F-FDOPA PET/MRI for Monitoring Early Response to Bevacizumab in Children with Recurrent Brain Tumors

Overview

Journal Neurooncol Pract

Publisher Oxford University Press

Date 2018 Apr 26

PMID 29692922

Citations 10

Authors

Karen Gauvain

Maria Rosana Ponisio

Amy Barone

Michael Grimaldi

Ephraim Parent

Hayden Leeds

Manu Goyal

Joshua Rubin

Jonathan McConathy

Affiliations

Soon will be listed here.

Abstract

Background: Noninvasively predicting early response to therapy in recurrent pediatric brain tumors provides a challenge. 3,4-dihydroxy-6-[F]fluoro-L-phenylalanine (F-FDOPA) PET/MRI has not been previously studied as a tool to evaluate early response to antiangiogenic therapy in children. The purpose of this study was to evaluate the safety and feasibility of using F-FDOPA PET/MRI to assess response to bevacizumab in children with relapsed brain tumors.

Materials And Methods: Six patients with recurrent gliomas (5 low-grade, 1 high-grade) planned to undergo treatment with bevacizumab were enrolled. F-FDOPA PET/MRI scans were obtained prior to and 4 weeks following the start of treatment, and these were compared with the clinical response determined at the 3-month MRI. The primary PET measure was metabolic tumor volume (MTV) at 10 to 15 min after F-FDOPA injection. For each tumor, the MTV was determined by manually defining initial tumor volumes of interest (VOI) and then applying a 1.5-fold threshold relative to the mean standardized uptake value (SUV) of a VOI in the frontal lobe contralateral to the tumor.

Results: F-FDOPA PET/MRI was well tolerated by all patients. All tumors were well visualized with F-FDOPA on the initial study, with peak tumor uptake occurring approximately 10 min after injection. Maximum and mean SUVs as well as tumor-to-brain ratios were not predictors of response at 3 months. Changes in MTVs after therapy ranged from 23% to 98% (n = 5). There is a trend towards the percent MTV change seen on the 4-week scan correlating with progression-free survival.

Conclusion: F-FDOPA PET/MRI was well tolerated in pediatric patients and merits further investigation as an early predictor of response to therapy.

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