Emerging Research at SNMMI Examines 18F-Flotufolastat in Managing Primary and Recurrent Prostate Cancer

In separate studies presented at the recent SNMMI 2024 conference, the positron emission tomography (PET) radiotracer ¹⁸F-flotufolastat demonstrated no urinary retention in patients with primary prostate cancer (PCa) and facilitated a 15 percent higher percentage of biochemical failure-free survival in comparison to conventional imaging for guided salvage radiotherapy in patients with recurrent PCa.

In one study comparing 18F-flotufolastat (Posluma, Blue Earth Diagnostics) and ⁶⁸Ga-PSMA-11-PET in 124 patients with primary PCa, researchers found that 18 percent of primary tumors located near the bladder in the ⁶⁸Ga-PSMA-11-PET group (3/17) were obscured by radioactivity in the bladder in comparison no obscured tumors with ¹⁸F-flotufolastat (0/24). The study authors also reported a 27.4 percent rate of halo artifacts with the ⁶⁸Ga-PSMA-11-PET cohort (17/62) in contrast to 4.8 percent (3/62) for those in the ¹⁸F-flotufolastat group.¹

The researchers also emphasized that there was no ureter retention with ¹⁸F-flotufolastat in comparison to 21 percent (13/62) for men in the ⁶⁸Ga-PSMA-11-PET group.¹

David Gauden, D.Phil, discussed these study results during an interview at the SNMMI conference.

“Their findings were clinically impactful in their opinion in that they had a much lower background radioactivity in the bladder (with ¹⁸F-flotufolastat) when they were evaluating the scans. (This) gave them more confidence in their diagnostic findings when they evaluated it on a multi-point scale of background (radiopharmaceutical) activity, leading them to believe that when you’re looking for local recurrences, using an agent with this lower bladder excretion could be clinically valuable in helping with the management of these patients,” noted Gauden, the chief executive officer for Blue Earth Diagnostics.

(Editor’s note: For related content, see “Study: 18F-Flotufolastat PET Imaging Changes Treatment in 89 Percent of Patients with Prostate Cancer Recurrence,” “Could Pluvicto Have a Role in Taxane-Naïve mCRPC?: an Interview with Oliver Sartor, MD” and “SNMMI: PSMA-18F DCFPyL Changes Treatment for PCa Recurrence in Significant Number of Patients with Low PSAs.”)

In a separate study of 110 patients with biochemical recurrence of PCa after radical prostatectomy, researchers compared ¹⁸F-flotufolastat PET-guided salvage radiotherapy (SRT) to conventional SRT. Although the researchers conceded a lack of statistical significance, they found that the ¹⁸F-flotufolastat PET-guided group had 8 percent, 15 percent, and 21 percent higher rates of biochemical failure-free survival at one, two and three years, respectively, than those who had conventional SRT.²

“Although it was a small study without a statistically significant finding, there were trends toward longer biochemical progression-free survival for the group where the radiotherapy was guided by PET imaging in addition to the standard field … ,” added Gauden.

For more insights from Mr. Gauden, watch the video below.

References

1. Rauscher I, Langbein T, Fuetterer CS, Weber W, Eiber M. Evaluation of qualitative and quantitative PET parameters in primary prostate cancer patients: double-match comparison of 18F-flotufolastat and 68Ga-PSMA-11-PET. Presented at the 2024 Society of Nuclear Medicine and Molecular Imaging Annual Meeting, June 8-11, Toronto, Canada. Available at: https://www.xcdsystem.com/snmmi/program/10OD8Tq/index.cfm . Accessed June 10, 2024.

2. Rauscher I, Vogel MME, Gschwend J, Peeken JC, Eiber M. 18F-rhPSMA-7 and 18F-flotufolastat PET-guided salvage radiotherapy in recurrent prostate cancer. Presented at the 2024 Society of Nuclear Medicine and Molecular Imaging Annual Meeting, June 8-11, Toronto, Canada. Available at: https://www.xcdsystem.com/snmmi/program/10OD8Tq/index.cfm . Accessed June 10, 2024.