Search

[West J Emerg Med. 2011;12(4):371.]

Although combination therapy is the standard of care for relapsed/refractory non-Hodgkin's lymphoma (RR-NHL), combination treatment chosen for an individual patient is empirical, and response rates remain poor in individuals with chemotherapy-resistant disease. Here, we evaluate an experimental-analytic method, quadratic phenotypic optimization platform (QPOP), for prediction of patient-specific drug combination efficacy from a limited quantity of biopsied tumor samples. In this prospective study, we enrolled 71 patients with RR-NHL (39 B cell NHL and 32 NK/T cell NHL) with a median of two prior lines of treatment, at two academic hospitals in Singapore from November 2017 to August 2021. Fresh biopsies underwent ex vivo testing using a panel of 12 drugs with known efficacy against NHL to identify effective single and combination treatments. Individualized QPOP reports were generated for 67 of 75 patient samples, with a median turnaround time of 6 days from sample collection to report generation. Doublet drug combinations containing copanlisib or romidepsin were most effective against B cell NHL and NK/T cell NHL samples, respectively. Off-label QPOP-guided therapy offered at physician discretion in the absence of standard options (n = 17) resulted in five complete responses. Among patients with more than two prior lines of therapy, the rates of progressive disease were lower with QPOP-guided treatments than with conventional chemotherapy. Overall, this study shows that the identification of patient-specific drug combinations through ex vivo analysis was achievable for RR-NHL in a clinically applicable time frame. These data provide the basis for a prospective clinical trial evaluating ex vivo–guided combination therapy in RR-NHL. Predicting possibilities with PDXs: Patients with non-Hodgkin's lymphomas (NHLs) often relapse after frontline treatment, and interpatient heterogeneity make personalized combination treatment difficult. Goh et al. have developed a hybrid experimental-analytic method that they call quadratic phenotypic optimization platform, or QPOP, to identify personalized drug combination therapies using ex vivo patient samples to improve patient outcomes. In a prospective cohort, physicians were able to alter treatment according to drug combinations identified using QPOP after 6 days to achieve complete responses in 5 of 17 patients with NHL. This is a promising step for providing new hope for patients who have relapsed NHL and provides a foundation for further clinical trials. [ABSTRACT FROM AUTHOR]

Background Increased somatostatin receptor (SSTR) expression in patients with undifferentiated nasopharyngeal carcinoma (NPC) has been demonstrated with receptor autoradiography, 111In-Octreotide scintigraphy, and 68Ga-DOTA-TOC positron emission tomography (PET)/CT imaging. We sought to compare and correlate the uptake of fluorodeoxyglucose (FDG) and DOTA-NOC in undifferentiated NPC to ascertain the possible role of 68Ga-DOTA-NOC PET/CT as a new imaging biomarker and to assess whether targeted peptide receptor radionuclide therapy is a feasible treatment option. Methods After obtaining approval from our institutional review board, 4 patients with biopsy proven nonkeratinizing undifferentiated NPC who had just undergone routine staging/restaging 18F-FDG PET/CT imaging were prospectively and consecutively recruited for 68Ga-DOTA-NOC PET/CT imaging. Of these 4 patients, 3 were newly diagnosed with untreated NPC, whereas 1 patient was diagnosed with a case of recurrent NPC with previous treatment. These patients subsequently underwent 68Ga-DOTA-NOC PET/CT within 10 days from the 18F-FDG PET/CT to ensure lesion comparability. Tracer uptake in tumor lesions were assessed visually and semiquantitatively by measuring maximum standardized uptake values (SUVmax). Results There were 12 FDG-avid lesions of which 7 showed avid uptake of DOTA-NOC greater than liver uptake, whereas 5 showed low uptake of DOTA-NOC less than liver uptake. Subset analysis of the FDG-avid lesions at the primary and recurrent sites showed that all the FDG-avid primary tumors in the nasopharynx showed avid uptake of DOTA-NOC. On the contrary, the case of recurrent NPC showed avid FDG uptake but low DOTA-NOC uptake. Subset analysis of the suspicious FDG-avid cervical lymph nodes showed that 50% of them demonstrated avid DOTA-NOC uptake greater than liver uptake, whereas the remaining demonstrated low-grade DOTA-NOC uptake less than liver uptake. The 2 subcentimeter cervical lymph nodes that showed low-grade uptake of FDG lower than mediastinal blood pool activity were deemed to be reactive/inflammatory and showed low-grade uptake of DOTA-NOC. Conclusion This study highlights the potential of 68Ga-DOTA-peptide PET/CT as a new molecular biomarker for newly diagnosed undifferentiated NPC, and less so for recurrent NPC and metastatic nodes. This potentially opens up new diagnostic and therapeutic options in the management of undifferentiated NPC. © 2015 Wiley Periodicals, Inc. Head Neck 38: E76-E80, 2016 [ABSTRACT FROM AUTHOR]

