Predictive And Prognostic Value Of Early Disease Progression By Pet Evaluation In Advanced Non-Small Cell Lung Cancer

Objective: To assess the predictive and prognostic value of progressive metabolic disease (PMD) by the use of early (18)Fluorodeoxyglucose positron emission tomography ((18)FDG-PET) in patients with clinical stage IV non-small cell lung cancer (NSCLC) treated with first-line chemotherapy. Methods: An (18)FDG-PET performed following the first cycle of chemotherapy (PET-1) was compared with a pretreatment (18)FDG-PET (PET-0) and a computed tomography (CT) scan after the third cycle (CT-3). The primary endpoint was the positive predictive value (PPV) of PMD. Secondary endpoints included the prognostic value of PMD. Results: Eleven of 38 patients (29%) had a PMD by PET-1, and 15 (39%), including all patients with a PMD, experienced a progressive disease by CT-3. The PPV of PMD was 100% according to both the European Organization for Research and Treatment of Cancer (EORTC) criteria and the PET Response Criteria In Solid Tumors (PERCIST) (p value for both, <0.0001). Patients with a PMD by PET-1 had a median overall survival of 7.0 months versus 14.0 months for those without a PMD (p = 0.04, according to the EORTC criteria). Conclusions: Early 18FDG-PET assessment deserves further investigation for the identification of NSCLC patients who do not benefit from first-line chemotherapy. (C) 2016 S. Karger AG, Basel