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A comparative study is carried out on two spectroscopic techniques employed to detect ultrafast absorption changes in the mid-infrared spectral range, namely direct multichannel detection via HgCdTe (MCT) photodiode arrays and the newly established technique of chirped-pulse upconversion (CPU). Whereas both methods are meanwhile individually used in a routine manner, we directly juxtapose their applicability in femtosecond pump-probe experiments based on 1 kHz shot-to-shot data acquisition. Additionally, we examine different phase-matching conditions in the CPU scheme for a given mid-infrared spectrum, thereby simultaneously detecting signals which are separated by more than 200 cm−1.
We aimed to elucidate the diagnostic potential of the C-X-C motif chemokine receptor 4 (CXCR4)-directed positron emission tomography (PET) tracer \(^{68}\)Ga-Pentixafor in patients with poorly differentiated neuroendocrine carcinomas (NEC), relative to the established reference standard \(^{18}\)F-FDG PET/computed tomography (CT). In our database, we retrospectively identified 11 treatment-naïve patients with histologically proven NEC, who underwent \(^{18}\)F-FDG and CXCR4-directed PET/CT for staging and therapy planning. The images were analyzed on a per-patient and per-lesion basis and compared to immunohistochemical staining (IHC) of CXCR4 from PET-guided biopsies. \(^{68}\)Ga-Pentixafor visualized tumor lesions in 10/11 subjects, while \(^{18}\)F-FDG revealed sites of disease in all 11 patients. Although weak to moderate CXCR4 expression could be corroborated by IHC in 10/11 cases, \(^{18}\)F-FDG PET/CT detected significantly more tumor lesions (102 vs. 42; total lesions, n = 107; p < 0.001). Semi-quantitative analysis revealed markedly higher 18F-FDG uptake as compared to \(^{68}\)Ga-Pentixafor (maximum and mean standardized uptake values (SUV) and tumor-to-background ratios (TBR) of cancerous lesions, SUVmax: 12.8 ± 9.8 vs. 5.2 ± 3.7; SUVmean: 7.4 ± 5.4 vs. 3.1 ± 3.2, p < 0.001; and, TBR 7.2 ± 7.9 vs. 3.4 ± 3.0, p < 0.001). Non-invasive imaging of CXCR4 expression in NEC is inferior to the reference standard \(^{18}\)F-FDG PET/CT.
The experimental technique predominantly employed within the scope of this Thesis constitutes one subarea of femtochemistry: the time-resolved spectroscopy of photoin-
duced chemical reactions in the liquid phase by means of molecular signatures in the mid-infrared (MIR) spectral range. Probing transient vibrational states, i.e., dynamic
changes in the vibrational motion of specic molecular subunits or functional Groups allows for a distinct separation and assignment of measured signals to emerging molecular species. For this purpose, one key building block is indispensable, which most of the investigations carried out within the eld of femtochemistry have in common: a coherent light source delivering ultrashort laser pulses with a temporal duration that matches the femtosecond time scale on which molecular motions typically occur. This instrumentation enables the observation of photoinduced chemical reactions from the
starting point|the excitation event to the appearance of intermediates to the nal formation of stable photoproducts after several pico- or nanoseconds.
This work comprises the acquisition and presentation of time-resolved spectroscopic data related to promising molecular systems upon photoexcitation as well as the im-
plementation and testing of experimental optical techniques both for the presented experiments but as well for experiments conceivable in the future. In addition, linear spectroscopy measurements and quantum-chemical simulations on the emerging chemical species have been carried out. In so doing, the primary processes and subse-
quently emerging reaction products of two compounds on a timescale of several nanoseconds after photoexcitation have been elucidated in great detail. Both compounds, the
[Mn(CO)3(tpm)]+ (tpm = tris(2-pyrazolyl)methane) CO-releasing molecule (CORM) and the 5-diazo Meldrum's acid (DMA), are of academic interest but in addition belong
to molecular classes that might be utilized in the near future as dark-stable prodrugs under physiological conditions or that are already utilized in industrial chemistry procedures, respectively. The ndings of both studies gave rise to implement and examine two techniques for prospective transient absorption experiments, namely the shaping and characterization of ultraviolet (UV) laser pulses and the recording of two-photon excitation spectra. Beyond that, since each of the depicted experiments is based on the detection of weak transient absorption signals in the MIR spectral region, two dif-
ferent detection schemes, via chirped-pulse upconversion (CPU) on the one hand and via direct multichannel MCT detection on the other hand, have been juxtaposed at the
conclusion of this work. Since both techniques are suitable in femtosecond pump-probe measurements but thereby exhibit individual strengths and weaknesses, a comparative study provides clarication of the respective pros and cons. The first study introduced within this work investigates the complex photochemistry
