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A comparative PET imaging study with the reversible and irreversible EGFR tyrosine kinase inhibitors [(11)C]erlotinib and [(18)F]afatinib in lung cancer-bearing mice.

Slobbe P, Windhorst AD, Stigter-van Walsum M, Smit EF, Niessen HG, Solca F, Stehle G, van Dongen GA, Poot AJ - EJNMMI Res (2015)

Bottom Line: Additionally, the effect of drug efflux transporter permeability glycoprotein (P-gp) on the tumor uptake of tracers was explored by therapeutic blocking with tariquidar.Under P-gp blocking conditions, no significant changes in tumor-to-background ratio were observed; however, [(18)F]afatinib demonstrated better tumor retention in all xenograft models.TKI-PET provides a method to image sensitizing mutations and can be a valuable tool to compare the distinguished targeting properties of TKIs in vivo.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, Amsterdam, 1081 HV The Netherlands ; Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, De Boelelaan 1117, Amsterdam, 1081 HV The Netherlands.

ABSTRACT

Background: Tyrosine kinase inhibitors (TKIs) have experienced a tremendous boost in the last decade, where more than 15 small molecule TKIs have been approved by the FDA. Unfortunately, despite their promising clinical successes, a large portion of patients remain unresponsive to these targeted drugs. For non-small cell lung cancer (NSCLC), the effectiveness of TKIs is dependent on the mutational status of epidermal growth factor receptor (EGFR). The exon 19 deletion as well as the L858R point mutation lead to excellent sensitivity to TKIs such as erlotinib and gefitinib; however, despite initial good response, most patients invariably develop resistance against these first-generation reversible TKIs, e.g., via T790M point mutation. Second-generation TKIs that irreversibly bind to EGFR wild-type and mutant isoforms have therefore been developed and one of these candidates, afatinib, has now reached the market. Whether irreversible TKIs differ from reversible TKIs in their in vivo tumor-targeting properties is, however, not known and is the subject of the present study.

Methods: Erlotinib was labeled with carbon-11 and afatinib with fluorine-18 without modifying the structure of these compounds. A preclinical positron emission tomography (PET) study was performed in mice bearing NSCLC xenografts with a representative panel of mutations: an EGFR-WT xenograft cell line (A549), an acquired treatment-resistant L858R/T790M mutant (H1975), and a treatment-sensitive exon 19 deleted mutant (HCC827). PET imaging was performed in these xenografts with both tracers. Additionally, the effect of drug efflux transporter permeability glycoprotein (P-gp) on the tumor uptake of tracers was explored by therapeutic blocking with tariquidar.

Results: Both tracers only demonstrated selective tumor uptake in the HCC827 xenograft line (tumor-to-background ratio, [(11)C]erlotinib 1.9 ± 0.5 and [(18)F]afatinib 2.3 ± 0.4), thereby showing the ability to distinguish sensitizing mutations in vivo. No major differences were observed in the kinetics of the reversible and the irreversible tracers in each of the xenograft models. Under P-gp blocking conditions, no significant changes in tumor-to-background ratio were observed; however, [(18)F]afatinib demonstrated better tumor retention in all xenograft models.

Conclusions: TKI-PET provides a method to image sensitizing mutations and can be a valuable tool to compare the distinguished targeting properties of TKIs in vivo.

No MeSH data available.


Related in: MedlinePlus

TACs of [11C]erlotinib (top) and [18F]afatinib (bottom) after tariquidar treatment. TACs are averaged over three animals. Mutations: A549 (wild type), H1975 (L858R/T790M), and HCC827 (exon 19 deletion). Tumor and background were manually outlined on the basis of an additional [18F]FDG scan, which was performed directly after the TKI-PET scan was finished.
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Fig5: TACs of [11C]erlotinib (top) and [18F]afatinib (bottom) after tariquidar treatment. TACs are averaged over three animals. Mutations: A549 (wild type), H1975 (L858R/T790M), and HCC827 (exon 19 deletion). Tumor and background were manually outlined on the basis of an additional [18F]FDG scan, which was performed directly after the TKI-PET scan was finished.

Mentions: The TACs of the pre-blocked mice bearing the same tumor models as in the non-blocked condition are depicted in Figure 5. In the wild-type xenograft (A549), a minor increase of [11C]erlotinib tumor accumulation was observed which is also reflected in the tumor-to-background ratio (Table 1, entry 7), although this was not found to be statistically significant. In this xenograft model, a higher uptake was observed after treatment with tariquidar in both the tumor and the background (compare Figure 5 with Figure 3). [18F]afatinib also demonstrates a higher absolute uptake of activity (%ID/g) in the tumor and background and no washout was observed in either tissues. Apparently, the blocking of the efflux transporter systems with tariquidar resulted in better tissue trapping of [18F]afatinib (Figure 5).Figure 5


A comparative PET imaging study with the reversible and irreversible EGFR tyrosine kinase inhibitors [(11)C]erlotinib and [(18)F]afatinib in lung cancer-bearing mice.

