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Research ArticleClinical Investigations

18F-FDG PET as a Surrogate Biomarker in Non–Small Cell Lung Cancer Treated with Erlotinib: Newly Identified Lesions Are More Informative Than Standardized Uptake Value

Thomas Bengtsson, Rodney J. Hicks, Amy Peterson and Ruediger E. Port
Journal of Nuclear Medicine April 2012, 53 (4) 530-537; DOI: https://doi.org/10.2967/jnumed.111.092544
Thomas Bengtsson
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Rodney J. Hicks
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Amy Peterson
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Ruediger E. Port
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  • FIGURE 1.
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    FIGURE 1.

    (A) Estimates of survival function for patients who were 18F-FDG PET–evaluable at day 14. Solid line represents Kaplan–Meier estimate, with thin dashed lines denoting 95% pointwise confidence limits. Smooth, dash-dotted line is estimated survival function based on AFT-model. (B) Estimates of survival function by PS values (0, 1, and 2). Solid lines give Kaplan–Meier estimates, and smooth lines depict corresponding estimates based on AFT model.

  • FIGURE 2.
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    FIGURE 2.

    Percentage change in SUVmax between baseline and week 2 vs. survival duration (mo). Censored observations are denoted by triangles, and Xs denote actual event times. (A) Best-fitting linear AFT model. Patients with new lesions are overlaid by red circle. (B) Data subset with known mutation status. Patients with EGFR mutations are overlaid by blue box.

  • FIGURE 3.
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    FIGURE 3.

    Estimated survival functions (smooth curves) for EGFR wild-type patients with PS = 0 (A) and PS = 1 (B), with and without new lesions (red and black curves, respectively). For lognormal AFT model, dotted lines show approximate 95% pointwise confidence intervals. Step functions give corresponding Kaplan–Meier estimates.

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    TABLE 1.

    Baseline Characteristics of Patients in OSI3926g and OAM4558g

    CharacteristicOSI3926g (n = 65)OAM4558g (n = 60)
    Age (y)
     Mean62.762.1
     SD9.210.6
    Women43.1%39.7%
    Race or ethnic group
     Asian4.6%0%
     Other95.4%100%
    Smoking status
     Never20.0%19.0%
     Previous12.3%12.7%
     Current67.7%68.3%
    Baseline ECOG status
     024.6%30.2%
     161.5%66.7%
     213.8%3.2%
    EGFR mutation6.2%9.5%
    Viable tissue sample69.2%88.9%
    Histologic type
     Adenocarcinoma69.2%63.2%
     Squamous cell carcinoma18.5%25.5%
    Median time since initial diagnosis (mo)10.311.8
    Median survival (mo)7.27.8
    • Except for available tumor tissue, no baseline variable is statistically significantly different between the 2 studies at 0.05 level.

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    TABLE 2.

    Maximum-Likelihood Parameter Estimates Along with R2 Values for Fitted AFT Models

    ModelE(log T)σ^Embedded ImageR2
    Population2.020.947Not applicable
    Prognostic (PS, SUV)2.91 − 0.47 PS* − 0.19 − SUV†base0.85516.4
    Predictive (δSUV)2.86 − 0.46 PS* − 0.19 SUV†base − 0.67 δSUV‡wk20.84019.7
    Predictive (NL)3.02 − 0.45 PS* − 0.18 SUV†base − 0.75 NLPET¶wk20.79227.0
    Predictive (NL, EGFR)2.75 − 0.40 PS‡ − 0.12 SUV‡base − 0.71 NLPET†wk2 + 0.95 EGFR†0.80030.6
    • * P < 0.0001.

    • † P < 0.001.

    • ‡ P < 0.01.

    • ¶ P < 0.05.

    • Prognostic model includes PS and SUVbase. Additionally, the 3 predictive models include, respectively, δSUVwk2, NLPET, and NLPET and EGFR.

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Journal of Nuclear Medicine: 53 (4)
Journal of Nuclear Medicine
Vol. 53, Issue 4
April 1, 2012
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18F-FDG PET as a Surrogate Biomarker in Non–Small Cell Lung Cancer Treated with Erlotinib: Newly Identified Lesions Are More Informative Than Standardized Uptake Value
Thomas Bengtsson, Rodney J. Hicks, Amy Peterson, Ruediger E. Port
Journal of Nuclear Medicine Apr 2012, 53 (4) 530-537; DOI: 10.2967/jnumed.111.092544

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18F-FDG PET as a Surrogate Biomarker in Non–Small Cell Lung Cancer Treated with Erlotinib: Newly Identified Lesions Are More Informative Than Standardized Uptake Value
Thomas Bengtsson, Rodney J. Hicks, Amy Peterson, Ruediger E. Port
Journal of Nuclear Medicine Apr 2012, 53 (4) 530-537; DOI: 10.2967/jnumed.111.092544
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