of DMA, a photoactive compound used in lithography and industrial chemistry. By femtosecond MIR transient absorption spectroscopy covering several nanoseconds, the
light-induced dynamics and ultrafast formation of several photoproducts from the manifold of reaction pathways have been disclosed to form a coherent picture of the overall
reaction scheme. After UV excitation of DMA dissolved in methanol to the second excited state S2, 70% of excited molecules relax back to the S0 ground state. In compet-
ing processes, they can either undergo an intramolecular Wolff rearrangement to form ketene, which reacts with a solvent molecule to an enol intermediate and further to carboxylate ester, or they rst relax to the DMA S1 state, from where they can isomerize to a diazirine. The third competing reaction channel, having the lowest quantum efficiency with respect to the rst two channels, is the formation of a singlet carbene out of the S1 state. From there an ylide can arise or, via an intersystem crossing, the triplet form of the carbene follows. Whereas the primary reaction steps occur on a picosecond timescale, the subsequently arising intermediates and stable photoproducts are formed
within a few hundreds to thousands of picoseconds. For a reliable identication of the involved compounds, density functional theory calculations on the normal modes and
Fourier-transform infrared spectroscopy of the reactant and the photoproducts in the chemical equilibrium accompany the analysis of the transient spectra. Additional experiments in ethanol and isopropanol led to slight spectral shifts as well as elongated time
constants due to steric hindrance in transient spectra connected with the ester Formation channel, further substantiating the assignment of the occurring reaction pathways and photoproducts.
The study demonstrated that the combination of linear and time-resolved spectroscopic measurements in conjunction with quantum-chemical calculations constitutes a powerful tool to unravel even highly complex photoreactions exhibiting multiple consecutive intermediate states within parallel reaction pathways. Although some of the individual reaction steps, for example the ketene formation via Wolff rearrangement, have been observed on ultrashort time scales before, this work encompassed the Observation of the whole set of appearing photoproducts of DMA in different alcohol solutions within several nanoseconds. In this sense, the ultrafast photochemistry of DMA represents a prototype example for a multisequential reaction scheme, elucidated by the capabilities of femtosecond MIR spectroscopy.
With a modified instrumentation concerning amongst others the system delivering the fundamental laser pulses or the generation of the UV pump pulses, the next ob-
jective within this work was to elucidate the primary processes upon UV Irradiation of a manganese tricarbonyl CORM in aqueous environment. The time-resolved
experiment was performed with two different pump wavelengths and furthermore supported by linear spectroscopy methods and time-dependent density functional theory (TDDFT) calculations on the excited states as well as DFT calculations on the ground
states. The measurements revealed that irradiating the compound with UV excitation pulses primarily leads to ultrafast photolysis of one CO ligand. Geminate recombination may occur within one picosecond but it remains a minor process as the photolyzed CO
group is liberated and the unoccupied coordination site is predominantly filled by an incoming solvent molecule. There was no evidence for hot CO bands, i.e., the remaining CO ligands|in the dicarbonyl photoproduct as well as in the intact CORM are not vibrationally excited through the UV excitation of the CORM. According to this, the excess energy merges into low-frequency vibrational modes associated with the molecule as a whole. Since studies on a macroscopic scale at irradiation times of several minutes prove that UV irradiation eventually leads to the release of two or even all three CO
ligands, further loss of CO most likely necessitates manganese oxidation or another interaction with light. To clarify the latter, a consecutive UV pulse was employed in order to excite the photoproducts subsequent to the initial pump interaction. However, the data obtained was not instructive enough to denitely exclude the manganese oxidation being responsible for the loss of further CO groups. Besides the exchange of a CO Group by a solvent molecule or the geminate recombination, the employment of two different excitation wavelengths in combination with ndings derived from the TDDFT calculations suggested another reaction process, namely the possibility that the excitation does not lead to any bond cleavage at all. As the CORM under investigation is tissue-selective and cytotoxic against cancer cells, knowledge of these rst photoinduced reaction steps is essential for a full understanding of its biological activity. Inspired by these two studies, experimental techniques for prospective transient absorption measurements have been implemented and tested within preparative measure-
