Association of Receipt of Positron Emission Tomography–Computed Tomography With Non–Small Cell Lung Cancer Mortality in the Veterans Affairs Health Care System

Vella, Maya; Meyer, Craig S.; Zhang, Ning; Cohen, Beth E.; Whooley, Mary A.; Wang, Sunny; Hope, Michael D.

doi:10.1001/jamanetworkopen.2019.15828

Cited by 8 publications

(15 citation statements)

References 45 publications

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“…Fluorodeoxyglucose (FDG)-PET scans are standard of care for the appropriate staging of newly diagnosed patients with NSCLC. Use of PET-CT has been demonstrated to increase compliance with stage appropriate treatment and result in a decreased 5-year mortality ( 164 ). When used in conjunction with invasive mediastinal staging techniques, FDG-PET has a high sensitivity and specificity for mediastinal lymph node staging, allowing for improved target delineation when designing radiation treatment plans.…”

Section: Metabolic Imaging and Treatment Modulationmentioning

confidence: 99%

Metabolic targeting, immunotherapy and radiation in locally advanced non-small cell lung cancer: Where do we go from here?

Dhawan

Pifer²,

Sandulache³

et al. 2022

Front. Oncol.

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In the US, there are ~250,000 new lung cancer diagnoses and ~130,000 deaths per year, and worldwide there are an estimated 1.6 million deaths per year from this deadly disease. Lung cancer is the most common cause of cancer death worldwide, and it accounts for roughly a quarter of all cancer deaths in the US. Non-small cell lung cancer (NSCLC) represents 80-85% of these cases. Due to an enormous tobacco cessation effort, NSCLC rates in the US are decreasing, and the implementation of lung cancer screening guidelines and other programs have resulted in a higher percentage of patients presenting with potentially curable locoregional disease, instead of distant disease. Exciting developments in molecular targeted therapy and immunotherapy have resulted in dramatic improvement in patients’ survival, in combination with new surgical, pathological, radiographical, and radiation techniques. Concurrent platinum-based doublet chemoradiation therapy followed by immunotherapy has set the benchmark for survival in these patients. However, despite these advances, ~50% of patients diagnosed with locally advanced NSCLC (LA-NSCLC) survive long-term. In patients with local and/or locoregional disease, chemoradiation is a critical component of curative therapy. However, there remains a significant clinical gap in improving the efficacy of this combined therapy, and the development of non-overlapping treatment approaches to improve treatment outcomes is needed. One potential promising avenue of research is targeting cancer metabolism. In this review, we will initially provide a brief general overview of tumor metabolism as it relates to therapeutic targeting. We will then focus on the intersection of metabolism on both oxidative stress and anti-tumor immunity. This will be followed by discussion of both tumor- and patient-specific opportunities for metabolic targeting in NSCLC. We will then conclude with a discussion of additional agents currently in development that may be advantageous to combine with chemo-immuno-radiation in NSCLC.

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Section: Metabolic Imaging and Treatment Modulationmentioning

confidence: 99%

Metabolic targeting, immunotherapy and radiation in locally advanced non-small cell lung cancer: Where do we go from here?

Dhawan

Pifer²,

Sandulache³

et al. 2022

Front. Oncol.

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“…The metabolic tumor burden is described with the maximum standardized uptake value (SUV-Max a ) of the primary tumor, depending on the rate of 18F-FDG uptake by the tumor [16,17]. Currently, PET-CT is a good procedure for the diagnosis of NSCLC patients because it has the capability of identifying the lesion which would pass unnoticed in CT, preventing and reducing unnecessary operation [18,19]. However, PET-CT shows low speci city for differential diagnosis of NSCLC from tuberculosis, due to the tuberculosis site also presents an elevated level of glucose consumption [20,21].…”

mentioning

confidence: 99%

Combination of Circulating Cell-Free DNA and Metabolic Tumor Burden to Distinguish Non-Small Cell Lung Cancer from Tuberculosis

