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J Nucl Med. 2015 Mar;56(3):354-60. doi: 10.2967/jnumed.114.146936. Epub 2015 Jan 29.

Castration-resistant prostate cancer bone metastasis response measured by 18F-fluoride PET after treatment with dasatinib and correlation with progression-free survival: results from American College of Radiology Imaging Network 6687.

Author information

1
University of Washington, Seattle, Washington evanyu@uw.edu.
2
Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island.
3
University of Washington, Seattle, Washington.
4
Duke University, Durham, North Carolina.
5
Oregon Health & Science University, Portland, Oregon.
6
Dana-Farber Cancer Institute, Boston, Massachusetts.
7
University of Pennsylvania, Philadelphia, Pennsylvania.
8
American College of Radiology Imaging Network (ACRIN), Philadelphia, Pennsylvania; and.
9
University of California San Francisco, San Francisco, California.

Abstract

(18)F-fluoride PET quantitatively images bone metabolism and may serve as a pharmacodynamic assessment for systemic therapy such as dasatinib, a potent SRC kinase inhibitor, with activity in bone.

METHODS:

This was an imaging companion trial (American College of Radiology Imaging Network [ACRIN] 6687) to a multicenter metastatic castration-resistant prostate cancer (CRPC) tissue biomarker-guided therapeutic trial (NCT00918385). Men with bone metastatic CRPC underwent (18)F-fluoride PET before and 12 weeks after initiation of dasatinib (100 mg daily). Dynamic imaging was performed over a 15-cm field of view for trial assessments. The primary endpoint was to determine whether changes in (18)F-fluoride incorporation in tumor and normal bone occurred in response to dasatinib. Other endpoints included differential effect of dasatinib between (18)F-fluoride incorporation in tumor and normal bone, (18)F-fluoride transport in bone metastases, correlation with progression-free survival (PFS), prostate-specific antigen, and markers of bone turnover.

RESULTS:

Eighteen participants enrolled, and 17 underwent interpretable baseline (18)F-fluoride PET imaging before initiation of dasatinib. Twelve of 17 patients underwent on-treatment PET imaging. Statistically significant changes in response to dasatinib were identified by the SUVmaxavg (average of maximum standardized uptake value [SUVmax] for up to 5 tumors within the dynamic field of view) in bone metastases (P = 0.0002), with a significant differential (18)F-fluoride PET response between tumor and normal bone (P < 0.0001). Changes in (18)F-fluoride incorporation in bone metastases had borderline correlation with PFS by SUVmaxavg (hazard ratio, 0.91; 95% confidence interval, 0.82-1.00; P = 0.056). Changes by SUVmaxavg correlated with bone alkaline phosphatase (P = 0.0014) but not prostate-specific antigen (P = 0.47).

CONCLUSION:

This trial provides evidence of the ability (18)F-fluoride PET to delineate treatment response of dasatinib in CRPC bone metastases with borderline correlation with PFS.

KEYWORDS:

18F-fluoride PET; bone metastases; dasatinib; metastatic castration-resistant prostate cancer

PMID:
25635138
PMCID:
PMC4410847
DOI:
10.2967/jnumed.114.146936
[Indexed for MEDLINE]
Free PMC Article

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