Early Prediction of Nonprogression in Advanced Non–Small-Cell Lung Cancer Treated With Erlotinib By Using [¹⁸F]Fluorodeoxyglucose and [¹⁸F]Fluorothymidine Positron Emission Tomography

Abstract

Early FDG-PET predicts PFS, OS, and nonprogression after 6 weeks of therapy with erlotinib in unselected, previously untreated patients with advanced NSCLC independent from EGFR mutational status.

PET Imaging of Proliferation with Pyrimidines

“…Patients with lower early and late residual tumor glycolysis ( 18 F-FDG uptake) and proliferation ( 18 F-FLT uptake) had a significantly prolonged progression-free survival. In another study of 34 patients, the changes in 18 F-FDG and 18 F-FLT uptake after 1 and 6 wk of erlotinib treatment were compared with nonprogression measured by CT after 6 wk of treatment (74). Early 18 F-FLT response predicted longer progression-free survival (hazard ratio, 0.31; 95% confidence interval, 0.10-0.95; P 5 0.04) but not overall survival and could not predict nonprogression after 6 wk of therapy.…”

Radiogenomics and Radioproteomics

“…They also found that an infiltrative "radiographic signature" predicted a worse prognosis [6]. Zander et al [16] and Sohn et al [17] found that FDG and Fluorothymidine (FLT), respectively, early in the course of treatment could predict outcomes to EGFR-TKI treatment. Additional authors have explored radiolabelled nuclear techniques of direct imaging of EGFR expression [18,19].…”

Optimisation and harmonisation: two sides of the same coin?

“…Conceptually it may represent the most metabolically active part of the tumour, which might contain the most prognostic or predictive value. Zander et al [6] showed that use of SUV max is a suitable predictive parameter and that it performed equally well compared to other SUVs. Moreover SUV max is uniquely defined, i.e.…”

“…In addition to diagnosis and staging, FDG PET/CT is used to measure treatment response. Here residual FDG uptake or changes in uptake during or after treatment are used as predictive factors [4][5][6]. To this end, criteria to measure FDG uptake changes and/or metabolic response have been proposed [7,8].…”

“…Yet, there is a strong interest to use FDG PET/CT in a quantitative manner. The uptake of FDG, expressed by standardised uptake values (SUV), has been shown to be useful prognostic and predictive measures [6]. Moreover, changes in SUV can be used to measure treatment efficacy, already early within a few weeks after start of treatment and may then impact subsequent patient management [5,13].…”