Zheng

Zhang

Quan

et al. 2020

Preprint

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Background: Non-small cell lung (NSCLC) holds high mortality owing to the difficulty to early detection from other lung mass, such as tuberculosis. This study evaluates the clinical value of the combination of circulating cell-free DNA (cfDNA) quantification and metabolic tumor burden to distinguish NSCLC from tuberculosis. Methods: A total of 149 NSCLC patients, 151 tuberculosis patients and 150 healthy controls were included. Quantifying serum cfDNA fragments from ALU (115 bp) gene by RT-PCR. Metabolic tumor burden (SUV-Maxa) values were detected by preoperative the 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT). A549 cell, NCI–H460 cell, NSCLC and tuberculosis mice model were used to elucidate the specific mechanism. Results: Serum cfDNA levels and SUV-Maxa were higher in NSCLC patients than those in healthy controls and those in tuberculosis. Meanwhile, mice models showed the similar discovery. In addition, obvious correlations of cfDNA and metabolic tumor burden were only existed in NSCLC patients and mice model, rather than tuberculosis and control. Moreover, the combination of cfDNA and metabolic tumor burden displayed better effect to distinguish NSCLC from tuberculosis than alone use. Mechanistically, upregulated Glucose transporter 1 (GLU1) increased necroptosis-induce cfDNA rise by FasL/caspase 8/caspase 3 pathway and promoted metabolic tumor burden in NSCLC. Conclusions: The combination of cfDNA and metabolic tumor burden displayed better effect to distinguish NSCLC from tuberculosis, owing to upregulated GLU1 increased cfDNA levels by FasL/caspase 8/caspase 3 pathways and promoted metabolic tumor burden in NSCLC.

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“…Thus, it is unclear how representative the cohort is in relation to the general population and if conclusions from the present cohort can be easily translated to patient groups outside the Veterans Affairs system. Nevertheless, the article by Vella et al 1 is an important piece within the evolving body of data on PET-CT in patients with NSCLC. So far, 2 randomized clinical trials 2,3 have been performed to assess whether the use of PET or PET-CT with FDG could improve the selection of surgically curable patients with NSCLC.…”

mentioning

confidence: 99%

“…However, 1 trial did not find a survival benefit, while the other trial did not investigate survival outcomes. In this context, the survival results represent a key strength of the study by Vella et al 1 The current literature has also been summarized by a variety of systematic reviews and metaanalyses. A 2018 meta-analysis 4 found that PET-CT with FDG had a high diagnostic performance for detecting distant metastasis in patients with NSCLC at initial staging.…”

mentioning

confidence: 99%

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The Role of Positron Emission Tomography–Computed Tomography in the Workup of Non–Small Cell Lung Cancer

Walter

2019

JAMA Netw Open

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Non-small cell lung cancer (NSCLC) remains a significant global health burden and is a leading cause of cancer-related death. The correct staging of patients with NSCLC is a key step in selecting an adequate treatment regimen, and combined positron emission tomography-computed tomography (PET-CT) with fluorine 18-labeled fluorodeoxyglucose (FDG) is increasingly used for staging and treatment monitoring of patients with NSCLC. The principal strengths of PET-CT with FDG in staging NSCLC include the assessment of intrathoracic lymph nodes and the detection of unanticipated stage IV disease. However, data on the effects of PET-CT with FDG on cancer-related mortality in NSCLC remain sparse.The article by Vella et al 1 aims to provide such data on cancer-related mortality. The authors examined the association of the use of PET-CT with NSCLC mortality in 64 103 patients treated in the US Department of Veterans Affairs from 2000 to 2013. They found that PET-CT use increased over this 13-year period, while mortality decreased. 1 Vella et al 1 concluded that PET-CT was associated with both a higher level of care and decreased mortality for veterans with NSCLC.To appreciate the contribution of this study in the context of the existing body of literature, it is worthwhile to summarize its main strengths and limitations. Strengths of the study by Vella et al 1 include a highly relevant research question, ie, the association of PET-CT with survival in one of the most frequent cancers today; a large patient number; and the choice of survival as the main clinical end point, which is arguably the most relevant clinical outcome in oncology.As does every study, the study by Vella et al 1 has limitations, which are openly discussed in the article. An association such as that shown in the study does not prove or even indicate a causal Open Access. This is an open access article distributed under the terms of the CC-BY License.

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Association of Receipt of Positron Emission Tomography–Computed Tomography With Non–Small Cell Lung Cancer Mortality in the Veterans Affairs Health Care System

Cited by 8 publications

References 45 publications

Metabolic targeting, immunotherapy and radiation in locally advanced non-small cell lung cancer: Where do we go from here?

Metabolic targeting, immunotherapy and radiation in locally advanced non-small cell lung cancer: Where do we go from here?

Combination of Circulating Cell-Free DNA and Metabolic Tumor Burden to Distinguish Non-Small Cell Lung Cancer from Tuberculosis

The Role of Positron Emission Tomography–Computed Tomography in the Workup of Non–Small Cell Lung Cancer

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