18F-Fluoro-2-Deoxy-Glucose Uptake Predicts Clinical Outcome in Patients with Gefitinib-Treated Non–Small Cell Lung Cancer

Abstract

Purpose: To evaluate response and survival according to 18 F-fluoro-2-deoxy-glucose uptake at presentation in patients with gefitinib-treated non^small cell lung cancer. Experimental Design: We retrospectively analyzed 84 positron emission tomography/computed tomography findings. Patient characteristics, response rates, and survivals were evaluated according to the maximum standardized uptake value (SUV) of primary tumor. The cutoff value of SUVs was obtained from receiver operating characteristic analysis. Results: The response rate (RR) was higher for never-smokers (41%) than ever-smokers (9%; P = 0.001). Patients with adenocarcinoma showed higher RR than those with other tumor histopathology (35% versus 9%; P = 0.009). The SUV was significantly lower in patients who were never-smokers (P = 0.005), patients with adenocarcinoma (P < 0.001), and female patients (P = 0.017). Patients with a low SUV showed higher RR compared with those with a high SUV (53% versus 18%; P = 0.003). Prolonged progression-free survival was observed in patients with low SUVs compared with those with high SUVs (median, 33.1 weeks versus 8.6 weeks; P = 0.003). While controlling for performance status, smoking history, and pathology, the high SUV conferred unfavorable outcome (hazard ratio, 2.3; P = 0.012). In terms of overall survival, a low SUV was associated with favorable outcome in univariate analysis (P = 0.011). Patients with a low SUV showed prolonged survival in multivariate analysis (P = 0.043). Conclusions: These results suggest that low SUVs at presentation can predict favorable response and survival in gefitinib-treated non^small cell lung cancer patients.

Changes in 18F-Fluorodeoxyglucose and 18F-Fluorodeoxythymidine Positron Emission Tomography Imaging in Patients with Non–Small Cell Lung Cancer Treated with Erlotinib

“…Our results are consistent with and greatly expand on results from several smaller clinical studies of PET imaging in NSCLC patients treated with EGFR inhibitors, although none of these other studies directly compared FDG-and FLT-PET imaging (21)(22)(23)(24)39). For example, Sohn and colleagues found that an FLT-PET scan after 7 days of gefitinib treatment could predict the response to treatment in 28 nonsmokers with advanced adenocarcinoma of the lung (22).…”

“…For example, Sohn and colleagues found that an FLT-PET scan after 7 days of gefitinib treatment could predict the response to treatment in 28 nonsmokers with advanced adenocarcinoma of the lung (22). Sunaga and colleagues reported similar findings with FDG-PET scans at 2 and 4 weeks after treatment with gefitinib (21). Soto Parra and colleagues recently reported that FDG-PET-detected changes occurring as early as 2 days after starting erlotinib can predict response in NSCLC patients (24).…”

“…For molecularly targeted therapies, several small studies in selected NSCLC patients have evaluated FDG-or FLT-PET changes (20)(21)(22)(23)(24)(25). However, for molecularly targeted therapies, it has not yet been established whether these imaging approaches provide a clinically meaningful assessment of therapeutic activity in NSCLC, particularly in the absence of tumor shrinkage.…”

Combined Treatment with Silibinin and Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors Overcomes Drug Resistance Caused by T790M Mutation

“…Response to treatment was assessed by 18 F-fludeoxyglucose (FDG) uptake changes and tumor growth inhibition. 18 F-FDG PET is useful for early prediction of the response to gefitinib in NSCLC (26,27). Although treatment with erlotinib produced a slight decrease in 18 F-FDG uptake, the erlotinib and silibinin combination more drastically reduced the uptake as compared with treatment with either drug alone on day 7 (Fig.…”

Correlation Analysis and Prognostic Impact of 18F-FDG PET and Excision Repair Cross-Complementation Group 1 (ERCC-1) Expression in Non-Small Cell Lung Cancer

“…b FDG-positive patients (SUVmax cutoff, 8.1) had significantly shorter OS than FDG-negative patients (HR, 5.05; 95 % CI, 2.38-10.70; p<0.001). In patients underwent chemotherapy group, there was no correlation between c ERCC-1 expression (p=0.055) and d FDG uptake (p=0.974) in predicting overall survival in these patients uptake in predicting therapy response is not yet established [23][24][25]. We have also shown in our study that ERCC-1 expression or FDG uptake predicted survival in platinumbased chemotherapy patients, but further studies are needed as our subanalysis study population was relatively small.…”