EURURO Vol. 72 No. 6

nivolumab seem to reduce the risk of death in patients

treated with prior pazopanib compared with sunitinib.

These data will require further evaluation in prospective

randomized clinical trials.

Conflicts of interest:

The authors have nothing to disclose.

References

[1]

Hsieh JJ, Purdue MP, Signoretti S, et al. Renal cell carcinoma. Nat Rev Dis Primers 2017;3:17009

[2]

Choueiri TK, Escudier B, Powles T, et al. Cabozantinib versus ever- olimus in advanced renal-cell carcinoma. N Engl J Med 2015;373: 1814 – 23

[3]

Motzer RJ, Escudier B, McDermott DF, et al. Nivolumab versus ever- olimus in advanced renal-cell carcinoma. N Engl J Med 2015;373: 1803 – 13

[4]

Escudier B, Sharma P, McDermott DF, et al. CheckMate 025 random- ized phase 3 study: outcomes by key baseline factors and prior therapy for nivolumab versus everolimus in advanced renal cell carcinoma. Eur Urol 2017;72:962 – 71

[5]

Choueiri TK, Escudier B, Powles. Cabozantinib versus everolimus in advanced renal cell carcinoma (METEOR): fi nal results from a randomised, open-label, phase 3 trial. Lancet Oncol 2016;17:917 – 27

Medical Oncology Unit, Department of Oncology, San Donato Hospital,

Arezzo, Italy

Department of Medical, Surgery and Health Sciences, University of Trieste,

Trieste, Italy

Breast Cancer Unit and Translational Research Unit, ASST Cremona,

Cremona, Italy

*Corresponding author. Oncology Unit, Oncology Department, Viale

Bracci 11, Siena 51100, Italy. Tel./Fax: +39 349 4046532.

E-mail address:

giandomenicoroviello@hotmail.it

(G. Roviello).

July 17, 2017

http://dx.doi.org/10.1016/j.eururo.2017.07.019

Hyperpolarized 1-[

C]-Pyruvate Magnetic Resonance Imaging

Detects an Early Metabolic Response to Androgen Ablation

Therapy in Prostate Cancer

Rahul Aggarwal

* , Daniel B. Vigneron, John Kurhanewicz

Hyperpolarized (HP)

Cmagnetic resonance spectroscopic

imaging (MRSI) is a novel imaging technique that allows

rapid and noninvasive monitoring of dynamic pathway-

specific metabolic and physiologic processes

[1]

with

unprecedented gain in sensitivity (10 000

–

200 000 fold

increase) for imaging of

C-labeled biomolecules that are

endogenous, nontoxic, and nonradioactive

[2,3]

. We previ-

ously reported the first-in-human phase 1 clinical study of

HP [

C]-pyruvate MRSI in patients with prostate cancer on

active surveillance, and confirmed the feasibility of

capturing regions of accelerated HP pyruvate-to-lactate

flux in high-grade versus low-grade cancer versus benign

tissue

[4]

Here we describe the first results demonstrating the

metabolic response to androgen deprivation therapy (ADT)

using HP [

C]-pyruvate MRSI. The patient presented with

serum prostate-specific antigen (PSA) of 25.2 ng/ml and

Gleason 4 + 5 prostate adenocarcinoma on biopsy.

Cross-sectional imaging demonstrated metastases within

the pelvic nodes and osseous structures. Baseline multi-

parametric (mp)

H MRI of the prostate (anatomic

imaging, diffusion-weighted imaging [DWI], dynamic

contrast-enhanced [DCE] imaging, and 3D

H MRSI) with

HP [

C]-pyruvate revealed a bulky tumor involving the left

apex, mid gland, and base peripheral and transition zones,

and right apex, mid gland, and base peripheral zone,

measuring 4.5 1.5 5.1 cm

. T2-weighted MRI showed a

well-defined focus of low signal intensity (T2 score 5/5;

Fig. 1

A). The lesion also had marked restricted diffusion

(DWI score 5/5; apparent diffusion coefficient [ADC] 930)

Table 1

–

Characteristics of the trials analyzed and data on survival according to prior treatment

Trial

Drug

Overall survival

Patients (

)

Median (mo)

Sunitinib

CheckMate 025

Nivolumab vs everolimus

257 vs 261

23.6 vs 19.8

METEOR

Cabozantinib vs everolimus

135 vs 132

Not reported

Pazopanib

CheckMate 025

Nivolumab vs everolimus

126 vs 136

Not reached vs 17.6

METEOR

Cabozantinib vs everolimus

88 vs 83

Not reported

E U R O P E A N U R O L O GY 7 2 ( 2 0 17 ) 10 2 7

–

10 2 9

1028