89Zr-panitumumab Combined With 18F-FDG PET Improves Detection and Staging of Head and Neck Squamous Cell Carcinoma

Author:

Lee Yu-Jin1ORCID,van den Berg Nynke S.2ORCID,Duan Heying3ORCID,Azevedo E. Carmen3ORCID,Ferri Valentina3ORCID,Hom Marisa4ORCID,Raymundo Roan C.1ORCID,Valencia Alex1ORCID,Castillo Jessa3ORCID,Shen Bin3ORCID,Zhou Quan5ORCID,Freeman Laura1,Koran Mary Ellen6ORCID,Kaplan Michael J.1ORCID,Colevas A. Dimitrios7ORCID,Baik Fred M.1ORCID,Chin Frederick T.3ORCID,Martin Brock A.8ORCID,Iagaru Andrei3ORCID,Rosenthal Eben L.4ORCID

Affiliation:

1. 1Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine. Stanford, California.

2. 2Department of Research, Intuitive Surgical Inc., Sunnyvale, California.

3. 3Department of Radiology, Stanford University School of Medicine. Stanford, California.

4. 4Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center. Nashville, Tennessee.

5. 5Department of Neurosurgery, Stanford University School of Medicine. Stanford, California.

6. 6Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center. Nashville, Tennessee.

7. 7Department of Medicine – Division of Medical Oncology, Stanford University School of Medicine. Stanford, California.

8. 8Department of Pathology, University of Louisville. Louisville, Kentucky.

Abstract

Abstract Purpose: Determine the safety and specificity of a tumor-targeted radiotracer (89Zr-pan) in combination with 18F-FDG PET/CT to improve diagnostic accuracy in head and neck squamous cell carcinoma (HNSCC). Experimental Design: Adult patients with biopsy-proven HNSCC scheduled for standard-of-care surgery were enrolled in a clinical trial and underwent systemic administration of 89Zirconium-panitumumab and panitumumab-IRDye800 followed by preoperative 89Zr-pan PET/CT and intraoperative fluorescence imaging. The sensitivity, specificity, and AUC were evaluated. Results: A total of fourteen patients were enrolled and completed the study. Four patients (28.5%) had areas of high 18F-FDG uptake outside the head and neck region with maximum standardized uptake values (SUVmax) greater than 2.0 that were not detected on 89Zr-pan PET/CT. These four patients with incidental findings underwent further workup and had no evidence of cancer on biopsy or clinical follow-up. Forty-eight lesions (primary tumor, LNs, incidental findings) with SUVmax ranging 2.0–23.6 were visualized on 18F-FDG PET/CT; 34 lesions on 89Zr-pan PET/CT with SUVmax ranging 0.9–10.5. The combined ability of 18F-FDG PET/CT and 89Zr-pan PET/CT to detect HNSCC in the whole body was improved with higher specificity of 96.3% [confidence interval (CI), 89.2%–100%] compared to 18F-FDG PET/CT alone with specificity of 74.1% (CI, 74.1%–90.6%). One possibly related grade 1 adverse event of prolonged QTc (460 ms) was reported but resolved in follow-up. Conclusions: 89Zr-pan PET/CT imaging is safe and may be valuable in discriminating incidental findings identified on 18F-FDG PET/CT from true positive lesions and in localizing metastatic LNs.

Funder

Stanford Comprehensive Cancer Center

Netherlands Organization for Scientific Research

National Cancer Institute

NIH/NIDCD

Publisher

American Association for Cancer Research (AACR)

Subject

Cancer Research,Oncology

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