Dr. Tirosh: Novel Prognostic Markers in Patients with Neuroendocrine Tumors

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Use of radiolabeled somatostatin analogues to evaluate NET disease and its progression.

Health & Medicine

Novel Prognostic Markers in Patients with
Neuroendocrine Tumors
Amit Tirosh, MD
Endocrine Oncology Branch
National Cancer Institute, NIH
Capitol Area Carcinoid Survivors Group Meeting
January 13th, 2018

Percision (personalized) medicine

Total 68Ga-DOTATATE-Avid Volume and NET Prognosis
Background
Strosberg et al NEJM 2017, Sadowski et al JCO 2016,
Schmid et al Neuroendocrinology 2012, Marincek et al J Transl Med 2013
• NETs typically express somatostatin receptors.
• Radiolabeled somatostatin analogues can be used in NET.
• 68Ga-DOTATATE PET/CT is superior to anatomic imaging
(CT/MRI) and functional imaging (18F-FDG-PET, Octreoscan)
in NETs.
Radioactive
isotope
Somatostatin
analogue
Objective- To evaluate the prognostic utility of 68Ga-DOTATATE-based volumetric
measurements in patients with NET.

Total68Ga-DOTATATE-Avid Volume and NET Prognosis
Patients and methods
• A prospective study including 184 patients with
68Ga-DOTATATE avid NETs.
• Study frame-
Pancreas (54%)Small intestine
(31%)
Unknown (7%)
Other (8%)
68Ga-DOTATATE TV
measurement
Proof of
concept
Setting 68Ga-DOTATATE TV
cutoff
Cutoff
validation
Other: gastric, duodenal, rectal, lung,
and appendiceal NETs

Total 68Ga-DOTATATE-Avid Volume and NET Prognosis
Results - 68Ga-DOTATATE TV measurement
• Semi-automatic, SUVmax threshold segmentation method.
68Ga-DOTATATE TV
measurement
Proof of concept
Setting 68Ga-
DOTATATE TV
cutoff
Cutoff validation
Tirosh et al. Gastroenterology, 2017

68Ga-DOTATATE TV
measurement
Proof of concept
Setting 68Ga-
DOTATATE TV
cutoff
Cutoff validation
Total 68Ga-DOTATATE-Avid Volume and NET Prognosis
Results
Disease-specific mortality
by 68Ga-DOTATATE TV quartiles
Progression-free survival
by 68Ga-DOTATATE TV quartiles
Tirosh et al. Gastroenterology, 2017

68Ga-DOTATATE TV
measurement
Proof of concept
Setting 68Ga-
DOTATATE TV
cutoff
Cutoff validation
Total 68Ga-DOTATATE-Avid Volume and NET Prognosis
ROC curve analysis – DSM by 68Ga-DOTATATE TV
Tirosh et al. Gastroenterology, 2017

68Ga-DOTATATE TV
measurement
Proof of concept
Setting 68Ga-
DOTATATE TV
cutoff
Cutoff validation
Total 68Ga-DOTATATE-Avid Volume and NET Prognosis
Risk for DSM and disease progression by 68Ga-DOTATATE TV cutoff
Pancreatic
NETs
Small-intestine
NETs
Disease-specific mortality Progression-free survival
Tirosh et al. Gastroenterology, 2017

Thank you!

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1. Novel Prognostic Markers in Patients with Neuroendocrine Tumors Amit Tirosh, MD Endocrine Oncology Branch National Cancer Institute, NIH Capitol Area Carcinoid Survivors Group Meeting January 13th, 2018

2. Percision (personalized) medicine

3. Total 68Ga-DOTATATE-Avid Volume and NET Prognosis Background Strosberg et al NEJM 2017, Sadowski et al JCO 2016, Schmid et al Neuroendocrinology 2012, Marincek et al J Transl Med 2013 • NETs typically express somatostatin receptors. • Radiolabeled somatostatin analogues can be used in NET. • 68Ga-DOTATATE PET/CT is superior to anatomic imaging (CT/MRI) and functional imaging (18F-FDG-PET, Octreoscan) in NETs. Radioactive isotope Somatostatin analogue Objective- To evaluate the prognostic utility of 68Ga-DOTATATE-based volumetric measurements in patients with NET.

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5. Total 68Ga-DOTATATE-Avid Volume and NET Prognosis Results - 68Ga-DOTATATE TV measurement • Semi-automatic, SUVmax threshold segmentation method. 68Ga-DOTATATE TV measurement Proof of concept Setting 68Ga- DOTATATE TV cutoff Cutoff validation Tirosh et al. Gastroenterology, 2017

6. 68Ga-DOTATATE TV measurement Proof of concept Setting 68Ga- DOTATATE TV cutoff Cutoff validation Total 68Ga-DOTATATE-Avid Volume and NET Prognosis Results Disease-specific mortality by 68Ga-DOTATATE TV quartiles Progression-free survival by 68Ga-DOTATATE TV quartiles Tirosh et al. Gastroenterology, 2017

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