Long term follow-up of neoadjuvant chemotherapy for non-small cell lung cancer (NSCLC) investigating early positron emission tomography (PET) scan as a predictor of outcome

Abstract

BackgroundNeoadjuvant chemotherapy is effective in improving survival of resectable NSCLC. Based on findings in the adjuvant and metastatic setting, FDG positron emission tomography (PET) scans may offer early prognostic or predictive value after one cycle of induction chemotherapy.MethodsIn this phase II non-randomized trial, patients with AJCC version 6 stage IB to IIIB operable NSCLC were treated with 3 cycles of cisplatin and pemetrexed neoadjuvant chemotherapy. Patients underwent FDG-PET scanning prior to and 18 to 21 days after the first cycle of chemotherapy. Investigators caring for patients were blinded to results, unless the scans showed evidence of disease progression. FDG-PET response was defined prospectively as a ≥ 20% decrease in the SUV of the primary lesion.ResultsBetween October 2005 and February 2010, 25 patients enrolled. Fifty two percent were female, 88% white, and median age was 62 years. Histology was divided into adenocarcinoma 66%, not otherwise specified (NOS) 16%, squamous cell 12%, and large cell 4%. Stage distribution was: 16% IB, 4% IIB, and 79% IIIA. Treatment was well tolerated and only one patient had a grade 4 toxicity. The median follow up was 95 months. The 5 year progression free survival (PFS) and overall survival (OS) for the entire population were 54 and 67%, respectively. Eighteen patients had a baseline FDG-PET scan and a repeat scan at day 18–21 available for comparison. Ten patients (56%) were considered metabolic responders on the day 18–21 FDG-PET scan. Responders had a 5 year PFS and OS of 60 and 70%, respectively, while the percentage for non-responders was 63 and 75% (p = 0.96 and 0.85).ConclusionsThis phase II trial did not demonstrate that a PET scan after one cycle of chemotherapy can predict survival outcomes of patients with NSCLC treated with neoadjuvant chemotherapy.Trial registrationNCT00227539 registered September 28th, 2005.

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“…The mortality rate of lung cancer is much higher than other malignant tumors [31]. NSCLC is the majority of lung cancer [8]. Therefore, NSCLC has become the focus and difficulty of global cancer prevention and treatment.…”

“…Currently, chemotherapy is the main treatment for advanced NSCLC. However, the toxic side effects of conventional chemotherapy drugs limit its wide application, and the chemotherapy effect has reached the plateau stage [8]. Targeted therapy is particularly important [9].…”

Role of fluorodeoxyglucose-positron emission tomography in predicting the pathological response and prognosis after neoadjuvant chemoradiotherapy for locally advanced non-small-cell lung cancer

“…Shiraishi et al [ 10 ] studied 37 patients with stage IB to IIIB lung cancer who received neoadjuvant chemoradiotherapy and reported that the SUV on FDG-PET was more predictive of the pathological response to preoperative treatment than CT, but neither FDG-PET nor CT were able to predict the prognosis. Romin et al [ 14 ] analysed 25 patients with stage IB to IIIB operable NSCLC who had received 3 cycles of cisplatin and pemetrexed neoadjuvant chemotherapy. They defined patients in whom the primary lesion showed a >20% decrease in SUV as metabolic responders.…”

“…Several recent studies have reported the efficacy of fluorodeoxyglucose-positron emission tomography (FDG-PET) for predicting the pathological response [ 9–11 ] and prognosis [ 12 , 13 ]. However, conflicting results regarding the prognostic value of FDG-PET have also been reported [ 10 , 14–16 ]. For these reasons, the usefulness of FDG-PET in decision-making in relation to surgical options after induction therapy remains controversial.…”

Botrychium schaffneri Underw. extract acts via DIABLO to induce apoptosis and inhibit proliferation of non-small cell lung carcinoma in vitro and in vivo

“…Despite rapid developments in treatment during the past decade, NSCLC continues to be the leading cause of tumor-related deaths worldwide (17). Management of patients diagnosed with NSCLC includes surgery, chemotherapy, and radiation therapy.…”