Improved identification of patients with oligometastatic clear cell renal cell carcinoma with PSMA-targeted 18 F-DCFPyL PET/CT

Ann Nucl Med. 2019 Aug;33(8):617-623. doi: 10.1007/s12149-019-01371-8. Epub 2019 May 30.

Abstract

Objective: Complete surgical resection of metastatic sites has been shown to prolong survival in select patients with oligometastatic RCC. This treatment strategy is dependent upon the accurate characterization of a patient's extent of disease. The objective of this study was to explore the utility of PSMA-targeted 18F-DCFPyL PET/CT in patients with presumed oligometastatic clear cell RCC.

Methods: This is a subset analysis of a prospective study in which patients with RCC were imaged with 18F-DCFPyL PET/CT (ClinicalTrials.gov identifier NCT02687139). In the present analysis, patients with oligometastatic clear cell RCC, defined as ≤ 3 metastatic lesions on conventional imaging, were evaluated. 18F-DCFPyL PET/CT scans were reviewed for sites of disease and compared to conventional imaging.

Results: The final cohort included 14 patients with oligometastatic clear cell RCC. Conventional imaging revealed 21 metastatic lesions and 3 primary tumors. 18F-DCFPyL PET/CT detected 29 sites of metastatic disease and 3 primary tumors. Of the 21 metastatic lesions detected on conventional imaging, 17 (81.0%) had radiotracer uptake. Additionally, all 3 primary tumors had radiotracer uptake. In 4 (28.6%) patients a total of 12 more lesions were identified on 18F-DCFPyL PET/CT than conventional imaging. Notably, 3 (21.4%) patients were no longer considered oligometastatic. The detection rates of conventional imaging and 18F-DCFPyL PET/CT for identifying sites of disease were 66.7% and 88.9%, respectively.

Conclusions: PSMA-targeted PET/CT appears to aid in the identification of patients with oligometastatic clear cell RCC. If borne out in future studies, this suggests that PSMA-targeted imaging has the potential to help select candidates for metastasis-directed therapy.

Keywords: Clear cell; Oligometastatic; PSMA; Renal cell carcinoma.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Renal Cell / diagnostic imaging*
  • Carcinoma, Renal Cell / metabolism
  • Carcinoma, Renal Cell / pathology*
  • Female
  • Glutamate Carboxypeptidase II / metabolism*
  • Humans
  • Kidney Neoplasms / diagnostic imaging*
  • Kidney Neoplasms / metabolism
  • Kidney Neoplasms / pathology*
  • Lysine / analogs & derivatives*
  • Male
  • Middle Aged
  • Neoplasm Metastasis
  • Positron Emission Tomography Computed Tomography*
  • Prospective Studies
  • Urea / analogs & derivatives*

Substances

  • 2-(3-(1-carboxy-5-((6-fluoropyridine-3-carbonyl)amino)pentyl)ureido)pentanedioic acid
  • Urea
  • Glutamate Carboxypeptidase II
  • Lysine

Associated data

  • ClinicalTrials.gov/NCT02687139