Impact of 18F-Fluciclovine PET/CT on Plans for Androgen Deprivation Therapy in Patients with Biochemical Recurrence of Prostate Cancer: Data Analysis from Two Prospective Clinical Trials - Beyond the Abstract
With the advent of highly sensitive molecular imaging modalities such as 18F-fluciclovine-PET and PSMA-PET, we are now able to accurately localize sites of recurrent disease, opening up potential for metastases-directed therapy in those with limited disease burden. This could help prostate cancer patients avoid ADT altogether or delay the time until it is needed.
We were able to utilize the data collected in two prospective clinical trials of 18F-fluciclovine to look at how this PET radiopharmaceutical can help guide patient management. The LOCATE and FALCON trials recorded patient management plans before and after 18F-fluciclovine-PET in a total of 317 patients with biochemical recurrence of prostate cancer. Our secondary analysis focused on all 146 patients who had an existing plan that included ADT prior to 18F-fluciclovine-PET scanning. LOCATE and FALCON were conducted in the USA and UK, respectively, and had very similar protocols allowing us to see how treatments varied in these countries. For instance, 56% of the US cohort had a pre-18F-fluciclovine plan that included ADT compared with 25% of the UK cohort. In addition, prescan plans for ADT monotherapy were only seen in the US cohort; all pre-scan plans for ADT in the UK cohort were planned in combination with another modality such as radiotherapy.
Our analysis of the post-18F-fluciclovine management plans from LOCATE and FALCON show that of those with a pre-18F-fluciclovine plan that included ADT, 85/146 (58%) had 18F-fluciclovine-avid lesions. The majority of these (39, 27%) were in extra-pelvic regions. Post-18F-fluciclovine, nearly two-thirds of patients (93, 64%) patients had a management change. Of these, and predominately among those with the least disseminated disease, 55 (59%) of the revisions were to abort ADT. Moreover, only one quarter of the patients originally planned for ADT monotherapy still had an unaltered plan for ADT monotherapy post-scan.
With better imaging we can offer more appropriate treatment, and although we did not evaluate patient outcomes in our study, our findings allow us to see how the use of 18F-fluciclovine can help identify patients for whom targeted salvage therapy may be a more appropriate treatment than ADT.
Written by: Gerald L. Andriole, MD, Johns Hopkins Medicine, Sibley Memorial Hospital, Washington, District of Columbia, USA
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