Phase IIa Clinical Trial of Trans-1-Amino-3-18F-Fluoro- Cyclobutane Carboxylic Acid in Metastatic Prostate Cancer

Document Type : Original Article

Authors

1 Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan

2 Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan

3 Department of Radiology, Kitasato University Hospital, Sagamihara, Kanagawa, Japan

4 Department of Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan

Abstract

Objective(s): We performed a phase IIa clinical trial of trans-1-amino-3-18Ffluoro-cyclobutane carboxylic acid (anti-18F-FACBC), a synthetic amino acid analog for PET, in patients with metastatic prostate cancer.
Methods: The study subjects consisted of 10 untreated prostate cancer patients having lymph node and/or bone metastasis. Five patients underwent whole-body PET 5 and 30 min after intravenous injection of anti-18F-FACBC. The other five patients underwent 60 min dynamic PET of the pelvis. Safety assessment was performed before and 24 h after injection. PET/CT images were assessed visually, and time courses of anti-18F-FACBC uptake were evaluated from dynamic imaging.
Results: Two mild adverse events were observed and resolved without treatment. All 10 patients showed increased accumulation of anti-18F-FACBC in the primary prostate lesion. CT revealed five enlarged lymph nodes indicating metastasis, and all showed increased uptake. Additionally, anti-18F-FACBC PET delineated unenlarged lymph nodes as hot spots. Anti-18F-FACBC PET demonstrated metastatic bone lesions, similar to conventional imaging. In one of two patients with lung metastasis, some lesions showed increased uptake. Regarding the time course, increased uptake of anti-18F-FACBC in the lesion was demonstrated immediately after injection, followed by gradual washout.
Conclusion: The results of this phase IIa clinical trial indicated the safety of anti-18F-FACBC in patients with prostate cancer and the potential of anti-18F-FACBC PET to delineate primary prostate lesions and metastatic lesions. This clinical trial was registered as JapicCTI-101326.

Keywords


1. Hricak H, Choyke PL, Eberhardt SC, Leibel SA, Scardino PT. Imaging prostate cancer: a multidisciplinary perspective. Radiology. 2007; 243:28‐53.
2. Jadvar H. Prostate cancer: PET with 18F‐FDG, 18For 11C‐acetate, and 18F‐ or 11C‐choline. J Nucl Med. 2011; 52:81‐9.
3. Apolo AB, Pandit‐Taskar N, Morris MJ. Novel tracers and their development for the imaging of metastatic prostate cancer. J Nucl Med. 2008;49:2031‐41.
4. Bauman G, Belhocine T, Kovacs M, Ward A, Beheshti M, Rachinsky I. 18F‐fluorocholine for prostate cancer imaging: a systematic review of the literature. Prostate Cancer Prostatic Dis. 2012; 15: 45‐55.
5. Söensen J, Owenius R, Lax M, Johansson S. Regional distribution and kinetics of [18F]fluciclovine (anti‐[18F]FACBC), a tracer of amino acid transport, in subjects with primary prostate cancer. Eur J Nucl Med Mol Imaging. 2013;40:394‐402.
6. Schuster DM, Votaw JR, Nieh PT, Yu W, Nye JA, Master V, et al. Initial experience with the radiotracer anti‐1‐amino‐3‐18F‐fluorocyclobutane‐1‐carboxylic acid with PET/CT in prostate carcinoma. J Nucl Med. 2007;48:56‐63.
7. Turkbey B, Mena E, Shih J, Pinto PA, Merino MJ, Lindenberg ML, et al. Localized prostate cancer detection with 18F FACBC PET/CT: Comparison with MR Imaging and histopathologic analysis. Radiology. 2014; 270:849‐56.
8. Schuster DM, Savir‐Baruch B, Nieh PT, Master VA, Halkar RK, Rossi PJ, et al. Detection of recurrent prostate carcinoma with anti‐1‐amino‐3‐18F‐fluorocyclobutane‐1‐carboxylic acid PET/CT and 111In‐capromab pendetide SPECT/CT. Radiology. 2011;259: 852‐61.
9. Nanni C, Schiavina R, Boschi S, Ambrosini V, Pettinato C, Brunocilla E, et al. Comparison of 18FFACBC and 11C‐choline PET/CT in patients with radically treated prostate cancer and biochemical relapse: preliminary results. Eur J Nucl Med Mol Imaging. 2013; 40 Suppl 1:S11‐7.
10. Nanni C, Schiavina R, Brunocilla E, Borghesi M, Ambrosini V, Zanoni L, et al. 18F‐FACBC compared With 11C‐choline PET/CT in patients with biochemical relapse after radical prostatectomy: a prospective study in 28 patients. Clin Genitourin Cancer. 2014; 12:106‐10.
11. Schuster DM, Nieh PT, Jani AB, Amzat R, Bowman FD, Halkar RK, et al. Anti‐3‐[18F]FACBC positron emission tomography‐computerized tomography and 111In‐capromab pendetide single photon emission computerized tomographycomputerized tomography in recurrent prostate carcinoma: results of a prospective clinical trial. J Urology. 2014; 191: 1446‐53.  
12. Asano Y, Inoue Y, Ikeda Y, Kikuchi K, Hara T, Taguchi C, et al. Phase I clinical study of NMK36:a new PET tracer with the synthetic amino acid analogue anti‐[18F]FACBC. Ann Nucl Med. 2011; 25:414‐8.
13. McConathy J, Voll RJ, Yu W, Crowe RJ, Goodman MM. Improved synthesis of anti‐[18F]FACBC: improved preparation of labeling precursor and automated radiosynthesis. Appl Radiat Isot. 2003; 58:657‐66.
14. Höels AM, Heesakkers RA, Adang EM, Jager GJ, Strum S, Hoogeveen YL, et al. The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta‐analysis. Clin Radiol. 2008;63: 387‐95.
15. Schuster DM, Taleghani PA, Nieh PT, Master VA, Amzat R, Savir‐Baruch B, et al. Characterization of primary prostate carcinoma by anti‐1‐amino‐ 2‐[(18)F] ‐fluorocyclobutane‐1‐carboxylic acid (anti‐3‐[(18)F] FACBC) uptake. Am J Nucl Med Mol Imaging. 2013; 3:85‐96.