Monitoring reversible and irreversible EGFR inhibition with erlotinib and afatinib in a patient with EGFR-mutated non-small cell lung cancer (NSCLC) using sequential [18F]fluorothymidine (FLT-)PET.
Non-small cell lung cancer (NSCLC) patients with activating epidermal growth factor receptor (EGFR) mutations benefit from treatment with EGFR-targeted therapy. While first-generation ("reversible") EGFR tyrosine kinase inhibitors (TKIs) are well established in the treatment of these patients, the remarkably lower efficacy of second-generation ("irreversible") EGFR-TKIs after failure of reversible EGFR inhibition is far less understood. Here we describe an EGFR-mutated patient treated sequentially with both reversible (erlotinib) and irreversible (afatinib) EGFR-TKIs monitored by sequential [(18)F]fluorothymidine (FLT-)PET. Our observations confirm the value of molecular imaging for assessment of pharmacodynamics and early prediction of response and relapse in these patients.
Department I for Internal Medicine, University Hospital of Cologne, Germany. matthias.scheffler@uk-koeln.de
Matthias
M
Scheffler
Carsten
C
Kobe
Thomas
T
Zander
Lucia
L
Nogova
Deniz
D
Kahraman
Roman
R
Thomas
Bernd
B
Neumaier
Markus
M
Dietlein
Jürgen
J
Wolf
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000188:drug therapy; D000077716:Afatinib; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology* / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004252:DNA Mutational Analysis; D015224:Dideoxynucleosides; D019008:Drug Resistance, Neoplasm; D066246:ErbB Receptors / Q000037:antagonists & inhibitors* / Q000235:genetics; D000069347:Erlotinib Hydrochloride; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy; D011799:Quinazolines / Q000008:administration & dosage; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D017384:Sequence Deletion
D015224:Dideoxynucleosides; D011799:Quinazolines; D019275:Radiopharmaceuticals; D000077716:Afatinib; D000069347:Erlotinib Hydrochloride; D066246:ErbB Receptors; C002854:alovudine