Is there a better PET tracer for NSCLC than F-18?

[V10fanatic]

My mom was recently diagnosed and her F-18 PET showed a 6cm tumor in her left lung. Her lower pulmonary lobe is collapsed, and the MO is thinking that the pleura might also be involved. She's afraid of having a Thoracoscopy and asked me if there is a more precise PET available. For reference sake, I participated in a clinical trial for a PSMA PET for my prostate cancer and that tracer picked up a bunch of mets that the standard Axumin PET scan missed. Thanks!

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Hi V10Sorry your mum being diagnosed. It's difficult I know. She shouldn't be afraid of a colonoscopy. It's routine

And you with prostate cancer.

I hope all goes well

[RoyCastleHelpline Partner Ask the Nurse Roy Castle]

Hi V10fanatic

Welcome to the forum and sorry to hear about your mum.

In the UK, the standard tracer licensed for use in the PET scan for the lungs is the F-18 (F-18 fluorodeoxyglucose sometimes known as FDG, this is based on proven research data.

It is only through research that advances are made with better diagnostics and treatments, however this can also be specific only to the area of the body that is being researched, hence imaging for Prostate may not have the same use for the lungs.

Although these tracers can pick up 'hot spots' where cancer is present/active, the most definitive diagnostic tool is biopsy, either of the tissue or the pleura fluid.

This link will take you to our booklet on 'Managing a lung cancer diagnosis', this provides information on the investigations and treatment options: roycastle.org/app/uploads/2...

I see you live in the United States of America, and if your mum is there also, you may wish to look at the information on the websites there, as they have different licensing regulations for investigations and treatments from the FDA.

This link is from the American Lung Association, you can also contact them directly to ask any questions you have.

lung.org/lung-health-diseas...

and

lcfamerica.org/lung-cancer-...

You are welcome to download any of our information booklets, which can be found on this link: roycastle.org/help-and-supp...

Lung cancer treatments have advanced in the past ten years with new treatments of immunotherapies and targeted therapies, however these only have an effect on certain cell mutations/ proteins that are present from biopsy.

It is understandable that your Mum would be concerned about any scope investigation, the Thoracoscopy would be used by the doctor to look at the area outside the lung and perhaps take some fluid for analysis.

The American Cancer Society has some information on this: cancer.org/treatment/unders....

Your mum could discuss her concerns with her specialist nurse or doctor.

It is a stressful and difficult time for you all and hope you have some answers soon so treatment can be started.

Kind regards

The Roy Castle Support Team

[V10fanatic in reply to RoyCastleHelpline]

Roy, my mom's genetic testing turned up nothing useful, so there are no targeted treatment options. Her MO is suggesting Keytruda(her TPS% is 30). She has numerous other serious issues and does not want to utilize chemo. If the pleura is not cancerous she is considering radiation therapy. Her collapsed lung occurred just after the initial biopsy procedure so she's trying to avoid the Thoracoscopy at all costs, hence my hope for a more definitive PET. It appears that there is no other option at this point though.

[RoyCastleHelpline Partner Ask the Nurse Roy Castle in reply to V10fanatic]

Dear V10fanatic

It is understandable your Mums anxiety with having experienced a collapsed lung post biopsy.

I assume you have discussed your queries with the oncologist or lung cancer nurse specialist.

This link will take you to our booklet on radiotherapy if this is a treatment option for your Mum: roycastle.org/app/uploads/2...

Even if there was another option with PET, it would still require pathology analysis of either tissue or pleural fluid.

You are welcome to email ask the nurse at [e-mail] if you wish to discuss anything further or call our freephone nurse led helpline number on 0800 358 7200 Monday to Thursday 0900-1700 and Friday 0900-1600

Kind regards

Ask the nurse

The Roy Castle Support Team

[JanetteR57]

PET is only one of a suite of diagnostics used to determine lung cancer or not - none are used in isolation - most genetic mutations are picked up from a biopsy/pathology in the UK.... it's important that a multi disciplinary team looks at the results from the various tests - thorascopy and bronchoscopy can be used (or EBUS) to gather biopsies, Many patients have fears about certain aspects of investigations and we often imagine we'll feel everything but sedation/anaesthetic are used for many. As treatments for non small cell lung cancer are so varied and determined in many cases by the characteristics of the tumour, treatment can't really be started to best effect until the results of these tests are in... I found the phrase 'all things must pass' helped me when things felt more difficult.... hope your mum finds a way to cope with the various tests required to access the best treatment for her condition... good luck to you both