B Ma1, A D King2, L Leung1, K Wang2, A Poon1, W M Ho1, F Mo1, C M L Chan1, A T C Chan1, S C C Wong3. 1. State Key Laboratory of Oncology in South China, Department of Clinical Oncology, Sir Y K Pao Centre for Cancer, Hong Kong Cancer Institute. 2. Department of Diagnostic and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR. 3. Department of Health Technology and Informatics, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China.
Abstract
BACKGROUND: This study investigated the predictive and prognostic significance of assessing early drug response with both positron-emission computerized tomography (PET-CT) and circulating tumor cells (CTCs) in patients receiving first-line chemotherapy for metastatic colorectal cancer. PATIENTS AND METHODS: Eligible patients had PET-CT and CTC analysis at baseline and 4-6 weeks after starting chemotherapy, and then a CT scan at 10-12 weeks to assess the Response Evaluation Criteria In Solid Tumors (RECIST) response. Early response was defined as achieving a dual-endpoint consisting of PET-CT (30% drop in the sum of maximum standard uptake values-SUVmax-of target lesions) and CTC response (CTC < 3 cells/7.5 ml blood) at 4-6 weeks after starting chemotherapy. RESULTS: About 84 patients were enrolled with a median follow-up of 32.9 months (95% confidence interval, CI, 24.5 months-not reached, NR), and 70 patients (84.3%) completed all assessments. Achieving an early response based on the dual-endpoint was independently associated with progression-free survival (hazard ratio, HR = 0.452, 95% CI 0.267-0.765). The median progression-free survival of early responders was 7.41 months (95% CI, 6.05-9.11) compared with 5.37 months (95% CI, 4.68-6.24) in non-responders (log-rank, P = 0.0167). RECIST response at 10 weeks was independently associated with overall survival (OS) (HR = 0.484, 95% CI, 0.275-0.852). Early response based on the dual-endpoint could predict the subsequent RECIST response with a sensitivity, specificity and positive predictive value of 64%, 70% and 74%, respectively. CONCLUSIONS: Early response based on both PET-CT and CTC analysis has prognostic and probably predictive significance in patients undergoing first-line chemotherapy for metastatic colorectal cancer. Its utility as a new tool for assessing early drug response should be further validated.
BACKGROUND: This study investigated the predictive and prognostic significance of assessing early drug response with both positron-emission computerized tomography (PET-CT) and circulating tumor cells (CTCs) in patients receiving first-line chemotherapy for metastatic colorectal cancer. PATIENTS AND METHODS: Eligible patients had PET-CT and CTC analysis at baseline and 4-6 weeks after starting chemotherapy, and then a CT scan at 10-12 weeks to assess the Response Evaluation Criteria In Solid Tumors (RECIST) response. Early response was defined as achieving a dual-endpoint consisting of PET-CT (30% drop in the sum of maximum standard uptake values-SUVmax-of target lesions) and CTC response (CTC < 3 cells/7.5 ml blood) at 4-6 weeks after starting chemotherapy. RESULTS: About 84 patients were enrolled with a median follow-up of 32.9 months (95% confidence interval, CI, 24.5 months-not reached, NR), and 70 patients (84.3%) completed all assessments. Achieving an early response based on the dual-endpoint was independently associated with progression-free survival (hazard ratio, HR = 0.452, 95% CI 0.267-0.765). The median progression-free survival of early responders was 7.41 months (95% CI, 6.05-9.11) compared with 5.37 months (95% CI, 4.68-6.24) in non-responders (log-rank, P = 0.0167). RECIST response at 10 weeks was independently associated with overall survival (OS) (HR = 0.484, 95% CI, 0.275-0.852). Early response based on the dual-endpoint could predict the subsequent RECIST response with a sensitivity, specificity and positive predictive value of 64%, 70% and 74%, respectively. CONCLUSIONS: Early response based on both PET-CT and CTC analysis has prognostic and probably predictive significance in patients undergoing first-line chemotherapy for metastatic colorectal cancer. Its utility as a new tool for assessing early drug response should be further validated.
Authors: P Therasse; S G Arbuck; E A Eisenhauer; J Wanders; R S Kaplan; L Rubinstein; J Verweij; M Van Glabbeke; A T van Oosterom; M C Christian; S G Gwyther Journal: J Natl Cancer Inst Date: 2000-02-02 Impact factor: 13.506
Authors: A Hendlisz; V Golfinopoulos; C Garcia; A Covas; P Emonts; L Ameye; M Paesmans; A Deleporte; G Machiels; E Toussaint; B Vanderlinden; A Awada; M Piccart; P Flamen Journal: Ann Oncol Date: 2011-11-23 Impact factor: 32.976
Authors: H Young; R Baum; U Cremerius; K Herholz; O Hoekstra; A A Lammertsma; J Pruim; P Price Journal: Eur J Cancer Date: 1999-12 Impact factor: 9.162
Authors: Steven J Cohen; Cornelis J A Punt; Nicholas Iannotti; Bruce H Saidman; Kert D Sabbath; Nashat Y Gabrail; Joel Picus; Michael Morse; Edith Mitchell; M Craig Miller; Gerald V Doyle; Henk Tissing; Leon W M M Terstappen; Neal J Meropol Journal: J Clin Oncol Date: 2008-07-01 Impact factor: 44.544
Authors: S C C Wong; S S M Ng; M T Cheung; L Y Luk; C M L Chan; A H K Cheung; V H M Lee; P B S Lai; B B Y Ma; E P Hui; M Y Y Lam; T C C Au; A T C Chan Journal: Br J Cancer Date: 2011-03-01 Impact factor: 7.640
Authors: Sai Mun Leong; Karen M L Tan; Hui Wen Chua; Doreen Tan; Delly Fareda; Saabry Osmany; Mo-Huang Li; Steven Tucker; Evelyn S C Koay Journal: J Hematol Oncol Date: 2015-06-25 Impact factor: 17.388
Authors: Brigette Ma; Edwin P Hui; Ann King; Sing F Leung; Michael Km Kam; Frankie Mo; Leung Li; Ki Wang; Herbert Loong; Ashley Wong; Charles Ml Chan; K C Allen Chan; S C Cesar Wong; Y M Dennis Lo; Anthony Tc Chan Journal: Br J Cancer Date: 2018-03-20 Impact factor: 7.640