A1 Journal article – refereed
[(18)F]-Fluorodeoxyglucose Positron Emission Tomography and Computed Tomography in ResponseEvaluation of Oncolytic Adenovirus Treatmentsof Patients with Advanced Cancer




List of Authors: Anniina Koski, Helena Ahtinen, Heidi Liljenback, Anne Roivainen, Anu Koskela, Minna Oksanen, Kaarina Partanen, Leena Laasonen, Kalevi Kairemo, Timo Joensuu, Akseli Hemminki
Publication year: 2013
Journal: Human Gene Therapy
Number in series: 12
Volume number: 24
Issue number: 12
ISSN: 1043-0342

Abstract

Computed tomography (CT) is the most commonly used radiological response evaluation method in contemporary


oncology. However, it may not be optimally suitable for assessment of oncolytic virus treatments because


of paradoxical inflammatory tumor swellings, which result from virus treatments, particularly when viruses are


armed with immunostimulatory molecules. Here we investigated the prognostic utility of CT and [18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) in oncolytic virus treatments. We also investigated


possible appearance of false-positive FDG signals in FDG-PET imaging of humans and hamsters treated with


oncolytic adenoviruses. First, immunocompetent Syrian hamsters were treated with intratumoral adenovirus


injections, tumor growth was followed up, and [18F]-FDG-uptake was quantitated with small animal PET/CT.


Second, we describe a retrospective patient series, essentially 17 individual case reports, of advanced cancer


patients treated with oncolytic adenoviruses in the context of an Advanced Therapy Access Program (ATAP)


who underwent radiological response evaluation with both contrast-enhanced CT and FDG-PET. Third, we


collected a retrospective case series of radiological response and survival data of 182 patients treated with


oncolytic adenoviruses in ATAP to evaluate the prognostic reliability of CT and FDG-PET. Overall, responses in


CT and FDG-PET correlated well with each other and were equally reliable as prognostic markers for long


survival after oncolytic adenovirus treatment. Interestingly, we observed that new FDG-avid lymph nodes


appearing in FDG-PET after virus treatments may represent inflammatory responses and therefore should not be


interpreted as treatment failure in the absence of other signs or verification of disease progression. We also


observed indications that FDG-PET might be more sensitive in detection of responses than tumor size.


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