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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Elena Zamagni, University of Bologna, Italy
- Second opponent: Associate Professor Laurent Garderet, Sorbonne Université, France
- Third member and chair of the evaluation committee: Associate Professor Tobias Gedde-Dahl, University of Oslo
Chair of the Defence
Professor Emeritus Borghild Barth-Heyerdahl Roald, University of Oslo
Principal Supervisor
Fredrik Schjesvold, Universitetet i Oslo
Summary
PET/CT and first-line treatment for multiple myeloma
Multiple myeloma is a cancer disease originating from malignant plasma cells in the bone marrow. Prognosis has improved markedly the recent years due to more treatment options available. However, almost all patients will experience relapse, need multiple treatments and eventually die from the disease. First line treatment for multiple myeloma includes induction therapy and autologous stem cell transplantation in patients below 65-70 years of age. PET/CT is an advanced imaging technique suitable for treatment evaluation in multiple myeloma but is currently not used for treatment decisions.
The aims of this thesis were to retrospectively compare induction treatments before ASCT, perform PET/CT in selected patients after ASCT and intensify treatment patients who were PET/CT positive in a phase 2 study, and explore the use a novel PET/CT tracer in multiple myeloma in a pilot study.
The induction treatment VRd (velcade-lenalidomid-dexamethasone) was associated with higher response rates compared with VCd (velcade-cyclophosphamide-dexamethasone). VRd was also associated with longer progression-free survival and overall survival. Only a small proportion of patients who had received VCd or VRd changed treatment. In contrast, a high proportion of patients who had received VTd (velcade-thalidomide-dexamethasone) changed treatment.
PET/CT was positive in 33% of patients who had received ASCT. These patients were treated with four cycles of consolidation therapy with KRd (carfilzomib-lenalidomide-dexamethasone). After treatment with KRd, 33% of patients converted into PET/CT negativity. In addition, PET/CT complemented response assessment with MRD (minimal residual disease).
The amino-acid based PET tracer [18F]Fluciclovine was compared to [18F]FDG in 13 patients. The results of this study was promising for [18F]Fluciclovine as it was assessed as positive in a higher number of patients and had higher semi-quantitative measurements compared with [18F]FDG.
Additional information
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