The article presents a case study of a 31-year-old man who was presented with progressive swelling of the left forearm. Topics discussed include the magnetic resonance imaging (MRI) performed on the patient; the fluorodeoxyglucose (FDG)-avid left forearm soft tissue mass revealed in positron emission tomography; and the diagnosis of a diffuse large B-cell lymphoma (DLBCL) in the patient. Also mentioned are the drugs used for the patient's treatment, including rituximab and doxorubicin.

Desmoplastic small round cell tumor (DSRCT) is an exceptionally rare and highly aggressive primary peritoneal neoplasm predominantly seen in adolescents and young adults. Despite the availability of various treatment modalities, the prognosis remains grim due to the tumor's aggressive nature and tendency for widespread metastasis. Although imaging of DSRCT is frequently documented using computed tomography (CT), the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the initial diagnosis, staging, and particularly in the follow-up evaluation, is less explored. This case report details the role and efficacy of 18F-FDG PET/CT in the follow-up of a patient with extensive peritoneal involvement by DSRCT, demonstrating its added advantage in monitoring treatment response over conventional CT imaging., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Huang et al.)

Introduction: This study determines the sensitivity and specificity of positron emission tomography/magnetic resonance imaging (PET/MRI) parameters in predicting treatment response in patients with localised rectal cancer who have undergone preoperative chemoradiotherapy (CRT)., Method: Patients with stage I-III adenocarcinoma of the rectum planned for preoperative CRT followed by surgery were recruited. Patients had PET/MRI scans at baseline and 6-8 weeks post-CRT. Functional MRI and PET parameters were assessed for their diagnostic accuracy for tumour regression grade (TRG). Nonparametric receiver operating characteristic analysis was employed to determine the area under the ROC curve (AUC), and the sensitivity and specificity of each quantile cut-off., Results: A total of 31 patients were recruited, of whom 20 completed study protocol. All patients included had mid or lower rectal tumours. There were 16 patients (80%) with node-positive disease at presentation. The median time to surgery was 75.5 days (range 52-106 days). Histopathological assessment revealed 20% good responders (TRG 1/2), and the remaining 80% of patients had a poor response (TRG 3/4). When predicting good responders, the AUC values for percent maximum thickness reduction and percent apparent diffusion coefficient (ADC) change were 0.82 and 0.73, respectively. A maximum thickness reduction cut-off of >47% and a percent ADC change of >20% yielded a sensitivity and specificity of 75%/95% and 75%/73%, respectively., Conclusion: Parameters such as percent maximum thickness reduction and percent ADC change may be useful for predicting good responders in patients undergoing preoperative CRT for rectal cancer. Larger studies are warranted to establish the utility of PET/MRI in rectal cancer staging.

Unlabelled: A 61 years old man with a history of prostate cancer Gleason 3+4, treated with radical prostatectomy, underwent fluorine-18-fluorocholine positron emission tomography/computed tomography ((18)F-FCH PET/CT) imaging to investigate rising serum prostate specific antigen (PSA) levels. (18)F-FCH PET/CT showed a focus of linear increased uptake by a possible Meckel's diverticulum in the right hemi-pelvis, which was an incidental finding in this asymptomatic patient. Uptake of (18)F-FCH by Meckel's diverticulum has not been reported before and thus the mechanism of uptake has not been established. Two postulations may explain this uptake. First, since Meckel's diverticulum is a true diverticulum containing all layers of the intestinal wall, the uptake may be related to physiological bowel-related uptake. Second, the uptake may be due to heterotopic pancreatic tissue in Meckel's diverticulum, especially since the intensity of uptake we have noticed was similar to that of physiological pancreatic uptake. As (18)F-FCH PET/CT scan is often used for evaluating prostate cancer, (18)F-FCH uptake by Meckel's diverticulum in the pelvis or lower abdomen may be mistaken for tumor involvement/recurrence. The identification by imaging of Meckel's diverticulum relies on the identification of a blind ending tubular structure, arising from the distal ileum. The identification of this structure may be best appreciated on the axial, coronal or sagittal plane., Conclusion: In this particular case, we managed to clearly demonstrate the presence of a tubular blind ending structure arising from the distal ileum on the sagittal images. The careful identification of this structure indicated that tracer uptake was in a Meckel's diverticulum and not within a pelvic lymph node or pelvic organ hence excluding recurrent disease.