The origin of cancer is often obscured by metastases – tumors that have already spread to other tissues. This is especially the case for neuroendocrine tumors (NETs), a malignancy of nerve cells scattered throughout various organ systems that are sensitive to the signaling of neurotransmitters and hormones. An investigational molecular imaging technique could be the key to finding the elusive primary tumor, say presenters at the 2015 Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging (SNMMI).
Researchers are rooting out these primary tumors, many of them found in the gastrointestinal tract or the lungs, with combined positron emission tomography and computed tomography (PET/CT), which provides both functional and structural imaging of the body. With the use of imaging agent Ga-68 DOTATOC, researchers get a better view of malignant tumors because the agent binds to the tumors more strongly than normal tissues.
“Our study shows that Ga-68 DOTATOC PET/CT can change the management of patients with unknown primary tumor and neuroendocrine metastases, including potential surgical resection of the primary tumor,” said Yusuf Menda, MD, lead author of the study and a researcher in the department of radiology and division of nuclear medicine at the University of Iowa in Iowa City, Iowa. “There is evidence that surgery could lead to improved survival for these patients.”
After several test with agent Ga-68 DOTATOC, results were successful, with 29 patients’ scans revealing strong-binding metastases with a high affinity for the imaging agent.
“Of these scans, 19 indicated the location of the primary tumor. Confirmation of primary tumor site was achieved in three patients by further imaging and in eight patients by histological examination. Five suspected primary tumors remained undefined, and no primary tumor site was found for seven patients went on to have primary tumors surgically removed, and another patient was treated with peptide receptor radionuclide therapy. In total 28 percent of patients underwent a major change in cancer management as a result of Ga-68 DOTATOC PET/CT”.
“Ga-68 DOTATOC and similar agents are investigational drugs in the United States and are not yet approved for clinical use,” said Menda. “They are being investigated in clinical trials across several U.S. institutions. It is hoped that these studies and previous European published experience will ultimately lead to regulatory approval of these agents within the next one to two years.”
Image courtesy of Dr. Jorge Carrasquillo, Nuclear Medicine Department, Clinical Center, National Institutes of Health, via miamicancer.com
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