Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 9/2014

01-09-2014 | Thoracic Oncology

18F-Fluorodeoxyglucose Positron Emission Tomography versus Computed Tomography in Predicting Histopathological Response to Epidermal Growth Factor Receptor–Tyrosine Kinase Inhibitor Treatment in Resectable Non-Small Cell Lung Cancer

Authors: Matthijs H. van Gool, MD, Tjeerd S. Aukema, MD, PhD, Eva E. Schaake, MD, Herman Rijna, MD, PhD, Henk E. Codrington, MD, Renato A. Valdés Olmos, MD, PhD, Hendrik J. Teertstra, MD, Renee van Pel, MD, Sjaak A. Burgers, MD, PhD, Harm van Tinteren, PhD, Houke M. Klomp, MD, PhD

Published in: Annals of Surgical Oncology | Issue 9/2014

Login to get access

Abstract

Purpose

To prospectively evaluate diagnostic computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for identification of histopathologic response to neoadjuvant erlotinib, an epidermal growth factor receptor–tyrosine kinase inhibitor in patients with resectable non-small cell lung cancer (NSCLC).

Methods

This study was designed as an open-label phase 2 trial, performed in four hospitals in the Netherlands. Patients received preoperative erlotinib 150 mg once daily for 3 weeks. CT and FDG-PET/CT were performed at baseline and after 3 weeks of treatment. CT was assessed according to the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. FDG-PET/CT, tumor FDG uptake, and changes were measured by standardized uptake values (SUV). Radiologic and metabolic responses were compared to the histopathological response.

Results

Sixty patients were enrolled onto this study. In 53 patients (22 men, 31 women), the combination of CT, FDG-PET/CT, and histopathological evaluation was available for analysis. Three patients (6 %) had radiologic response. According to European Organisation for Research and Treatment of Cancer (EORTC) criteria, 15 patients (28 %) showed metabolic response. In 11 patients, histopathologic response (≥50 % necrosis) was seen. In predicting histopathologic response, relative FDG change in SUVmax showed more SUVmax decrease in the histopathologic response group (−32 %) versus the group with no pathologic response (−4 %) (p = 0.0132). Relative change in tumor size on diagnostic CT was similar in these groups with means close to 0.

