FDG-PET/CT response evaluation during EGFR-TKI treatment in patients with NSCLC

Abstract

Over recent years, [18F]-fluorodeoxyglucose positron emission tomography acquired together with low dose computed tomography (FDG-PET/CT) has proven its role as a staging modality in patients with non-small cell lung cancer (NSCLC). The purpose of this review was to present the evidence to use FDG-PET/CT for response evaluation in patients with NSCLC, treated with epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKI). All published articles from 1 November 2003 to 1 November 2013 reporting on 18F-FDG-PET response evaluation during EGFR-TKI treatment in patients with NSCLC were collected. In total 7 studies, including data of 210 patients were eligible for analyses. Our report shows that FDG-PET/CT response during EGFR-TKI therapy has potential in targeted treatment for NSCLC. FDG-PET/CT response is associated with clinical and radiologic response and with survival. Furthermore FDG-PET/CT response monitoring can be performed as early as 1-2 wk after initiation of EGFR-TKI treatment. Patients with substantial decrease of metabolic activity during EGFR-TKI treatment will probably benefit from continued treatment. If metabolic response does not occur within the first weeks of EGFR-TKI treatment, patients may be spared (further) unnecessary toxicity of ineffective treatment. Refining FDG-PET response criteria may help the clinician to decide on continuation or discontinuation of targeted treatment.

Human Organotypic Lung Tumor Models: Suitable For Preclinical 18F-FDG PET-Imaging

“…Proof of concept experiments in 2D cultures demonstrated specific FDG uptake by NSCLC cell lines which reduced FDG retention upon treatment in EGFR-mutant and therefore gefitinib-sensitive HCC827 cells (54, 55, 56, 57, 32) but not in the resistant A549 cells. These data suggest the feasibility of using FDG retention to monitor tumor metabolism and response to therapy and are in agreement with the proven value of FDG-PET for diagnosis, staging and monitoring of therapeutic responses of patients with lung cancer [ 36 , 65 ]. Transferring these findings to the 3D lung tumor model and actual PET-imaging is not trivial, as the size of tumor nodules has to exceed the resolution limit of 1.4 mm of the μPET-scanner in order to allow analysis of individual tumor cell clusters.…”

Volumetric and texture analysis of pretherapeutic 18F-FDG PET can predict overall survival in medullary thyroid cancer patients treated with Vandetanib

“…Changes in PET features for TKI response assessment and survival prediction have been evaluated in numerous previous studies. However, primarily SUV parameters (SUV peak , SUV max ) have been investigated for outcome prediction, e.g., in NSCLC treated with the TKI erlotinib [29][30][31]. Cook et al reported on heterogeneity assessment in NSCLC treated with the same TKI and the change of first-order parameters were correlated with survival [19].…”

SEOM–SERAM–SEMNIM guidelines on the use of functional and molecular imaging techniques in advanced non-small-cell lung cancer

“…Even further, when there was a significant reduction of metabolic activity 1–2 weeks after initiating an anti-EGFR treatment, maintaining this therapy was seen to be beneficial for the patient. In contrast, lack of an early response to EGFR TKI indicated treatment inefficacy [ 59 ]. In addition, another recent study in ALK-positive NSCLC examined metabolic response in comparison with CT following treatment with crizotinib, ALK inhibitor that induces a high response rate in this type of patients.…”