Inter-heterogeneity and intra-heterogeneity of αvß3 in non-small cell lung cancer and small cell lung cancer patients as revealed by 68Ga-RGD2 PET imaging.

PURPOSE: Integrin αvß3 is the therapeutic target of the anti-angiogenic drug cilengitide. The objective of this study was to compare αvß3 levels in non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) patients, by using the positron emission tomography (PET) tracer 68Ga-labeled dimerized-RGD (68Ga-RGD2). METHODS: Thirty-one patients with pathologically confirmed lung cancer were enrolled (21 were NSCLC and 10 were SCLC). PET/CT images were acquired using 68Ga-RGD2.18F-FDG PET/CT images were also acquired on the consecutive day as reference. The standard uptake values (SUV) and the tumor/nontarget (T/NT) values were quantitatively compared. Expression of the angiogenesis marker αvß3 in NSCLC and SCLC lesions was analyzed by immunohistochemistry. RESULTS: The 18F-FDG SUVmax and the SUVmean were not significantly different between NSCLC and SCLC patients. The 68Ga-RGD2 uptake of SCLC patients was at background levels in both SUV and T/NT measurements and was significantly lower than that of NSCLC patients. The range value of 68Ga-RGD2 SUVmean was 4.5 in the NSCLC group and 2.2 in the SCLC group, while the variation coefficient was 36.2% and 39.3% in NSCLC and SCLC primary lesions, respectively. Heterogeneity between primary lesions and putative distant metastases was also observed in some NSCLC cases. Immunostaining showed that αvß3 integrin was expressed in the cells and neovasculature of NSCLC lesions, while SCLC samples had negative expression. CONCLUSIONS: The uptake of 68Ga-RGD2 in SCLC patients is significantly lower than that in NSCLC patients, indicating a lower αvß3 target level for cilengitide in SCLC. Apparent intra-tumor heterogeneities of αvß3 also exist in both NSCLC and SCLC. Such inter- and intra-heterogeneity of αvß3 may potentially improve current applications of αvß3-targeted therapy and diagnostic imaging in lung cancer.