image: Example of whole-body planar scans at 24 hours after 123I-NaI administration at baseline, before selumetinib was administered (A), and after 4 weeks of treatment with selumetinib (B). view more
Credit: Image created by Jan Taprogge, et al., The Royal Marsden Hospital, Sutton, UK.
Reston, VA—A combination of pretherapy imaging and dosimetry can help ensure that patients with refractory differentiated thyroid cancer obtain the maximum benefit from radioactive iodine treatments following redifferentiation therapy. In this novel approach, a small amount of radioactive iodine was used to determine whether the treatment was being delivered to the thyroid lesions. If the treatment was absorbed well, researchers from The Royal Marsden NHS Foundation Trust were able to calculate a personalized dosage of treatment for each patient. Results from this multicenter phase II trial, led by the UK NCRI Thyroid Cancer Research Group, were published in the June issue of The Journal of Nuclear Medicine.
Differentiated thyroid cancer has been treated with radioactive iodine for over 80 years. While the majority of patients respond well to initial treatment, in some cases further administration is needed. After several treatments, five to 10 percent of patients no longer take up the iodine. This carries a poor prognosis with a median overall survival of three to five years.
“The drug selumetinib has shown potential to restore or enhance the uptake of radioactive iodine treatment in patients,” said Jan Taprogge, PhD, Principal Clinical Scientist at The Royal Marsden NHS Foundation Trust. “In this study we aimed to investigate whether selumetinib could resensitize these differentiated thyroid cancer patients to radioiodine.”
Patients with iodine refractory disease (one or more lesions with no measurable iodine uptake or an iodine-avid lesion that progressed within 12 months of radioactive iodine treatments) were included in the study. Participants underwent baseline 123I-NaI SPECT/CT and then received selumetinib orally twice daily for four weeks. Follow-up 123I-NaI SPECT/CT imaging was used to determine if an increase in 123I-NaI was observed after taking selumetinib. In patients who did see an increase, therapy was warranted. Pretherapy and posttherapy dosimetry were performed and the range of absorbed doses was calculated.
A wide variation in the radiation delivered to different areas of disease was found among patients. However, researchers noted that this variability can be accurately predicted from scans taken just before the therapy with just a small amount of the radioactive drug.
“It is likely that the response to treatment is largely dependent on how much of the injected radiation is delivered to the disease as absorbed dose, and the range of radiation doses delivered may partly explain the variation in outcomes. The ability to predict the radiation doses delivered to areas of disease implies that this could be considered when planning treatment and that treatments may be tailored to individual patients,” stated Taprogge.
The authors noted that the methods developed for this study—in particular the close collaboration between medical centers to collect and share images and radiation dosimetry results—open the door to more informed treatments that could improve outcomes. These methods can be applied to the wider field of molecular radiotherapy and could significantly improve the clinical and cost effectiveness of existing and new radiotherapeutics.
This study was made available online in April 2023.
The authors of “The Role of Pretherapy Quantitative Imaging and Dosimetry in Radioiodine Therapy for Advanced Thyroid Cancer” include Jan Taprogge, Carla Abreu, Jonathan I. Gear, Rebecca Gregory, Francesca Leek, Iain Murray and Glenn D. Flux, Joint Department of Physics, Royal Marsden NHSFT, Sutton, United Kingdom, and Institute of Cancer Research, London, United Kingdom; Siraj Yusuf and Yong Du, Department of Nuclear Medicine and PET/CT, Royal Marsden NHSFT, Sutton, United Kingdom; Gemma Ainsworth, Rachel H. Phillip, Amy B. Coulson, and Sarah R. Brown, Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom; Kate Newbold, Thyroid Unit, Royal Marsden NHSFT, Sutton, United Kingdom; and Jonathan Wadsley, Department of Oncology, Weston Park Hospital, Sheffield, United Kingdom.
Visit the JNM website for the latest research, and follow our new Twitter and Facebook pages @JournalofNucMed or follow us on LinkedIn.
###
Please visit the SNMMI Media Center for more information about molecular imaging and precision imaging. To schedule an interview with the researchers, please contact Rebecca Maxey at (703) 652-6772 or rmaxey@snmmi.org.
About JNM and the Society of Nuclear Medicine and Molecular Imaging
The Journal of Nuclear Medicine (JNM) is the world’s leading nuclear medicine, molecular imaging and theranostics journal, accessed 15 million times each year by practitioners around the globe, providing them with the information they need to advance this rapidly expanding field. Current and past issues of The Journal of Nuclear Medicine can be found online at http://jnm.snmjournals.org.
JNM is published by the Society of Nuclear Medicine and Molecular Imaging (SNMMI), an international scientific and medical organization dedicated to advancing nuclear medicine and molecular imaging—precision medicine that allows diagnosis and treatment to be tailored to individual patients in order to achieve the best possible outcomes. For more information, visit www.snmmi.org.
Journal
Journal of Nuclear Medicine
Article Title
The Role of Pretherapy Quantitative Imaging and Dosimetry in Radioiodine Therapy for Advanced Thyroid Cancer
Article Publication Date
1-Jun-2023
COI Statement
Financial support was received from Cancer Research U.K. (CRUK) (CRUK reference CRUK/14/041), AstraZeneca U.K. Limited, the NIHR Biomedical Research Centre at RMH/ICR, and the National Institute for Health Research (NIHR). Sanofi Genzyme provided recombinant human thyroid-stimulating hormone. Sarah Brown, Glenn Flux, Jonathan Wadsley, Jan Taprogge, Iain Murray, Jonathan Gear, and Carla Abreu report funding or provision of study materials from CRUK, AstraZeneca, and Sanofi Genzyme during the conduct of the study. Jan Taprogge, Carla Abreu, Jonathan Gear, Iain Murray, and Glenn Flux report funding from the National Health Service to the NIHR Biomedical Research Centre at the Royal Marsden and the ICR and grants from Euratom research and training program 2014–2018 and the NIHR and NIHR Royal Marsden Clinical Research Facility. Jonathan Gear reports personal fees and honoraria from the European Association of Nuclear Medicine. Jonathan Wadsley reports personal fees and honoraria from Lilly, Eisai, Novartis, AAA, Bayer, Ipsen, and Roche. Amy Coulson reports grants and nonfinancial support from BMS/Celgene, Merck Sharpe & Dohme, Amgen, and Takeda. Sanofi Genzyme provided recombinant human thyroid-stimulating hormone. The research was developed with support from NCRI CTRad. NHS funding was provided to the NIHR Biomedical Research Centre at the Royal Marsden and the ICR. The RTTQA group is funded by the NIHR. We acknowledge infrastructure support from NIHR Royal Marsden Clinical Research Facility funding. This report is independent research funded by the NIHR. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.