[18F]FDG Positron Emission Tomography within Two Weeks of Starting Erlotinib Therapy Can Predict Response in Non-Small Cell Lung Cancer Patients

Abstract

PurposeThe aim of this prospective study was to evaluate whether [18F]FDG-PET/CT, performed within two weeks of starting erlotinib therapy can predict tumor response defined by RECIST 1.1 criteria after 8 weeks of treatment in patients with inoperable (stage IIIA to IV) non-small cell lung cancer patients.Patients and MethodsThree [18F]FDG-PET/CT scans were acquired in 12 patients before (5±4 days) and after 9±3 days (early PET) and 60±6 days (late PET) of erlotinib therapy. Conventional evaluation, including at least chest CT (baseline versus after 8 weeks of treatment), was performed according to RECIST 1.1 criteria. Change in [18F]FDG uptake was compared with conventional response, progression-free survival (PFS), and overall survival (OS).ResultsBy using ROC analysis, the Area Under the Curve for prediction of metabolic non-progressive disease (mNP) by early PET was 0.86 (95% CI, 0.62 to 1.1; P = 0.04) at a cut-off of 21.6% reduction in maximum Standardized Uptake Value (SUVmax). This correctly classified 11/12 patients (7 with true progressive disease; 4 with true non-progressive disease; 1 with false progressive disease). Non-progressive disease after 8 weeks of treatment according to RECIST 1.1 criteria was significantly more frequent in patients classified mNP (P = 0.01, Fisher's exact test). mNP patients showed prolonged PFS (HR = 0.27; 95% CI, 0.04 to 0.59; P<0.01) and OS (HR = 0.34; 95% CI, 0.06 to 0.84; P = 0.03). Late PET analysis provided concordant results.ConclusionMorphologic response, PFS and OS survival in non-small cell lung cancer patients can be predicted by [18F]FDG-PET/CT scan within 2 weeks after starting erlotinib therapy.

In vitro and in vivo antitumor effect of gefitinib nanoparticles on human lung cancer

“…PET detection of new lesions early in the course of therapy has been reported to be a strong, independent predictive factor for overall survival in NSCLC patients treated with EGFR inhibitor (Aukema et al, 2010). In our study, small-animal PET/CT also confirmed that GEF-NPs has superior antitumor effect, as compared with free GEF or control group, GEF-NPs group had the lowest tumor uptake, which has a prognostic value in NSCLC (Hachemi et al, 2013). Furthermore, no new lesions detected by micro-PET early in the course of therapy were observed, in accordance with the result of survival analysis.…”

Association Between 18F-FDG Avidity and the BRAF Mutation in Papillary Thyroid Carcinoma

“…There was also a report that in iodine-refractory differentiated thyroid cancer, an early 18 F-FDG PET response was useful for identifying sorafenib non-responders, although no BRAF mutation analysis was performed in those patients [29]. As for other targeted agents, such as gefitinib and erlotinib for lung cancer [30][31][32][33], 18 F-FDG PET/CT may have a role in BRAF mutant PTC treated with sorafenib.…”

TLG-S criteria are superior to both EORTC and PERCIST for predicting outcomes in patients with metastatic lung adenocarcinoma treated with erlotinib

“…Although patients carrying mutations of the EGFR gene generally respond better to tyrosine kinase inhibitors (TKIs) [1], erlotinib may improve survival even in subjects with EGFR wild-type tumors [2]. Several studies have shown that FDG-PET is a useful imaging modality for predicting response to erlotinib in patients with non-small cell lung cancer (NSCLC) [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. However, most of these studies used only the primary tumor as the target lesion for sequential imaging [3][4][5][6][7][8][9][10][11][12], and treatment response was largely assessed using the European Organization for Research and Treatment of Cancer (EORTC) criteria [3][4][5][6][7][8][9]20].…”