Impact of Tumor Burden on Normal Organ Distribution in Patients Imaged with CXCR4-Targeted [68Ga]Ga-PentixaFor PET/CT

Sebastian E Serfling, Constantin Lapa, Niklas Dreher, Philipp E Hartrampf, Steven P Rowe, Takahiro Higuchi, Andreas Schirbel, Alexander Weich, Stefanie Hahner, Martin Fassnacht, Andreas K Buck, Rudolf A Werner, Sebastian E Serfling, Constantin Lapa, Niklas Dreher, Philipp E Hartrampf, Steven P Rowe, Takahiro Higuchi, Andreas Schirbel, Alexander Weich, Stefanie Hahner, Martin Fassnacht, Andreas K Buck, Rudolf A Werner

Abstract

Background: CXCR4-directed positron emission tomography/computed tomography (PET/CT) has been used as a diagnostic tool in patients with solid tumors. We aimed to determine a potential correlation between tumor burden and radiotracer accumulation in normal organs.

Methods: Ninety patients with histologically proven solid cancers underwent CXCR4-targeted [68Ga]Ga-PentixaFor PET/CT. Volumes of interest (VOIs) were placed in normal organs (heart, liver, spleen, bone marrow, and kidneys) and tumor lesions. Mean standardized uptake values (SUVmean) for normal organs were determined. For CXCR4-positive tumor burden, maximum SUV (SUVmax), tumor volume (TV), and fractional tumor activity (FTA, defined as SUVmean x TV), were calculated. We used a Spearman's rank correlation coefficient (ρ) to derive correlative indices between normal organ uptake and tumor burden.

Results: Median SUVmean in unaffected organs was 5.2 for the spleen (range, 2.44 - 10.55), 3.27 for the kidneys (range, 1.52 - 17.4), followed by bone marrow (1.76, range, 0.84 - 3.98), heart (1.66, range, 0.88 - 2.89), and liver (1.28, range, 0.73 - 2.45). No significant correlation between SUVmax in tumor lesions (ρ ≤ 0.189, P ≥ 0.07), TV (ρ ≥ -0.204, P ≥ 0.06) or FTA (ρ ≥ -0.142, P ≥ 0.18) with the investigated organs was found.

Conclusions: In patients with solid tumors imaged with [68Ga]Ga-PentixaFor PET/CT, no relevant tumor sink effect was noted. This observation may be of relevance for therapies with radioactive and non-radioactive CXCR4-directed drugs, as with increasing tumor burden, the dose to normal organs may remain unchanged.

Keywords: C-X-C motif chemokine receptor 4; CXCR4; Endoradiotherapy; PET; Theranostics; [177Lu]/[90Y]PentixaTher; [68Ga]PentixaFor.

Conflict of interest statement

The authors declare no conflict of interest.

© 2022. The Author(s).

Figures

Fig. 1.
Fig. 1.
Correlations of mean standardized uptake values (SUVmean) from organs (a, heart; b, liver; c, spleen; d, bone marrow; and e, kidney) with tumor-derived maximum standardized uptake values (SUVmax). Rhombuses and squares are partially overlaid. No significance was reached. R = right. L = left
Fig. 2.
Fig. 2.
Correlations of mean standardized uptake values (SUVmean) from organs (a, heart; b, liver; c, spleen; d, bone marrow; and e, kidney) with PET-based tumor volume (cm3). No significance was reached. Rhombuses and squares are partially overlaid. R = right. L = left
Fig. 3.
Fig. 3.
Planar maximum intensity projection (MIP) of patients with different tumor burden which have been scanned using [68Ga]Ga-PentixaFor PET. Patient in (a) has low, patient in (b) has intermediate and patient in (c) has high tumor burden. Red arrows indicate tumor lesions. On a visual assessment, normal organ uptake did not decrease in patients with high tumor burden. Due to the extensive tumor burden in (c), bone marrow (BM) was not marked. H = heart, L = liver, K = kidney, and S = spleen

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Source: PubMed

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