Evaluation of early response to SU101 target-based therapy in patients with recurrent supratentorial malignant gliomas using FDG PET and Gd-DTPA MRI

• Published in: Journal of neuro-oncology 2000-01, Vol.46 (3), p.249-259
• Main Authors: VLASSENKO, A. G, THIESSEN, B, BEATTIE, B. J, MALKIN, M. G, BLASBERG, R. G
• Format: Article
• Language: English
• Subjects: Adult; Antineoplastic Agents - pharmacology; Antineoplastic Agents - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Astrocytoma - diagnostic imaging; Astrocytoma - drug therapy; Astrocytoma - metabolism; Astrocytoma - pathology; Astrocytoma - radiotherapy; Astrocytoma - surgery; Biological and medical sciences; Biological Transport, Active - drug effects; Carmustine - administration & dosage; Chemotherapy, Adjuvant; Combined Modality Therapy; Cranial Irradiation; Disease Progression; Disease-Free Survival; Energy Metabolism - drug effects; Female; Fluorodeoxyglucose F18; Gadolinium DTPA; Glioblastoma - diagnostic imaging; Glioblastoma - drug therapy; Glioblastoma - metabolism; Glioblastoma - pathology; Glioblastoma - radiotherapy; Glioblastoma - surgery; Glucose - metabolism; Humans; Isoxazoles - pharmacology; Isoxazoles - therapeutic use; Leflunomide; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - diagnostic imaging; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - metabolism; Neoplasm Recurrence, Local - pathology; Neurology; Platelet-Derived Growth Factor - physiology; Prognosis; Signal Transduction - drug effects; Supratentorial Neoplasms - diagnostic imaging; Supratentorial Neoplasms - drug therapy; Supratentorial Neoplasms - metabolism; Supratentorial Neoplasms - pathology; Supratentorial Neoplasms - radiotherapy; Supratentorial Neoplasms - surgery; Tomography, Emission-Computed; Treatment Outcome; Tumors of the nervous system. Phacomatoses
• ISSN: 0167-594X; 1573-7373
• DOI: 10.1023/A:1006481313747

Changes in [18F]-2-fluoro-2-deoxyglucose (FDG) uptake and gadopentetate dimeglumine (Gd-DTPA) enhancement before and after the first course of treatment with a cytostatic agent SU101 (N-[(4-trifluoromethyl)-phenyl]-5-methylisoxazole-4-carboxamide, SUGEN) were assessed using positron emission tomography (PET) and magnetic resonance imaging (MRI) in a pilot study of 8 patients with recurrent supratentorial malignant gliomas. The localization and the volume of Gd-DTPA enhancement and FDG hypermetabolism were analyzed. PET and MRI studies were performed one week before and 7.6+/-3.7 weeks after administration of SU101. The ratios of mean tumor activity to mean contralateral white matter and ipsilateral cerebellar activity were calculated for tumor regions, and SUV values corrected to the subjects' body surface area and glucose level (SUVbsa*glu) were calculated for nontumor regions. Five patients had a substantial increase of tumor volume on both PET and MRI during the first course of SU101. PET and MRI showed roughly equivalent volume changes. Large tumor volume increases were associated with a short time to clinical progression. The metabolic change in the tumor following the first course of SU101 varied from patient to patient, ranging from a 31% reduction to a 43% increase in FDG uptake ratio. Changes in FDG uptake were not predictive of time to progression or survival. In 2 patients with marked clinical deterioration and rapid tumor growth, there were differences in localization of Gd-DTPA enhancement and FDG hypermetabolism suggesting that hypermetabolism beyond the area of contrast enhancement may be of value in predicting rapid progression of high-grade glioma. SU101 did not induce any appreciable changes in SUVbsa*glu for non-tumor brain in 6 of 8 patients.