title: Prognostic impact of [18F]fluorothymidine and [18F]fluoro-D-glucose baseline uptakes in patients with lung cancer treated first-line with erlotinib.
abstract: 3'-deoxy-3'-[(18)F]fluoro-L-thymidine (FLT) and 2'-deoxy-2'-[(18)F]fluoro-D-glucose (FDG) are used to visualize proliferative and metabolic activity of tumors. In this study we aimed at evaluating the prognostic value of FLT and FDG uptake measured by positron emission tomography (PET) in patients with metastatic non-small cell lung cancer (NSCLC) prior to systemic therapy with erlotinib. FLT and FDG maximum standardized uptake (SUVmax) values per patient were analyzed in 40 chemotherapy naive patients with advanced NSCLC (stage IV) before treatment with erlotinib. Prior therapy median SUVmax was 6.6 for FDG and 3.0 for FLT, respectively. In univariate analysis, patients with an FDG SUVmax <6.6 had a significantly better overall survival (16.3 months [95% confidence interval [CI] 7.1-25.4 months]) compared to patients with an FDG SUVmax ≥6.6 (3.1 months [95% CI 0.6-5.5 months]) (p<0.001, log rank). Similarly, low FLT uptake (SUVmax <3.0) was associated with significantly longer survival (10.3 months (0-23.3 months, 95% CI) compared to high FLT uptake (3.4 months (0-8.1 months, 95% CI) (p = 0.027). The independent prognostic value of baseline FDG uptake was demonstrated in multivariate analysis (p = 0.05, Cox regression). These data suggest that baseline SUVmax values for both FDG and FLT PET might be further developed as markers for prognostic stratification of patients in advanced NSCLC treated with tyrosine kinase inhibitors (TKI) directed against the epidermal growth factor receptor (EGFR).
  
  
  BACKGROUND
  Clinicaltrials.gov, Identifier: NCT00568841.
authors: Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany.
authors: Matthias
authors: M
authors: Scheffler
authors: Thomas
authors: T
authors: Zander
authors: Lucia
authors: L
authors: Nogova
authors: Carsten
authors: C
authors: Kobe
authors: Deniz
authors: D
authors: Kahraman
authors: Markus
authors: M
authors: Dietlein
authors: Irini
authors: I
authors: Papachristou
authors: Lukas
authors: L
authors: Heukamp
authors: Reinhard
authors: R
authors: Büttner
authors: Ron
authors: R
authors: Boellaard
authors: Adriaan A
authors: AA
authors: Lammertsma
authors: Silvia
authors: S
authors: Querings
authors: Erich
authors: E
authors: Stoelben
authors: Walburga
authors: W
authors: Engel-Riedel
authors: Bernd
authors: B
authors: Neumaier
authors: Jürgen
authors: J
authors: Wolf
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000235:genetics; D015224:Dideoxynucleosides; D000069347:Erlotinib Hydrochloride; D005260:Female; D019788:Fluorodeoxyglucose F18; D018773:Genes, erbB-1; D006801:Humans; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000378:metabolism / Q000473:pathology; D008175:Lung Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000235:genetics; D008297:Male; D008875:Middle Aged; D009154:Mutation; D049268:Positron-Emission Tomography; D011379:Prognosis; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011799:Quinazolines / Q000627:therapeutic use*
chemical_list: D015224:Dideoxynucleosides; D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D019788:Fluorodeoxyglucose F18; D000069347:Erlotinib Hydrochloride; C002854:alovudine