Abstract
18F-fluorodeoxyglucose-positron emission tomography/computed tomography (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 non-squamous NSCLC, 18F-FDG-PET/CT was performed before treatment and after two-weeks, 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 case of progressive disease bevacizumab was combined with erlotinib. Standardized uptake value (SUV) corrected for lean body mass (SUL and SULpeak) were obtained. PET response criteria in solid tumors (PERCIST) were used for response evaluation. These semi-quantitative parameters were correlated with progression free survival (PFS) and overall survival (OS). Results: Metabolic response, defined by a significant reduction in SULpeak ≥30% after two weeks of CPB, was predictive of PFS and OS. For partial metabolic responders (n = 19) median OS was 22.8 mo. One year and 2-y OS were 79% and 47%, respectively. Non-metabolic 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 one treatment cycle is predictive of outcome to first line chemotherapy with bevacizumab in patients with advanced non-squamous NSCLC. This enables identification of patients at risk of treatment failure, permitting treatment alternatives such as early switch to a different therapy.
- Correlative Imaging
- Oncology: Lung
- PET/CT
- 18F-FDG PET/CT
- Early response prediction
- PERCIST
- advanced non-small cell lung cancer
- bevacizumab
- Copyright © 2017 by the Society of Nuclear Medicine and Molecular Imaging, Inc.