Conclusions

FDG-PET/CT has an advantage over CT as a predictive tool to identify histopathologic response after 3 weeks of EGFR–TKI treatment in NSCLC patients.
Appendix
Available only for authorised users
Literature
1.
Pisters KM, Le CT. Adjuvant chemotherapy in completely resected non-small-cell lung cancer. J Clin Oncol. 2005;23:3270–3278.PubMedCrossRef
2.
Gilligan D, Nicolson M, Smith I, et al. Preoperative chemotherapy in patients with resectable non-small cell lung cancer: results of the MRC LU22/NVALT 2/EORTC 08012 multicentre randomised trial and update of systematic review. Lancet. 2007;369:1929–1937.PubMedCrossRef
3.
Cobo M, Isla D, Massuti B, et al. Customizing cisplatin based on quantitative excision repair cross-complementing 1 mRNA expression: a phase III trial in non-small-cell lung cancer. J Clin Oncol. 2007;25:2747–2754.PubMedCrossRef
4.
Lynch TJ, Bell DW, Sordella R, et al. Activating mutations in the epidermal growth factor receptor underlying responsiveness of non-small-cell lung cancer to gefitinib. N Engl J Med. 2004;350:2129–2139.PubMedCrossRef
5.
6.
Soria JC, Mok TS, Cappuzzo F, Janne PA. EGFR-mutated oncogene-addicted non-small cell lung cancer: current trends and future prospects. Cancer Treat Rev. 2012;38:416–430.PubMedCrossRef
7.
Cohen MH, Johnson JR, Chattopadhyay S, et al. Approval summary: erlotinib maintenance therapy of advanced/metastatic non-small cell lung cancer (NSCLC). Oncologist. 2010;15:1344–1351.PubMedCentralPubMedCrossRef
8.
Schaake EE, Kappers I, Codrington HE, et al. Tumor response and toxicity of neoadjuvant erlotinib in patients with early-stage non-small-cell lung cancer. J Clin Oncol. 2012;30:2731–2738.PubMedCrossRef
9.
Lardinois D, Weder W, Hany TF, et al. Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med. 2003;348:2500–2507.PubMedCrossRef
10.
Antoch G, Stattaus J, Nemat AT, et al. Non-small cell lung cancer: dual-modality PET/CT in preoperative staging. Radiology. 2003;229:526–533.PubMedCrossRef
11.
van Tinteren H, Smit EF, Hoekstra OS. FDG-PET in addition to conventional work-up in non-small-cell lung cancer. J Clin Oncol. 2005;23:1591.PubMedCrossRef
12.
Aukema TS, Kappers I, Olmos RA, et al. Is 18F-FDG PET/CT useful for the early prediction of histopathologic response to neoadjuvant erlotinib in patients with non-small cell lung cancer? J Nucl Med. 2010;51:1344–1348.PubMedCrossRef
13.
Benz MR, Herrmann K, Walter F, et al. 18F-FDG PET/CT for monitoring treatment responses to the epidermal growth factor receptor inhibitor erlotinib. J Nucl Med. 2011;52:1684–1689.PubMedCrossRef
14.
O’Brien ME, Myerson JS, Coward JI, et al. A phase II study of 18F-fluorodeoxyglucose PET-CT in non-small cell lung cancer patients receiving erlotinib (Tarceva); objective and symptomatic responses at 6 and 12 weeks. Eur J Cancer. 2012;48:68–74.PubMedCrossRef
15.
Zander T, Scheffler M, Nogova L, et al. Early prediction of nonprogression in advanced non-small-cell lung cancer treated with erlotinib by using [18F]fluorodeoxyglucose and [18F]fluorothymidine positron emission tomography. J Clin Oncol. 2011;29:1701–1708.PubMedCrossRef
16.
Hoekstra CJ, Stroobants SG, Smit EF, et al. Prognostic relevance of response evaluation using [18F]-2-fluoro-2-deoxy-d-glucose positron emission tomography in patients with locally advanced non-small-cell lung cancer. J Clin Oncol. 2005;23:8362–8370.PubMedCrossRef
17.
Mileshkin L, Hicks RJ, Hughes BG, et al. Changes in 18F-fluorodeoxyglucose and 18F-fluorodeoxythymidine positron emission tomography imaging in patients with non-small cell lung cancer treated with erlotinib. Clin Cancer Res. 2011;17:3304–3315.PubMedCrossRef
18.
Tanvetyanon T, Eikman EA, Sommers E, Robinson L, Boulware D, Bepler G. Computed tomography response, but not positron emission tomography scan response, predicts survival after neoadjuvant chemotherapy for resectable non-small-cell lung cancer. J Clin Oncol. 2008;26:4610–4616.PubMedCrossRef
19.
Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–247.PubMedCrossRef
20.
Young H, Baum R, Cremerius U, et al. Measurement of clinical and subclinical tumour response using [18F]-fluorodeoxyglucose and positron emission tomography: review and 1999 EORTC recommendations. European Organization for Research and Treatment of Cancer (EORTC) PET Study Group. Eur J Cancer. 1999;35:1773–1782.PubMedCrossRef