Slobbe P, Windhorst AD, Stigter-van Walsum M, Smit EF, Niessen HG, Solca F, Stehle G, van Dongen GA, Poot AJ - EJNMMI Res (2015)

TACs of [11C]erlotinib (top) and [18F]afatinib (bottom) after tariquidar treatment. TACs are averaged over three animals. Mutations: A549 (wild type), H1975 (L858R/T790M), and HCC827 (exon 19 deletion). Tumor and background were manually outlined on the basis of an additional [18F]FDG scan, which was performed directly after the TKI-PET scan was finished.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4385286&req=5

Fig5: TACs of [11C]erlotinib (top) and [18F]afatinib (bottom) after tariquidar treatment. TACs are averaged over three animals. Mutations: A549 (wild type), H1975 (L858R/T790M), and HCC827 (exon 19 deletion). Tumor and background were manually outlined on the basis of an additional [18F]FDG scan, which was performed directly after the TKI-PET scan was finished.
Mentions: The TACs of the pre-blocked mice bearing the same tumor models as in the non-blocked condition are depicted in Figure 5. In the wild-type xenograft (A549), a minor increase of [11C]erlotinib tumor accumulation was observed which is also reflected in the tumor-to-background ratio (Table 1, entry 7), although this was not found to be statistically significant. In this xenograft model, a higher uptake was observed after treatment with tariquidar in both the tumor and the background (compare Figure 5 with Figure 3). [18F]afatinib also demonstrates a higher absolute uptake of activity (%ID/g) in the tumor and background and no washout was observed in either tissues. Apparently, the blocking of the efflux transporter systems with tariquidar resulted in better tissue trapping of [18F]afatinib (Figure 5).Figure 5

Bottom Line: Additionally, the effect of drug efflux transporter permeability glycoprotein (P-gp) on the tumor uptake of tracers was explored by therapeutic blocking with tariquidar.Under P-gp blocking conditions, no significant changes in tumor-to-background ratio were observed; however, [(18)F]afatinib demonstrated better tumor retention in all xenograft models.TKI-PET provides a method to image sensitizing mutations and can be a valuable tool to compare the distinguished targeting properties of TKIs in vivo.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, Amsterdam, 1081 HV The Netherlands ; Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, De Boelelaan 1117, Amsterdam, 1081 HV The Netherlands.

ABSTRACT

Background: Tyrosine kinase inhibitors (TKIs) have experienced a tremendous boost in the last decade, where more than 15 small molecule TKIs have been approved by the FDA. Unfortunately, despite their promising clinical successes, a large portion of patients remain unresponsive to these targeted drugs. For non-small cell lung cancer (NSCLC), the effectiveness of TKIs is dependent on the mutational status of epidermal growth factor receptor (EGFR). The exon 19 deletion as well as the L858R point mutation lead to excellent sensitivity to TKIs such as erlotinib and gefitinib; however, despite initial good response, most patients invariably develop resistance against these first-generation reversible TKIs, e.g., via T790M point mutation. Second-generation TKIs that irreversibly bind to EGFR wild-type and mutant isoforms have therefore been developed and one of these candidates, afatinib, has now reached the market. Whether irreversible TKIs differ from reversible TKIs in their in vivo tumor-targeting properties is, however, not known and is the subject of the present study.

Methods: Erlotinib was labeled with carbon-11 and afatinib with fluorine-18 without modifying the structure of these compounds. A preclinical positron emission tomography (PET) study was performed in mice bearing NSCLC xenografts with a representative panel of mutations: an EGFR-WT xenograft cell line (A549), an acquired treatment-resistant L858R/T790M mutant (H1975), and a treatment-sensitive exon 19 deleted mutant (HCC827). PET imaging was performed in these xenografts with both tracers. Additionally, the effect of drug efflux transporter permeability glycoprotein (P-gp) on the tumor uptake of tracers was explored by therapeutic blocking with tariquidar.

Results: Both tracers only demonstrated selective tumor uptake in the HCC827 xenograft line (tumor-to-background ratio, [(11)C]erlotinib 1.9 ± 0.5 and [(18)F]afatinib 2.3 ± 0.4), thereby showing the ability to distinguish sensitizing mutations in vivo. No major differences were observed in the kinetics of the reversible and the irreversible tracers in each of the xenograft models. Under P-gp blocking conditions, no significant changes in tumor-to-background ratio were observed; however, [(18)F]afatinib demonstrated better tumor retention in all xenograft models.

Conclusions: TKI-PET provides a method to image sensitizing mutations and can be a valuable tool to compare the distinguished targeting properties of TKIs in vivo.

No MeSH data available.


Related in: MedlinePlus