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Can Axumin find metastases in bones or soft tissue outside the prostate itself ?

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Posted 1/16/2017 10:02 PM (GMT 0)
Have searched in this forum under axumin, have tried to read clinical studies
on it, and other articles on it --

literature talks about its use related to recurrent pca, but not clear if thats
just to see if its still active in the prosate area itself or also bones and soft tissue
in other parts of the body.


Or might one still need to get a bone scan (Na F for me) to see about the bone
metastases themselves ? (and perhaps also a traditional CT scan)



Axumin has started being done in my area although only a handful have been
done yet, so don't know if more experience is needed by that facility to give
me more confidence in the procedure and reading of results.

But if a separate PET/CT bone scan would be needed as well, then I need to
understand that since that would mean 2 PET/CT scans in a short time.
(The NaF bone scan is the only one I can get; am not able to go get the
Choline or Acetate or PSMA ones)


Thanks for any clarifications about this.
Posted 1/16/2017 10:25 PM (GMT 0)
Axumin (aka fluciclovine, FACBC) can find mets in soft tissue and bones. You don't need a NaF PET scan with it. You also don't need a bone scan with it.
Posted 1/17/2017 5:07 PM (GMT 0)
I'm in Chicago area. Is it available near me, or where?
Posted 1/17/2017 6:11 PM (GMT 0)
Rigby-

The Axumin PET is available for men with a biochemical recurrence at Loyola U Medical center.

/clinicaltrials.gov/ct2/show/NCT02680041

Check with your insurance - FDA approval doesn't automatically mean it will be covered.

If you can wait, they will be recruiting patients at the U of Chicago for a study of the DCFPyL PET - the most accurate so far, but that will be out of pocket:

/clinicaltrials.gov/ct2/show/NCT02981368

You'd have to come to California for the Ga 68-PSMA PET, but it will be out of pocket.
Posted 2/26/2017 6:09 PM (GMT 0)
Allen,

on the topic of if Axumin can detect in bones, the manufacturer of it had told
someone in support group that the manufacturer has no information that Axumin can detect things in bone. (and they shared that communication with me)

Yet I have seen some reports on forums that said that based on their result reports, it did show things in bone (besides in soft tissue).

Thus this seems to be 2 conflicting pieces of information.

I don't know if there are more than one version of Axumin, perhaps made by or sold by some other company that has a different makeup and perhaps its that version that is used at places where folks have mentioned it showed things in bone.
If so, perhaps that explains the discrepancy.

Or if there is just one Axumin product and scan process and procedure.

In any case, its confusing to hear of this, since based on what manufacturer
said, one might need a bone scan besides Axumin scan.
Posted 2/26/2017 6:25 PM (GMT 0)

Tall Allen said...
Rigby-

The Axumin PET is available for men with a biochemical recurrence at Loyola U Medical center.

/clinicaltrials.gov/ct2/show/NCT02680041

Check with your insurance - FDA approval doesn't automatically mean it will be covered....

TA makes a good point. This is a valid caution for anyone considering advanced scans. My insurance won't even cover C11-Choline, saying it's not "proven for prostate cancer". I haven't asked yet, but I'm betting they won't approve anything beyond the traditional tech-99 bone scan or common CT. "If those don't find it, it's not worth finding", I suppose would be their argument.

As one contemplating possible biochemical recurrence, these scans are of interest. If warranted, I'll do one, but it's going to be out of pocket. So for likely $3k+, it had better be worth it! I wouldn't do the scan unless it will affect the course of treatment from that point.

In engineering tests, my rule has always been that unless you're going to change your actions based on the result of the test, don't do the test.
Posted 2/26/2017 9:39 PM (GMT 0)
tomhw-

There is really no controversy about this. Axumin (fluciclovine/ FACBC) was FDA-approved for recurrence detection. You can see that it is more sensitive than a bone scan in detecting bone mets:

/www.ncbi.nlm.nih.gov/pmc/articles/PMC4155751/

The manufacturer's representative was obviously mistaken, or what he said was misinterpreted. There is only one Axumin.
Posted 2/26/2017 10:07 PM (GMT 0)
Allen,

I will ask if they can check back with manufactuer and point to the study.

I have no experience in reading/interpreting studies, but noticed in this one that it said
"In addition, this trial was not designed to evaluate diagnostic performance for skeletal metastasis since a negative bone scan was a study entry criterion."

which seems to match what rep said related to no information being available
related to the studies as to finding things in bone, and that patients had to have had a negative bone scan
to be in the studies.

But am guessing the elsewhere in that study report that there is a mention of it detecting things in bone -

perhaps at
"Of the 70 patients 22 had true positive anti-3-[18F]FACBC PET-CT findings for extraprostatic disease, including node only in 19 and bone only in 3" ?

Could you let me know if this sentence and any others refer to the results of axumin as to finding things in bone, and then the rep can be pointed to those sections ?

Allen, thanks for taking the time to look at my comments.
Posted 2/26/2017 10:31 PM (GMT 0)
While a negative bone scan was necessary for entrance into that study, what it found was that there were detectable mets outside of the local prostate area (prostate/bed) when they used Axumin to find them. As one would expect, most of the recurrence sites were in the prostate (after RT) or the prostate bed (after RP). When there is detectable extraprostatic recurrence after primary surgery or radiation, it is primarily in the pelvic lymph node area, and much less often in the bones. What was significant in this study was that Axumin could detect those bone mets even when a bone scan could not. The way they confirmed that they were indeed bone mets was this: "For bone involvement, histological proof or a characteristic appearance on no fewer than 2 other imaging studies (MR, CT and/or bone scan) was accepted."

Axumin detects a protein metabolic pathway that is only active in prostate cancer cells, regardless of whether those cancer cells are in the prostate, the prostate bed, lymph nodes, bones or viscera.
Posted 2/28/2017 2:12 AM (GMT 0)
RE: coverage, I'm on Medicare with BCBS supplemental plan F. I had the scan at Loyola (thanks TA for the tip) and it seems to be fully covered.

My results? They didn't find anything that would be called definite. I'm not able to look up the exact wording. They also said the bladder shadowed the bed area, I think.
Posted 3/1/2017 1:32 AM (GMT 0)
I've been told to wait til PSA climbs between 1 and 2 before having the axumin scan.
Make sense?
Bob
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