title: (18)F-FDG PET/CT for monitoring treatment responses to the epidermal growth factor receptor inhibitor erlotinib.
abstract: Response rates of unselected non-small cell lung cancer (NSCLC) patients to the epidermal growth factor receptor inhibitor erlotinib are low and range from 10% to 20%. Early response assessments are needed to avoid costs and side effects of inefficient treatments. Here we determined whether early changes in tumor uptake of (18)F-FDG can predict progression-free and overall survival in NSCLC patients who are treated with erlotinib.
  
  
  METHODS
  Twenty-two patients (6 men, 16 women; mean age ± SD, 64 ± 13 y) with stage III or stage IV NSCLC who received erlotinib treatment were enrolled prospectively. (18)F-FDG PET/CT was performed before the initiation of treatment (n = 22), after 2 wk (n = 22), and after 78 ± 21 d (n = 11). Tumor maximum standardized uptake values were measured for a maximum of 5 lesions for each patient. Tumor responses were classified using modified PET Response Criteria in Solid Tumors (use of maximum standardized uptake values). Median overall survival by Kaplan-Meier analysis was compared between groups using a log-rank test.
  
  
  RESULTS
  The overall median time to progression was 52 d (95% confidence interval, 47-57 d). The overall median survival time was 131 d (95% confidence interval, 0-351 d). Patients with progressive metabolic disease on early follow-up PET showed a significantly shorter time to progression (47 vs. 119 d; P < 0.001) and overall survival (87 vs. 828 d; P = 0.01) than patients classified as having stable metabolic disease or partial or complete metabolic response.
  
  
  CONCLUSIONS
  These data suggest that (18)F-FDG PET/CT performed early after the start of erlotinib treatment can help to identify patients who benefit from this targeted therapy.
authors: Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: Matthias R
authors: MR
authors: Benz
authors: Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: Ken
authors: K
authors: Herrmann
authors: Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: Franziska
authors: F
authors: Walter
authors: Division of Medical Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: Edward B
authors: EB
authors: Garon
authors: City of Hope and Beckman Research Institute, Duarte, California.
authors: Karen L
authors: KL
authors: Reckamp
authors: Division of Hematology Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
authors: Robert
authors: R
authors: Figlin
authors: Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: Michael E
authors: ME
authors: Phelps
authors: Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California.|Abteilung Nuklearmedizin, University of Freiburg, Freiburg, Germany.
authors: Wolfgang A
authors: WA
authors: Weber
authors: Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: Johannes
authors: J
authors: Czernin
authors: Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors: Martin S
authors: MS
authors: Allen-Auerbach
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001692:Biological Transport; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D018450:Disease Progression; D066246:ErbB Receptors / Q000037:antagonists & inhibitors*; D000069347:Erlotinib Hydrochloride; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D047428:Protein Kinase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D011799:Quinazolines / Q000494:pharmacology / Q000627:therapeutic use*; D016019:Survival Analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D019788:Fluorodeoxyglucose F18; D000069347:Erlotinib Hydrochloride; D066246:ErbB Receptors