ments. First, in the course of a UV-pump-MIR-probe experiment with specically tailored excitation pulses, one could pursue the aim of coherently controlling the outcome of a photoreaction in the liquid phase. Out of the rich photochemistry of DMA the vibrational signature of a particular molecular species might thereby serve as a feedback signal, which is a central part of a learning loop that adaptively determines the pulse shape that steers the quantum mechanical system upon photoexcitation into a desired direction. This motivated the installation and testing of devices by means of which the shaping and characterization of ultrashort laser pulses in the UV could be performed. Second, motivated by the biological applications of CORMs, one can imagine a scenario where a certain amount of CORMs is deposited inside cancerous tissue. Since the activation of CO loss by means of UV pulses is not possible due to the absorption characteristics of biological tissue, the simultaneous excitation via two photons from the visible spectral regime seems appealing. However, success or failure of such an application depends on whether the deposited compound efficiently absorbs two photons simultaneously, i.e., whether the two-photon absorption cross section is large enough. Therefore, a setup to record two-photon excitation spectra under full consideration of
the crucial laser pulse parameters like the pulse duration, energy and central wavelength was arranged and tested. The rst results were obtained with a commercially available reference system (Mn2CO10) but the setup as well as the described measurement and
data analysis procedure can easily be applied to record the two-photon absorption cross section of more promising molecular systems. Third, as the detection of probe pulses
in the MIR spectral region is part of each time-resolved measurement throughout this thesis, a comparison between the newly established technique of CPU and direct multi-
channel MCT detection is presented by means of pump{probe experiments on Mn2CO10 and Co4CO12 with a 1 kHz shot-to-shot data acquisition. It was shown that the CPU detection technique scores with its high spectral resolution and coverage of the easy-to-handle and more cost-effective CCD detectors. On the other hand, in the course of the additional nonlinear upconversion process intensity fluctuations of the chirped fundamental pulses are transferred to the probe spectrum in the visible regime. This entails a lower signal-to-noise ratio than the direct MCT detection, which can be compensated by an additional normalization procedure applied to the CPU probe pulses. As a consequence, the CPU detection scheme offers more flexibility for future investigations
employing MIR probe pulses. This is of great importance for many applications within the presented eld of femtochemistry as a huge variety of time-resolved investigations on a multitude of systems in the liquid phase is based on the detection of weak transient
absorption signals in the MIR spectral region.
Background
Prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT) is increasingly incorporated in the therapeutic algorithm of patients with metastatic castration-resistant prostate cancer (mCRPC). We aimed to elucidate the predictive performance of early biochemical response for overall survival (OS).
Materials and Methods
In this bicentric analysis, we included 184 mCRPC patients treated with \(^{177}\)Lu-PSMA RLT. Response to treatment was defined as decrease in prostate-specific antigen (PSA) levels 8 weeks after the first cycle of RLT (any decline or >50% according to Prostate Cancer Working Group 3). OS of responders and nonresponders was then compared using Kaplan–Meier curves and log-rank comparison.
Results
A total of 114/184 patients (62.0%) showed any PSA decline (PSA response >50%, 55/184 [29.9%]). For individuals exhibiting a PSA decline >50%, OS of 19 months was significantly longer relative to nonresponders (13 months; hazard ratio of death [HR] = 0.64, 95% confidence interval [95% CI] = 0.44–0.93; p = 0.02). However, the difference was even more pronounced for any PSA decline, with an OS of 19 months in responders, but only 8 months in nonresponders (HR = 0.39, 95% CI = 0.25–0.60; p < 0.001).
Conclusions
In mCRPC patients scheduled for RLT, early biochemical response was tightly linked to prolonged survival, irrespective of the magnitude of PSA decline. As such, even in patients with PSA decrease of less than 50%, RLT should be continued.
Background
CXCR4-directed positron emission tomography/computed tomography (PET/CT) has been used as a diagnostic tool in patients with solid tumors. We aimed to determine a potential correlation between tumor burden and radiotracer accumulation in normal organs.
Methods
Ninety patients with histologically proven solid cancers underwent CXCR4-targeted [\(^{68}\)Ga]Ga-PentixaFor PET/CT. Volumes of interest (VOIs) were placed in normal organs (heart, liver, spleen, bone marrow, and kidneys) and tumor lesions. Mean standardized uptake values (SUV\(_{mean}\)) for normal organs were determined. For CXCR4-positive tumor burden, maximum SUV (SUV\(_{max}\)), tumor volume (TV), and fractional tumor activity (FTA, defined as SUV\(_{mean}\) x TV), were calculated. We used a Spearman's rank correlation coefficient (ρ) to derive correlative indices between normal organ uptake and tumor burden.
