Effectiveness of FDG-PET/CT for evaluating early response to induction chemotherapy in head and neck squamous cell carcinoma

Anjos, Renata Fockink dos; Anjos, Dalton Alexandre dos; Vieira, Danielle Leal; Leite, André Ferreira; Figueiredo, Paulo Tadeu de Souza; Melo, Nilce Santos de

doi:10.1097/md.0000000000004450

Cited by 11 publications

(8 citation statements)

References 51 publications

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“…In an exploratory study, fifteen patients underwent PET imaging with 18 FDG before and 12 days after starting treatment to determine if FGFR inhibition alters tumor glucose metabolism and if metabolic tumor response correlates with subsequent clinical outcome (27–29). Three patients (20%) had metabolic responses with no discernable changes in tumor size.…”

Section: Resultsmentioning

confidence: 99%

“…Exploratory analyses included evaluation of early metabolic tumor response rate (day 12), changes in quality of life (QOL), and biomarker studies. Early metabolic responses were defined as 25% reduction in the maximal standard uptake (SUV) of 18F-fluorodeoxyglucose ( 18 FDG) on PET scans done on day 12 as compared to pre-treatment values (27). QOL outcomes were monitored by the FACT-G questionnaires at each clinic visit.…”

Section: Methodsmentioning

confidence: 99%

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A Phase II Study of Dovitinib in Patients with Recurrent or Metastatic Adenoid Cystic Carcinoma

Dillon

Petroni

Horton

et al. 2017

Clinical Cancer Research

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Purpose Genetic and preclinical studies have implicated fibroblast growth factor receptor (FGFR) signaling in the pathogenesis of adenoid cystic carcinoma (ACC). Dovitinib, a suppressor FGFR activity, may be active in ACC. Methods In a two-stage phase II study, 35 patients with progressive ACC were treated with dovitinib 500mg orally for 5 of 7 days continuously. The primary endpoints were objective response rate (ORR) and change in tumor growth rate (TGR). Progression-free survival (PFS), overall survival (OS), metabolic response, biomarker and QOL were secondary endpoints. Results Of thirty-four evaluable patients, two (6%) had a partial response and 22 (65%) had stable disease >4 months. Median PFS was 8.2 months and OS was 20.6 months. The slope of the overall TGR fell from 1.95 to 0.63 on-treatment (p<0.001). Toxicity was moderate; 63% of patients developed grade 3–4 toxicity, 94% required dose modifications, and 21% stopped treatment early. An early metabolic response based on 18FDG-PET scans was seen in 3/15 patients but did not correlate with RECIST response. MYB gene translocation was observed and significantly correlated with over-expression of MYB but did not correlate with FGFR1 phosphorylation or clinical response to dovitinib. Conclusion Dovitinib produced few objective responses in patients with ACC but did suppress the TGR with a PFS that compares favorably to those reported with other targeted agents. Future studies of more potent and selective FGFR inhibitors in biomarker-selected patients will be required to determine if FGFR signaling is a valid therapeutic target in ACC.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

A Phase II Study of Dovitinib in Patients with Recurrent or Metastatic Adenoid Cystic Carcinoma

Dillon

Petroni

Horton

et al. 2017

Clinical Cancer Research

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“…At that time, the role of FDG in the early response assessment was questionable in head and neck cancer. However, recently, in a systematic review, the potential value of F-FDG PET/CT as a diagnostic tool for early response assessment in head and neck cancer patients has been confirmed [32]. …”

Section: Early Response Assessments and Imaging Biomarkersmentioning

confidence: 99%

Defining Clinical Response Criteria and Early Response Criteria for Precision Oncology: Current State-of-the-Art and Future Perspectives

et al. 2017

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In this era of precision oncology, there has been an exponential growth in the armamentarium of genomically targeted therapies and immunotherapies. Evaluating early responses to precision therapy is essential for “go” versus “no go” decisions for these molecularly targeted drugs and agents that arm the immune system. Many different response assessment criteria exist for use in solid tumors and lymphomas. We reviewed the literature using the Medline/PubMed database for keywords “response assessment” and various known response assessment criteria published up to 2016. In this article we review the commonly used response assessment criteria. We present a decision tree to facilitate selection of appropriate criteria. We also suggest methods for standardization of various response assessment criteria. The relevant response assessment criteria were further studied for rational of development, key features, proposed use and acceptance by various entities. We also discuss early response evaluation and provide specific case studies of early response to targeted therapy. With high-throughput, advanced computing programs and digital data-mining it is now possible to acquire vast amount of high quality imaging data opening up a new field of “omics in radiology”—radiomics that complements genomics for personalized medicine. Radiomics is rapidly evolving and is still in the research arena. This cutting-edge technology is poised to move soon to the mainstream clinical arena. Novel agents with new mechanisms of action require advanced molecular imaging as imaging biomarkers. There is an urgent need for development of standardized early response assessment criteria for evaluation of response to precision therapy.

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“…However, 6 of 7 studies concluded that FDG-PET allowed early evaluation response to induction chemotherapy and predicted survival outcomes. 60 The studies cited above demonstrate the potential of FDG-PET to assess response to induction chemotherapy in order to select patients for treatment adaptation (ie, concomitant chemoradiation or surgery). Unfortunately, different parameters have been used for response assessment.…”

Section: De Bree Et Almentioning

confidence: 99%

“…The authors concluded that a meta‐analysis was not possible because the selected studies were heterogeneous concerning response criteria, reference standards, chemotherapy strategy, and endpoints. However, 6 of 7 studies concluded that FDG‐PET allowed early evaluation response to induction chemotherapy and predicted survival outcomes …”

Section: Introductionmentioning

confidence: 99%

Response assessment after induction chemotherapy for head and neck squamous cell carcinoma: From physical examination to modern imaging techniques and beyond

et al. 2017

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Significant correlations between the response to induction chemotherapy and success of subsequent radiotherapy have been reported and suggest that the response to induction chemotherapy is able to predict a response to radiotherapy. Therefore, induction chemotherapy may be used to tailor the treatment plan to the individual patient with head and neck cancer: following the planned subsequent (chemo)radiation schedule, planning a radiation dose boost, or reassessing the modality of treatment (eg, upfront surgery). Findings from reported trials suggest room for improvement in clinical response assessment after induction chemotherapy, but an optimal method has yet to be identified. Historically, indices of treatment efficacy in solid tumors have been based solely on systematic assessment of tumor size. However, functional imaging (eg, fluorodeoxyglucose‐positron emission tomography (FDG‐PET) potentially provides an earlier indication of response to treatment than conventional imaging techniques. More advanced imaging techniques are still in an exploratory phase and are not ready for use in clinical practice.

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Effectiveness of FDG-PET/CT for evaluating early response to induction chemotherapy in head and neck squamous cell carcinoma

Cited by 11 publications

References 51 publications

A Phase II Study of Dovitinib in Patients with Recurrent or Metastatic Adenoid Cystic Carcinoma

A Phase II Study of Dovitinib in Patients with Recurrent or Metastatic Adenoid Cystic Carcinoma

Defining Clinical Response Criteria and Early Response Criteria for Precision Oncology: Current State-of-the-Art and Future Perspectives

Response assessment after induction chemotherapy for head and neck squamous cell carcinoma: From physical examination to modern imaging techniques and beyond

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