title: Early prediction of nonprogression in advanced non-small-cell lung cancer treated with erlotinib by using [(18)F]fluorodeoxyglucose and [(18)F]fluorothymidine positron emission tomography.
abstract: OBJECTIVE
  Positron emission tomography (PET) with both 2'-deoxy-2'-[(18)F]fluoro-D-glucose (FDG) and 3'-[(18)F]fluoro-3'-deoxy-L-thymidine (FLT) was evaluated with respect to the accuracy of early prediction of nonprogression following erlotinib therapy, independent from epidermal growth factor receptor (EGFR) mutational status, in patients with previously untreated advanced non-small-cell lung cancer (NSCLC).
  
  
  METHODS
  Thirty-four patients with untreated stage IV NSCLC were evaluated in this phase II trial. Changes in FDG and FLT uptake after 1 (early) and 6 (late) weeks of erlotinib treatment were compared with nonprogression measured by computed tomography after 6 weeks of treatment, progression-free survival (PFS), and overall survival (OS).
  
  
  RESULTS
  Changes in FDG uptake after 1 week of therapy predicted nonprogression after 6 weeks of therapy with an area under the receiver operating characteristic curve of 0.75 (P = .02). Furthermore, patients with an early metabolic FDG response (cutoff value: 30% reduction in the peak standardized uptake value) had significantly longer PFS (hazard ratio [HR], 0.23; 95% CI, 0.09 to 0.59; P = .002) and OS (HR, 0.36; 95% CI, 0.13 to 0.96; P = .04). Early FLT response also predicted significantly longer PFS (HR, 0.31; 95% CI, 0.10 to 0.95; P = .04) but not OS and was not predictive for nonprogression after 6 weeks of therapy.
  
  
  CONCLUSIONS
  Early FDG-PET predicts PFS, OS, and nonprogression after 6 weeks of therapy with erlotinib in unselected, previously untreated patients with advanced NSCLC independent from EGFR mutational status.
authors.affiliation: Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, University Hospital of Cologne, 50924 Cologne, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zander
authors.forename: Matthias
authors.initials: M
authors.lastname: Scheffler
authors.forename: Lucia
authors.initials: L
authors.lastname: Nogova
authors.forename: Carsten
authors.initials: C
authors.lastname: Kobe
authors.forename: Walburga
authors.initials: W
authors.lastname: Engel-Riedel
authors.forename: Martin
authors.initials: M
authors.lastname: Hellmich
authors.forename: Irini
authors.initials: I
authors.lastname: Papachristou
authors.forename: Karin
authors.initials: K
authors.lastname: Toepelt
authors.forename: Andreas
authors.initials: A
authors.lastname: Draube
authors.forename: Lukas
authors.initials: L
authors.lastname: Heukamp
authors.forename: Reinhard
authors.initials: R
authors.lastname: Buettner
authors.forename: Yon D
authors.initials: YD
authors.lastname: Ko
authors.forename: Roland T
authors.initials: RT
authors.lastname: Ullrich
authors.forename: Egbert
authors.initials: E
authors.lastname: Smit
authors.forename: Ronald
authors.initials: R
authors.lastname: Boellaard
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Lammertsma
authors.forename: Michael
authors.initials: M
authors.lastname: Hallek
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Jacobs
authors.forename: Andreas
authors.initials: A
authors.lastname: Schlesinger
authors.forename: Karin
authors.initials: K
authors.lastname: Schulte
authors.forename: Silvia
authors.initials: S
authors.lastname: Querings
authors.forename: Erich
authors.initials: E
authors.lastname: Stoelben
authors.forename: Bernd
authors.initials: B
authors.lastname: Neumaier
authors.forename: Roman K
authors.initials: RK
authors.lastname: Thomas
authors.forename: Markus
authors.initials: M
authors.lastname: Dietlein
authors.forename: Jürgen
authors.initials: J
authors.lastname: Wolf
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D015224:Dideoxynucleosides; D018572:Disease-Free Survival; D000069347:Erlotinib Hydrochloride; D005260:Female; D019788:Fluorodeoxyglucose F18; D018773:Genes, erbB-1; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009154:Mutation; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D011799:Quinazolines / Q000627:therapeutic use*
chemical_list: D015224:Dideoxynucleosides; D011799:Quinazolines; D019788:Fluorodeoxyglucose F18; D000069347:Erlotinib Hydrochloride; C002854:alovudine