18F-FDOPA PET/MRI for monitoring early response to bevacizumab in children with recurrent brain tumors.

Abstract

BACKGROUND:

Noninvasively predicting early response to therapy in recurrent pediatric brain tumors provides a challenge. 3,4-dihydroxy-6-[18F]fluoro-L-phenylalanine (18F-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 18F-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. 18F-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 18F-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:

18F-FDOPA PET/MRI was well tolerated by all patients. All tumors were well visualized with 18F-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:

18F-FDOPA PET/MRI was well tolerated in pediatric patients and merits further investigation as an early predictor of response to therapy.

• Authors: Karen Gauvain, Maria Rosana Ponisio, Amy Barone, Michael Grimaldi, Ephraim Parent, Hayden Leeds, Manu Goyal, Joshua Rubin, Jonathan McConathy
• Journal: Neuro-oncology practice (Neurooncol Pract) Vol. 5 Issue 1 Pg. 28-36 (Mar 2018) ISSN: 2054-2577 [Print] England
• PMID: 29692922 (Publication Type: Journal Article)