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[18F]FDG PET/CT-based response assessment of stage IV non-small cell lung cancer treated with paclitaxel-carboplatin-bevacizumab with or without nitroglycerin patches

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: Nitroglycerin (NTG) is a vasodilating drug, which increases tumor blood flow and consequently decreases hypoxia. Therefore, changes in [18F] fluorodeoxyglucose positron emission tomography ([18F]FDG PET) uptake pattern may occur. In this analysis, we investigated the feasibility of [18F]FDG PET for response assessment to paclitaxel-carboplatin-bevacizumab (PCB) treatment with and without NTG patches. And we compared the [18F]FDG PET response assessment to RECIST response assessment and survival.

Methods: A total of 223 stage IV non-small cell lung cancer (NSCLC) patients were included in a phase II study (NCT01171170) randomizing between PCB treatment with or without NTG patches. For 60 participating patients, a baseline and a second [18F]FDG PET/computed tomography (CT) scan, performed between day 22 and 24 after the start of treatment, were available. Tumor response was defined as a 30 % decrease in CT and PET parameters, and was compared to RECIST response at week 6. The predictive value of these assessments for progression free survival (PFS) and overall survival (OS) was assessed with and without NTG.

Results: A 30 % decrease in SUVpeak assessment identified more patients as responders compared to a 30 % decrease in CT diameter assessment (73 % vs. 18 %), however, this was not correlated to OS (SUVpeak30 p = 0.833; CTdiameter30 p = 0.557). Changes in PET parameters between the baseline and the second scan were not significantly different for the NTG group compared to the control group (p value range 0.159–0.634). The CT-based (part of the [18F]FDG PET/CT) parameters showed a significant difference between the baseline and the second scan for the NTG group compared to the control group (CT diameter decrease of 7 ± 23 % vs. 19 ± 14 %, p = 0.016, respectively).

Conclusions: The decrease in tumoral FDG uptake in advanced NSCLC patients treated with chemotherapy with and without NTG did not differ between both treatment arms. Early PET-based response assessment showed more tumor responders than CT-based response assessment (part of the [18F]FDG PET/CT); this was not correlated to survival. This might be due to timing of the [18F]FDG PET shortly after the bevacizumab infusion.

No MeSH data available.


Mean values and standard deviations for the CT- and PET-derived image parameters for the experimental arm and the control arm. p values of the independent samples Mann–Whitney U test of the mean change from baseline of the control arm vs. the mean change from baseline of the experimental arm (*significantly different for the experimental arm compared to the control arm with a significance level of 5 %). SUV: standardized uptake value; TLG: total lesion glycolysis
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Fig3: Mean values and standard deviations for the CT- and PET-derived image parameters for the experimental arm and the control arm. p values of the independent samples Mann–Whitney U test of the mean change from baseline of the control arm vs. the mean change from baseline of the experimental arm (*significantly different for the experimental arm compared to the control arm with a significance level of 5 %). SUV: standardized uptake value; TLG: total lesion glycolysis

Mentions: The mean decrease in SUVmax between the 31 patients treated with PCB (46 ± 27 %) and the 29 patients treated with PCB + NTG (42 ± 29 %) was not statistically significantly different (p = 0.510). The other PET parameters (SUVmean, SUVpeak and TLG) showed on average > 40 % decrease from baseline, but this was also not statistically significantly different between the experimental arm and the control arm (Fig. 3). Although for CT, part of the [18F]FDG PET/CT, in the control arm, the CT diameter decreased significantly more than in the experimental arm (19 ± 14 % vs. 7 ± 23 %; p = 0.028).Fig. 3


[18F]FDG PET/CT-based response assessment of stage IV non-small cell lung cancer treated with paclitaxel-carboplatin-bevacizumab with or without nitroglycerin patches
Mean values and standard deviations for the CT- and PET-derived image parameters for the experimental arm and the control arm. p values of the independent samples Mann–Whitney U test of the mean change from baseline of the control arm vs. the mean change from baseline of the experimental arm (*significantly different for the experimental arm compared to the control arm with a significance level of 5 %). SUV: standardized uptake value; TLG: total lesion glycolysis
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC5121177&req=5

Fig3: Mean values and standard deviations for the CT- and PET-derived image parameters for the experimental arm and the control arm. p values of the independent samples Mann–Whitney U test of the mean change from baseline of the control arm vs. the mean change from baseline of the experimental arm (*significantly different for the experimental arm compared to the control arm with a significance level of 5 %). SUV: standardized uptake value; TLG: total lesion glycolysis
Mentions: The mean decrease in SUVmax between the 31 patients treated with PCB (46 ± 27 %) and the 29 patients treated with PCB + NTG (42 ± 29 %) was not statistically significantly different (p = 0.510). The other PET parameters (SUVmean, SUVpeak and TLG) showed on average > 40 % decrease from baseline, but this was also not statistically significantly different between the experimental arm and the control arm (Fig. 3). Although for CT, part of the [18F]FDG PET/CT, in the control arm, the CT diameter decreased significantly more than in the experimental arm (19 ± 14 % vs. 7 ± 23 %; p = 0.028).Fig. 3

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: Nitroglycerin (NTG) is a vasodilating drug, which increases tumor blood flow and consequently decreases hypoxia. Therefore, changes in [18F] fluorodeoxyglucose positron emission tomography ([18F]FDG PET) uptake pattern may occur. In this analysis, we investigated the feasibility of [18F]FDG PET for response assessment to paclitaxel-carboplatin-bevacizumab (PCB) treatment with and without NTG patches. And we compared the [18F]FDG PET response assessment to RECIST response assessment and survival.

Methods: A total of 223 stage IV non-small cell lung cancer (NSCLC) patients were included in a phase II study (NCT01171170) randomizing between PCB treatment with or without NTG patches. For 60 participating patients, a baseline and a second [18F]FDG PET/computed tomography (CT) scan, performed between day 22 and 24 after the start of treatment, were available. Tumor response was defined as a 30 % decrease in CT and PET parameters, and was compared to RECIST response at week 6. The predictive value of these assessments for progression free survival (PFS) and overall survival (OS) was assessed with and without NTG.

Results: A 30 % decrease in SUVpeak assessment identified more patients as responders compared to a 30 % decrease in CT diameter assessment (73 % vs. 18 %), however, this was not correlated to OS (SUVpeak30 p = 0.833; CTdiameter30 p = 0.557). Changes in PET parameters between the baseline and the second scan were not significantly different for the NTG group compared to the control group (p value range 0.159–0.634). The CT-based (part of the [18F]FDG PET/CT) parameters showed a significant difference between the baseline and the second scan for the NTG group compared to the control group (CT diameter decrease of 7 ± 23 % vs. 19 ± 14 %, p = 0.016, respectively).

Conclusions: The decrease in tumoral FDG uptake in advanced NSCLC patients treated with chemotherapy with and without NTG did not differ between both treatment arms. Early PET-based response assessment showed more tumor responders than CT-based response assessment (part of the [18F]FDG PET/CT); this was not correlated to survival. This might be due to timing of the [18F]FDG PET shortly after the bevacizumab infusion.

No MeSH data available.