Edwin A Usmanij1, Tinatin Natroshvili2, Johanna N H Timmer-Bonte3, Wim J G Oyen2,4, Miep A van der Drift5, Johan Bussink6, Lioe-Fee de Geus-Oei2,7. 1. Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands Edwin.Usmanij@radboudumc.nl. 2. Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. 3. Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands. 4. The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom. 5. Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands. 6. Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands; and. 7. Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
Abstract
18F-FDG PET/CT is potentially applicable to predict response to chemotherapy in combination with bevacizumab in patients with advanced non-small cell lung cancer (NSCLC). Methods: In 25 patients with advanced nonsquamous NSCLC, 18F-FDG PET/CT was performed before treatment and after 2 wk, at the end of the second week of first cycle carboplatin-paclitaxel and bevacizumab (CPB) treatment. Patients received up to a total of 4 cycles of CPB treatment. Maintenance treatment with bevacizumab monotherapy was continued until progressive disease without significant treatment-related toxicities of first-line treatment. In the case of progressive disease, bevacizumab was combined with erlotinib. SUV corrected for lean body mass (SUL and SULpeak) were obtained. PERCIST were used for response evaluation. These semiquantitative parameters were correlated with progression-free survival and overall survival (OS). Results: Metabolic response, defined by a significant reduction in SULpeak of 30% or more after 2 wk of CPB, was predictive of progression-free survival and OS. For partial metabolic responders (n = 19), the median OS was 22.8 mo. One-year and 2-y OS were 79% and 47%, respectively. Nonmetabolic responders (n = 6) (stable metabolic disease or progressive disease) showed a median OS of 4.4 mo (1-y and 2-y OS was 33% and 0%, respectively) (P < 0.001). Conclusion: 18F-FDG PET/CT after 1 treatment cycle is predictive of outcome to first-line chemotherapy with bevacizumab in patients with advanced nonsquamous NSCLC. This enables identification of patients at risk of treatment failure, permitting treatment alternatives such as early switch to a different therapy.
18F-FDG PET/CT is potentially applicable to predict response to chemotherapy in combination with bevacizumab in patients with advanced non-small cell lung cancer (NSCLC). Methods: In 25 patients with advanced nonsquamous NSCLC, 18F-FDG PET/CT was performed before treatment and after 2 wk, at the end of the second week of first cycle carboplatin-paclitaxel and bevacizumab (CPB) treatment. Patients received up to a total of 4 cycles of CPB treatment. Maintenance treatment with bevacizumab monotherapy was continued until progressive disease without significant treatment-related toxicities of first-line treatment. In the case of progressive disease, bevacizumab was combined with erlotinib. SUV corrected for lean body mass (SUL and SULpeak) were obtained. PERCIST were used for response evaluation. These semiquantitative parameters were correlated with progression-free survival and overall survival (OS). Results: Metabolic response, defined by a significant reduction in SULpeak of 30% or more after 2 wk of CPB, was predictive of progression-free survival and OS. For partial metabolic responders (n = 19), the median OS was 22.8 mo. One-year and 2-y OS were 79% and 47%, respectively. Nonmetabolic responders (n = 6) (stable metabolic disease or progressive disease) showed a median OS of 4.4 mo (1-y and 2-y OS was 33% and 0%, respectively) (P < 0.001). Conclusion: 18F-FDG PET/CT after 1 treatment cycle is predictive of outcome to first-line chemotherapy with bevacizumab in patients with advanced nonsquamous NSCLC. This enables identification of patients at risk of treatment failure, permitting treatment alternatives such as early switch to a different therapy.