mRCC therapy response by FPIA PET/CT
Research type
Research Study
Full title
Determining the Magnitude of Change in [18F]FPIA-detectable Short Chain Fatty Acid Uptake in Metastatic Renal Cell Cancer Following Therapy
IRAS ID
283224
Contact name
Naveed Sarwar
Contact email
Duration of Study in the UK
3 years, 11 months, 29 days
Research summary
Research Summary
Cancers have increased energy demands to allow for their rapid growth compared to healthy cells. Glucose is the main source of energy for many cells in the body, however it has been shown that some tumour cells can create energy differently using fatty acids.
We are looking to to see if we can measure this fatty acid metabolism and therefore see how renal cell cancers respond to treatment. We will do this by using the information obtained from a PET/CT scan together with a blood test, a urine test and a tissue biopsy sample. The study will not involve any change to the patient’s normal clinical pathway.
A PET/CT produces images by detecting a radioactive tracer injected into the body. The [18F]FPIA tracer allows us to look for groups of cells with fatty acid metabolism changes.
We will look at 24 patients who have metastatic renal cell cancer.
Each patient will have three scan visits; before cancer treatment starts and, 4-6 and approximately 12 weeks after. At each visit they will also have a blood and urine test for carnitine levels (a natural substance in the body which plays a vital role in fatty acid metabolism/energy production).By measuring how much [18F]FPIA can be seen on the scan and differences in uptake between the 3 scans, we hope to be able to identify if the cancer is responding to treatment or not. These will be compared to routine care scans and a relationship between the levels of urine / blood carnitine explored.
Further tests on tissue biopsies will look for changes in cancer cell DNA (deoxyribonucleic acid) which may provide important information about best treatments/how the treatments work.Summary of Results
This study looked at a new radiotracer for PET imaging called [18F]FPIA, developed to help doctors see cancer more clearly on imaging. The aim was to find out whether [18F]FPIA PET/CT scans could be useful for patients with metastatic renal (kidney) cancer, particularly to monitor how their cancer responds to treatment. We included 10 adults with metastatic renal cancer who were attending uro-oncology clinics at Imperial College Healthcare NHS Trust, all of whom were about to start a new chemotherapy or targeted treatment. Each person was asked to attend up to three study visits for an [18F]FPIA PET/CT scan: a baseline scan performed prior to starting treatment, an initial follow-up scan 4-6 weeks after starting treatment, and a final follow-up scan 12 weeks (±4 weeks) after starting treatment. At each visit, we also collected blood and urine samples to study substances related to how the body processes fats. All patients tolerated the scans well, and no adverse events were reported. The 10 patients were aged between 57-78 (median 67), and two were female. Six had newly diagnosed metastatic renal cancer, and four had metastatic renal cancer that had returned after earlier treatment. Two of the ten patients recruited completed all three [18F]FPIA PET/CT scans, with a further three completing two scans (baseline plus one follow-up). The remaining patients did not return for follow-up scans due to worsening illness, changes in treatments plans, or personal choice. This reflects the challenges faced by people living with advanced kidney cancer, which often causes significant health problems. The [18F]FPIA radiotracer was taken up most within the tumour, lungs and liver. Tumour areas generally showed moderately good visibility compared with surrounding tissue, with the highest uptake seen in primary kidney tumours and lung metastases. The [18F]FPIA PET/CT scans did not identify any new tumours that were not already identified from standard clinical imaging. Most tumours showed low uptake, and due to the limited number of patients that completed all three study scans, we could not draw strong conclusions about whether [18F]FPIA can reliably track treatment response. The blood and urine samples showed changes in several substances related to fat metabolism. However, the limited number of patients that had completed all three scans limits how much we can conclude. Overall, this early study shows that [18F]FPIA is safe and provides reasonable visibility of tumours in patients with metastatic renal cancer. However, due to only a small number of patients with available data for all three [18F]FPIA PET/CT scans, we could not fully assess whether this tracer is effective for monitoring treatment response. Further research is needed in a larger group of patients, ideally with fewer hospital visits, to make participation easier for patients with advanced disease.REC name
West of Scotland REC 5
REC reference
20/WS/0150
Date of REC Opinion
2 Dec 2020
REC opinion
Further Information Favourable Opinion