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Source: Forschungszentrum JulichJülich, October 8th – New cancer therapies such as immunotherapy and targeted therapy hold great opportunities. The treatments are not only directed against the primary tumor. They are also said to fight deposits in other organs – especially the brain. So-called positron emission tomography (PET) with radioactively marked amino acids can provide valuable additional information in such cases to assess the success of a therapy. This is shown by a study that was recently published in the renowned journal Journal of Nuclear Medicine. The first author of the study, Prof. Norbert Galldiks, is working at the Jülich Research Center and the Cologne University Hospital with newer diagnostic methods that are supposed to help improve the care of To improve patients with brain tumors. In the interview he sheds light on the newly gained knowledge.

Prof. Galldiks, for whom is immunotherapy and targeted therapy relevant? Dr. med. Norbert GalldiksCopyright: University Hospital Cologne, Klaus Schmidt Immunotherapy activates the body’s immune system to destroy cancer cells. Targeted therapy includes drugs that target certain characteristics of cancer cells. These new therapies have been used against various types of cancer for about ten years and have helped to significantly improve the chances of survival in many cases. These successes were certainly one of the reasons why the development of immunotherapy was awarded the Nobel Prize in 2018, an approach used in black skin cancer, for example. Other types of cancer include lung cancer, breast cancer, and kidney and bladder cancer. In recent years, studies have also shown that these newer forms of therapy are also effective for brain colonization, which is also known as brain metastases. Because the lifespan of many cancers has been lengthened as a result of the development of these forms of therapy During this longer period of time, it is more and more common for a tumor to “spread” to other organs. The patients we examined in our study all had deposits in the brain that came from a lung tumor or from a malignant skin cancer known as melanoma. What is special about the new method? The radioactively labeled amino acid F18-fluoroethyl tyrosine ( FET) for PET examinations was developed at Forschungszentrum Jülich in the 1990s. That means there is already a lot of experience with this technology. FET is preferentially deposited in tumor cells and can thus help to detect tumors more precisely. The realization that immunotherapy and targeted therapy can curb not only the growth of primary tumors but also of brain metastases is still relatively new. Our study has now shown for the first time on a larger scale that FET-PET as supplementary imaging can provide important additional information for decision-making. What are the consequences of this additional information? The problem is that immunotherapy in particular can lead to reactions which are difficult to interpret with the standard method, magnetic resonance imaging (MRI) with contrast agent. Particularly noteworthy are inflammatory changes that can be triggered by immunotherapy. These changes in the tissue can easily be misinterpreted as further spread of brain metastases. With the help of FET-PET imaging, however, the accuracy can be improved to 85 percent. We were able to identify several cases in which there was no metastasis at all. This differentiation is extremely important. Because the question that arises after such an examination is: Do I have to change the therapy or keep it? If an effective therapy is not interrupted unnecessarily, this ultimately leads to an extension of the lifespan. Above: In the FET-PET (right), brain metastases of a skin cancer patient are visible on the basis of increased metabolic activity. Bottom: 12 weeks after the onset of immunotherapy and radiation therapy, FET-PET (right) shows a significant decrease in metabolic activity, while MRI images (left, center) suggest a growth in metastases according to common assessment criteria. Copyright: J Nucl Med (2020), Galldiks et al., DOI: 10.2967 / jnumed.120.248278 (http://jnm.snmjournals.org/site/misc/permission.xhtml) How did the FET-PET examinations work? The majority of patients were examined at Forschungszentrum Jülich. The patients within the Center for Integrated Oncology (CIO) were assigned mainly by the Skin Tumor Center, the Lung Cancer Group Cologne and the Brain Tumor Center of the University Hospital Cologne. Further examinations were carried out in cooperation with the Zurich Brain Tumor Center. The patients were measured independently on site. Will the method now also be used in everyday clinical practice? We very much hope that the method will now find more widespread use in patients with brain metastases. In addition to Forschungszentrum Jülich, there are now several other centers in Germany that offer PET with FET. However, the procedure has not yet been generally approved and the reimbursement of costs is at the discretion of the responsible health insurance company. Original publication: Galldiks N, Abdulla DS, Scheffler M, Wolpert F, Werner JM, Huellner MW, Stoffels G, Schweinsberg V, Schlaak M, Kreuzberg N, Landsberg J, Lohmann P, Ceccon G, Baues C, Trommer M, Celik E, Ruge MI, Kocher M, Marnitz S, Fink GR, Tonn JC, Weller M, Langen KJ, Wolf J, Mauch C. Treatment Monitoring of Immunotherapy and Targeted Therapy using 18F-FET PET in Patients with Melanoma and Lung Cancer Brain Metastases: Initial Experiences. J Nucl Med. (Published online 2020 Sep 4), doi: 10.2967 / jnumed.120.248278

Contact person: Prof. Dr. med. Norbert GalldiksInstitute for Neurosciences and Medicine (INM-3), Research Center Jülich & Head of Neuro-oncology, Neurological University Clinic Cologne, Email: n.galldiks@fz-juelich.de Contact for patient inquiries: Special neuro-oncological consultation at the Clinic and Polyclinic for Neurology at the Cologne University Hospital Research Center Jülich Tel .: +49 2461 61-4771 E-Mail: t.schloesser@fz-juelich.de

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