Metabolic Burden Measured by <sup>18</sup>F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Is a Prognostic Factor in Patients with Small Cell Lung Cancer

Abstract

PurposeEvidence regarding the usefulness of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in predicting the prognosis of non-small cell lung cancer is increasing. However, data on small cell lung cancer (SCLC) are scarce. The aim of this study was to evaluate the prognostic value of metabolic parameters measured using 18F-FDG PET/CT in patients with SCLC.Materials and MethodsWe conducted a retrospective review of 114 patients with pathologically proven SCLC (26 cases of limited disease and 88 cases of extensive disease) who underwent pretreatment 18F-FDG PET/CT. The maximal SUV (SUVmax) was used quantitatively for determination of FDG PET activity. The SUVmax of the primary tumor (primary SUVmax), the sum of SUVmax values of malignant lesions (SUVsum), and the mean SUVmax of malignant lesions were calculated.ResultsThe patient population was subdivided using a median SUVsum value of 24.6. High SUVsum showed a significant association with known factors for poor prognosis, including higher neuron-specific enolase (p=0.010), CYFRA 21-1 (p=0.014), and extensive disease status (p=0.007). Patients with high SUVsum had significantly shorter median overall survival (6.6 months vs. 13.0 months, p<0.001) and progression-free survival (5.2 months vs. 8.0 months, p<0.001) than patients with low SUVsum. Results of multivariate analysis showed that SUVsum, chemotherapy cycles, and the response to first-line treatment were significant prognostic factors of survival. In contrast, mean SUVmax and primary SUVmax were not significant predictors of survival.ConclusionIn this study, metabolic burden represented by SUVsum from pretreatment 18F-FDG PET/CT was an independent prognostic factor in patients with SCLC.

First-in-human phase I study of copanlisib (BAY 80-6946), an intravenous pan-class I phosphatidylinositol 3-kinase inhibitor, in patients with advanced solid tumors and non-Hodgkin's lymphomas

“…These preliminary data suggest rapid onset of copanlisib pharmacodynamic activity (48–72 h post-infusion), suggestive of copanlisib-mediated inhibition of tumor PI3K signaling. The use of maximum standardized uptake as a measure of tumor metabolic burden has been previously described as a prognostic marker in various tumor types, including NHL [ 34 , 35 ], and may indicate pharmacodynamic and anti-tumor activity [ 36 ]. Although the 18 FDG-PET sample size was relatively low ( n = 21), the pharmacodynamic data may support the use of hyperglycemia as a biomarker for anti-tumor activity in patients with solid tumors and NHL; one patient with an objective response had early changes in PET imaging.…”

Metabolic tumor burden is associated with major oncogenomic alterations and serum tumor markers in patients with resected pancreatic cancer

“…Recent reports have demonstrated the feasibility of measuring metabolic tumor burden using 18 F-fludrodeoxyglucose ( 18 F-FDG) PET/CT in patients with prostate [7], esophageal [8] and non-small-cell lung cancers and multiple sites of disease [9]. Some studies also have reported correlation between genetic alterations and 18 F-FDG uptake in colorectal cancer and non-small-cell lung cancer, in which KRAS and EGFR mutations are associated with tumor progression [10,11].…”

Prognostic Factors in Patients Treated with 223Ra: The Role of Skeletal Tumor Burden on Baseline 18F-Fluoride PET/CT in Predicting Overall Survival

“…One of the advantages of 18 F-FDG PET/CT imaging is the ability to objectively quantify tumor metabolism, providing prognostic or predictive information (15)(16)(17).…”