The Predictive Value of Early In-Treatment 18 F-FDG PET/CT Response to Chemotherapy in Combination with Bevacizumab in Advanced Nonsquamous Non-Small Cell Lung Cancer

• Published in: Journal of Nuclear Medicine Vol. 58; no. 8; pp. 1243 - 1248
• Main Authors: Usmanij, Edwin A, Natroshvili, Tinatin, Timmer-Bonte, Johanna N H, Oyen, Wim J G, van der Drift, Miep A, Bussink, Johan, Geus-Oei, Lioe-Fee de
• Format: Journal Article
• Language: English
• Published: United States 01.08.2017
• Subjects: Adult; Aged; Aged, 80 and over; Bevacizumab - therapeutic use; Carcinoma, Non-Small-Cell Lung - diagnostic imaging; Carcinoma, Non-Small-Cell Lung - drug therapy; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Humans; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - drug therapy; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Time Factors; bevacizumab; 18F-FDG PET; advanced non-small cell lung cancer; early response prediction; PERCIST
• ISSN: 0161-5505; 1535-5667; 2159-662X
• DOI: 10.2967/jnumed.116.185314

F-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). In 25 patients with advanced nonsquamous NSCLC, F-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 SUL ) were obtained. PERCIST were used for response evaluation. These semiquantitative parameters were correlated with progression-free survival and overall survival (OS). Metabolic response, defined by a significant reduction in SUL of 30% or more after 2 wk of CPB, was predictive of progression-free survival and OS. For partial metabolic responders ( = 19), the median OS was 22.8 mo. One-year and 2-y OS were 79% and 47%, respectively. Nonmetabolic responders ( = 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) ( 0.001). F-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.