Results
Median SUV\(_{mean}\) in unaffected organs was 5.2 for the spleen (range, 2.44 – 10.55), 3.27 for the kidneys (range, 1.52 – 17.4), followed by bone marrow (1.76, range, 0.84 – 3.98), heart (1.66, range, 0.88 – 2.89), and liver (1.28, range, 0.73 – 2.45). No significant correlation between SUV\(_{max}\) in tumor lesions (ρ ≤ 0.189, P ≥ 0.07), TV (ρ ≥ -0.204, P ≥ 0.06) or FTA (ρ ≥ -0.142, P ≥ 0.18) with the investigated organs was found.
Conclusions
In patients with solid tumors imaged with [\(^{68}\)Ga]Ga-PentixaFor PET/CT, no relevant tumor sink effect was noted. This observation may be of relevance for therapies with radioactive and non-radioactive CXCR4-directed drugs, as with increasing tumor burden, the dose to normal organs may remain unchanged.
Background: The benefit of hearing rehabilitation is often measured using audiological tests or subjective questionnaires/interviews. It is important to consider both aspects in order to evaluate the overall benefits. Currently, there is no standardized method for reporting combined audiological and patient reported subjective outcome measures in clinical practice. Therefore, this study focuses on showing the patient’s audiological, as well as subjective outcomes in one graph using data from an existing study. Method: The present paper illustrated a graph presenting data on four quadrants with audiological and subjective findings. These quadrants represented speech comprehension in quiet (unaided vs. aided) as WRS% at 65 dB SPL, speech recognition in noise (unaided vs. aided) as SRT dB SNR, sound field threshold (unaided vs. aided) as PTA\(_4\) in dB HL, wearing time and patient satisfaction questionnaire results. Results: As an example, the HEARRING graph in this paper represented audiological and subjective datasets on a single patient level or a cohort of patients for an active bone conduction hearing implant solution. The graph offered the option to follow the user’s performance in time. Conclusion: The HEARRING graph allowed representation of a combination of audiological measures with patient reported outcomes in one single graph, indicating the overall benefit of the intervention. In addition, the correlation and consistency between some results (e.g., aided threshold and aided WRS) can be better visualized. Those users who lacked performance benefits on one or more parameters and called for further insight could be visually identified.
Background
Radioligand therapy (RLT) with \(^{177}\)Lu-labeled prostate-specific membrane antigen (PSMA) ligands is associated with prolonged overall survival (OS) in patients with advanced, metastatic castration-resistant prostate cancer (mCRPC). A substantial number of patients, however, are prone to treatment failure. We aimed to determine clinical baseline characteristics to predict OS in patients receiving [\(^{177}\)Lu]Lu-PSMA I&T RLT in a long-term follow-up.
Materials and methods
Ninety-two mCRPC patients treated with [\(^{177}\)Lu]Lu-PSMA I&T with a follow-up of at least 18 months were retrospectively identified. Multivariable Cox regression analyses were performed for various baseline characteristics, including laboratory values, Gleason score, age, prior therapies, and time interval between initial diagnosis and first treatment cycle (interval\(_{Diagnosis-RLT}\), per 12 months). Cutoff values for significant predictors were determined using receiver operating characteristic (ROC) analysis. ROC-derived thresholds were then applied to Kaplan–Meier analyses.
Results
Baseline C-reactive protein (CRP; hazard ratio [HR], 1.10, 95% CI 1.02–1.18; P = 0.01), lactate dehydrogenase (LDH; HR, 1.07, 95% CI 1.01–1.11; P = 0.01), aspartate aminotransferase (AST; HR, 1.16, 95% CI 1.06–1.26; P = 0.001), and interval\(_{Diagnosis-RLT}\) (HR, 0.95, 95% CI 0.91–0.99; P = 0.02) were identified as independent prognostic factors for OS. The following respective ROC-based thresholds were determined: CRP, 0.98 mg/dl (area under the curve [AUC], 0.80); LDH, 276.5 U/l (AUC, 0.83); AST, 26.95 U/l (AUC, 0.73); and interval\(_{Diagnosis-RLT}\), 43.5 months (AUC, 0.68; P < 0.01, respectively). Respective Kaplan–Meier analyses demonstrated a significantly longer median OS of patients with lower CRP, lower LDH, and lower AST, as well as prolonged interval\(_{Diagnosis-RLT}\) (P ≤ 0.01, respectively).
Conclusion
In mCRPC patients treated with [\(^{177}\)Lu]Lu-PSMA I&T, baseline CRP, LDH, AST, and time interval until RLT initiation (thereby reflecting a possible indicator for tumor aggressiveness) are independently associated with survival. Our findings are in line with previous findings on [\(^{177}\)Lu]Lu-PSMA-617, and we believe that these clinical baseline characteristics may support the nuclear medicine specialist to identify long-term survivors.
