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@ARTICLE{Seifert:275761,
author = {R. Seifert$^*$ and T. Telli$^*$ and B. Hadaschik$^*$ and W.
P. Fendler$^*$ and P. H. Kuo and K. Herrmann$^*$},
title = {{I}s 18{F}-{FDG} {PET} {N}eeded to {A}ssess 177{L}u-{PSMA}
{T}herapy {E}ligibility? {A} {VISION}-like,
{S}ingle-{C}enter {A}nalysis.},
journal = {Journal of nuclear medicine},
volume = {64},
number = {5},
issn = {0097-9058},
address = {New York, NY},
publisher = {Soc.},
reportid = {DKFZ-2023-00860},
pages = {731 - 737},
year = {2023},
abstract = {18F-FDG and prostate-specific membrane antigen (PSMA) PET
have been used to assess eligibility for PSMA-targeted
therapy by some centers. However, it remains unclear whether
both examinations are needed as a part of workup in the
clinical practice or whether PSMA PET alone, as was done in
the positive phase 3 VISION trial, is sufficient to identify
suitable candidates. The aim was to reanalyze all patients
who underwent both 18F-FDG and PSMA PET for PSMA-targeted
therapy eligibility assessment using the VISION trial
criteria. Methods: Eighty-nine men with metastatic
castration-resistant prostate cancer referred to 177Lu-PSMA
therapy from June 2019 to October 2021 who underwent both
18F-FDG and PSMA PET (using either 68Ga-PSMA-11 or
18F-PSMA-1007) examinations within 2 wk were included in
this analysis. Eligibility status was determined in
accordance with either knowledge of both 18F-FDG and PSMA
PET (clinical routine) or VISION criteria with PSMA PET-only
(study reassessment, done twice with liver only for PSMA-11
and liver/spleen as reference for PSMA-1007). A metastasis
seen on 18F-FDG PET or CT but not on PSMA PET was denoted as
a mismatch finding and led to exclusion from 177Lu-PSMA
therapy. On the basis of clinical assessment, 52 patients
received 177Lu-PSMA therapy, and 37 did not; all patients
were reassessed. Results: Patients treated with 177Lu-PSMA
therapy had significantly longer overall survival than those
not treated (12.4 vs. 6.8 mo, P < 0.01). PSMA-only analysis
(spleen/liver reference) and 18F-FDG/PSMA mismatch reads had
substantial agreement (Cohen κ = 0.73). Eighteen percent (n
= 16/89) of patients had a mismatch finding based on
18F-FDG/PSMA PET. With the liver/spleen reference, a minor
fraction of patients who had no mismatch finding (and were
therefore treated) would have been withheld from therapy by
PSMA-only analysis $(3\%).$ Three percent (n = 3) of all
patients had an 18F-FDG/PSMA mismatch finding not detected
by PSMA PET-only (VISION-like) analysis. For patients not
receiving PSMA therapy, the overall survival was not
statistically significantly different comparing 18F-FDG/PSMA
mismatch versus nonmismatch (P = 0.61) patients. Conclusion:
18F-FDG and PSMA PET provide complementary information, yet
less than $5\%$ of patients had mismatch findings not
detected using PSMA PET-only. Based on our data,
18F-FDG/PSMA mismatch examination and PSMA-only analysis
have a substantial level of agreement.},
keywords = {Male / Humans / Fluorodeoxyglucose F18 /
Radiopharmaceuticals: therapeutic use / Dipeptides:
therapeutic use / Prostate-Specific Antigen / Prostatic
Neoplasms, Castration-Resistant: diagnostic imaging /
Prostatic Neoplasms, Castration-Resistant: radiotherapy /
Prostatic Neoplasms, Castration-Resistant: drug therapy /
Positron Emission Tomography Computed Tomography / Lutetium:
therapeutic use / Heterocyclic Compounds, 1-Ring:
therapeutic use / Treatment Outcome / PET (Other) / PSMA
therapy (Other) / PSMA-1007 (Other) / PSMA-11 (Other) /
prostate cancer (Other) / Fluorodeoxyglucose F18 (NLM
Chemicals) / Radiopharmaceuticals (NLM Chemicals) /
Dipeptides (NLM Chemicals) / Prostate-Specific Antigen (NLM
Chemicals) / Lutetium (NLM Chemicals) / Heterocyclic
Compounds, 1-Ring (NLM Chemicals)},
cin = {ED01},
ddc = {610},
cid = {I:(DE-He78)ED01-20160331},
pnm = {899 - ohne Topic (POF4-899)},
pid = {G:(DE-HGF)POF4-899},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:36522186},
doi = {10.2967/jnumed.122.264741},
url = {https://inrepo02.dkfz.de/record/275761},
}