients for Cancer drug selecTion (IMPACT)-renal cell cancer (RCC) study is to evaluate the lesion detection of baseline contrast-enhanced CT, [89Zr]Zr-DFO-girentuximab-PET/CT and [18F]FDG-PET/CT in detecting ccRCC lesions in patients with a good or intermediate prognosis metastatic clear cell renal cell carcinoma (mccRCC) according to the International Metastatic Database Consortium (IMDC) risk model.MethodsBetween February 2015 and March 2018, 42 newly diagnosed mccRCC patients with good or intermediate prognosis, eligible for watchful waiting, were included. Patients underwent CT, [89Zr]Zr-DFO-girentuximab-PET/CT and [18F]FDG-PET/CT at baseline. Scans were independently reviewed and lesions of ≥10 mm and lymph nodes of ≥15 mm at CT were analyzed. For lesions with [89Zr]Zr-DFO-girentuximab or [18F]FDG-uptake visually exceeding background uptake, maximum standardized uptake values (SUVmax) were measured.ResultsA total of 449 lesions were detected by ≥1 modality (median per patient: 7; ICR 4.25–12.75) of which 42% were in lung, 22% in lymph nodes and 10% in bone. Combined [89Zr]Zr-DFO-girentuximab-PET/CT and CT detected more lesions than CT alone: 91% (95%CI: 87–94) versus 56% (95%CI: 50–62, p = 0.001), respectively, and more than CT and [18F]FDG-PET/CT combined (84% (95%CI:79–88, p < 0.005). Both PET/CTs detected more bone and soft tissue lesions compared to CT alone.ConclusionsThe addition of [89Zr]Zr-DFO-girentuximab-PET/CT and [18F]FDG-PET/CT to CT increases lesion detection compared to CT alone in newly diagnosed good and intermediate prognosis mccRCC patients eligible for watchful waiting.
Highlights
Renal cell carcinoma (RCC) accounts for 2% of all malignancies worldwide, with an estimated 403,262 new cases in 2018
The addition of [89Zr]Zr-DFO-girentuximab-PET/computed tomography (CT) and [18F]FDG-PET/CT to CT increases lesion detection compared to CT alone in newly diagnosed good and intermediate prognosis metastatic clear cell renal cell carcinoma (mccRCC) patients eligible for watchful waiting
In this prospective multicenter cohort study, patients aged 18 years and older with histologically or cytologically proven RCC with a clear cell component, recently (
Summary
Renal cell carcinoma (RCC) accounts for 2% of all malignancies worldwide, with an estimated 403,262 new cases in 2018. Seventy percent have a clear cell component. Metastatic clear cell (mcc) RCC has a variable course, with a subgroup of patients showing slow disease progression. In those patients, it is safe to observe the course of disease in a period of socalled watchful waiting, avoiding unnecessary side-effects and costs of systemic treatment. To identify patients eligible for watchful waiting, prognostic schemes such as the International Metastatic Database Consortium (IMDC) risk model have been used to differentiate between patients with a good, intermediate or poor prognosis [1, 2]. For staging mRCC, European Society of Medical Oncology (ESMO) guidelines mandate contrast-enhanced computed tomography (CT) of chest, abdomen and pelvis [3]
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