21.
Junker K, Thomas M, Schulmann K, Klinke F, Bosse U, Muller KM. Tumour regression in non-small-cell lung cancer following neoadjuvant therapy. Histological assessment. J Cancer Res Clin Oncol. 1997;123:469–477.PubMedCrossRef
22.
Lara-Guerra H, Waddell TK, Salvarrey MA, et al. Phase II study of preoperative gefitinib in clinical stage I non-small-cell lung cancer. J Clin Oncol. 2009;27:6229–6236.PubMedCrossRef
23.
24.
Cerfolio RJ, Ojha B, Mukherjee S, Pask AH, Bass CS, Katholi CR. Positron emission tomography scanning with 2-fluoro-2-deoxy-d-glucose as a predictor of response of neoadjuvant treatment for non-small cell carcinoma. J Thorac Cardiovasc Surg. 2003;125:938–944.PubMedCrossRef
25.
Zhang C, Liu J, Tong J, Sun X, Song S, Huang G. 18F-FDG-PET evaluation of pathological tumour response to neoadjuvant therapy in patients with NSCLC. Nucl Med Commun. 2013;34:71–77.
26.
Tuma RS. Sometimes size doesn’t matter: reevaluating RECIST and tumor response rate endpoints. J Natl Cancer Inst. 2006;98:1272–1274.PubMedCrossRef
27.
Vansteenkiste J, Fischer BM, Dooms C, Mortensen J. Positron-emission tomography in prognostic and therapeutic assessment of lung cancer: systematic review. Lancet Oncol. 2004;5:531–540.PubMedCrossRef
28.
Port JL, Kent MS, Korst RJ, Keresztes R, Levin MA, Altorki NK. Positron emission tomography scanning poorly predicts response to preoperative chemotherapy in non-small cell lung cancer. Ann Thorac Surg. 2004;77:254–259.PubMedCrossRef
29.
Su H, Bodenstein C, Dumont RA, et al. Monitoring tumor glucose utilization by positron emission tomography for the prediction of treatment response to epidermal growth factor receptor kinase inhibitors. Clin Cancer Res. 2006;12:5659–5667.PubMedCrossRef
30.
Besse B, Ropert S, Soria JC. Targeted therapies in lung cancer. Ann Oncol. 2007;18(Suppl 9):ix135–142.
31.
Stang A, Pohlabeln H, Muller KM, Jahn I, Giersiepen K, Jockel KH. Diagnostic agreement in the histopathological evaluation of lung cancer tissue in a population-based case-control study. Lung Cancer. 2006;52:29–36.PubMedCrossRef
32.
Field RW, Smith BJ, Platz CE, et al. Lung cancer histologic type in the surveillance, epidemiology, and end results registry versus independent review. J Natl Cancer Inst. 2004;96:1105–1107.PubMedCrossRef
33.
Kahraman D, Scheffler M, Zander T, et al. Quantitative analysis of response to treatment with erlotinib in advanced non-small cell lung cancer using 18F-FDG and 3′-deoxy-3′-18F-fluorothymidine PET. J Nucl Med. 2011;52:1871–1877.PubMedCrossRef
Metadata
Title
18F-Fluorodeoxyglucose Positron Emission Tomography versus Computed Tomography in Predicting Histopathological Response to Epidermal Growth Factor Receptor–Tyrosine Kinase Inhibitor Treatment in Resectable Non-Small Cell Lung Cancer
Authors
Matthijs H. van Gool, MD
Tjeerd S. Aukema, MD, PhD
Eva E. Schaake, MD
Herman Rijna, MD, PhD
Henk E. Codrington, MD
Renato A. Valdés Olmos, MD, PhD
Hendrik J. Teertstra, MD
Renee van Pel, MD
Sjaak A. Burgers, MD, PhD
Harm van Tinteren, PhD
Houke M. Klomp, MD, PhD
Publication date
01-09-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 9/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3791-6

Other articles of this Issue 9/2014

Annals of Surgical Oncology 9/2014 Go to the issue

Thoracic Oncology

Number of Negative Lymph Nodes is Associated with Survival in Thoracic Esophageal Squamous Cell Carcinoma Patients Undergoing Three-Field Lymphadenectomy

Head and Neck Oncology

Outcome of Patients Undergoing Salvage Surgery for Recurrent Nasopharyngeal Carcinoma: A Meta-analysis

Breast Oncology

Impact of Breast Reconstruction on the Decision to Undergo Contralateral Prophylactic Mastectomy

Thoracic Oncology

Optimizing Surrogate End Points for Preoperative Systemic Therapies in Non-Small Cell Lung Cancers

Thoracic Oncology

Outcomes of Preoperative Chemotherapy with Docetaxel, Cisplatin, and 5-Fluorouracil Followed by Esophagectomy in Patients with Resectable Node-Positive Esophageal Cancer

Hepatobiliary Tumors

Comparison of Survival of Patients with BCLC Stage A Hepatocellular Carcinoma After Hepatic Resection or Transarterial Chemoembolization: A Propensity Score-Based Analysis