Response rates of unselected non-small cell lung cancer (NSCLC) patients to the epidermal growth factor receptor inhibitor erlotinib are low and range from 10% to 20%. Early response assessments are needed to avoid costs and side effects of inefficient treatments. Here we determined whether early changes in tumor uptake of (18)F-FDG can predict progression-free and overall survival in NSCLC patients who are treated with erlotinib.
Twenty-two patients (6 men, 16 women; mean age ± SD, 64 ± 13 y) with stage III or stage IV NSCLC who received erlotinib treatment were enrolled prospectively. (18)F-FDG PET/CT was performed before the initiation of treatment (n = 22), after 2 wk (n = 22), and after 78 ± 21 d (n = 11). Tumor maximum standardized uptake values were measured for a maximum of 5 lesions for each patient. Tumor responses were classified using modified PET Response Criteria in Solid Tumors (use of maximum standardized uptake values). Median overall survival by Kaplan-Meier analysis was compared between groups using a log-rank test.
The overall median time to progression was 52 d (95% confidence interval, 47-57 d). The overall median survival time was 131 d (95% confidence interval, 0-351 d). Patients with progressive metabolic disease on early follow-up PET showed a significantly shorter time to progression (47 vs. 119 d; P < 0.001) and overall survival (87 vs. 828 d; P = 0.01) than patients classified as having stable metabolic disease or partial or complete metabolic response.
These data suggest that (18)F-FDG PET/CT performed early after the start of erlotinib treatment can help to identify patients who benefit from this targeted therapy.
"The principle of using PET for (early) therapy evaluation has since been tested in numerous studies and settings, including conventional cytotoxic chemotherapy, radiotherapy and molecular-targeted therapy, that is EGFR tyrosine kinase inhibitors (Hoekstra et al., 2002; Mac Manus et al., 2005; van Baardwijk et al., 2007; Kong et al., 2007; Maziak et al., 2009; Benz et al., 2011). All studies conclude that PET is potentially useful for therapy planning and evaluation; however, larger controlled trials assessing the clinical effect is still lacking as is necessary standardization of SUV measurements (Weber & Figlin, 2007). "
[Show abstract][Hide abstract] ABSTRACT: Lung cancer represents an increasingly frequent cancer diagnosis worldwide. An increasing awareness on smoking cessation as an important mean to reduce lung cancer incidence and mortality, an increasing number of therapy options and a steady focus on early diagnosis and adequate staging have resulted in a modestly improved survival. For early diagnosis and precise staging, imaging, especially positron emission tomography combined with CT (PET/CT), plays an important role. Other functional imaging modalities such as dynamic contrast-enhanced CT (DCE-CT) and diffusion-weighted MR imaging (DW-MRI) have demonstrated promising results within this field. The purpose of this review is to provide the reader with a brief and balanced introduction to these three functional imaging modalities and their current or potential application in the care of patients with lung cancer.
"Multiple studies demonstrate that PET/CT is more sensitive and specific than PET alone in evaluating the lung cancer since it provides combined morphological and functional information of the tumour.4–7 High accuracy of PET/CT has been observed in the early assessment of response to therapy, showing a close correlation between the reduction of tumour metabolic activity measured after a course of therapy and the clinical outcome of patients after the previewed cycles of therapy in patients in advanced stage.8–9 In early stage, Tumour Node Metastasis (TNM) staging system, it is still the most reliable prognostic factor to predict the outcome after surgery. "
[Show abstract][Hide abstract] ABSTRACT: The purpose of the study was to evaluate the correlation between the maximum standardized uptake value (SUVmax), size of primary lung lesion, disease-free survival (DFS) and overall survival (OS) in patients with stage I and II non-small cell lung cancer (NSCLC) in 2 years follow-up.
Forty-nine patients with stage I-II NSCLC were included in this study. Pre-surgical 2-deoxy-2-[18F]fluoro-D-glucose positron-emission tomography ((18)F-FDG PET/CT) study was performed for all patients. The relationship between SUVmax, tumour size and clinical outcome was measured. The cut-off value for SUVmax and tumour size with the best prognostic significance, probability of DFS and the correlation between SUVmax and the response to therapy were calculated.
There was a statistically significant correlation between SUVmax and DFS (p = 0.029). The optimal cut-offs were 9.00 for SUVmax (p = 0.0013) and 30mm for tumour size (p = 0.0028). Patients with SUVmax > 9 and primary lesion size > 30 mm had an expected 2years-DFS of 37.5%, while this rose to 90% if the tumour was <30 mm and/or SUVmax was <9.
In stage I-II, SUVmax and tumour size might be helpful to identify the subgroup of patients with high chance for recurrence.
Radiology and Oncology 09/2013; 47(3):219-23. DOI:10.2478/raon-2013-0023 · 1.91 Impact Factor
"18F-FDG PET has also been used successfully to assess tumor responses to targeted, predominantly cytostatic therapies, including imatinib [134, 135], gefitinib , erlotinib  (Fig. 3), and the B-Raf inhibitor PLX4032  (Fig. 4). The prompt reduction of 18F-FDG tumor uptake in response to imatinib and gefitinib appears to be explained by a translocation of membrane-bound glucose transporters into the cytoplasm and thus their inactivation . "
[Show abstract][Hide abstract] ABSTRACT: The discovery of the Warburg effect in the early twentieth century followed by the development of the fluorinated glucose analogue 18F-fluorodeoxyglucose (18F-FDG) and the invention of positron emission tomographs laid the foundation of clinical PET/CT. This review discusses the challenges and obstacles in clinical adoption of this technique. We then discuss advances in instrumentation, including the critically important introduction of PET/CT and current PET/CT protocols. Moreover, we provide evidence for the clinical utility of PET/CT for patient management and its potential impact on patient outcome, and address its cost and cost-effectiveness. Although this review largely focuses on 18F-FDG imaging, we also discuss a variety of additional molecular imaging approaches that can be used for cancer phenotyping with PET. Throughout this review we emphasize the critical contributions of CT to the strength of PET/CT.
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