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With regard to the other renal histologies, carbonic anhydrase IX (CAIX) is highly expressed in the surface of CCRCC cells, and it has been used as a target for molecular imaging. Girentuximab is an IgG1 chimeric antibody designed to target CAIX, and this agent recently combined with Iodine-121 to aid in molecular imaging of CCRCC. In a study published by Divgi et al in 2013, the use of 121-I-girentuximab was evaluated, showing a sensitivity for localized and metastatic CCRCC of approximately 86%. Sadly, validation studies are lacking.
Prostate-specific membrane antigen (PSMA) has been observed to also be highly expressed in CCRCC. The group at Hopkins performed a validation trial in a patient with widely metastatic CCRCC followed by rapid autopsy. PSMA PET/CT was able to identify 53 of the 54 sites of metastatic disease previously identified with conventional CT. PSMA PET/CT noted 12 additional lesions not seen with conventional imaging. On rapid autopsy, all the lesions were confirmed to be metastatic CCRCC.
In Dr. Allaf’s conclusion, sestamibi- and CAIX-based imaging are promising modalities for the radiographic biopsy of renal tumors. PSMA-based imaging has shown encouraging results, he observed, but it still requires further validation.
Presenter: Alessandro Volpe, MD university of south piedmont, Italy
Written By: Andres F. Correa, MD, Society of Urologic Oncology Fellow, Fox Chase Cancer Center
at the 2017 Genitourinary Cancers Symposium - February 16 - 18, 2017 – Orlando, Florida USA