Introduction
In men with metastatic castration-resistant prostate cancer (mCRPC) scheduled for prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT), biochemical response is assessed based on repeated measurements of prostate-specific antigen (PSA) levels. We aimed to determine overall survival (OS) in patients experiencing sustained PSA increase, decrease, or fluctuations during therapy.
Materials and methods
In this bicentric study, we included 176 mCRPC patients treated with PSMA-directed RLT. PSA levels were determined using blood samples prior to the first RLT and on the admission days for the following cycles. We calculated relative changes in PSA levels compared to baseline. Kaplan–Meier curves as well as log-rank test were used to compare OS of different subgroups, including patients with sustained PSA increase, decrease, or fluctuations (defined as change after initial decrease or increase after the first cycle).
Results
Sixty-one out of one hundred seventy-six (34.7%) patients showed a sustained increase and 86/176 (48.8%) a sustained decrease in PSA levels. PSA fluctuations were observed in the remaining 29/176 (16.5%). In this subgroup, 22/29 experienced initial PSA decrease followed by an increase (7/29, initial increase followed by a decrease). Median OS of patients with sustained decrease in PSA levels was significantly longer when compared to patients with sustained increase of PSA levels (19 vs. 8 months; HR 0.35, 95% CI 0.22–0.56; P < 0.001). Patients with PSA fluctuations showed a significantly longer median OS compared to patients with sustained increase of PSA levels (18 vs. 8 months; HR 0.49, 95% CI 0.30–0.80; P < 0.01), but no significant difference relative to men with sustained PSA decrease (18 vs. 19 months; HR 1.4, 95% CI 0.78–2.49; P = 0.20). In addition, in men experiencing PSA fluctuations, median OS did not differ significantly between patients with initial decrease or initial increase of tumor marker levels (16 vs. 18 months; HR 1.2, 95% CI 0.38–4.05; P = 0.68).
Conclusion
Initial increase or decrease of PSA levels is sustained in the majority of patients undergoing RLT. Sustained PSA decrease was linked to prolonged survival and men with PSA fluctuations under treatment experienced comparable survival benefits. As such, transient tumor marker oscillations under RLT should rather not lead to treatment discontinuation, especially in the absence of radiological progression.
(1) Background: Prostate-specific membrane antigen (PSMA)-directed radioligand therapy (RLT) has shown remarkable results in patients with advanced prostate cancer. We aimed to evaluate the toxicity profile of the PSMA ligand [\(^{177}\)Lu]Lu-PSMA I&T. (2) Methods: 49 patients with metastatic, castration-resistant prostate cancer treated with at least three cycles of [\(^{177}\)Lu]Lu-PSMA I&T were evaluated. Prior to and after RLT, we compared leukocytes, hemoglobin, platelet counts, and renal functional parameters (creatinine, eGFR, n = 49; [\(^{99m}\)Tc]-MAG3-derived tubular extraction rate (TER), n = 42). Adverse events were classified according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 and KDIGO Society. To identify predictive factors, we used Spearman's rank correlation coefficient. (3) Results: A substantial fraction of the patients already showed impaired renal function and reduced leukocyte counts at baseline. Under RLT, 11/49 (22%) patients presented with nephrotoxicity CTCAE I or II according to creatinine, but 33/49 (67%) according to eGFR. Only 5/42 (13%) showed reduced TER, defined as <70% of the age-adjusted mean normal values. Of all renal functional parameters, absolute changes of only 2% were recorded. CTCAE-based re-categorization was infrequent, with creatinine worsening from I to II in 2/49 (4.1%; GFR, 1/49 (2%)). Similar results were recorded for KDIGO (G2 to G3a, 1/49 (2%); G3a to G3b, 2/49 (4.1%)). After three cycles, follow-up eGFR correlated negatively with age (r = −0.40, p = 0.005) and the eGFR change with Gleason score (r = −0.35, p < 0.05) at baseline. Leukocytopenia CTCAE II occurred only in 1/49 (2%) (CTCAE I, 20/49 (41%)) and CTCAE I thrombocytopenia in 7/49 (14%), with an absolute decrease of 15.2% and 16.6% for leukocyte and platelet counts. Anemia CTCAE II occurred in 10/49 (20%) (CTCAE I, 36/49 (73%)) with a decrease in hemoglobin of 4.7%. (4) Conclusions: After PSMA-targeted therapy using [\(^{177}\)Lu]Lu-PSMA I&T, no severe (CTCAE III/IV) toxicities occurred, thereby demonstrating that serious adverse renal or hematological events are unlikely to be a frequent phenomenon with this agent.