Ravi Madan, MD, discusses key findings using PET imaging and Tc99 scans in conjunction with enzalutamide in mCRPC


Ravi Madan, MD, discusses clinical results using PET imaging and Tc99 scans in patients with metastatic castration-resistant prostate cancer who are treated with enzalutamide

At European Society of Medical Oncology 2021 Annual Congress, CancerNetwork® spoke to Ravi A. Madan, MD, clinical director of the Genitourinary Malignant Tumors Branch at the Center for Cancer Research, National Cancer Institute, about the key results of a clinical trial (NCT01867333) using PET imaging and technetium (Tc99) coupled scans in patients with metastatic castration-resistant prostate cancer undergoing treatment with enzalutamide (Xtandi).


The highlights of this research in the context of a major finding [that wasn’t] surprising [was that] we have done a pretty good job of helping patients understand that staying on [drug] until radiographic progression is an important way to optimize and get the full benefit of enzalutamide. In a separate analysis we presented earlier, which probably isn’t too surprising for people who use the drug, on average, [patients on] patients on enzalutamide had a first [prostate-specific antigen] increase at 6 months but radiographic progression did not occur until 23 months. This gave us the opportunity, in the meantime, to assess what was going on [in] sodium fluoride PET scans.

What we saw in this population that was treated with enzalutamide and immunotherapy … is that although the patients had stable disease on Tc99 scans and still had clinical benefit in terms of stable symptoms, there was a lot going on [with] Tc99 scans. But all of this did not represent the progression of the disease, which, if they had only had one or two scans, at certain intervals, it could have been misinterpreted. What we saw is that among these 18 patients [was] nearly 400 new lesions appear on sodium fluoride scans, nearly 28% of [which] actually resolved over time. [Therefore], they did not represent, in my opinion, a clinically relevant progressive disease. Of the 18 patients, 14 had lesions that appeared and disappeared despite stable technetium scans. One of the important things to remember is that even if you see what might be considered new lesions or discoveries on a platform like sodium fluoride, it may not represent treatment failure.


Madan RA, Gandhy SU, Bilusic M, et al. Analysis of serial PET imaging and paired Tc99 scans in metastatic castration-resistant prostate cancer (mCRPC) treated with enzalutamide. Presented at the 2021 annual congress of the European Society of Medical Oncology; September 16-21, 2021; virtual. Abstract 605P.


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