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Anlotinib in progressive RAI-refractory differentiated thyroid cancer: long-term results and PET/CT prognostic
Di Sun1,2, Xin Zhang1,2, Yingqiang Zhang1,2
1Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Abstract:
The efficacy and tolerability of anlotinib in patients with progressive radioactive iodine refractory differentiated thyroid cancer (RAIR-DTC), especially those with prior VEGFR-targeted therapies, are not fully understood. This study reported the long-term outcomes of anlotinib-treated progressive RAIR-DTC patients and evaluated the prognostic value of 68Ga-NOTA-3PRGD2 and 18F-FDG PET/CT parameters. In this open-label, single-arm, single-center, prospective trial, 20 progressive RAIR-DTC patients were enrolled to receive anlotinib (orally once daily on days 1-14 every 3 weeks). The study endpoints included long-term efficacy and safety. The association between PET/CT parameters at baseline and 6-week assessments and progression-free survival (PFS) was also investigated. The median PFS was 22.5 (95% CI, 16.8-27.9) months, the estimated median overall survival was 38.4 (95% CI, 20.4-56.4) months, the overall response rate was 47.4% (95% CI, 24.4-71.1), the disease control rate was 89.5% (95% CI, 66.9-98.7), and the median time to response was 4.1 (range, 1.3-8.4) months. There were no significant differences in clinicopathological, efficacy, and safety markers between patients with prior VEGFR-targeted agents (treated group, n = 10) or those without (naïve group, n = 10) (P > 0.05). Higher baseline integrin-expressing tumor burden on 68Ga-NOTA-3PRGD2 PET/CT and glucose metabolic progression on 18F-FDG PET/CT 6 weeks after anlotinib treatment were both associated with shorter PFS. Anlotinib showed promise as an effective treatment option for both initial and salvage therapy in progressive RAIR-DTC patients. Integrin- and glucose metabolic-based PET/CT parameters showed predictive potential in anlotinib-treated patients and warrant further study.
Insights
Anlotinib demonstrates efficacy in treating progressive radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC), offering a median progression-free survival of 22.5 months. Integrin and glucose PET/CT scans may predict treatment response in these patients.
Area of Science:
- Oncology
- Radiopharmaceuticals
- Molecular Imaging
Background:
- Differentiated thyroid cancer (DTC) that is refractory to radioactive iodine (RAIR-DTC) and progresses presents a significant treatment challenge.
- The efficacy of anlotinib, a multi-targeted tyrosine kinase inhibitor, in progressive RAIR-DTC, particularly in patients with prior vascular endothelial growth factor receptor (VEGFR)-targeted therapy, requires further elucidation.
- Novel imaging biomarkers are needed to predict treatment outcomes in these patients.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of anlotinib in patients with progressive RAIR-DTC.
- To investigate the prognostic value of baseline and post-treatment 68Ga-NOTA-3PRGD2 and 18F-FDG PET/CT parameters for progression-free survival (PFS).
Main Methods:
- An open-label, single-arm, prospective trial enrolled 20 patients with progressive RAIR-DTC who received anlotinib orally.
- Long-term efficacy and safety endpoints were assessed.
- The association between baseline and 6-week 68Ga-NOTA-3PRGD2 PET/CT (integrin expression) and 18F-FDG PET/CT (glucose metabolism) parameters and PFS was analyzed.
Main Results:
- The median PFS was 22.5 months, with a median overall survival of 38.4 months.
- The overall response rate was 47.4%, and the disease control rate was 89.5%.
- Higher baseline integrin expression and increased glucose metabolism at 6 weeks post-treatment were associated with shorter PFS. No significant differences were observed between patients with or without prior VEGFR-targeted therapy.
Conclusions:
- Anlotinib is a promising treatment option for progressive RAIR-DTC, suitable for both initial and salvage therapy.
- Integrin and glucose metabolic parameters assessed by PET/CT imaging show potential as predictive biomarkers for anlotinib treatment response in RAIR-DTC.
- Further studies are warranted to validate these imaging biomarkers.
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