CC BY 4.0 · World J Nucl Med 2023; 22(02): 152-170
DOI: 10.1055/s-0043-1769950
Presentation Abstracts

Imaging of PARP Upregulation in Small Cell Neuroendocrine Lung Carcinoma with [123I] I-PARPi SPECT/CT

Honest Ndlovu
1   Nuclear Medicine Research Infrastructure (NuMeRI), Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
,
Ismaheel O. Lawal
1   Nuclear Medicine Research Infrastructure (NuMeRI), Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
2   Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, United States
,
Kgomotso Mokoala
1   Nuclear Medicine Research Infrastructure (NuMeRI), Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
,
Yonwaba Mzizi
1   Nuclear Medicine Research Infrastructure (NuMeRI), Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
,
Dineo Disenyane
3   National Health Laboratory Services and the University of Pretoria, South Africa
,
Meshack Bida
3   National Health Laboratory Services and the University of Pretoria, South Africa
,
Mike M. Sathekge
1   Nuclear Medicine Research Infrastructure (NuMeRI), Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
› Author Affiliations
› Further Information
 

ndlovuhonest@gmail.com

Introduction: PARP (poly[ADP-ribose] polymerase) inhibitors (PARPi) are effective oncology agents for tumors harboring certain genetic mutations that make them resistant to conventional therapies such as chemotherapy and radiotherapy. We demonstrate, for the first time, that iodine-123 radiolabeled PARPi SPECT/CT imaging can be used as a marker of PARP upregulation and a predictor of chemotherapy resistance in a patient with small cell neuroendocrine tumor.

Methods: We present the case of a 61-year-old male with an inoperable small cell neuroendocrine carcinoma of the right lung who was referred for [18F] FDGPET/CT staging. As part of the standard workup, he had an initial staging, interim after three cycles of chemotherapy, and end of therapy [18F] FDG PET/CT scans. He was enrolled in an ongoing study on [123I] I-PARPi SPECT/CT in solid tumors, which correlates with immunohistochemical evaluation for PARP upregulation.

Results: The patient had [18F] FDG-PET/CT scans and [123I] I-SPECT/CT imaging at baseline, interim, and end of treatment. The SPECT/CT scans were performed 1, 4, and 24 hours after [123I] I-PARPi injection, which was well tolerated with no side effects. Baseline PET/CT revealed a metabolically active right apical lung mass with ipsilateral mediastinal lymph node metastases. Subsequent PET/CT scans revealed that the disease was progressing, with a new right adrenal gland and left head of femur osteolytic skeletal metastases. SPECT/CT imaging done at respective time intervals revealed uptake of [123I] I-PARPi on both the primary and metastases across all time intervals. Immunohistochemistry confirmed PARP upregulation.

Conclusion: [123I] I PARPi SPECT/CT is feasible, safe, and may be a valuable noninvasive tool for assessing PARP upregulation and predicting response to therapies with no PARPi in non-small cell neuroendocrine carcinoma. In this patient with progressive disease on chemotherapy, it demonstrated persistent uptake in the primary tumor and metastatic lesions providing a possibility of radioligand therapy with auger electrons or α and β-targeted therapies.



Publication History

Article published online:
25 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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