title: Predictive and prognostic value of early response assessment using 18FDG-PET in advanced non-small cell lung cancer patients treated with erlotinib.
abstract: BACKGROUND
  [18F]fluorodeoxyglucose (FDG)-PET is being evaluated as a tool for the early detection of response to various targeted agents in solid tumors. The aim of this study was to evaluate the predictive value of PET response after 2 days of erlotinib in unselected pretreated patients with stage IV NSCLC.
  
  
  METHODS
  FDG-PET/CT scans were conducted at baseline and after 2 days of erlotinib, with a CT evaluation performed at baseline and after 45-60 days of therapy. PET responses were evaluated by quantitative changes on SUVmax tumor/non-tumor ratio and classified according to EORTC criteria. PET responses were compared with RECIST responses and related to progression-free (PFS) and overall (OS) survival. Erlotinib effects on glucose uptake were also studied in a panel of NSCLC cell lines.
  
  
  RESULTS
  Fifty-three patients were enrolled. At 2 days of erlotinib, 20 (38 %) patients showed partial metabolic response (PMR), 25 (47 %) had stable metabolic disease (SMD) and 8 (15 %) had progressive metabolic disease (PMD). All patients with PMD had confirmed RECIST progression at 45-60 days. Patients with early PMR and SMD had significantly longer PFS (p < 0.001 and p = 0.001, respectively) and OS (p = 0.001 for both) than PMD patients.
  
  
  CONCLUSIONS
  FDG-PET assessment after 2 days of erlotinib could be useful to identify early resistant patients and to predict survival in unselected NSCLC pretreated population.
authors.affiliation: Oncologia Medica, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy, mtiseo@ao.pr.it.
authors.forename: Marcello
authors.initials: M
authors.lastname: Tiseo
authors.forename: Massimo
authors.initials: M
authors.lastname: Ippolito
authors.forename: Maura
authors.initials: M
authors.lastname: Scarlattei
authors.forename: Pietro
authors.initials: P
authors.lastname: Spadaro
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Cosentino
authors.forename: Fiorenza
authors.initials: F
authors.lastname: Latteri
authors.forename: Livia
authors.initials: L
authors.lastname: Ruffini
authors.forename: Marco
authors.initials: M
authors.lastname: Bartolotti
authors.forename: Beatrice
authors.initials: B
authors.lastname: Bortesi
authors.forename: Claudia
authors.initials: C
authors.lastname: Fumarola
authors.forename: Cristina
authors.initials: C
authors.lastname: Caffarra
authors.forename: Andrea
authors.initials: A
authors.lastname: Cavazzoni
authors.forename: Roberta R
authors.initials: RR
authors.lastname: Alfieri
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Petronini
authors.forename: Roberto
authors.initials: R
authors.lastname: Bordonaro
authors.forename: Paolo
authors.initials: P
authors.lastname: Bruzzi
authors.forename: Andrea
authors.initials: A
authors.lastname: Ardizzoni
authors.forename: Hector J
authors.initials: HJ
authors.lastname: Soto Parra
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology; D018450:Disease Progression; D018572:Disease-Free Survival; D000069347:Erlotinib Hydrochloride; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000379:methods; D011379:Prognosis; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D011799:Quinazolines / Q000627:therapeutic use*; D019275:Radiopharmaceuticals; D016896:Treatment Outcome
chemical_list: D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D000069347:Erlotinib Hydrochloride