Scholarlink

Background <p>&#xa0;Gliomas remain challenging malignancies where conventional MRI increasingly fails to assess response to targeted therapies. IDH inhibitors (vorasidenib), multi-kinase inhibitors (regorafenib), and anti-angiogenic agents produce complex biological effects—metabolic reprogramming, vascular normalization, multi-pathway inhibition—manifesting as pseudoresponse and pseudoprogression. Amino acid PET offers unique metabolic insights that may overcome these limitations.</p> Methods <p>&#xa0;We performed a state-of-the-art narrative review of amino acid PET ([18F]FET, [11C]MET, [18F]DOPA, [18F]Fluciclovine) for monitoring targeted glioma therapies. Our analysis focused on optimal protocols, assessment timing, and response criteria for each therapeutic class, incorporating the 2024 RANO/EANO recommendations.</p> Key findings <p>Amino acid PET appears to achieve 80–90% accuracy in differentiating tumor progression from treatment effects across multiple therapeutic classes. For established therapies, PET helps identifying responders to multi-kinase inhibitors within 4–6 weeks and revealing metabolically active disease masked by anti-angiogenic pseudoresponse. Metabolic changes may predict survival outcomes weeks to months before MRI changes. While biological rationale suggests similar utility for IDH inhibitors, prospective data is pending. PET RANO 1.9 provides a general framework for PET implementation in treatment monitoring, but therapy-specific adaptations are under investigation.</p> Conclusions <p>&#xa0;Amino acid PET is increasingly used for monitoring targeted glioma therapies. Its ability to detect therapy-specific metabolic signatures—gradual changes with IDH inhibitors, rapid effects with kinase inhibitors—enables optimized treatment decisions. As precision oncology advances, amino acid PET provides critical biological insights for personalized glioma management, enabling treatment modifications in 40–50% of cases.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Metabolic signatures of response: how amino acid PET is revolutionizing glioma therapy assessment in the molecular era

  • 期刊论文

  • 发表日期：

    2026年4月2日

查看全文
  • Spimpolo Alessandro,
  • Sokolova Viktorija,
  • Lorenzon Leda,
  • Fracchetti Alessandro,
  • Gusella Sara,
  • Tredici Manuel,
  • Ruta Rossella,
  • Schwarz Thomas,
  • Farsad Mohsen

摘要

Background

 Gliomas remain challenging malignancies where conventional MRI increasingly fails to assess response to targeted therapies. IDH inhibitors (vorasidenib), multi-kinase inhibitors (regorafenib), and anti-angiogenic agents produce complex biological effects—metabolic reprogramming, vascular normalization, multi-pathway inhibition—manifesting as pseudoresponse and pseudoprogression. Amino acid PET offers unique metabolic insights that may overcome these limitations.

Methods

 We performed a state-of-the-art narrative review of amino acid PET ([18F]FET, [11C]MET, [18F]DOPA, [18F]Fluciclovine) for monitoring targeted glioma therapies. Our analysis focused on optimal protocols, assessment timing, and response criteria for each therapeutic class, incorporating the 2024 RANO/EANO recommendations.

Key findings

Amino acid PET appears to achieve 80–90% accuracy in differentiating tumor progression from treatment effects across multiple therapeutic classes. For established therapies, PET helps identifying responders to multi-kinase inhibitors within 4–6 weeks and revealing metabolically active disease masked by anti-angiogenic pseudoresponse. Metabolic changes may predict survival outcomes weeks to months before MRI changes. While biological rationale suggests similar utility for IDH inhibitors, prospective data is pending. PET RANO 1.9 provides a general framework for PET implementation in treatment monitoring, but therapy-specific adaptations are under investigation.

Conclusions

 Amino acid PET is increasingly used for monitoring targeted glioma therapies. Its ability to detect therapy-specific metabolic signatures—gradual changes with IDH inhibitors, rapid effects with kinase inhibitors—enables optimized treatment decisions. As precision oncology advances, amino acid PET provides critical biological insights for personalized glioma management, enabling treatment modifications in 40–50% of cases.