Development of sodium fluoride PET response criteria for solid tumours (NAFCIST) in a clinical trial of radium-223 in osteosarcoma: from RECIST to PERCIST to NAFCIST. (28th February 2019)

• Record Type: Journal Article
• Authors: Kairemo, Kalevi; Rohren, Eric M; Anderson, Pete M; Ravizzini, Gregory; Rao, Arvind; Macapinlac, Homer A; Subbiah, Vivek
• Is Part Of: ESMO open. Volume 4(2019)Supplement 1
• Publication Date: 2019-02-28
• Subjects: osteosarcoma -- 223RaCl2 -- Na18F PET -- 18F-FDG PET -- bone scintigraphy -- RECIST -- PERCIST -- Imaging; Cancer -- Periodicals; 616.994005
• DOI: 10.1136/esmoopen-2018-000439
• Languages: English
• ISSNs: 2059-7029

Abstract

Abstract : Purpose: The development of osteosarcoma therapeutics has been challenging, in part because of the lack of appropriate criteria to evaluate responses. We developed a novel criteria in a clinical trial of radium-223 dichloride ( 223 RaCl2 ) for response assessment in osteosarcoma, NAFCIST (Na 18 F PET response Criteria in Solid Tumors). Experimental design: Patients received one to six cycles of 223 RaCl2, and cumulative doses varied from 6.84 MBq to 57.81 MBq. Molecular imaging with technetium-99m phosphonate scintigraphy, fluorine-18-fluorodeoxyglucose ( 18 FDG) positron emission tomography (PET) or sodium fluoride-18 (Na 18 F) PET was used to characterise the disease. Correlation of biomarkers and survival was analysed with NAFCIST measure from Na 18 F PET. Results: Of the 18 patients, 17 had bone lesions visible in at least one of the imaging studies. In four of seven patients with multiple skeletal lesions (>5), FDG PET and NaF PET studies could be compared. The skeletal tumour locations varied in our patient population: cranium=2, extremities=7, pelvis=10, spine=12 and thorax=9. The 18 F-FDG PET and Na 18 F PET studies could be compared in all four patients who had multiple lung lesions (>5). Overall the Response Evaluation Criteria in Solid Tumors response was seen in one patient, but four patients experienced mixed responses better defined by Na 18 F PET. Changes in NAFCIST were correlated with changes in bone alkaline phosphatase levels (r=0.54) and negatively with cumulative dose of 223 RaCl2 (r=− 0.53). NAFCIST correlated with overall survival (p value of 0.037) while the PERCIST (PET Response Criteria in Solid Tumors) did not (p value of 0.19). Conclusions: Our results indicate that Na 18 F PET should be further studied in osteosarcoma staging. NAFCIST may be a promising criteria for high-risk osteosarcoma response evaluation and correlates with survival. Further validation studies are needed.