Head-to-Head Comparison of ⁶⁸Ga-PentixaFor PET/CT and FDG PET/CT for Detecting Hematologic and Solid Cancers: A Systematic Review and Meta-Analysis.

Abstract

<b>BACKGROUND</b>. Numerous studies have shown the superiority of PET/CT performed with the use of chemokine-targeted tracer ⁶⁸Ga-boclatixafortide (⁶⁸Ga-PentixaFor, Pentixapharm) compared with FDG PET/CT for oncologic evaluation, although outcomes have varied across tumor types. <b>OBJECTIVE</b>. This study aimed to conduct a head-to-head comparison of ⁶⁸Ga-PentixaFor PET/CT and FDG PET/CT for detecting hematologic malignancies and solid tumors. <b>EVIDENCE ACQUISITION</b>. The PubMed and Embase databases were searched through March 4, 2024, for studies reporting a head-to-head comparison of the detection performance of ⁶⁸Ga-PentixaFor PET/CT versus FDG PET/CT in patients with cancer. Data were extracted from studies on a patient basis for each test in terms of the detection rate, SUV_max, and target-to-background ratio (TBR). The two tests were compared separately for hematologic malignancies and solid tumors. <b>EVIDENCE SYNTHESIS</b>. The meta-analysis included 28 studies (15 studies of hematologic malignancies and 13 of solid cancers), with a total of 493 patients who underwent both tests. For hematologic malignancies, ⁶⁸Ga-PentixaFor PET/CT, compared with FDG PET/CT, showed a significantly higher detection rate overall (relative risk [RR] = 1.19, <i>p</i> < .001) and for bone marrow involvement (RR = 1.69, <i>p</i> < .001), but it showed no significant difference for extramedullary involvement (RR = 1.10, <i>p</i> = .88); ⁶⁸Ga-PentixaFor PET/CT, compared with FDG PET/CT, showed a significantly higher SUV_max overall (mean difference [MD] = 2.26, <i>p</i> < .001) for bone marrow involvement (MD = 4.75, <i>p</i> < .001) and for extramedullary involvement (MD = 5.88, <i>p</i> < .001), as well as a significantly higher TBR (MD = 1.28, <i>p</i> = .03). For solid tumors, ⁶⁸Ga-PentixaFor PET/CT, compared with FDG PET/CT, showed a significantly lower detection rate overall (RR = 0.73, <i>p</i> = .005) but no significant difference for primary lesions (RR = 0.83, <i>p</i> = .11), lymph node metastases (RR = 0.86, <i>p</i> = .04), or distant metastases (RR = 0.64, <i>p</i> = .13); ⁶⁸Ga-PentixaFor PET/CT, compared with FDG PET/CT, showed a significantly lower SUV_max (MD = -8.79, <i>p</i> < .001) and TBR (MD = -3.35, <i>p</i> < .001). <b>CONCLUSION</b>. In a head-to-head comparison of diagnostic performance, ⁶⁸Ga-PentixaFor PET/CT outperformed FDG PET/CT for hematologic malignancies, whereas FDG PET/CT outperformed ⁶⁸Ga-PentixaFor PET/CT for solid tumors. <b>CLINICAL IMPACT</b>. The findings of this study can help guide the selection of optimal imaging strategies in patients with cancer.